Short Takes On News & Events

For High-Risk Women, Some Breast Cancer Drugs To Be Free

Starting next September, women at increased risk for breast cancer will be able to get some drugs shown to help prevent the disease without a co-pay, the Obama administration said Thursday.

The U.S. Preventive Services Task Force  recommended last September that clinicians give medications such as tamoxifen or raloxifene to such women to reduce their risk of the disease. Under the Affordable Care Act, items or services rated A or B by the independent review board of physicians and academics must be covered by insurers without a co-pay or deductible. Insurers are given a year to make the change.

A spokesman for the insurance industry noted that while helping breast cancer patients get care is “a top priority for health plans,”  prescription drugs are not “free,” and the costs of those drugs would be reflected in the premiums that all consumers pay for coverage.

In addition, “we are concerned about the precedent of expanding the definition of prevention to now include some treatments that must be covered with no cost-sharing,” said the spokesman, Robert Zirkelbach of America’s Health Insurance Plans (AHIP).

The American Cancer Society Cancer Action Network praised the requirement,  saying it would help more women stay healthy, thereby saving money in the long term.

“This policy means millions of women at high risk for breast cancer will know they can access proven risk-reducing medications at no cost to them,” said spokesman Steve Weiss. “Studies show that even modest cost-sharing can keep patients from taking advantage of proven preventive tests and therapies. By making prevention more accessible and affordable, the health care law is helping people stay healthy and avoid the high costs of treatment after diagnosis.”

A 2010 study  found that about 52,000 women were taking tamoxifen, yet the researchers wrote “in 2000, there would have been some 10 million women in the United States 35 to 79 years of age who were eligible for tamoxifen chemoprevention on the basis of their risk factors … For 2.4 million of these women, it was believed that the benefits of taking tamoxifen outweighed the risks.”


January 9th, 2014, 3:14 PM by Phil Galewitz

Short Takes On News & Events

New Customer Service Data Available On California Medical Groups

Californians looking for more information about their doctors can now turn to a statewide website that includes new data on 170 physician groups.

The website rates medical groups based on patients’ survey responses on access, care and customer service. Patients can compare doctor groups on such criteria as how easy it was to get appointments, how helpful the office staff was and how effectively the doctors communicated.

The California HealthCare Foundation made the physician data available on the free site,, through a partnership with Consumer Reports Health and the nonprofit California Healthcare Performance Information System. The website also includes ratings on hospitals, nursing homes and hospice providers.

“It’s a one-stop shopping experience,” said Andy Krackov, senior program officer at the California HealthCare Foundation.

The medical group data, which covers both primary care and specialty physician groups, is also available through a special insert in the February edition of Consumer Reports magazine.

Physician groups performed slightly better in Northern California than in Southern California, according to the data. Among the highest performers statewide were Kaiser Permanente, Palo Alto Medical Foundation, St. Joseph Heritage Medical Group and UCSD Medical Group. (Kaiser Health News is not affiliated with Kaiser Permanente.)

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January 9th, 2014, 9:20 AM by Anna Gorman

Short Takes On News & Events

Report: Effort To Curb Health Costs Should Be ‘Led By The States’

Governors and other state leaders have the leverage to slow rising health costs and should not wait for action by the federal government, a commission chaired by two former governors said in a report Wednesday.

Ritter and Leavitt (Photos by Bill Ingalls-NASA/Jessica Marcy-KHN)

State leaders can use their clout as large purchasers of health care as well as regulators to set goals for health spending and quality, said the report by the State Health Care Cost Containment Commission.

“This must be led by the states,” said former Colorado Gov. Bill Ritter, a Democrat and co-chair of the commission along with former Utah Gov. Michael Leavitt, a Republican. Other commissioners included members representing insurers, hospitals, employers and consumer groups.

Leavitt noted that Utah and Massachusetts — a red state and a blue state, respectively — have each made strides to control costs and create more integrated health care systems.

“They are two very different cultures, but both moved forward long before the federal government,” he said a briefing in Washington, D.C.

Robert Reischauer, another member of the commission, said the group’s recommendations “point in the direction of the types of regulations that will make for a vibrant market.” Reischauer is a Medicare trustee and was director of the Congressional Budget Office from 1989 to 1995.

States that are successful will see their economies grow, wages rise, and health care improve, Reischauer said. “As other states see the differences, they will come along.”

The group was organized by the University of Virginia’s Miller Center and funded by insurer Kaiser Permanente and the Robert Wood Johnson Foundation. (KHN is not affiliated with Kaiser Permanente).

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January 9th, 2014, 5:00 AM by Julie Appleby

Short Takes On News & Events

More Shoppers, Including Young Ones, Showing Up At Health Exchanges

The road to enrolling Americans in the online health exchanges has been fraught with glitches and a rich source of political fodder. But a new survey says there are signs of improvement.

