KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Political Cartoon: 'Out Of Your Gourd?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Out Of Your Gourd?'" by Dave Coverly, Speed Bump.

Here's today's health policy haiku:


A tax on sugar
curbs soda, but physicians
want more of the pie.

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Health Law Issues And Implementation

Insurers Predict Surge In Obamacare Sign-Ups

Reuters reports that insurers selling 2015 health law plans expect at least 20 percent growth in customers and more than a doubling in some states. Also in the news, reports about enrollment efforts in California and premium cost confusion in Minnesota and North Carolina.

Reuters: Insurers Have Big Plans For 2015 Obamacare Enrollment
U.S. insurers planning to sell 2015 Obamacare health plans expect at least 20 percent growth in customers and in some states anticipate more than doubling sign-ups. In interviews with Reuters, half a dozen privately held and non-profit health insurers around the country say they are expecting this growth based on interest from potential customers they are hearing about through their call centers, sales forces and brokers. With the start of enrollment barely two weeks away, their assessment is dramatically different from a year ago, when it was unclear how many Americans would apply for the brand new insurance and income-based subsidies offered under President Barack Obama’s healthcare law. (Humer, 10/30)

Kaiser Health News: For Families With Mixed Immigration Status, Health Insurance Can Be Puzzling
Jessica Bravo walks house-to-house in the piercing Southern California heat. Over and over, at doorsteps around Orange County, she asks the same question: 'Are you insured?' Getting an answer isn’t always easy. Doors slam in her face. She gets shooed from porches. And sometimes people cut her off mid-spiel. Bravo is a paid health outreach worker for the Orange County Congregation Community Organization, a faith-based nonprofit. Her job is to inform people about getting health insurance under the nation’s landmark health law, the Affordable Care Act. (de Marco, 10/31)

Minnesota Public Radio: PoliGraph: MNsure Rate Hike Rhetoric Flies; Claims Inconclusive
When the Minnesota Department of Commerce announced rates would increase by 4.5 percent for 2015 open enrollment, they simply averaged the premium rate increase reported by each insurance company selling plans on the exchange. But that number focused only on how much more insurance companies are charging, a figure that is greater than the amount the many MNsure participants getting a subsidy will actually pay. (Richert and Catlin, 10/30)

Raleigh News & Observer/Charlotte Observer: Blue Cross Mistakenly Notifies 42,000 NC Customers Of Incorrect Rate Increases
Blue Cross and Blue Shield, the state’s largest health insurer, said Thursday that about 42,000 customers around the state received insurance renewal letters with incorrect rates, some showing cost increases of more than 100 percent. The Chapel Hill company has been flooded with calls since Wednesday from irate customers who began receiving their renewal notices this week. Blue Cross officials soon realized the insurance rates were incorrectly transferred from the company’s database to the computer-generated renewal notices. The affected customers are on grandfathered Blue Advantage Plan A policies with a $15 co-pay, and all 42,000 customers on that individual health plan were sent the wrong rates for 2015 renewals, said Blue Cross spokeswoman Michelle Douglas. Customers who signed up for those plans before the passage of the Affordable Care Act in March 2010 were allowed to keep them. (Murawski and Helms, 10/30)

Also, media outlets report on Medicaid expansion developments -

The Associated Press: McCrory Says He's Assessing NC Medicaid Expansion
Gov. Pat McCrory said Thursday he's weighing whether to expand Medicaid, the health insurance plan for the poor and disabled, adding to signs that state Republican leaders may reconsider their opposition to extending the social program. In addition to shaping a plan for networks of physicians and hospitals to share the risk of rising health care costs, "I'm also trying to figure out what to do with Medicaid and whether to expand that or not, because the feds are offering all this money and yet I've got to be concerned with the bureaucracy that could be grown because of that," McCrory told a gathering of corporate CEOs at a Raleigh country club. "I'm doing that assessment right now." (Dalesio, 10/30).

