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USHL NEWS & Updates

On March 5, 2014, CMS announced that it would allow insurers to extend some health plans until October 2016 even if the plans do not meet new healthcare reform standards.

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Healthcare Subsidies At Risk - Pending Legislation Could Deny Subsidies In States Utilizing National Exchange

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Standard Analytical Service, Inc. (SAS), publishers of independent insurance reports, recently released its 2014 annual comparative report of the 25 leading domestic health insurance providers. USHL received a favorable ranking.

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USHL recently introduced its Wellness Resources Center, a convenient one-stop health and wellness information library on the USHL website which visitors can reference for a variety of objectives.

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  • First Edition: October 1, 2014

    Today's headlines include coverage of the debut of the Open Payments database, a federal information trove designed to shed light on the financial connections between physicians and the drug and medical device industry.  

    Kaiser Health News: As Payments Database Debuts, Doctors Urge Caution
    Kaiser Health News staff writer Shefali Luthra reports: “A federal database unveiled Tuesday afternoon details 4.4 million payments from pharmaceutical and medical technology companies to doctors and teaching hospitals, sparking concerns that consumers might misinterpret the information” (Luthra, 10/1). Read the story.

    Kaiser Health News: 'The Health Care System Falls Apart When You're A Complex Patient'
    Kaiser Health News staff writer Lisa Gillespie reports: “Jeffrey Brenner doesn’t believe in blaming a person for showing up at an emergency room for a cold or an ear infection, even if the illness could have been treated in a doctor’s office at much lower cost. Instead, he faults the health care system, and he wants to prove that if providers, employers and insurers work together more effectively, that person will stop going to the ER” (Gillespie, 10/1). Read the interview.

    The New York Times: U.S. Cannot Subsidize Health Plans In States With No Marketplace, A Judge Rules
    A federal district judge in Oklahoma dealt a blow to the Affordable Care Act on Tuesday, ruling that the federal government could not subsidize health insurance in three dozen states that refused to establish their own marketplaces. This appears to increase the likelihood that the Supreme Court will ultimately resolve the issue (Pear, 9/30).

    The Wall Street Journal: Federal Judge Rules Against Some Affordable Health Care Subsidies
    A federal judge in Oklahoma ruled that subsidies under the Affordable Care Act can't go to consumers who obtained health coverage through a federal exchange. The decision adds to a mix of rulings on whether consumers in states relying on the federal marketplace are legally entitled to subsidies, a question that many expect will wind up before the U.S. Supreme Court. Two U.S. appeals courts in July issued conflicting rulings on health-law subsidies, raising questions about the fate of tax credits provided to millions of Americans (Armour, 9/30).

    Politico: Judge Rules Against White House On Affordable Care Act
    Judge Ronald A. White said that the administration’s decision to allow subsidies to go through either a state-run health insurance exchange or the federal exchange is an improper and invalid reading of the Affordable Care Act and must be struck. White’s ruling marks the second judgment against the government on the subsidy question and comes as the Supreme Court could decide whether to weigh in (Haberkorn, 9/30).

    The Wall Street Journal’s Washington Wire: Immigrant Groups Try To Block Termination Of Health Plans
    Immigrant advocates are accusing the Obama administration of violating antidiscrimination provisions in the federal health-care law by moving to terminate coverage for around 115,000 people who bought coverage through HealthCare.gov who didn’t take additional steps to prove they are legal U.S. residents. Two immigrant groups filed complaints Tuesday with the Department of Health and Human Services’ Office of Civil Rights asking it to block the action, which is being carried out by other units of the department. The Office of Civil Rights is in charge of enforcing rules in the 2010 law that bar discrimination in the sale of health plans (Radnofsky, 9/30).

    The New York Times: Detailing Financial Links Of Doctors And Drug Makers
    Pharmaceutical and device makers paid doctors roughly $380 million in speaking and consulting fees, with some doctors reaping over half a million dollars each, during a five-month period last year, according to an analysis of federal data released Tuesday. Other doctors made millions of dollars in royalties from products they helped develop (Thomas, Armendariz and Cohen, 9/30).

    Los Angeles Times: Database Shows $3.5 Billion In Industry Ties To Doctors, Hospitals
    The details published Tuesday in a new government database have been sought for years by consumer advocates and lawmakers concerned that conflicts of interest in the medical profession are jeopardizing patient care and costing taxpayer-funded health programs. This first batch of payment data covers just five months of 2013, but it shows the extensive ties medical companies have forged with doctors and academic medical centers across the country. About 546,000 U.S. physicians and 1,360 teaching hospitals received some form of compensation (Terhune, Levey and Poindexter, 9/30).

