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Consumer Group Urges Hospitals To Stop Promoting Questionable Screenings

Consumer advocacy group Public Citizen on Thursday called on 20 hospital systems to stop partnering with companies that offer low-cost screenings for heart disease and stroke risk, saying the promotions are “unethical” and the exams are more likely to do harm than good.

In recent years, more hospitals have paired with firms offering such testing packages, partly to build community goodwill and referrals.  Hospitals say residents benefit from the testing packages, which can cost less than $150, because some will discover they are at higher risk for heart problems or stroke early enough to take steps to reduce their risks.

But some medical groups and consumer advocates object to the programs, saying they are a waste of money for most consumers.

Public Citizen argues “the promotions rely on fear mongering and erroneously suggest that for most adults in the general population, these screening tests are useful in the prevention of several potentially life-threatening cardiovascular illnesses.”

It sent letters to hospitals in eight states, including Inova in the Washington, D.C. area, Scottsdale Healthcare in Arizona, Dignity Health in California and the University of Iowa Health Alliance, urging them to stop promoting such tests.

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Thursday, June 19th, 2014

HHS Releases New Details About 2014 Marketplace Premiums, Subsidies


Federal officials on Wednesday released new data about who enrolled in the federal health marketplace plans for 2014, how much the law’s subsidies helped offset the cost and how many plans people from could choose from, among other details.

“What we’re finding is that the marketplace is working. Consumers have more choices and they’re paying less for their premiums,” newly installed Health and Human Services Secretary Sylvia Burwell said in a statement.

The report was one in a series of ongoing updates from HHS about enrollment in the online exchanges or marketplaces. Federal officials have said more than 8 million people signed up for coverage under the health law. The document analyzed trends in the 36 states where the federal government is running the online marketplace, or exchange. It did not include similar data for the 14 states and the District of Columbia that are running their own exchanges because the data is not available, according to the report.

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Wednesday, June 18th, 2014

Enroll America Pushes Ahead To Second Enrollment Period

Enroll America convened a national conference this week in Washington to review the strategies that proved successful during the inaugural Affordable Care Act open enrollment period and  to  gear up for the next one, which will start Nov. 15.

Organizers also want to ensure that the navigators and organizations working toward enrollment maintain their energy — despite reports of backlogged Medicaid applications and continuing struggles in some state-run exchanges.

“It’s energizing people and bringing them together and reminding them why they got into the work in the first place,” said Anne Filipic, president of Enroll America, a nonprofit group organized primarily to sign up consumers for new health coverage. “We’re five months out, so it’s time to be implementing and outreaching.”

Kentucky Gov. Steve Beshear, a Democrat, was among those at the conference Tuesday to offer a list of accomplishments. Kentucky, he said, enrolled 421,410 people in individual health coverage either via kynect, the state’s online insurance portal, or Medicaid.  Seventy-five percent of them had never had health care insurance before.

Beshear credits this public response to the decision to insulate kynect from the affiliation with the national health law The enrollment numbers suggest that worked. In Kentucky, traditionally considered a red state, 60 percent of voters supported Republican candidate Mitt Romney in 2012.

Looking forward, he also said that the re-election efforts of naysayer lawmakers — those who have worked so hard to discredit and disband the overhaul — will come down to how people with the new coverage experience the benefits of the law.

Meanwhile, former Health and Human Services Secretary Kathleen Sebelius told attendees that they were pivotal in making the first enrollment season successful. “You combated relentless misinformation and obstruction, people who were faced with getting fingerprinted and paying a fee in order to help access care,” Sebelius said.

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Wednesday, June 18th, 2014

Insurer Begins Huge Palliative Care Program

“Person-centered care” is the buzz phrase  floating around the health care industry, and a Pacific Northwest-based giant insurer thinks it has hit the mark with a new palliative care program coming this summer.