Alabama Media Group: Map: How Much Alabama Counties Lost In Revenue When Medicaid Wasn't Expanded
Jefferson County didn't get about $342 million. Montgomery County left $157 million on the table. Madison County missed out on about $75 million; and Baldwin County, about $26 million. That's the estimated amount of money those counties would have received this year for health care to the poor - Medicaid money - had the state agreed to expand Medicaid under the Affordable Care Act. The state as a whole would have received $1.4 billion. (Oliver, 10/30)

Capitol Hill Watch

As GOP Election-Day Confidence Grows, McConnell Reiterates Obamacare Opposition

Earlier in the week, Sen. Mitch McConnell, R-Ky., who hopes the mid-terms will not only result in his re-election but also GOP control of the Senate and his own rise to majority leader, made comments that repeal of the health law might not be in the cards. Since then, however, he has sought to reassure conservatives about his opposition to the overhaul. Meanwhile, other news outlets analyze how a Republican majority in the Senate, and other electoral outcomes, might impact the health policy agenda.

Politico: McConnell Reassures GOP On Obamacare Opposition
Senate Minority Leader Mitch McConnell is reassuring conservatives that his position on Obamacare has never wavered as Republicans grow increasingly confident that they will take the Senate and install McConnell as the majority leader. McConnell’s comments Tuesday to Neil Cavuto that a standalone repeal vote would require 60 votes and a presidential signature were taken as a change in position from the Kentucky senator’s frequent references to the goal of repealing the health care law “root and branch.” NPR posted a headline that “McConnell Concedes GOP Senate Will Not Mean Obamacare Repeal” while the Senate Conservatives Fund likened it to a “surrender.” (Everett, 10/31)

WBUR: How The Upcoming Elections Might Shift The National Health Care Landscape
Here’s a solid prediction about next Tuesday’s elections: They’ll be crucial to the future of universal health care in America — or at least its near-term future. For those who believe universal coverage is a good thing, prospects aren’t good, judging from an analysis of 27 national polls scoured by researchers at the Harvard School of Public Health. (Knox, 10/30)

Democrats Face Voter Appeal Challenges On Health Care, Safety Net

The Wall Street Journal looks at how Democratic messaging on health care and other social and safety-net issues is playing during this election season. Also, the Sacramento Bee and CBS News parse the veracity of campaign ads.

The Wall Street Journal: Democrats Lose Their Grip On Voters With Keys To The House
Reclaiming white, working-class voters is a tall order for Democrats, who have won the popular vote in five of the past six presidential elections with broad support from minorities, single women and younger voters. Democrats have won national elections with the message that government should help people through such programs as subsidized student loans, food stamps and the Affordable Care Act. (Peterson and Chinni, 10/30)

Sacramento Bee: Ad Watch: Republicans’ Obamacare Ad Rings True
The Congressional Leadership Fund, the Republican group affiliated with House Speaker John Boehner, is wading into the heavily targeted 7th Congressional District, hitting Sacramento-area Democratic Rep. Ami Bera for his support of the federal Affordable Care Act. The ad opens with a video snippet of Bera, a medical doctor, addressing GOP challenger Doug Ose at the pair’s recent debate. (Cadelago, 10/30)


HHS Watchdog Criticizes Medicare Rule That Allows Drug Purchases After Patient's Death

Also, in other Medicare news, officials cut $60 million from Medicare spending on home health services.

The Associated Press: Medicare Bought Meds For Dead People
A report coming out Friday from the Health and Human Services Department’s inspector general says the Medicare rule allows payment for prescriptions filled up to 32 days after a patient’s death — at odds with the program’s basic principles, not to mention common sense. “Drugs for deceased beneficiaries are clearly not medically indicated, which is a requirement for (Medicare) coverage,” the IG report said. It urged immediate changes to eliminate or restrict the payment policy. Medicare said it’s working on a fix. (Alonso-Zaldivar, 10/31)

The Hill: Medicare Finalizes $60M Cut To Home Health
The Centers for Medicare and Medicaid Services (CMS) finalized a $60 million cut to home health agencies for 2015 in a rule released Thursday. The cut equals 0.3 percent of Medicare payments to the industry, which provides home-based medical services to roughly 3.5 million seniors. Groups representing home healthcare providers have lobbied to stop the cuts, arguing they will endanger care for vulnerable patients with few clinical options. (Viebeck, 10/30)

