Archive for the ‘Syndicate to AP’ Category

Fast Track For Primary Care Docs At One Calif. University

Some doctors in the state of California will soon be able to practice after three years of medical school instead of the traditional four. The American Medical Association is providing seed money for the effort in the form of a $1 million, five-year grant to the University of California at Davis.

UC Davis medical student Ngabo Nzigira interacts with a patient at a Kaiser Permanente clinic in Sacramento. (Andrew Nixon/Capital Public Radio)

Student Ngabo Nzigira is in his sixth week of medical school and he’s already interacting with patients, as he trains under the guidance of a doctor at Kaiser Permanente in Sacramento. (KHN is not affliated with Kaiser Permanente).

In a traditional medical school, Nzigira wouldn’t be in a clinic until his third year.  In this accelerated course, students can shave up to $60,000 off their education debt. Still, Nzigira initially had hesitations.

“I thought ‘Oh man, you want me to put the intensity and stress that is medical school in four years, you want me to condense it down to three years? I’m not sure about that,’” Nzigira says. But, after learning more, he became convinced it was a good path for him.

The curriculum cuts out summer vacations, electives and the residency search. It’s designed to get primary care physicians into the field faster, says Dr. Tonya Fancher, director of the program, called Accelerated Competency-based Education in Primary Care, or ACE-PC .

“There’s a huge problem, a huge shortage of primary care physicians,” Fancher says.

UC Davis says more people gaining health insurance coverage under the Affordable Care Act is expected to compound the need for primary care, and one of the goals of the new curriculum is to make family medicine a more appealing and lasting choice for young doctors.

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Thursday, August 7th, 2014

First Look At Medicare Quality Incentive Program Finds Little Benefit

One of Medicare’s attempts to improve medical quality –by rewarding or penalizing hospitals — did not lead to improvements in the first nine months of the program, a study has found.

The quality program, known as Hospital Value-Based Purchasing, is a pillar of the federal health law’s campaign to use the government’s financial muscle to improve patient care. Since late 2012, Medicare has been giving small increases or decreases in payments to nearly 3,000 hospitals based on how patients rated their experiences and how faithfully hospitals followed a dozen basic standards of care, such as taking blood cultures of pneumonia patients before administering antibiotics. As much as 1 percent of their Medicare payments were at stake in the first year and 1.25 percent this year, though most hospitals gained or lost a fraction of that. Hospitals were judged both on how they compare to others and how much they are improving.

The program is one of several payment initiatives instituted by the health law. Others include penalties for hospitals that have high rates of Medicare patients readmitted within 30 days and penalties that will go into effect this fall for hospitals with high rates of patient injuries or infections.

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Wednesday, August 6th, 2014

Large California Insurers Invite Others To Join Data Network

Now that two of California’s biggest health insurers have teamed up on a project to share patients’ digitized medical records, they are planning to invite other companies to join.

The project will initially cover about 9 million Californians, making it possible for doctors and hospitals to quickly access patients’ medical histories and avoid unnecessary tests and procedures.

Heads of the two rival insurers — Blue Shield of California and Anthem Blue Cross – said Tuesday that they eventually want to include as many people as possible in the network, dubbed Cal Index.

“Ultimately our goal is to have all payers and all providers participating in Cal Index,” said Paul Markovich, president of Blue Shield, during a call with reporters. “We are open to anyone and everyone who can and will contribute data.”

Organizers said they plan to reach out to other insurers with the idea of creating a comprehensive, statewide system. The project is set to go live later this year, bringing patients’ digitized lab, pharmacy, outpatient and hospital records into one place that can be accessed by both patients and their medical providers.

California’s Secretary of Health and Human Services Diana Dooley said she was excited about the project but cautioned that it needs to protect the privacy rights of consumers.

“Patients have expectations that their records will be private at the same time they want their providers to have access to enhance their medical options and outcomes,” she said. “This is the balance we are all striving for.”

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Wednesday, August 6th, 2014

Survey: Insurance Rates Lag In Health Law Holdout States

A Gallup poll released Tuesday says that the Affordable Care Act is significantly increasing the number of Americans with health insurance, especially in states that are embracing the law. It echoes previous Gallup surveys, and similar findings by the Urban Institute and RAND Corp.

The latest Gallup survey found that, nationwide, the number of uninsured Americans dropped from 18 percent in September 2013, to 13.4 percent in June 2014. States that chose to follow the ACA’s provisions most closely, both by expanding Medicaid and establishing their own new health insurance marketplaces, as a group saw their uninsured rate drop nearly twice as much as states that declined to do so.

“Those states that have not embraced those two major mechanisms have had about half of the decline in uninsured,” said Gallup’s Dan Witters. “So there’s a clear difference in the states that have implemented those mechanisms versus those who haven’t.”

