Archive for the ‘Short Takes On News & Events’ Category

Report: Adults With Serious Mental Illnesses Face 80% Unemployment

This KHN story can be republished for free. (details)

Employment rates for people with a serious mental illness are dismally low and getting worse, according to a report from the National Alliance on Mental Illness. Just 17.8 percent of people receiving public mental health services were employed in 2012 – down from 23 percent in 2003.

That’s an unemployment rate of more than 80 percent.

“It isn’t surprising,” says Sita Diehl, director of state policy at NAMI and author of the report.  The problem has less to with the workers themselves, she says, and more with the organizations that provide services for people with serious mental illness.  “We knew that mental health services really took it on the chin during the recession. Employment rates had already been dismal to begin with, and when the supports were eroded, people with mental illness lost support and lost jobs.”

Rates of unemployment for people with mental illnesses varied greatly by state – from 92.6 percent in Maine to 56 percent in Wyoming.

Most adults with mental illness want to work, and six in 10 can succeed with the right supports, according to the report. Yet only 1.7 percent received supported employment services in 2012.

Without proper supports, many end up on expensive public programs including Supplemental Security Income (SSI) and Social Security Disability Income (SSDI). People with mental illnesses make up the largest and fastest growing group for both programs.

There are, however, several evidence-based programs to help individuals with mental illnesses find jobs and maintain them.

(more…)

Thursday, July 10th, 2014

CMS May Soften Paperwork Requirements For Home Health Care

This KHN story can be republished for free. (details)

Doctors may not have to write a narrative summary for patients needing home health care if a proposed rule by the Centers for Medicare and Medicaid Services is finalized.

For Medicare to pay for a home health visit, which includes physical therapy, speech therapy and skilled nursing care, the patient must be seen by a doctor either 90 days prior to the start of the home health care or 30 days after the start of the services. Currently, Medicare also requires that physicians certify that these patients are under their care and that they have trouble leaving home without the help of a walker or special transportation because of an illness or injury. To do so, doctors have to fill out what’s referred to as a face-to-face document, which states when the doctor saw the patient, and includes a narrative summary stating why the patient is homebound.

Home health agencies have pushed back against these requirements, saying Medicare contractors have denied them payments if physicians’ summaries are too short and not descriptive enough. And physicians have little incentive to do it a second time since the patient has already received care, according to home health sources. Hospital physicians may also not have enough of a full picture of the homebound status of a patient to write detailed summaries, and primary care physicians might not be in the know if a patient becomes homebound after a hospitalization.

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Wednesday, July 9th, 2014

Advocates Say California Is Rejecting ‘Free Money’ To Renew Poor People’s Insurance

This KHN story can be republished for free. (details)

Consumer advocates and some legislators were surprised and frustrated when California health officials recently refused a $6 million donation to help people re-up their Medi-Cal health coverage.

Now two senators have proposed an unusual solution: a bill to force the state to accept the offer from The California Endowment.

Photo by Calsidyrose via Flickr

Sens. Ed Hernandez and Mark Leno, both Democrats, said the money from the health care philanthropy is needed to help people through the process of keeping their health coverage. Moreover, taking the money would make the state eligible for another $6 million in matching funds from the federal government, they say.

“I can’t see leaving money on the table,” Hernandez said Thursday. “It doesn’t cost us a penny.”

The state Department of Finance, however, has said it doesn’t need the money. “We think this is just a duplication of efforts,” Keely Boster, chief deputy director of the department, said in a legislative hearing last month.

The state is already faced with a backlog of new Medi-Cal applicants because of the program’s expansion under the federal health law. Now, advocates say, it is imperiling continued access for existing beneficiaries.

“It’s a head scratcher to me,” said Kristen Golden Testa, health director of The Children’s Partnership, a nonprofit child advocacy organization. “Free money to help keep people covered seems to make a lot of sense to me.”

(more…)

Friday, July 4th, 2014

Pelvic Exams No Longer Recommended For Well-Woman Visits

The American College of Physicians announced a major change to their screening guidelines Monday evening: Healthy women should no longer receive pelvic exams during their annual well-woman visits.

The recommendation does not apply to women who are pregnant or who have symptoms of pelvic disease.

“It’s an intrusive test, it’s a test women don’t like, and there’s no evidence that we should be doing it,” says Dr. Hanna Bloomfield, associate chief of staff of research at the Minneapolis VA Healthcare System, who conducted the evidence review that led to the new recommendation.

During the exam, the patient lies on the exam table with her feet in stirrups. The doctor examines the woman internally with one hand and applies pressure externally with the other hand, in what is known as a “bimanual exam.” Another part of the exam involves the use of a speculum. The screening is used to find cancer, noncancerous masses and infection in the ovaries, uterus and other pelvic organs.

But the latest evidence review found that in non-pregnant adult women without symptoms, there are no studies showing that cancer is actually detected by pelvic exams alone. And the screenings are more likely to hurt women than help them. The most likely harms include pain, discomfort, anxiety, embarrassment and fear for the woman, says  Bloomfield. But in more serious cases, doctors may also identify false positives that can subject the patient to “a diagnostic cascade” of unnecessary tests and even surgery.

(more…)

Tuesday, July 1st, 2014

Poll: Americans Bristle At Penalties In Wellness Programs


Workers believe employer wellness programs should be all gain but no pain, according to a poll released Tuesday.

The poll from the Kaiser Family Foundation found employees approve of corporate wellness programs when they offer perks, but recoil if the plans have punitive incentives such as higher premiums for those who do not take part. (KHN is an editorially independent program of the foundation.)