CQ Healthbeat: Medicare Shaves 2015 Home Health Payments By Net $60 Million
Medicare said it expects to reduce its 2015 expenses for home health services by $60 million, the cumulative effect of balancing policies that adjust certain payments. ... The release was the first of a series of payment rules that Medicare is expected to issue this week. Other rules cover physician fees and outpatient services provided by hospitals, as well as care at ambulatory surgical centers. Additional rules cover dialysis treatment and medical equipment and devices. (Young, 10/30)

The Associated Press: Dignity Health Pays $37M For Overcharging Medicare
A large hospital chain based in Northern California agreed Thursday to pay $37 million to settle allegations that it overcharged the federal Medicare program. San Francisco-based Dignity Health also agreed to hire an independent auditor to review its Medicare claims. The settlement resolves a 2009 whistleblower lawsuit filed in San Francisco federal court by a former Dignity worker who claimed the hospital chain submitted false and inflated Medicare claims from 2006 to 2010. The former worker, Kathleen Hawkins, will receive about $6.25 million. Hawkins' lawsuit claimed that 13 of Dignity's hospitals often admitted patients for procedures that could have been done less expensively in an outpatient setting. Operations such as installing pacemakers and stents in patients' hearts were billed as expensive in-patient procedures instead of less expensive out-patient operations. (Elias, 10/30)


Aging Baby Boomers Spark High-Tech Health Innovation

Entrepreneurs and venture capitalists are building companies to address the needs of baby boomers as they age. Meanwhile, health insurers Cigna, Aetna and Humana continue to report revenue increases as the financial losses from the Affordable Care Act decline in the third quarter.

The Washington Post: Firms Gearing Health-Related Technology Toward Baby Boomers
Like many of her fellow baby boomers, Rubin was accustomed to solving problems with the help of advanced tech tools. But she believed that a lot of health-care communications still tended to be more phone-and-fax than apps-and-Web. So Rubin adapted office technology to her caregiving needs. She and her brother, John, continually update a shared Google Docs spreadsheet, tracking their mother’s symptoms, physicians, medications and questions. (Yoquinto, 10/31)

The Wall Street Journal: Cigna Raises Outlook As Results Exceed Expectations
Cigna Corp. again raised its guidance as fee and premium revenue grew along with its customer base in the third quarter. The health insurer’s results easily topped analysts’ expectations. The company predicted earnings for the year of $7.25 to $7.45 a share, up from $7.20 to $7.40. Fellow health insurers WellPoint Inc. and Aetna Inc. also raised their guidance this week, showing how the industry is profiting amid changes brought by the Affordable Care Act. (Wilde Mathews and Calia, 10/30)

Reuters: Cigna Says Obamacare Business Losses On The Decline
Cigna Corp. said on Thursday that financial losses from the new Obamacare health insurance eased in the third quarter, becoming the second insurer this week to say that business was improving. Cigna, Aetna Inc and Humana Inc have said since the beginning of the year that they were posting losses on the plans because their patients were older and sicker than what they had anticipated when they set premiums. Others, like WellPoint Inc., are making a profit, a fact WellPoint confirmed this week was the case in the third quarter. Humana reports next week. (Humer, 10/30)

Meanwhile, Kindred Health names a new CEO -

The Wall Street Journal: Kindred Health Names Operating Chief Breier As New CEO
Kindred Healthcare Inc. on Thursday named operating chief Benjamin Breier as the company’s next chief executive, a key step for the long-term care provider as it moves forward with its acquisition of Gentiva Health Services Inc. Mr. Breier, 43 years old, will succeed Paul Diaz, who will become executive vice chairman of Kindred’s board after a decade in the company’s top executive spot. (Dulaney, 10/30)

Public Health And Education

Debate Heats Up Over Mandatory Quarantines For People Who Are Not Sick

NPR reports that legal experts contend that certain states may be going too far. In addition, The Associated Press examines how the Ebola protocols for returning military and civilian workers are different.