    The Wall Street Journal: Doctors Net Billions From Drug Firms
    The database revealed some eye-popping totals, such as the $122.5 million paid by Roche Holding’s Genentech unit to City of Hope medical center in Duarte, Calif., as royalties on sales of several products including blockbuster cancer treatments Herceptin and Avastin. Genentech licensed patents from City of Hope based on research the medical center conducted in the early 1980s. The company said that excluding the City of Hope royalties, about 85% of the physician payments it reported to CMS were focused on drug research. City of Hope said the royalties are allocated to the inventors and to support continuing research (Loftus, 9/30).

    The Washington Post’s Wonkblog: You Can Now Track The Billions That Drug Companies Pay Doctors And Hospitals
    Thanks to a bipartisan transparency initiative contained in the 2010 Affordable Care Act, the federal government has compiled a massive database of how much drug and device companies spend on consulting fees, research grants, travel, free lunches and other items worth more than $10. … The rollout of this federal database has been somewhat problematic. Records aren't complete — about 40 percent of payments have been de-identified because of problems with the data. The Centers for Medicare and Medicaid Services, the agency publishing the database, is holding back other records that are still in dispute. It's also been difficult to navigate the database this afternoon. But these payments will be published on a regular basis, and the quality and reliability of the information is expected to improve (Millman, 9/30).

    The Associated Press: Drug And Device Firms Paid $3.5B To Care Providers
    The massive trove of information named companies and many of the recipients. Also listed were types of payments, with details down to travel destinations. Some 546,000 clinicians and 1,360 teaching hospitals received benefits. It’s part of a new initiative called Open Payments, required by President Barack Obama’s health care law. It was intended to allow patients to easily look up their own doctors online, but that functionality isn’t fully developed. In future years, the information will cover a full 12 months and will be easier to search, officials said (9/30).

    NPR: Database Flaws Cloud Sunshine On Industry Payments To Doctors
    But the database is also something else: a very limited window into the billions in industry spending. Before you dive in and search your doctor, here are five caveats to keep in mind (Ornstein, 9/30).

    Politico: ‘Data Dump’ Reveals Billions In Pharma Payments To Docs, Hospitals
    In its first hours, the website was tortuously slow. And it was incomplete: About 40 percent of the records do not identify the recipient because CMS could not match data provided by manufacturers with existing databases (Wheaton, 10/1).

    The Wall Street Journal’s Pharmalot: Does The Open Payments Database ‘Distort’ What Docs Get For Research?
    The database, which is being administered by the Centers for Medicare & Medicaid Services, will initially display payments made in the last five months of 2013 and will be updated going forward. Already, though, both industry and physician groups have complained that payment data lack sufficient context for the public to understand what doctors are paid. And doctors also griped they had little time to review data. Now, a group of academics from Johns Hopkins University have raised another issue. The law requires drug makers to report the total amount of “research payments” to researchers for use in clinical trials. But the academics – three bioethicists and a professor of medicine and pharmacology – argue this stipulation creates a “distorted” image of the money that doctors may receive, because it does not break out a value assigned to medicines that companies provide for the research (Silverman, 9/30).

    The New York Times: Loss Of A Democratic Power Leaves Arkansas In Doubt
    Mr. Beebe’s knack for knowing what his political opponent needed to get a deal done during his long tenure in the legislature has served him well in the governor’s office. He has been able to get past the kind of partisan impasses that plague Washington. No one tries to lump Mr. Beebe with Mr. Obama, but the same cannot be said for Senator Pryor, whom Mr. Cotton called “a loyal foot soldier for Barack Obama and his agenda.” And yet Mr. Beebe worked with Republican legislators to put together, and pass with the required three-fourths majority, a private-option health insurance program that has helped more than 200,000 poor residents get covered, without the stigma of being associated with the unpopular Affordable Care Act. The program allowed the state to take federal money to expand Medicaid under the Affordable Care Act and use that money to buy private insurance for the poor, instead of adding them directly to the Medicaid rolls. Also, it brought the state national attention for its bipartisan collaboration (Chozick, 9/30).

    The New York Times: Doctors Find Barriers To Sharing Digital Medical Records
    Regardless of who is at fault, doctors and hospital executives across the country say they are distressed that the expensive electronic health record systems they installed in the hopes of reducing costs and improving the coordination of patient care — a major goal of the Affordable Care Act — simply do not share information with competing systems (Creswell, 9/30).

    The Wall Street Journal: Walgreen Profit Remains Pressured By Drug Price Miscalculation
    Walgreen Co. continues to pay the price for a miscalculation in the pricing of generic prescription drugs. The pharmacy chain shocked investors in August when it slashed its long-term profit forecast because it had failed to account for a rapid rise in the price of generics as it negotiated contracts to provide prescription drugs under Medicare's Part D program. On Tuesday, it warned that lower drug reimbursement rates and higher costs for generic drugs will continue to hurt profits (Ziobro and Calia, 9/30).