Photo by ulrichkarljoho via Flickr

Cambia Health Solutions, which includes Regence Blue Cross Blue Shield,will offer training to providers and additional benefits for policyholders: more than 2.2 million members in Cambia’s family of health plan companies in Oregon, Washington, Idaho and Utah.

Palliative care improves the quality of life by managing pain and other problems for people who have serious life-threatening medical conditions, such as cancer, heart and kidney failure. It differs from hospice care, especially because patients do not necessarily have less than six months to live.

Mark Ganz, president and CEO of Cambia, said the company realized providers are focused on disease treatment but they “never stop to ask the patient and family ‘How do you want to live with this?’”

“Palliative care at its best is in partnership with curative care,” Ganz said. “It’s not after curative care when it no longer matters or no longer is working.”

The company is going to start paying for things not typically reimbursed by other insurance companies including home health aides and advanced care planning counseling. One of the larger initiatives is training physicians and caregivers in how to have appropriate conversations about end-of-life care.

Dr. Csaba Mera, chief medical officer at Cambia Health,  said the goal is to develop a holistic, comprehensive integrated program: “It’s about making sure (the patient’s) wishes are clearly documented, they’re respected and that they’re implemented so it’s not a crisis if they do at some point end up in terminal care and decisions have to be made,” Mera said.

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Tuesday, June 17th, 2014

High Court Rules Anti-Abortion Group Can Sue Over Election ‘Truth-Telling’ Law

A group challenging an Ohio election law that makes it a crime to make “false statements” about a candidate’s record during a campaign has standing to challenge the constitutionality of that law, according to today’s unanimous Supreme Court decision.

Photo by Karl Eisenhower/KHN

The opinion, written by Justice Clarence Thomas, did NOT strike down Ohio’s false statement law. But it did hold that the Susan B. Anthony List demonstrated “a sufficiently imminent injury” from potential prosecution under the law that it can challenge it in federal court.

Michael Carvin, the attorney who argued the case before the court for the Susan B. Anthony List, told reporters in a conference call that he anticipates as a result of the ruling, however, Ohio’s measure and similar “truth-telling commissions” in more than a dozen other states “will be struck down” as a violation of free speech rights.

The case arose during the 2010 mid-term elections, when the group, which describes itself as “dedicated to electing candidates and pursuing policies that will reduce and ultimately end abortion,” targeted a number of anti-abortion Democrats who voted for the Affordable Care Act. The SBA List contends that the health law “supports taxpayer-funded abortion,” despite promises to the contrary and an executive order issued by President Barack Obama.

In an attempt to stop billboards accusing him of voting for taxpayer-funded abortions from being erected by the group, then-Rep. Steve Driehaus filed a complaint — at the height of the campaign season — with the Ohio Election Commission, which found “probable cause” that the statements were false.

Driehaus lost the election, and withdrew his complaint, but the SBA list and another group, the Coalition Opposed to Additional Spending and Taxes, sued the election commission anyway. They argued that the law violates the Constitution’s guarantee of free speech, and that it “chilled” them from making assertions about candidates due to fear of prosecution.

The Supreme Court agreed, as far as allowing them to pursue their claim. “The burdens that Commission proceedings can impose on electoral speech are of particular concern here,” said the opinion. “Moreover, the target of a false statement complaint may be forced to divert significant time and resources to hire legal counsel and respond to discovery requests in the crucial days leading up to an election.”

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Monday, June 16th, 2014

PhRMA, Advocates: Specialty Drug Costs For Patients Too High

Here’s the next salvo in the back and forth between insurers and the drug industry over drug prices: the Pharmaceutical Research and Manufacturers of America are pushing the Department of Health and Human Services to take action to protect consumers who have gained insurance via the health law’s online marketplaces from high, out-of-pocket costs for specialty drugs.

Photo by Erin DeMay/For KHN

Specialty drugs are most often prescribed for complex, chronic and often costly health conditions like rheumatoid arthritis and hepatitis C that require continuous monitoring by a health care provider.