The Associated Press: Soldier Or Civilian, Ebola Protocols Not The Same
A U.S. soldier returning from an Ebola response mission in West Africa would have to spend 21 days being monitored, isolated in a military facility away from family and the broader population. A returning civilian doctor or nurse who directly treated Ebola patients? Depends. The Pentagon has put in place the most stringent Ebola security measures yet, going beyond even the toughest measures adopted by states such as New York, New Jersey and Maine and much further than the guidance set by the federal Centers for Disease Control and Prevention for travelers returning from the afflicted region. (10/31)

The New York Times: From Governors, A Mix Of Hard-Line Acts And Conciliation Over Ebola
In Louisiana, Gov. Bobby Jindal, a Republican, issued a stern warning on Thursday to medical experts coming to an international conference on tropical diseases that they should stay away if they had been in Ebola-affected countries in the past 21 days, and that those who defied would be confined to their hotel rooms. But in New York, Gov. Andrew M. Cuomo, a Democrat, who last week called for mandatory quarantines for health care workers returning from West Africa, sounded a more conciliatory note, joining Mayor Bill de Blasio to announce financial incentives to encourage health professionals to go to West Africa to treat Ebola patients. (Bidgood and Zernike, 10/30)

The New York Times: In New York, Protections Offered For Medical Workers Joining Ebola Fight
New York officials announced on Thursday that they would offer employee protection and financial guarantees for health care workers joining the fight against the Ebola outbreak in three West African nations. The announcement was an effort to alleviate concerns that the state’s mandatory quarantine policy could deter desperately needed workers from traveling overseas. (Santora and Hartocollis, 10/30)

The Associated Press: Life Goes On For Nurse In Standoff Over Ebola
She has rebelled against the restrictions, saying that her rights are being violated and that she is no threat to others because she has no symptoms. She tested negative last weekend for Ebola, though it can take days for the virus to reach detectable levels. State officials said that they were seeking a court order to require a quarantine through Nov. 10, the end of the 21-day incubation period for the Ebola virus. But it was unclear Thursday whether the state had gone to court or whether there had been any progress in negotiations aimed at a compromise. (10/31)

State Watch

Candidate Credentials Hinging On Health Law

Elsewhere, a "health care compact" to give states more control over their health care, and less power to the federal health law, becomes a campaign issue in Kansas.

The Washington Post: Anthony Brown’s Work As Md. Lieutenant Governor Was Mostly Behind The Scenes
Brown’s tenure as lieutenant governor was bookended by two projects, both of which offered opportunities for Maryland to stand out from other states: Preparing for an influx of jobs at military posts because of a congressionally ordered base realignment, and leading the implementation of the Affordable Care Act. ... The health-care effort was marred by the failed launch of the state’s online insurance marketplace, which Brown has said was not his direct responsibility. (Johnson, 10/29)

Kansas Health Institute News Service: Health Care Compact Gains Attention As Campaign Issue
A once-obscure effort by a group of states to get out from under federal health care regulations has become an issue in the final days of the Kansas governor’s race. On Wednesday, Democratic lieutenant governor candidate Jill Docking teamed with Republican Insurance Commissioner Sandy Praeger at a Wichita news conference to criticize Republican Gov. Sam Brownback for signing a bill authorizing Kansas’ membership in a multi-state health care compact. Docking, Democrat Paul Davis’ running mate, said the compact could put the “Medicare benefits of Kansas seniors at risk.” If the compact is approved by Congress, its nine member states could suspend federal health care regulations within their borders and take over several programs now administered by the federal government. (McLean, 10/30)

Elsewhere, support for California's health care ballot initiatives is examined --

Modern Healthcare: Medical Liability Premiums Flat As California Battles Over Caps
A TV political ad opposing Proposition 46 in California opens with black silhouettes of plaintiff lawyers shaking hands. In a later frame, a worried older woman opens a medical bill. A doctor in an empty hallway shakes his head. Opponents of Proposition 46, who backed the ad, say it accurately portrays what will happen if Californians vote Tuesday in favor of the ballot initiative supported by plaintiff lawyers and patient advocacy groups. Among other things, the measure would raise the cap on non-economic damages in medical malpractice suits from $250,000 to $1.1 million and index the cap to inflation. They argue that raising that cap—which hasn't been increased since it was approved in 1975—would cause doctors' medical liability insurance premiums to rise. Those costs, they say, would then be passed on to consumers. (Schencker, 10/30)

Florida Medicaid Lawsuit Delayed Again

Medicaid lawsuits and settlements also make news in Kansas and Louisiana. In the meantime, a proposal in Alaska to limit Medicaid payments for physical, occupational and speech therapy draws protests.