Wellness programs, which are encouraged under the federal health law, are structured in various ways. In some plans, the worker has to join a particular program, such as an exercise class, while others focus on outcomes, such as the employees’ blood sugar or cholesterol. Evidence is mixed about whether any substantially improve workers’ health or lower costs to employers and insurers.

The poll found 76 percent of workers thought it was appropriate for employers to offer wellness programs that promote healthy behavior. But a majority opposed wellness plans that had financial repercussions for workers: 62 percent did not think employers should charge higher health insurance premiums to workers who did not participate, and 74 percent said management should not charge more to those who did not reach health goals.

The Obama administration is allowing employers to link up to 30 percent of health premiums to wellness programs. Penalties and rewards for participating in a tobacco cessation program can be as high as 50 percent of the insurance plan cost.

The poll found that among workers who get health insurance from their employer, 48 percent said there was a wellness program in their workplace. Six out of 10 people said they participate; women were more likely to take part than men.

(more…)

Tuesday, July 1st, 2014

Premiums For Many In The Individual Market May Change Next Year

Health insurance premiums for people with subsidies could increase substantially in some markets – but consumers who shop around may not end up paying more, a new report out Thursday says.

Shopping around may not be as likely, however, under proposed rules also released Thursday by the Obama administration which will automatically re-enroll the vast majority of those who are signed up for plans through the online marketplaces. Automatic re-enrollments might ease the experience, but will also make it less likely consumers will check out other options.

Consumers who choose to would still be able to shop around, the administration said. And the Avalere study shows they should.

The analysis of rates filed in nine states found that as insurers battle for a share of the individual market, some plans that were the low-priced leaders this year are not the least expensive options next year.

Because subsidies through the Affordable Care Act are tied to “benchmark” plans, which are the second lowest-cost silver-tier plans in each market, even those with subsidies could see the monthly amounts they pay change. In most of the states studied, the second lowest-cost plan is changing.

“If you are a savvy buyer, you could pick a low-cost plan and probably avoid a significant rate increase,” said Caroline Pearson, vice president at Avalere. But those who do nothing may end up paying more.

(more…)

Thursday, June 26th, 2014

‘Right-To-Try’ Laws On Experimental Drugs Stir Debate

KHN’s Julie Rovner participated in a Google Hangout with PBS NewsHour on state “right-to-try” laws, first approved in Colorado, which allow terminally ill patients to try potentially life-saving, but unapproved drugs to treat their conditions. Watch the discussion below:

Tuesday, June 24th, 2014

Employer Health Costs Forecast To Accelerate In 2015

Health costs will accelerate next year, but changes in how people buy care will help keep them from attaining the speed of several years ago, PricewaterhouseCoopers says in a new report.

The prediction, based on interviews and modeling, splits the difference between hopes that costs will stay tame and fears that they’re off to the races after having been slow since the 2008 financial crisis.

“This is not an immediate return to double-digit growth rates,” says Ben Isgur, a director in PwC’s Health Research Institute. However, he adds, “what we’re seeing for 2015 will be our first uptick in some time.”

If health plans stay unchanged, PwC sees medical costs rising by 6.8 percent in 2015, up from a projected increase of 6.5 percent this year. (PwC defines medical costs as per-capita health expenses for private insurers and large, self-insured employers. This is different from the government’s measure of health spending, which includes outlays for the government programs Medicaid and Medicare.)

But PwC doesn’t expect plans to stay the same. In a separate study, the consulting firm forecasts that employers and insurers will continue to raise deductibles and give members other incentives to mind the price of care. (The deductible is what patients pay before insurance kicks in.)

Those changes should slow growth in the total cost of care to 4.8 percent, PwC says, as greater exposure to price tags prompts workers to undergo fewer treatments and tests. (PwC expects the deceleration from 6.8 percent to 4.8 percent to come solely from changes in consumer behavior, not money employers save by shifting costs to workers.)

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Tuesday, June 24th, 2014

Talking Medicare’s Hospital Fines For Too Many Patient Injuries

KHN’s Jordan Rau was on NPR and C-SPAN Monday to talk about coming Medicare penalties for about a quarter of the nation’s hospitals as detailed in his story More Than 750 Hospitals Face Medicare Crackdown On Patient Injuries.

The penalties will ding hospitals up to 1 percent of their Medicare pay for having higher rates of patient injuries. Watch the C-SPAN video interview and listen to the NPR audio of his conversation below:

Monday, June 23rd, 2014

Senators Offer Bill To Ease Readmission Penalties On Some Hospitals

A bipartisan group of senators introduced legislation on Thursday to make Medicare take the financial status of hospital patients into account when deciding whether to punish a hospital for too many readmissions.

The bill attempts to address one of the main complaints about the readmissions program: that hospitals serving large numbers of low-income patients are more likely be penalized. Over the past two years, the federal government has reduced payments to two-thirds of the nation’s hospitals because they have high numbers of patients becoming ill and returning after being discharged. This fall the program will put as much as 3 percent of a hospital’s Medicare payments at risk and it will expand the number of conditions it bases the assessment on — currently heart attack, heart failure or pneumonia – to include chronic obstructive pulmonary disease and total hip and knee replacement.

Medicare does adjust for different levels of sickness of patients among hospitals, but it has said the Affordable Care Act, which created the program, does not give regulators the leeway to take socio-economic status into account.

An advisory committee to Congress last year recommended that lawmakers change the program.  The idea of taking socio-economic status into account has also been endorsed in a draft report from  a panel created by the National Quality Forum, which is a nonprofit group that reviews quality measures for the government.

(more…)

Thursday, June 19th, 2014

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