    The New York Times: Freelancers Union To End Its Health Insurance Plans In New York
    The Freelancers Union, which provides health insurance to 25,000 of its members in New York State, is ending an experiment in providing low-cost insurance to independent workers, saying the new landscape created by the federal Affordable Care Act makes it impossible to do so (Hartocollis, 9/30).

    The Washington Post: ‘Death Doctor’ Who Profited From Unnecessary Chemotherapy For Fake Cancers Could Resume Practice In 5 Years
    The Michigan state house health policy committee approved the proposal to tighten the rules. Next it will go before the full house for a vote. Fata pleaded guilty in U.S. District Court earlier this month to 13 counts of health-care fraud, one count of conspiracy to pay or receive kickbacks and two counts of money laundering. He will be sentenced in February and faces up to 175 years in prison (Sullivan, 10/1).

    Check out all of Kaiser Health News' e-mail options including First Edition and Breaking News alerts on our Subscriptions page. 

  • As Payments Database Debuts, Doctors Urge Caution

    A federal database unveiled Tuesday afternoon details 4.4 million payments from pharmaceutical and medical technology companies to doctors and teaching hospitals, sparking concerns that consumers might misinterpret the information.

    The Centers for Medicare & Medicaid Services website itemized $3.5 billion worth of payments to 546,000 doctors and 1,360 teaching hospitals, made between August 2013 and December 2013. But about 40 percent of those payments were listed without noting who received them, either because of concerns about whether CMS had the correct recipient information, or because the physicians named hadn’t had enough time to verify the payment information.

    The database is the result of a Sunshine Act that was incorporated into the health law and is intended to intensify scrutiny of the relationships between physicians and the drug and device industries. Consumer advocates have argued that making this information available to the public – on gifts, speaker fees, research grants, meals, travel and investment interests worth $10 or more – is a vital step in ensuring doctors don’t have conflicts of interest affecting their research and medical decisions.

    Pharmaceutical and medical device companies submitted the information, and CMS was required to give doctors and hospitals 45 days to review and contest any claims.

    Another 199,000 records were not published because they detailed ongoing pharmaceutical research or because physicians were still disputing their contents. That information will be updated and published as it becomes ready, CMS Deputy Administrator Shantanu Agrawal said in a conference call with reporters.

    Providers and industry groups said they hope consumers don’t reach the wrong conclusions.

    “You have to understand, there are many facets of the relationship between physicians and industry,” said John Murphy, associate general counsel at Pharmaceutical Research and Manufacturers of America. “And they are vital to ensuring drugs get developed and get to the market.”

    Industry representatives have suggested the database could distort relationships that are either innocuous or promote valuable research. But those supporting the Sunshine Act say that when making medical decisions, patients have a right to know their doctor’s connections. Research from the Pew Charitable Trusts found that doctors who receive money from the industry will sometimes change their prescription practices based on those interests.

    In response to industry concerns, CMS is working to appropriately contextualize the information included in the database, Agrawal said.

    “The intention is to provide a very balanced view of what the data is and what it is not,” said Agrawal, who is also director of CMS’ Center for Program Integrity. Some information, he added, might indicate productive relationships between providers and industry, while other details could note conflict of interest.

    In addition to a broader statement explaining what the data may or may not indicate, the site includes information companies may have provided to describe specific payments, Agrawal said.

    “We’re heartened to see – it looks like CMS put quite a fair amount of effort in putting in some context and background” on the site, Murphy said.

    But, given the difficulty some have faced in accessing or navigating the site, it’s still hard to tell how effective some of those explanations have been and how accurate the information is, said Linda Burns, president of the American Society of Hematology.

    “We want the data to certainly be transparent and publicly available, but we also understand that it’s only beneficial if the data is complete and accurate,” Burns said. “And I think that’s still yet to be seen.”

    Other concerns about the site’s accuracy surfaced earlier this summer. In August, a physician reviewing which payments were attributed to him found incorrect information in the site. Following that, CMS temporarily took the site down to address that information – ultimately leading to the 40 percent of payments the agency published but did not identify.

    That discovery prompted calls from interest groups such as the American Medical Association to push back the site’s launch to March 31, 2015. The AMA argued that site inaccuracies could unfairly harm physicians and that technical challenges had left doctors insufficient time to review and challenge the information included.