The Miami Herald: Medicaid Lawsuit In Florida Delayed Again
A long running lawsuit alleging deficiencies in the way Florida handles Medicaid for children has been delayed again after the state filed two motions days before a federal judge was supposed to issue a final ruling on the case. The class-action suit, filed by the Florida Pediatric Society in 2005, accused Florida health officials of failing to provide essential medical and dental services to children on Medicaid. A trial ended in 2012. In motions filed last week, lawyers for Florida’s Office of the Attorney General argued that recent changes to the state’s Medicaid system required by the federal Affordable Care Act, as well as the state’s move to a managed-care system, had addressed the plaintiffs’ complaints. The state asked Judge Adalberto Jordan, who had planned to rule at the end of October, to allow it to present new evidence in the case. (Nehamas, 10/30)

Kansas Health Institute News Service: Lawsuit Against KanCare Company Puts Program In Spotlight Again
A lawsuit alleging that one of the for-profit companies running KanCare ordered employees to shift KanCare members away from high-cost providers has put a renewed spotlight on the program, one of the Brownback administration’s signature achievements. In the lawsuit filed this week in federal court in Kansas City, Kan., a former official of the company, Sunflower State Health Plan Inc., claimed she was fired after she objected to the directive, saying it was unethical and possibly illegal. (Margolies, 10/30)

The [Baton-Rouge, La.] Advocate: Court Settlement Reached In Medicaid Case
The [Louisiana] state health agency has entered into a settlement in a federal lawsuit over the inadequacy of notices denying Medicaid recipients access to services. U.S. District Judge Jim Brady, of Baton Rouge, approved the settlement, in which the state agrees to do a better job of providing specific information about the reasons for the service denials. He will oversee state compliance for the next five years. The settlement came in a class-action lawsuit, Wells v. the Department of Health and Hospitals. The lawsuit alleged that the notices were so lacking that an individual would not know on what basis to appeal the denial and what kind of information would be needed to reverse the decision. (10/30)

The Associated Press: Critics Pan Recommendation To Cut Medicaid Therapy
Alaskans lined up Wednesday to tell Gov. Sean Parnell's advisory committee on Medicaid that it would be a bad idea to limit payments for therapy services. More than 150 people attended the meeting that lasted more than five hours. Elann "Lennie" Moren, 62, testified that she was told she might not walk or talk again after she was slashed in 2007 by a machete wielded by her finance's son. Seven years later, she walked to a microphone and told the Medicaid Reform Advisory Group that through occupational, physical and speech therapy, "much is possible." The advisory group has recommended trimming therapeutic service to cut Medicaid costs. "If this is an example of Parnell care ... then it's no care at all," Moren said. (10/30)

State Highlights: Ga. Official On Insurer's Contract With Docs; Calif. Nursing Home Audit

A selection of health policy stories from Georgia, California, Texas, Pennsylvania, Montana, West Virginia and Louisiana.

Georgia Health News: State Takes Action On Blue Cross Contracts
Georgia’s insurance commissioner, in a rare regulatory action, has told the state’s largest health insurer to rescind newly added amendments to contracts with thousands of physicians. Physicians had complained that the Blue Cross and Blue Shield of Georgia contract revisions lacked clarity on the insurer’s payment rates for medical services. (Miller, 10/30)

Los Angeles Times: State Inadequately Investigates Nursing Home Complaints, Audit Finds
The California Department of Public Health has failed to effectively investigate nursing home complaints, a state audit released Thursday found, with a total of 11,000 unresolved complaints in its system. The department, which is responsible for monitoring more than 2,500 nursing homes, classified more than 40% of these complaints and incidents as having caused or being likely to cause harm to a resident. Yet the state auditor’s office found that the average number of days these complaints were open ranged from 14 to 1,042 days. (Flores, 10/30)