Arkansas saw the biggest decline in its uninsured rate, from 22 percent to 12 percent. Kentucky, Delaware and Colorado also saw significant declines.

“To drop 10 percent in the uninsured rate within really just six months is really an incredible achievement,” said Arkansas Surgeon General Dr. Joe Thompson. Thompson lobbied for his state’s unique, bipartisan Medicaid expansion, which uses federal funding to buy private insurance for low income people. He says about 80 percent of those with new, private insurance in Arkansas purchased it with Medicaid subsidies.

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Wednesday, August 6th, 2014

Advocates Say Florida Consumers To Pay For State Lawmakers’ Decision

Republicans were quick to pounce Monday on Florida’s announcement that residents buying health insurance on the individual market for next year will face a 13.2 percent average increase in monthly premiums — one of the steepest rate hikes announced for any state. “Obamacare is a bad law that just seems to be getting worse,” said Florida Gov. Rick Scott, a Republican who is running for re-election.

But consumer advocates and Sen. Bill Nelson, D-Fla., the state’s former insurance commissioner, blame the increases on Florida lawmakers’  decision last year to suspend the state’s authority to negotiate and approve premiums on policies sold to people who buy insurance themselves instead of getting it through an employer.

The Republican-controlled Florida legislature voted to cancel that authority until 2016 because it did not want to have any involvement with insurance plans sold through the Affordable Care Act, saying that job should be done by the Obama administration. The federal government has authority to review but not change insurance rates.

Most health experts agree that state regulation of insurance rates helps hold down premiums. According to the National Conference of State Legislatures, about two dozen states empower regulators to approve or disapprove insurance premium changes, although the power varies widely.

A report by the Kaiser Family Foundation in 2012 found that one out of every five insurer’s requests for higher rates submitted to states in 2011 resulted in a lower rate increase or no increase at all. On average, approved rate increases were 1.4 percentage points lower than what insurers initially requested, a reduction of about one-fifth.

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Tuesday, August 5th, 2014

Some California Hospitals, Insurers Disappointed in ‘Bundled Payments’

Giving health-care providers a lump sum payment for certain treatments – touted as a way to save money and improve coordination of care — yielded disappointing results for some major California hospitals and insurers, a study found.

The RAND Corp. study, funded by a $2.9-million federal grant,  looked at “bundled payments” for care of insured orthopedic patients under 65 at a handful of large hospitals and insurers in California.

Six of the state’s biggest insurers and eight hospitals started out in a pilot program in 2010, but only three insurers and two hospitals actually decided to enter contracts to adopt bundled payments. The others dropped out because they didn’t think bundled care, such procedures as total knee replacement surgery, would change the delivery of care significantly or lower costs, according to the study, published in the journal Health Affairs Monday.

The pilot project resulted in such a small number of hospital cases that it was hard to draw conclusions about how bundled payments affect health care quality or costs, which were the initial goals of the study, the researchers reported. Two ambulatory surgery centers managed to partner with an insurance company and had a higher volume of cases, but generally health plans have been slow to contract with them, the study found.

“That was unexpected,” said Susan Ridgely, the lead author of the study and a senior policy analyst at RAND, a Santa Monica, Calif.-based think tank. “They were a bit more flexible and also wanted the business, but hospitals began to see that it required too much time and effort or maybe that it was not in their best interest.”

Under bundled payments, doctors, hospitals and other health providers share a fixed payment that covers the average cost of a “bundle” of services – caring for a person with a hip replacement, for instance.

Hospital and payer incentives were sometimes at odds. It’s in the best interest of doctors and hospitals, for example, to limit bundles to the lowest-risk patients. Also, to keep costs down and maximize profits, they want to shorten the period during which the bundled payment covers treatment. Insurers, on the other hand, want providers to treat a diverse population of patients for as long — and for as little money — as possible.

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Tuesday, August 5th, 2014

Poverty Linked To Diabetic Amputations In California

People with diabetes in low-income neighborhoods in California are twice as likely to have a leg or foot amputated as those living in wealthier areas, according to a study released Monday.

The study, published in the journal Health Affairs, underscores the stark differences in outcomes for diabetes patients throughout the state.

“We are not particularly surprised, but we are disturbed,” said Carl Stevens, one of the authors and a clinical professor at UCLA David Geffen School of Medicine. “Is it okay that we are losing limbs … in low-income people? Most Americans would find this inequality in outcomes unacceptable, regardless of their political leanings or their opinions.”

About one in seven Californians has diabetes, a metabolic disease that leads to high blood sugar. The vast majority are Type 2 cases, in which the body doesn’t use insulin properly. Amputations are a serious complication of the disease but are generally preventable with proper care. The disease can lead to blindness, kidney disease and death.