    Robert Wah, president of the AMA, cited data from CMS that indicated about 26,000 physicians registered with the Open Payments site to review and dispute any claims. That number, he noted in an interview, was much smaller than the 546,000 doctors in the system, meaning most doctors have had little time to review information.

    He cautioned consumers that “there is a high likelihood of inaccuracy when only 26,000 physicians had a chance to look at it.”

    CMS intends to unveil a second, more user-friendly site for consumers in October, Agrawal said. Some questioned how accessible the site now is. For instance, a PDF of a dictionary meant to help users navigate the site and understand its terminology spans 51 pages. Others pointed out the lengthy period of time it took to download the spreadsheet of payment information.

    “I’m hoping we’ll see some fact sheets and Q&As – which they promised but I don’t see yet,” Murphy said.

  • 'The Health Care System Falls Apart When You're A Complex Patient'

    Jeffrey Brenner doesn’t believe in blaming a person for showing up at an emergency room for a cold or an ear infection, even if the illness could have been treated in a doctor’s office at much lower cost. Instead, he faults the health care system, and he wants to prove that if providers, employers and insurers work together more effectively, that person will stop going to the ER.

    Jeffrey Brenner. (Photo by MacArthur Foundation)

    Brenner, a 2013 MacArthur Fellow and executive director of the Camden Coalition of Healthcare Providers, is testing this theory with a randomized controlled trial. Findings are due out in 2016.

    The trial extends what the Coalition has been doing for years in hospitals and primary care offices that serve the low-income neighborhoods of Camden, N.J. For the past decade, the nonprofit has worked to bring together hospitals, physician offices and other providers to create programs to better coordinate care for the high proportion of Medicare and Medicaid patients in the region. Brenner’s team flags patients with multiple hospital visits -- the so-called “super utilizers” -- and sends a care coordinator to their bedside. The goal is to find out why they went to the hospital instead of a doctor’s office. Then, a nurse, a health coach and a social worker meet regularly with patients, and determine how to address their continuing needs.

    Employer health plans also have super-utilizers who rack up medical bills, prompting some employers to experiment with ways to control these costs.

    Brenner recently spoke with KHN’s Lisa Gillespie about the trial and the work still left to be done. An edited transcript of that conversation follows.

    Q: Can you explain the randomized trial? What are you trying to show? 

    A: We identify the patients … who have had two or more hospital admissions, and then they get randomized into the control [group] -- care as usual -- or they have 90 to 120 days of intensive wrap-around coaching. [We] will track them for a year and possibly longer. The end point [measures] are [whether we achieve] a reduction in ER and hospitalization utilization. We also look at [the] patients’ overall wellbeing.

    We’re trying to prove that we’re using the wrong methods to approach these patients. You don’t need new money [to care for patients], you just need new service delivery systems. We have to stop giving up on poor people. There is a feeling that it’s the patients’ fault that their care process isn’t going well, and that the health care system has done everything it can do and the rest is up to the patient.

    We spend money in the wrong places delivering the wrong services at the wrong time, and this is about rethinking how we deliver care. As I meet with congressmen, hospital CEOs, the numbers of stories told behind closed doors of family members getting lost in the health care system is tragic. As baby boomers age, more and more families are experiencing what it feels like to get lost and have too much unnecessary stuff done to a family member.

    Q: So the trial is looking at a high proportion of Medicaid and Medicare patients, but do you think the findings could also prove helpful to employers regarding the health costs of workers’ and retirees’ coverage?

    A: A lot of the failures happening for poor people are happening for the middle class. [We] are all trying to solve a similar problem: how do you engage very sick people and help them work their way through problems? In every population that you look at, a small percentage of patients is responsible for most of the costs.  So for employees and their dependents, you’ll find the same pattern -- that 1 percent of patients account for 25 percent of costs. Whether you’re middle class or poor, the health care system falls apart when you’re a complex patient. We need to coordinate care and have engagement models for the sickest patients.

    Take for instance a middle class woman with a master’s degree getting care at a five-hospital integrated system, connected electronically. She was going to the ER repeatedly and, in a three-and-a-half-year period, she had 79 CT scans to the head. A group of family medicine residents got to know her and found out she had severe anxiety, so they got her working with a psychologist and she stopped going to the ER.

    These hospitals were electronically connected. They could have seen the other CAT scans, but they did not. So I don’t think the phenomena we’re talking about is exclusively for poor patients. If you have good insurance, you can also have an enormous amount of unnecessary care.

    Q:  Are public and private insurance plans already doing some of this coordinated care you’re talking about?

    A:  There are lots of examples: Boeing has a patient-centered medical home for employees, and Bravo Health has a Medicare Advantage plan in Philly.