Seventeen percent of people potentially eligible for coverage visited the marketplaces when they opened in October, according to a survey  of 622 people conducted by The Commonwealth Fund. That encompasses people going to both the finicky run by the federal government for 36 states and those who went to the marketplaces run by 14 states and the District of Columbia. By the end of December — after government officials announced a fix to some of the website glitches — that number had risen to 24 percent.

Among the shoppers visiting the marketplace, researchers were surprised to find that people aged 19 to 34 comprised 41 percent of the total visitors. These “young invincibles,” as they have been dubbed, are the youthful and often healthy people needed to help hold down insurers’ overall health care costs.

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January 9th, 2014, 12:01 AM by Ankita Rao

Short Takes On News & Events

Survey Finds Wealthier Patients In California More Satisfied With Their Health Care

Money may not buy happiness, but patients with more money to spend tend to be happier with their health care providers, a statewide survey sponsored by the Blue Shield of California Foundation found.

Based on responses from 1,500 California residents, researchers found that among those whose household incomes fell below 200 percent of the federal poverty line, only about half said the quality of their care was excellent or very good, compared to almost 70 percent of those with household incomes above 200 percent of the poverty line.

The underlying reasons for this disparity, according to the researchers, were not the patients’ income per se but the quality of their relationships with caregivers.  Low-income people — who often get their care from resource-strapped community clinics and emergency rooms — tended to see different providers each time they sought care, felt less involved in their own health care decision-making and felt less connected to the facilities where they were treated.

By focusing on improving satisfaction and communicating better with patients, health systems serving low-income populations might deliver better care and ultimately better outcomes — without necessarily spending more money, the researchers said. (The Blue Shield of California Foundation helps to support Kaiser Health News’ coverage of the state.)

“It comes down to customer service,” said Peter Long, the president and CEO of the foundation. “Instead of worrying about problems that could take years to fix, let’s start working today on communication, information and trust.”

This patient-centered, team-based approach is cheaper — and possibly more effective long-term — than recruiting extra doctors or investing in high-tech gadgets, Long said.

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January 8th, 2014, 5:00 AM by Daniela Hernandez

Short Takes On News & Events

Detailed Report Delivers Good News On Health Costs, But Will It Last?

Definitive 2012 numbers show continued, historically low increases in medical prices and the use of medical services. Health spending rose 3.7 percent, up slightly from 2011 but far below the 8 percent increases of the early 2000s, according to figures released Monday by the Centers for Medicare & Medicaid Services.

Health spending has grown faster than incomes and overall economic output almost continuously for decades. But 2012 marked the second year in a row in which health expenditures shrank slightly as a portion of the economy. The annual CMS report is seen as the most precise accounting of an industry that has grown to be a sixth of the economy. Early results suggest that health-cost escalation stayed moderate again in 2013.

Those trends, if continued, would transform dismal projections for government deficits. They would give employers more room to raise workers’ wages instead of paying big increases for insurance premiums. They might ease the pressure to increase consumers’ out-of-pocket health costs.

But analysts who published the data gave much of the credit to lingering effects of the 2008 economic crash. They refused to say the health-cost monster is dead or even wounded.

And despite White House claims that the Affordable Care Act should get credit for taming medical spending, the health law played almost no role in raising or reducing 2012 health costs, the analysts said in the CMS report published in Health Affairs. (Most of the law’s coverage expansion doesn’t become effective until this year.)

“We see no evidence to say that the cycle has been broken,” said Anne Martin, a CMS economist.

Many factors that contained expenses are one-time deals. The recession and its aftermath reduced demand for care. Expiring patents for blockbuster drugs Plavix, Singulair and Lipitor meant health plans could buy much cheaper generic versions. (Three-fourths of all prescriptions in 2012 were less than $10.) Medicare cut payments to high-level nursing homes following an increase the year previously.

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January 6th, 2014, 4:04 PM by Jay Hancock

Short Takes On News & Events

How Much Does A New Hip Cost? Even The Surgeon Doesn’t Know

What will a gallon of milk set you back? How about a new car? You probably have a rough idea.

But what about a medical device — the kind that gets implanted during a knee or hip replacement? Chances are you have no clue. And you are not alone: The surgeons who implant those devices probably don’t know either, a just-published survey shows.

Medicare spends about $20 billion each year on implantable medical devices — nearly half of it for orthopedic procedures. And as the population ages and more Americans get joint replacements, that number is only going up, which will have a bigger and bigger impact on the nation’s health care spending.

