HealthLeadersMedia.com - Health Plan News & Analysis

How the most powerful woman in healthcare finds balance

Thu, 23 May 2013 12:26:00 GMT

Since taking her post as Secretary of the Department of Health and Human Services (HHS) in 2009, Power Woman Kathleen Sebelius has arguably one of the most difficult jobs in the nation. Just named by Forbes as the 25th Most Powerful Woman in the world, she's not just at the center of one of the most controversial and immensely complicated pieces of legislation in this country – the Affordable Care Act – she's tasked with turning it into a reality. For Sebelius, this involves a nightmare of administrative challenges, particularly given that something on this scale and difficulty has never before been attempted in American history with the possible exception of Franklin Roosevelt's National Recovery Administration which the Supreme Court eventually ruled to be unconstitutional.

UC hospitals cancel surgeries, divert patients amid strike

Thu, 23 May 2013 12:23:00 GMT

A strike by University of California patient care workers Tuesday caused the cancellation of hundreds of surgeries, the closure of laboratory stations and the diversion of emergency room patients, officials said. The hospitals prepared for the two-day strike by postponing elective surgeries and hiring temporary workers, but services still were affected after thousands of employees took to the picket line at the medical centers in Los Angeles, Irvine, San Diego, San Francisco and Sacramento, where the UC Davis facility is located.

Latest from Parkland: All the good stuff happens in executive session

Thu, 23 May 2013 12:16:00 GMT

Parkland Memorial Hospital's board of managers met Wednesday for its monthly committee meetings, an all-day affair starting at 8 a.m. and ending somewhere around 3 p.m. The agendas promised lively discussions about: – The federal Affordable Care Act, which likely will bring dramatic changes to Dallas County's lone public hospital. – Review of recent "safety events" at the hospital, which actually describe mistakes that had the potential to harm patients. And, most importantly, an update on the hospital's efforts to satisfy a System's Improvement Agreement with the federal government, Parkland's on-going effort to retain its government funding. However, none of these discussions occurred during the board’s public session. They took place behind closed doors so that the media and members of the general public could not hear what anyone said.

Opinion: Health IT—Make sure policy umbrella is big enough for all

Thu, 23 May 2013 12:13:00 GMT

The growing trend toward incorporating health information technology (HIT) and patient-defined and patient-generated data into the healthcare delivery system is clear. From funding included in the American Recovery and Reinvestment Act of 2009 to provisions included in the 2010 Affordable Care Act, to the call for inclusion of patient-generated data in Stage 3 meaningful use, HIT implementation is an essential component of federal plans to improve healthcare quality and lower costs. The trend may be clear, but we still need a better comprehension of how broad the range of patient-generated data really is.

KY short 3,800 doctors even before Medicaid expansion

Thu, 23 May 2013 12:10:00 GMT

FRANKFORT, KY. — Kentucky needs 3,790 more doctors, including 183 additional primary care physicians, to meet current demand for care — and those numbers will grow when more Kentuckians get coverage through a Medicaid expansion and health benefit exchange under health reform. Those are some of the findings in a workforce capacity study report by Deloitte Consulting that was the subject of a briefing Wednesday held by the state Cabinet for Health and Family Services. The report is scheduled to be made available on the Kentucky Health Benefit Exchange website next week.

Fortunately, Angelina Jolie Isn't On Medicare

Wed, 22 May 2013 16:56:00 GMT

Most large private payers cover testing for a genetic marker indicating inherited breast cancer risk and will pay for associated prophylactic surgery. But Medicare has no national coverage decision for the test or for preventive mastectomy.

Uncompensated Care Faces a Double Hit in Some States

Wed, 22 May 2013 12:27:00 GMT

Hospitals in states that opt not to expand Medicaid are at a severe disadvantage to their counterparts in other states, not only because they will miss out on additional Medicaid-based reimbursement, but also because they will face the same cuts in disproportionate share funding as everyone else.

House Lawmakers Grill CMS Over Health Exchange Navigators

Wed, 22 May 2013 12:11:00 GMT

The role of navigators, expected to help millions of uninsured make their way through the health insurance market, came under fire Tuesday by members of Congress who raised questions about oversight and the role of the IRS in the implementation of healthcare reform.

Loophole in healthcare law could stick doctors with tab

Wed, 22 May 2013 11:05:00 GMT

A loophole in California's upcoming health care overhaul could be exploited by families gaming the system or responding to hardship in a way that doctors say could leave a pile of unpaid bills. A chain of events would create a two-month period during which a family has medical coverage but no insurer must pay its claims. Nonpayment of premiums for subsidized policies would trigger the oddity: Federal law provides a three-month grace period before cancellation - but insurers are responsible only for the first month.

End of health price secrecy may be starting in Miami

Wed, 22 May 2013 11:02:00 GMT

When Medicare released thousands of health-care prices this month, one of the biggest criticisms was that these figures didn't represent what patients actually paid. Medicare, for example, pays hospitals on a set fee schedule, regardless of their prices. Health insurance plans typically negotiate a lower rate with a hospital than the sticker price that showed up in the new data. Those prices still remain secret — but that may change. Spurred by the release of the Medicare data, the chief executive of Mt. Sinai Medical Center in Miami has now pledged to release those negotiated rates that tend to be kept secret. Via MedCity News:

Humana CEO sticks with Medicare focus amid funding pressure

Wed, 22 May 2013 11:00:00 GMT

As the federal government squeezes payments for private Medicare plans, Humana Inc. (HUM), the big health insurer most tethered to the government health program, has no plans to shift gears. Instead, the Louisville, Ky., company is pressing ahead with efforts to grow Medicare membership, while making its plans work more efficiently through methods such as providing more intense care upfront for sicker patients. Like other companies running Medicare Advantage plans, which cover more than 14 million Americans, Humana has to find ways to make a good business by doing more with less.