    There’s been a big shift amongst health care plans because telephonic health case management isn’t effective. It takes boots on the ground to shift the trajectory. So you’re seeing more and more insurers get into the work of delivering care. Bravo Health has built two physical offices to deliver care, with shuttles and vans picking people up and [with] phenomenal hospitalists. They’ve put these in two of the poorest neighborhoods in Philly. They’ve made incredible profit, and Cigna bought them and now they’re trying to scale the model. That’s evidence that there’s money to be made on delivering coordinated care.

  • Website Launches Today Showing Drugmakers' Payments To Doctors

    The so-called Open Payments program is intended to shine a light on potential ethical conflicts and allow patients to look up their doctors online. The first batch of data, however, will be incomplete, covering only a few months at the end of 2013. Journalism website ProPublica says it has tracked 3.4 million payments to health professionals since 2009, totaling more than $4 billion.

    The Associated Press: Gov’t To Reveal Drug Company Payments To Doctors
    Striving to shine a light on potential ethical conflicts in medicine, the Obama administration is releasing data on drug company payments to tens of thousands of individual doctors. As conceived, the so-called Open Payments program was intended to allow patients to easily look up their own doctors online. That functionality won’t be ready yet. And although preliminary data to be released Tuesday will be incomplete, it’s expected to be useful for professional researchers (9/30).

    Propublica/NPR: 4 Years Of Lessons Learned About Drugmakers' Payments To Doctors
    On Tuesday, the federal government is expected to release details of payments to doctors by every pharmaceutical and medical device manufacturer in the country. The information is being made public under a provision of the 2010 Affordable Care Act. The law mandates disclosure of payments to doctors, dentists, chiropractors, podiatrists and optometrists for things like promotional speaking, consulting, meals, educational items and research. It's not quite clear what the data will show — in part because the first batch will be incomplete, covering spending for only a few months at the end of 2013 — but we at ProPublica have some good guesses. That's because we have been detailing relationships between doctors and the pharmaceutical industry for the past four years as part of our Dollars for Docs project (Ornstein, Grochowski Jones and Sagara, 9/29).

  • Senate Control Still Up In The Air As Democrats Shift Focus To Medicare, Other Popular Programs

    The strategy being employed by Democrats -- to nationalize the election by highlighting popular programs such as Medicare and Social Security as well as issues that resonate with younger voters -- is a regular approach during midterm elections. Meanwhile, in Virginia, Senate candidate Ed Gillespie promises to disclose specifics of his plans to replace the health law. 

    Los Angeles Times: As Election Nears, Control Of Senate Looks Surprisingly Uncertain
    Democrats have tried to shift the focus from a debate over big government, embodied by the unpopular national healthcare law, to the merits of popular programs, such as Social Security and Medicare, and issues that are especially resonant to minorities, young people and single women. All are Democratic-leaning voter groups that tend to sit out midterm elections. … That tactic — one party trying to nationalize the election, the other trying to make contests more localized and issue-specific — is also typical of midterm elections (Barabak and Mascaro, 9/29).

    Richmond Times-Dispatch: Gillespie Backs Debate, Vote On Use Of Force Against ISIL
    During an interview about five weeks before the election, [Virginia Senate candidate Ed] Gillespie also said he soon will disclose more specific proposals to replace the Affordable Care Act and to reform entitlement programs in order to preserve Social Security and Medicare for future generations (Cain, 9/29).

  • State Highlights: Calif. Health Laws Signed; Mass. Judge Considers Partners Deal

    A selection of health policy stories from California, Massachusetts, New York, the District of Columbia, Minnesota and Kansas.

    Kaiser Health News: Capsules: California To Launch Medicaid-Funded Teledentistry
    California Governor Jerry Brown has signed into law a bill that would require Medi-Cal, the state’s insurance program for the poor, to pay for dental services delivered by teams of hygienists and dentists connected through the Internet. California is among the first states to launch such teledentistry services, which are intended to increase the options for patients in remote and underserved areas. Other states, like Oregon, Colorado, Hawaii and West Virginia, are interested in creating their own teledentistry programs but are farther behind, advocates for the projects said (Hernandez, 9/29).

    California Healthline: Governor Agrees To Take $6M California Endowment Grant, Signs Many Health Bills
    Gov. Jerry Brown (D) signed a flurry of health-related bills at the end of last week including a bill to reverse the state's position on accepting a grant to help with Medi-Cal enrollment renewals. More than eight million Californians are up for renewal in the Medi-Cal program (California's version of Medicaid). New eligibility rules and new forms have slowed the response rate so far. The California Endowment offered the Department of Health Care Services a $6 million grant to help with the renewal effort that would be doubled by matching federal funding. The state turned down the $12 million money during May budget negotiations (Gorn, 9/29).