At a June 11 press event, PhRMA, the drug industry’s trade association, and five patient advocacy groups, ranging from the Colon Cancer Alliance to the Immune Deficiency Foundation, pointed to an analysis by the consulting firm Avalere Health — commissioned by PhRMA — as reason for worry regarding these medicines.

The Avalere study examined 123 formularies from silver-level exchange plans — the benchmark plan that will generally pay 70 percent of covered medical expenses, leaving the consumer responsible for 30 percent  – and found that a fifth of them required cost sharing of 40 percent or more for certain classes of specialty drugs used to treat HIV/AIDS, multiple sclerosis, bipolar disorder, cancer and other illnesses. Avalere also concluded that 60 percent of silver plan formularies placed all medications for multiple sclerosis, Crohn’s disease, cancer and other illnesses in the plan’s highest formulary tier. That means patients who need these medicines would face the highest coinsurance percentage.

PhRMA President John Castellani called on HHS to limit insurers’ ability to structure drug coverage in a way that subjects patients with these types of chronic and severe illnesses from these type of high out-of-pocket costs.

“Placing all medicines in the highest cost-sharing tier makes the best treatments for patient outcomes and overall value the most expensive and undermines the goal of the ACA. Cost to the patient is determined by the insurance market,” Castellani said during the event.

Insurers are currently submitting exchange premium rates for 2015, and Castellani said HHS could take action before those rates are finalized.

Others at the press event, including Carl Schmid, deputy executive director at the AIDS Institute, said HHS could redefine essential health benefits to stipulate that plans not include high cost-sharing for specialty prescription drugs. Silver-level plans mostly have an average of $70 for tier 3 drugs, and $270 for tier 4, according to a presentation to a recent meeting of the International Myeloma Foundation, one of the groups at the event.

“Certain plans are singling out medications — it’s not all plans or the majority — and those plans are fooling patients by putting every single drug in the highest tier,” Schmid said.

The groups, however, did not address issues related to the drugs’ actual price tags — only coverage costs to patients. But America’s Health Insurance Plans, the trade group for insurers, said in a blog post that PhMRA is trying to distract attention from drug pricing.

Meanwhile, these recent comments come amid growing debate on the issue.

The National Coalition on Health Care launched in May the Campaign for Sustainable Rx Pricing, which includes more than 80 organizations that represent employers, disease advocacy groups, providers and consumers.

John Rother, president and CEO of the NCHC, said though the concern about patients paying large coinsurance percentages is a valid one, it’s not the real problem — instead it is the overall cost of specialty drugs.

“Putting a limit on coinsurance probably would require legislative action, whereas reducing price is something companies could do tomorrow,” Rother told Kaiser Health News. “All we’re arguing about here is whether you pay out of one pocket or another. The real problem is the total price they have to pay. It’s not a poor industry — they can make it up on volume particular in the international market.”

AARP, which is a member of NCHC, also said if insurers were to eat the cost of specialty drugs without some amount of cost sharing, premiums would rise.

“Talking about high levels of cost-sharing without talking about the high levels of costs is disingenuous — they wouldn’t be so high if the prices of drugs weren’t so high,” said Leigh Purvis, senior strategic policy advisor at AARP’s Public Policy Institute.

Thursday, June 12th, 2014

Obamacare Health Spending Surge? Not So Fast

A growing economy and an Obamacare spending surge, many suspected, had ended five years of moderate health-spending growth.

Early government figures showed medical-cost acceleration at the beginning of the year. “Health care spending rose at the fastest pace since 1980 in the first quarter as the new health insurance law prompted many more Americans to visit doctors and hospitals,” reported USA Today among others a month ago.

Not really.

The preliminary estimates that prompted the story were off. Hospital revenue fell in 2014′s first quarter compared with the final three months of 2013, the Census Bureau estimated Wednesday. So did revenue for medical labs and outpatient care.