The study didn’t determine the cause of the higher rates of amputations, but researchers said less access to ongoing primary care, coordinated teams of providers and trained specialists likely contributes to the problem. In addition, patients in low-income neighborhoods may not be as educated about their health and may have fewer places to buy healthy food or to exercise safely.

As in the state as a whole, the amputation rates in Los Angeles County in 2009 were roughly double in poorer neighborhoods than more affluent ones. In parts of the county, however, the disparities were even greater. For example, there were about 11 amputations per 1,000 diabetics in Compton, compared to 1 per 1,000 patients in Beverly Hills.

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Tuesday, August 5th, 2014

Smokers Paying Less For Some Health Plans Than Expected

The health law allows insurance plans to charge tobacco users as much as 50 percent more for their premiums, but plans on average increased costs for these consumers by significantly less, according to a new study published in Health Affairs.

Researchers found the median surcharge amount to be about 10 percent. Close to 90 percent of plans stayed well below the maximum surcharge, according to the study’s authors. But even still, because tobacco users were still charged more than others, they more frequently could not access affordable health insurance, a situation that the authors said could deter tobacco users from purchasing insurance at all.

Affordable coverage is defined as “access to at least one plan with premiums of less than 8 percent of income after subsidies,” according to the study.  The authors used that standard because the health law exempts from the requirement to buy insurance individuals who do not have at least one insurance option that costs less than 8 percent of income.

Insurers’ pricing may be based on the use of health care services by tobacco users. “It seems as if smokers don’t actually – at least in the age range that the health insurance exchanges are targeting – use 50 percent more in terms of costs for health care,” said Cameron Kaplan, an assistant professor of preventive medicine at the University of Tennessee Health Science Center and the study’s lead author.

On average, smokers appear to use about 10 percent more health care, Kaplan said, so plans for the most part have reflected that in their pricing, a strategy he said makes sense if insurers “want to attract people into their plan.” Though smokers have more health problems than do non-smokers, Kaplan added, tobacco users in the exchange appear, for whatever reason, “to be the people who avoid using health services.”

The surcharges have drawn criticism from groups such as the American Lung Association. It argues that higher costs will discriminate against smokers and preclude them from obtaining coverage.

“No one wants tobacco users to be uninsured – we know they have health consequences,” said Jennifer Singleterry, the lung association’s director of national health policy.  “We certainly want someone who has lung cancer to have insurance.”

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Monday, August 4th, 2014

Study: ER Closures Raise Death Rates At Nearby Hospitals

Emergency patients who are admitted to the hospital are at greater risk of dying if another emergency room at a hospital nearby has closed its doors, a new study of California hospitals has found.

The analysis is believed to be the first to examine the impact that emergency department closures have on the quality of patient care at other hospitals within the same service area.

Six percent of the nation’s emergency rooms have closed their doors in recent years, including many that serve poor inner-city and rural communities. At the same time, the number of emergency visits throughout the country has increased by 51 percent, a combination of developments that has led to more overcrowding and longer waits for emergency care.

The study was published Monday in the August issue of the journal Health Affairs.

“Emergency department closures generally happen in vulnerable communities, but their ripple effects extend to other hospitals,” said the senior author, Dr. Renee Y. Hsia, an associate professor in the department of emergency medicine and the Institute of Health Policy Studies at the University of California, San Francisco.

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Monday, August 4th, 2014

Unfavorable Views Of Health Law Spike In July: Poll

The health law’s unpopularity among the public rose sharply in July with a surge of disapproval from people who had been agnostic about it in recent months, a poll released Friday shows. The law is as unpopular as it has been since it was enacted four years ago.

The poll from the Kaiser Family Foundation found that 53 percent of the public had an unfavorable view of the law in July, the highest level since the law was passed in 2010. It was up from 45 percent in June. (KHN is an editorially independent program of the foundation.)  The law’s unpopularity hit similar levels several times since passing, most recently in January when 50 percent of people disliked it.

Support for the law in July remained about the same as in June, with 37 percent supporting it. The change came from the number of people who had previously told pollsters they did not know or refused to discuss their opinions: while 16 percent fell into that group in June, only 11 percent did in July.

The poll did not provide any definitive answers for the change but noted that people reported that their informal chatter with friends and family was more than four times as likely to be negative as supportive toward the law.

Public opinion was evenly divided on the Supreme Court’s decision that closely held companies such as the Hobby Lobby craft stores could refuse to provide workers with birth control through their insurance because it violated the religious beliefs of the company. Women and men also saw things pretty much the same. Seven of 10 Republicans hailed the decision, and Democrats disliked it just as strongly. The public was split about whether the decision will make it harder for women to get prescription birth control. Few people said the court’s action would make them more likely to vote in the fall mid-term elections.

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Friday, August 1st, 2014

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