    WBUR: Judge Wrestles With Partners Deal
    Suffolk Superior Court judge Janet Sanders is wrestling with a decision that will shape the health care industry in Massachusetts for at least a decade. On the face of it, Sanders is reviewing a customary settlement in an anti-trust case. Partners HealthCare and Attorney General Martha Coakley reached an agreement to avoid a lengthy court fight. The agreement would allow Partners to acquire at least three hospitals and hire more physicians in exchange for limits on price increases and unchecked expansion through the next decade (Bebinger, 9/30).

    Boston Globe: Judge Delays Decision On Partner Accord
    A Superior Court judge raised serious concerns Monday about an increasingly controversial deal that would allow Partners HealthCare to acquire three community hospitals, and she moved her decision on the transaction until after the November election. Judge Janet L. Sanders scheduled the next hearing for Nov. 10, meaning Partners’ nearly three-year effort to merge with South Shore Hospital in Weymouth and its subsequent move to take over hospitals in Medford and Melrose could be delayed for months (McCluskey, 9/29).

    The New York Times: Cuomo’s Ad Faults Astorino On Health Care For Older Adults
    Gov. Andrew M. Cuomo has attacked his Republican opponent, Rob Astorino, over his views on issues like abortion rights, same-sex marriage and gun control. Now Mr. Cuomo is trying to focus attention on health care for older adults. While Mr. Cuomo holds a wide lead in polls, he has not relented in airing negative commercials about Mr. Astorino, and the advertisements appear to be working: In a statewide poll conducted by Siena College from Sept. 18-23, 29 percent of likely voters had a favorable view of Mr. Astorino, compared with 30 percent who had an unfavorable view of him (Kaplan, 9/29).

    The New York Times: De Blasio’s Executive Order Will Expand Living Wage Law To Thousands More
    Mayor Bill de Blasio plans to sign an executive order on Tuesday significantly expanding New York City’s living wage law, covering thousands of previously exempt workers and raising the hourly wage itself, to $13.13 from $11.90, for workers who do not receive benefits. … The executive order will immediately cover employees of commercial tenants on projects that receive more than $1 million in city subsidies going forward. Workers who receive benefits such as health insurance will earn $11.50 an hour, compared with $10.30 before (Flegenheimer, 9/29).

    The Washington Post: D.C. Government’s Infant-Mortality Program Eyed For Cuts As Mayor Touts New Initiative
    A loss of $4 million in federal funding is threatening to curtail District services to young mothers and infants, complicating the city’s efforts to care for its youngest residents even as officials tout a new focus on reducing infant mortality. Over two decades, the city received tens of millions of dollars in funding through the federal Healthy Start program. But that program recently changed its structure, dispensing with a long-standing preference for previous grantees and instituting a more competitive funding process (DeBonis, 9/29).

    Boston Globe: Charlie Baker’s Alternative Applies Sick Time Only To Larger Firms
    The [Massachusetts] Republican gubernatorial candidate, Charlie Baker, wants only those companies with 50 or more employees to be required to offer paid sick time to their workers, according to the “Alternative Paid Sick Leave Initiative” he issued Monday. A ballot question in November will ask Massachusetts voters if employees at companies with 11 or more workers would be allowed to earn and use paid sick time if they miss work for a variety of reasons dealing with their health or the health of a loved one (Johnson, 9/29).

    Minneapolis Star-Tribune: In Reform Effort, State Hospital Will Give Families A Seat At The Table
    Facing intense criticism from parents and patient advocates, the state’s largest psychiatric hospital is preparing to give families much greater say in the treatment of mentally ill patients. The move is part of a broad series of reforms at the embattled state hospital, which has struggled with staff turnover, incidents of patient maltreatment and serious security lapses. Hundreds of parents, siblings and spouses of patients will get letters this week from the state Department of Human Services, inviting them to become members of the first-ever family advisory council at the Minnesota Security Hospital in St. Peter. The council will advise the hospital, which houses about 225 of the state’s most dangerous and mentally ill patients, on everything from group therapy to patient security and room decor (Serres, 9/29).

    Kansas Health Institute News Service: Democrats Call For Special Committee To Vet KanCare Contracting
    The top Democrats on the KanCare Oversight Committee on Monday called for a separate committee to be appointed to study whether any legal or ethical boundaries were crossed when Gov. Sam Brownback's administration contracted with three managed care organizations to privatize Medicaid. Rep. Jim Ward, D-Wichita, and Sen. Laura Kelly, D-Topeka, said the request was spurred by the months-old news of FBI agents interviewing Capitol denizens for information on allegations of corruption within the administration. The FBI has not confirmed the investigation, per agency policy, but some of those interviewed have told news outlets that the $3 billion KanCare contracts are at the center of the questions. Sen. Laura Kelly, left, and Rep. Jim Ward, the top Democrats on the KanCare Oversight Committee, on Monday requested that a special committee be appointed to study whether any legal or ethical boundaries were crossed when Gov. Sam Brownback's administration contracted with three managed care organizations to privatize Medicaid (Marso, 9/29).