Fees and insurance reimbursements collected by doctor offices — which some thought would be swamped by patients newly covered under the Affordable Care Act — fell by 6 percent from the fourth quarter to the first. (Those numbers aren’t adjusted for normal seasonal fluctuations, but total first-quarter health spending fell even after accounting for seasonal differences, JPMorgan Chase economist Dan Silver calculated in a note to clients.)

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Thursday, June 12th, 2014

Some Costly Hospital Complications Not Tracked by Medicare, Analysis Finds

An analysis released Thursday identified dozens of potentially avoidable hospital complications that are not being tracked by the government even though some occur frequently and are expensive to treat.

Premier, Inc., a consulting company that works with hospitals on improving quality, analyzed 5.5 million patient records to identify 86 common complications that occurred in the hospital and were associated with patient deaths, higher costs or longer lengths of stays. The consultants offered estimates for each condition, which include heart attacks in the hospital, sepsis and acute kidney failure.

Premier said these occurred more often than some of the “narrow” handful of “hospital-acquired conditions” the federal government looks at when setting Medicare payments for hospitals. Since 2008, Medicare has refused to pay extra for patients who develop certain potentially avoidable complications occurring in the hospital, such as when patients are given blood that is incompatible with their own blood type.

Beginning in 2012, Medicare issued financial penalties to hospitals with higher than expected rates of readmissions, which are often caused by conditions that started in the hospital, such as infections. That year, Medicare also started giving incentives and penalties to hospitals based on their mortality rates and other quality factors. This fall, the government will add another layer of penalties to hospitals with the highest rates of infections and avoidable medical mishaps. Medicare has plans to add additional ones each year to its payment formulas.

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Thursday, June 12th, 2014

The Continuing Drama Over Medicaid Expansion

With Virginia Gov. Terry McAuliffe throwing in the towel in his effort to push a Medicaid expansion through the state’s General Assembly, KHN’s Julie Rovner joined Judy Woodruff on PBS NewsHour to discuss where Medicaid expansion stands in states across the country. Watch that conversation in the video below.

Wednesday, June 11th, 2014

Study: Health Law Boosts Hospital Psych Care For Young Adults

Expanded coverage for young adults under the Affordable Care Act substantially raised inpatient hospital visits related to mental health, finds a new study by researchers at Indiana and Purdue universities.

That looks like good news: Better access to care for a population with higher-than-average levels of mental illness that too often endangers them and people nearby.

But it might not be the best result, said Kosali Simon, an economist at Indiana University and one of the authors. Greater hospital use by the newly insured might be caused by inadequate outpatient resources to treat mental-health patients earlier and less expensively, she said.

The health law let people under age 26 stay on their parents’ group insurance plans starting in late 2010. Other research shows the provision raised coverage for young adults. The paper by Yaa Akosa Antwi, Asako S. Moriya and Simon, based on a big national sample from community hospitals, found it also increased their hospital use.

Total inpatient visits for those aged 19 to 25 increased 3.5 percent compared with people aged 27 to 29, who couldn’t be on their parents’ plans. Mental health admissions increased much more — by 9 percent.

That’s a little puzzling. When Massachusetts broadened medical coverage with its 2006 state-based health reform law there were no big increases in mental-health hospitalizations for young adults there.

But psychiatrists, psychologists and other mental-health providers are more available in Massachusetts than elsewhere, Simon said. Perhaps community caregivers largely met the needs of newly insured Bay Staters, saving them from crisis visits to the emergency room.

In the national study, a large portion of psychiatric admissions came through the emergency department.

Neither the Massachusetts study nor the national study looked at the volume of outpatient mental-health care. But even if they had, they wouldn’t have produced a final answer on the effectiveness of expanded coverage.

That will take more research. Increasing insurance and treatments aren’t necessarily the same as helping patients.

“We eventually judge all these [insurance] expansions based on the final outcomes that we care about,” said Simon. “How did this affect the well-being of young adults? Is there a measurable improvement of health status? Does it appear that there is better mental health as a result of this increase?”

Wednesday, June 11th, 2014

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