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

Registered Nurses Increasingly Delay Retirement, Study Finds

Despite predictions of an impending nurse shortage, the current number of working registered nurses has surpassed expectations in part due to the number of baby-boomer RNs delaying retirement, a study by the RAND Corp. found.

The study, published online Wednesday by Health Affairs, notes that the RN workforce, rather than peaking in 2012 at 2.2 million – as the researchers predicted a decade ago – reached 2.7 million that year and has continued growing. The trend of nurses delaying retirement accounted for an extra 136,000 RNs in 2012, the study suggests.

Shifts in retirement benefits and “economic uncertainty in general” could have contributed to their decisions to extend their careers, said David Auerbach, the study’s primary author and a policy researcher at RAND.

Furthermore, Auerbach said, some researchers have “found RNs were especially attached to the mission of what they do.”

“They get a lot of satisfaction from their job and don’t want to leave it,” he said.

The surge in RNs, and in particular in RNs working beyond the age of 50, could hold significant implications for how patients receive their health care and how they relate to their health providers.

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Wednesday, July 16th, 2014

Obamacare Help Was In High Demand, Survey Shows

Most working people in the U.S. sign up for health insurance in a very straightforward way: a few forms, a few questions for human resources, a few choices of plans.

Navigator Nini Hadwen, right, works with Marta Aguirre as she shops for health insurance in Florida (Photo by Joe Raedle/Getty Images).

Signing up for Affordable Care Act insurance was nothing like that. It involved questions about income, taxes, family size and immigration status. And in most places in the country, there were myriad choices of plans with subtle differences between them.

Guess what? People looked for help on the decision.

During the Affordable Care Act’s first open enrollment period, about 10.6 million people received personal help from navigators and other enrollment assisters, according to an online survey of the programs released Tuesday by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

And the assistance was time consuming: 64 percent of the programs reported that they spent an hour to two hours with each consumer on average. The assisters and navigators included 28,000 full-time-equivalent workers across the country, funded by federal and state governments as well as outside sources, the survey found.

But those assisters were not distributed equally across states.

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Tuesday, July 15th, 2014

Avoid The Rush! Some ERs Are Taking Appointments

This KHN story also ran on Southern California Public Radio. It can be republished for free. (details)

Three times within a week, 34-year-old Michael Granillo went to Northridge Hospital Medical Center because of intense back pain. Each time, Granillo, who didn’t have insurance, stayed for less than an hour before leaving without being seen by a doctor.

“I was in so much pain I wanted to be taken care of now,” said Granillo, who lives in Reseda and runs a hot dog cart business. “I didn’t want to sit and wait.”

On a recent Wednesday morning, he woke up feeling even worse. This time, Granillo’s wife, Sonya, tried something different: Using a new service offered by the hospital, she was able to make an ER appointment online, using her mobile phone.

When they arrived at the hospital, he was seen almost immediately.

Michael Granillo speaks to a doctor at Northridge Hospital Medical Center (Photo by Anna Gorman/KHN).

“That was my last resort and it worked,” she said. “He would have probably been at home in pain if not for the service.”

In an era of increased competition driven by the nation’s health law, hospitals in California and around the country are hoping online ER appointments will help attract patients anxious to avoid long waits in a crowded and often chaotic environment.

“It makes for a happier camper,” said Susan Dubuque, a national expert in hospital marketing. “When it comes to health care, consumers want more control over everything.”

The system, adopted by Northridge and other hospitals in the Dignity Health chain about a year ago, is intended only for patients who don’t have life-threatening or debilitating emergencies. To check in online, patients must explain the reason for their visit and check a box that they can wait for treatment.

Patients having chest pain or trouble breathing, for instance, are instructed to call 911 or go directly to an ER. Those with an ankle sprain or a fever, for instance, might be able to make an appointment.

When patients get to the hospital, they still may be bumped by more seriously ill patients.

(more…)

Monday, July 14th, 2014

Feds Demand Medicaid Backlog Fixes By Six States

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

Tired of waiting for states to reduce their backlogs of Medicaid applications, the Obama administration has given six states until Monday to submit plans to resolve issues that have prevented more than 1 million low-income or disabled people from getting health  coverage.

The targeted states are Alaska, California, Kansas, Michigan, Missouri and Tennessee.

“CMS is asking several state Medicaid agencies to provide updated mitigation plans to address gaps that exist in their eligibility and enrollment systems to ensure timely processing of applications and access to coverage for eligible people,” said Aaron Albright, a spokesman for the Centers for Medicare & Medicaid Services. He said the agency will monitor states’ progress in solving the problems getting people enrolled in the state-federal insurance program for the poor.

The agency sent letters June 27 requesting the plans, giving states 10 days to respond. It is unclear if any have submitted plans yet. The letters was first reported by InsideHealthPolicy, a trade publication.

(more…)

Thursday, July 10th, 2014

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

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