    Kansas Health Institute News Service: Ruling On In-Home Medicaid Services Creates Questions For Providers, Beneficiaries
    Karen Barezinsky is looking for an answer to what she says is a simple question: Are the people who run the state’s Medicaid program planning to cut the supports she and her husband use to keep her son, Ray Santin, who’s paralyzed from his neck down, out of a nursing home? “I can’t find out anything,” said Karen, 62, who lives in Scranton with her husband and son. “I leave messages with Ray’s case manager, but nobody calls me back.” Karen is worried because she’s read news stories about Gov. Sam Brownback and Kansas Department for Aging and Disability Services Secretary Kari Bruffett warning legislators that a recent ruling by the U.S. Department of Labor could cause reductions of in-home services for some people with disabilities and frail elders (Ranney, 9/29).

  • More Insurers Change How They Pay Medical Providers

    Commercial insurers are moving rapidly from the old system of paying health providers for every test or procedure they do toward payments based on the value rather than volume of services, according to a report by Catalyst for Payment Reform, a business coalition focused on health care costs.

    Marketplace: How Insurers Are Adjusting Payment To Medical Providers
    Commercial insurers are ditching or at least tweaking the way they pay medical providers, according to a report out Tuesday from the group Catalyst for Payment Reform. For years, commercial insurers as well as state and federal governments have paid doctors and hospitals under what’s called fee-for-service. To many in the healthcare world, fee-for-service is seen as one of the key drivers behind the run-up in healthcare costs, because it offers providers a financial incentive to provide extra services that may not be needed (Gorenstein, 9/30).

    Dallas Morning News: Quick Uptake For New Health Care Payment Plans
    Health insurance companies, hospitals and physicians are moving with alacrity toward new payment models that promote value rather than volume of care. The Catalyst for Payment Reform, a business coalition concerned with the high cost of medical care, reported Tuesday that 40 percent of insurance plan payments are now made with methods that stress affordability and quality. Last year, the survey found 10.9 percent of payments to hospitals and doctors were made with value-based payments (Landers, 9/30).

    Modern Healthcare: Incentive-based Contracts Thriving In Commercial Insurance Market
    Health plans that cover two-thirds of commercially insured Americans used incentives this year to motivate hospitals and doctors to improve quality and manage costs, according to a new survey. Those contracts were responsible for 40% of insurers' medical spending.  The survey is the second by Catalyst for Payment Reform, a health policy not-for-profit founded and funded by employers, and the results offer a snapshot of how some of the nation's largest insurers use the promise of financial gain or loss to influence the way providers deliver care and run their businesses.  Four of the five largest U.S. insurers were among 39 health plans that responded to the survey, and together they cover 101 million lives, Catalyst said. About 15% of the enrollees had providers with incentive-based contracts, the survey found (Evans, 9/30).

    Meanwhile, The Charlotte Observer reports on how one large physician practice is moving from 'volume to value' -

    Charlotte Observer:  OrthoCarolina Of Charlotte To Bundle Knee, Hip Replacement Costs
    Hospital leaders in Charlotte talk a lot about transforming the health-care system and moving from “volume to value.” By that, they mean a future where doctors and hospitals get paid, not just for treating patients each time they get sick, but for keeping them well. Still, the current system relies mostly on so-called “fee-for-service” reimbursement, under which patients and insurance companies pay for each appointment, test or procedure. The more services, the more payments. Instead of waiting for change to be imposed, doctors at Charlotte’s OrthoCarolina, one of the region’s largest physician groups, have taken the lead in adopting a system to simplify billing and improve coordination of care. Patients undergoing knee and hip replacements can get a single bill with a “bundled payment” that covers preoperative care, surgery, followup appointments, 90 days of physical therapy and the services of a “patient navigator” who serves as a guide through the process (Garloch, 9/29).

  • Drug And Device News: Study Questions Medical Devices' Safety Evidence

    Elsewhere, The Associated Press reports on a new advertising approach for Viagra -- a TV commercial that targets women.  

    The Wall Street Journal: Medical Devices Lack Safety Evidence, Study Finds
    The majority of moderate- to high-risk medical devices approved by the U.S. Food and Drug Administration lack publicly available scientific evidence to verify their safety and effectiveness despite requirements in the law, according to a study released Monday (Burton, 9/29).