House immigration talks hang on healthcare

Wed, 22 May 2013 10:56:00 GMT

House immigration negotiators have given themselves until the end of the week to hash out language on what kind of health benefits should be available to undocumented immigrants seeking U.S. citizenship, a crucial issue for the talks. If they can't resolve this issue, the four-year immigration negotiations could come to a crashing halt. Top Democrats said late Tuesday they do not think Republicans will walk away from the talks. It was only less than a week ago that the bipartisan House group announced it had reached a tentative agreement on a proposal "in principle" to be introduced in June.

WI hospitals reduce central-line infections

Wed, 22 May 2013 10:53:00 GMT

Painstaking work by Wisconsin hospitals in recent years has sharply lowered the occurrence of one of the most deadly types of infections: those from central lines used to deliver fluids, medication and blood to patients. Infections in intensive care units from central lines — tubes placed in a large vein in a patient's neck, chest or arm — were 56% lower last year than a national baseline established in 2008, according to a report by the Wisconsin Division of Public Health. That progress — which included a 21% reduction from 2011 — has stemmed from a series of initiatives since 2009 by the Wisconsin Hospital Association, as well as from projects by individual hospitals.

Public in Deep South supports expanding Medicaid, but lawmakers don't

Wed, 22 May 2013 10:45:00 GMT

Even though governors and lawmakers in five Deep South states oppose a plan to cover more people through Medicaid under the health care overhaul, 62 percent of the people in Alabama, Georgia, Louisiana, Mississippi and South Carolina support expanding the program, according to a new poll. The level of support for expanding Medicaid – the state and federal health insurance program for the poor and disabled – ranged from a low of 59 percent in Mississippi to a high of 65 percent in South Carolina, according to the poll by the Joint Center for Political and Economic Studies, a leading research and public policy think tank that focuses on African-Americans and other people of color.

How Chargemaster Data May Affect Hospital Revenue

Tue, 21 May 2013 12:05:00 GMT

The now transparent federal database of hospital prices could motivate hospital financial assistance offices to write more flexible policies for collecting from uninsured, underinsured, and Medicare Advantage patients.

Healthcare regs move forward

Tue, 21 May 2013 11:22:00 GMT

The Obama administration is moving forward with a pair of major Affordable Care Act (ACA) regulations, as Republicans move to link the landmark law to the ongoing scandal at the Internal Revenue Service. Final rules written to extend access to insurance for people with pre-existing conditions and set maximum profit margins for certain providers are set to be published this week in the Federal Register. Beginning in 2014, insurance providers would not be able to deny coverage for people with pre-existing conditions that currently make it impossible for them to get health insurance under current market realities.

Some could have gaps in medical coverage under new law

Tue, 21 May 2013 11:13:00 GMT

When the national healthcare law takes full effect next year, millions of Americans risk disrupted health coverage because of common life events: getting married or divorced, having children or taking on a second job. As their family incomes change, so too will their eligibility for public insurance programs. And if nothing is done, policymakers warn, many low-income patients will lose access to their doctors and medications during this massive game of health coverage pingpong. Policymakers and healthcare industry leaders across the nation are paying close attention to the issue and working to close the coverage gaps before Jan. 1, said Alan Weil, executive director of the National Academy for State Health Policy.

Healthcare workers set to strike CA public hospitals

Tue, 21 May 2013 11:10:00 GMT

Nearly 13,000 healthcare employees at five University of California medical centers plan to strike on Tuesday in a move that threatens to back up emergency rooms and already has forced the postponement of elective surgeries. Vocational nurses, respiratory therapists and radiology technologists say they will walk off their jobs for two days to draw attention to issues they tried unsuccessfully to address at the negotiating table - "chronic understaffing and reckless cost-cutting," said Todd Stenhouse, spokesman for the American Federation of State, County and Municipal Employees.

Is the future of American health care in OR?

Tue, 21 May 2013 10:58:00 GMT

The past few years have seen two remarkable health-care experiments in the Beaver State. One is the Oregon Health Insurance Experiment, the first randomized, controlled trial comparing Medicaid — or any kind of health insurance — with being uninsured. The other is Kitzhaber's effort to rebuild the state's Medicaid program around community health rather than individual fee-for-service treatments. The health-insurance experiment has gotten all the attention. But it's the Medicaid reforms that really matter. The Oregon health insurance experiment didn't begin as an experiment. It began as a budget cut. From 2002 to 2008, Oregon threw 93,000 people out of its Medicaid program.

WA hospitals fight to limit reports on infections

Tue, 21 May 2013 10:55:00 GMT

Consumers Union and the Washington State Hospital Association are still tangling over legislation approved unanimously by the Legislature to require more reporting by hospitals when patients develop infections during care. The state Department of Health is taking the hospitals' side, opposing requirements to do separate reports for every knee, hip or cardiac surgery. Otherwise, the parties agree on the bill, which is broadly meant to bring the state's reporting requirements into alignment with the demands of President Barack Obama's health care law. House Bill 1471 passed the House and Senate unanimously in the way Consumers Union prefers.