But orthopedic surgeons don’t know much about how much their work contributes to that spending. They were only able to correctly estimate the cost of a device 21 percent of the time, according to a survey of 503 physicians at seven major academic medical centers published this week in Health Affairs. Their guesses ranged from 1.8 percent of the actual price to 24.6 times the actual price. Researchers could not release the actual costs, because they signed nondisclosure agreements with the hospitals.

And residents were worse at guessing — they were correct only 17 percent of the time. Estimates within 20 percent of the actual cost were considered correct. The study did not look at what patients know about cost.

“In orthopedic surgery, we’re never told how much things cost.  We never see the cost displayed anywhere, and even if you were interested, there’s no great way to find it,” says Dr. Kanu Okike, lead author of the Health Affairs study and an orthopedic surgeon at Kaiser Permanente Moanalua Medical Center in Honolulu (Kaiser Health News is not affiliated with Kaiser Permanente).

Unlike pretty much every other consumer industry, health care costs are not transparent, even for the surgeons. Each hospital system and purchasing group negotiates deals with device manufacturers and signs a nondisclosure form, promising not to share the details of those prices with anyone else.  That’s because “medical device manufacturers strive to keep their prices confidential so that they can sell the same implant at a different price to different health care institutions,” the study authors write.

But costs matter: for a total knee replacement, the actual piece of machinery that gets implanted can cost anywhere from $1,797 to $12,093, depending on the negotiated price. And there’s little evidence that one particular device is any better than another for the patient, says Okike.

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January 6th, 2014, 4:00 PM by Jenny Gold

Data Dives

364 Hospitals Have High Rates Of Overall Readmissions, New Medicare Data Show

Medicare’s new comprehensive measure of hospital readmissions shows that at least 20 percent of the hospitals in Illinois, Maryland, Massachusetts, New Jersey, New York and Rhode Island have higher rates of patients returning than the national average.

Colorado, Hawaii, Idaho, North Carolina, Oregon, South Carolina, Utah and Washington led the states with the highest proportion of hospitals with low readmission rates. In those states, between 13 and 16 percent of hospitals came in below the national average, which was 16 percent of Medicare patients, the data show.

Since 2008, Medicare has been tracking hospital readmission rates and publishing those for three common ailments. In December, the government expanded its disclosure by publishing hospital rates of Medicare patients of all diagnoses who returned within a month for unplanned reasons from July 2011 through June 2012. At 364 hospitals, or 8 percent, patients returned more frequently than did patients at the average hospitals. Some of these facilities are among the most revered in the country, such as the Cleveland Clinic and Duke University Hospital in Durham, N.C.

Patients at 315 hospitals, or 7 percent of those rated across the country, were readmitted at a lower rate than the national average. They included Baylor University Medical Center in Dallas, California Pacific Medical Center in San Francisco and Intermountain Medical Center in Murray, Utah. The rest of the nation’s hospitals were rated as average.

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January 6th, 2014, 5:00 AM by Jordan Rau

Health Care In The States

Maryland Plan Offers Retroactive Coverage Due To Sign-up Problems

Dr. Peter Beilenson may be the only health insurance CEO who picks up the phone when reporters call. So Kaiser Health News bothers him a lot. We caught up with the boss of Maryland’s Evergreen Health Co-op late last week to learn how one insurer moved from Obamacare theory to Obamacare practice.

“They have their first appointments,” he said of the plan’s clinics. “We’ve seen our first patients.”

But not nearly as many as the company had hoped for.

A consumer-owned cooperative started with federal loans, Evergreen runs four health centers in metro Baltimore and Greenbelt, near Washington, D.C. Since Oct. 1, the company has struggled with Maryland’s dysfunctional online insurance marketplace, Maryland Health Connection, which so far has enrolled 18,257 people in private health plans like the ones sold by Evergreen.

The online exchange has gotten “mildly better,” Beilenson said. But even after the New Year launch date of coverage under the health law Evergreen got “significant numbers of calls — in the dozens of people — who have tried to go on the exchange for between a week and 10 weeks and have been frozen out,” he said. “Now they’re calling us out of desperation”

Evergreen would try to enroll subscribers through the first week in January for coverage retroactive to Jan. 1, he said. After that, new enrollees will get care starting Feb. 1. Individuals can sign up through March 31, the end of open enrollment for 2014.

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January 5th, 2014, 5:00 PM by Jay Hancock

Short Takes On News & Events

New Year Brings Many Key Provisions Of Health Law

KHN’s Julie Appleby appeared on PBS NewsHour Thursday to discuss the status of the health law rollout as of Jan. 1, a date that marks the start of many of the Affordable Care Act’s most important provisions.

Watch video of the segment below:

January 3rd, 2014, 8:18 AM by KHN Editors