    The Associated Press: Viagra Ads Target Women For 1st Time
    The maker of the world's top-selling erectile dysfunction drug on Tuesday will begin airing the first Viagra TV commercial that targets the less-obvious sufferers of the sexual condition: women. In the new 60-second ad, a middle-aged woman reclining on a bed in a tropical setting addresses the problems couples encounter when a man is impotent (9/30).

  • Federal Database On Physician Quality Ratings Comes Up Short, Experts Say

    The database, which was created by the health law, offers only the most basic information, according to USA Today. 

    USA Today: Federal Doctor Ratings Face Accuracy, Value Questions
    Consumers searching this fall for the best doctor covered by their new public or private insurance plan won't get very far on a federal database designed to rate physician quality. The Affordable Care Act requires the Centers for Medicare and Medicaid Services to provide physician quality data, but that database offers only the most basic information. It's so limited, health care experts say, as to be useless to many consumers (O’Donnell, 9/29).

    Meanwhile, critical access hospitals are not yet part of the federal government's push for improving quality -

    Kaiser Health News: Many Rural Hospitals Are Excluded From Government's Push For Better Quality
    The Department of Health and Human Services has not yet incorporated the 1,256 primarily rural, "critical access" hospitals such as [Crawford Memorial Hospital, in rural Robinson, Ill.] into Medicare's pay-for-performance programs. With no more than 25 beds, these hospitals are generally located in isolated areas, making them the only acute-care option for local residents. Medicare repays them their cost plus 1 percent, more than it pays other hospitals, to ensure they do not close. While some of the facilities deliver exemplary care, a study published last year by Harvard School of Public Health researchers found that death rates at critical access hospitals in 2010 were higher than at other small, rural hospitals and the industry overall (Rau, 9/30).

  • Today Is The Deadline For Thousands To Provide Information To Keep Subsidies

    The administration has notified more than 300,000 people that they need to provide documentation to keep their health insurance subsidies. Also in news on the health law, supporters are weighing a new focus on the individual mandate, and the administration promises changes to the ACO rules.

    The Wall Street Journal: Hundreds Of Thousands Face Health Law Subsidy Deadline
    Hundreds of thousands of Americans face a Tuesday deadline to verify their income and are at risk of losing or having to pay back their federal health-insurance subsidies under the Affordable Care Act. The need for people to pay back the government could become a headache during next year's tax season, when Americans are expected to pay back any subsidies they weren't eligible for. The Obama administration has told more than 300,000 individuals who obtained coverage through the federal HealthCare.gov site that they may lose some or all of the subsidies if they don't provide additional income information that jibes with Internal Revenue Service data. That information includes tax returns, wages and tax statements, pay stubs and letters from employers (Armour, 9/29).

    Politico: Obamacare: New Messaging Hurdles Ahead
    The second Obamacare enrollment season could go negative — but not because of the health care law's critics. Obama administration allies are weighing a focus on the loathsome individual mandate and the penalties that millions of Americans could face if they don't get covered. It would be a calculated approach to prompt sign-ups, a task that the law's supporters expect to be more difficult, or at least more complex, than in its coverage's inaugural year (Haberkorn, 9/29).

    Politico: Obamacare's Surprises
    Most of the debate over the Affordable Care Act has focused on its coverage provisions: the health-care exchanges where Americans can shop for insurance, the controversial mandates for employers and individuals and the expansion of Medicaid in the states. But in a 900-plus-page landmark bill, there are bound to be a few surprises. Here are some of Obamacare’s hidden corners (Kenen and Wheaton, 9/29).

    CQ Healthbeat: Medicare Officials Prepare To Issue Proposed Changes To ACOs
    The Centers for Medicare and Medicaid Services will soon release a rule updating the main program that pays groups of hospitals and doctors that coordinate patients' care through accountable care organizations, a top agency official said Monday. CMS Deputy Administrator Sean Cavanaugh told insurance industry executives gathered at a conference sponsored by the America's Health Insurance Plans trade group that the so-called "shared savings" program will be modified through a proposed regulation. When asked for more information after the briefing, he did not elaborate (Adams, 9/29).

    Connecticut Mirror: CT Hospitals Say Obamacare Hasn't Cut Uncompensated Care
    A recent federal report says hospitals saw a major decrease in uncompensated care after the rollout of key provisions of the federal health law this year. But so far, that’s not what Connecticut hospitals are experiencing, according to their association. From January to June of this year, after the major coverage expansion provisions of Obamacare took effect, uncompensated care provided by Connecticut hospitals represented 2.4 percent of total patient revenue, according to the Connecticut Hospital Association (Levin Becker, 9/29).