The New York Times' DealBook: Judge Approves Bankruptcy Exit For Stockton, Calif.
Stockton had asked the court to approve its plan, which calls for budget cuts, haircuts for bondholders and even a sales tax increase, which city residents approved in a referendum last year. But it did not touch pensions, not even the benefits that current workers hope to earn in future years. Prospective pension cuts are routine when companies go bankrupt under Chapter 11 and even outside of bankruptcy. But Judge Christopher Klein of the United States Bankruptcy Court for the Eastern District of California in Sacramento said he found Stockton’s proposed plan acceptable, noting that it eliminated the retirees’ health benefits. (Walsh, 10/30)

The Associated Press: Judge Sides With Highmark On Nixing UPMC Coverage
A judge is siding with Highmark Inc. in a dispute with state regulators over an insurance plan that doesn't cover doctors working for the University of Pittsburgh Medical Center. Commonwealth Court Judge Dan Pellegrini ruled Thursday that Highmark hadn't violated terms of a consent agreement meant to alleviate tensions between the healthcare competitors. The judge rejected calls from the state attorney general's office and the health and insurance departments to hold Pittsburgh-based Highmark in contempt. (10/30)

The Billings Gazette: VA Montana Erroneously Releases Patients' Confidential Information
A Glendive veteran says his confidential medical diagnosis, birth date, address and Social Security information were compromised when the VA Montana Health Care System mishandled his request for medical services. Kip Braden, a U.S. Army, Air Force and National Guard veteran, was waiting for authorization papers from the VA for outpatient services, but when his paperwork arrived, it was for a Bozeman veteran. The authorization papers included the Bozeman veteran’s name, address, date of birth, Social Security information and his medical condition. VA officials have characterized the mix-up as a “mishandling” of correspondence. (Uken, 10/30)

The Charleston Gazette: West Virginia Hospital Eyes Smoke-Free Loophole To Continue Pay From CMS
Randy Hodges, the hospital’s administrator, has asked the Putnam County Development Authority to buy the hospital’s only two smoking areas — for one dollar — while the hospital continues to maintain the areas and assume legal liability for them. ... An accreditation company that determines whether the hospital can continue getting paid to serve Medicare and Medicaid patients — representing more than half of its total patient volume — requires CAMC Teays Valley to move toward being a “smoke-free campus.” (Quinn, 10/30)

The Baton Rouge, La., Advocate: At-Risk Youth Mental Health Program Draws Federal Complaint
Two civil rights groups called for a federal investigation into a Jindal administration program that they allege is failing to deliver on promised services to keep at-risk youth with mental health problems out of detention centers and hospitals. In response, the state health chief acknowledged Wednesday that there are “challenges” in getting providers to meet the specialized needs of the youth and their families, but said the administration remains committed to the program. The Southern Poverty Law Center and the Advocacy Center complained to the federal Centers for Medicare and Medicaid Services, called CMS, about shortcomings of the program that attorneys claim violate federal law. (Shuler, 10/30)

Health Policy Research

Research Roundup: The Effects Of ACOs; Declines In Medical Liability Payments

Each week, KHN compiles a selection of recently released health policy studies and briefs.

The New England Journal of Medicine: Changes In Patients' Experiences In Medicare Accountable Care Organizations
[W]e compared experiences of care reported by Medicare beneficiaries served by provider organizations entering the [accountable care organization] programs in 2012 with the experiences reported by beneficiaries served by other providers, before versus after the start of ACO contracts. ... incentives for participating provider organizations to limit health care utilization and improve quality of care were associated with meaningful improvements in some measures of patients' experiences and with unchanged performance in others. ... patients served by ACOs reported improvements in domains more easily affected by organizations (access to care and care coordination) but not in domains in which changes in physicians' interpersonal skills may be required to achieve gains .... In addition, medically complex patients ... reported significantly better overall care after the start of ACO contracts. (McWilliams, Landon, Chernew and Zaslavsky, 10/30)

The Journal of the American Medical Association: The Medical Liability Climate And Prospects For Reform
For many physicians, the prospect of being sued for medical malpractice is a singularly disturbing aspect of modern clinical practice. State legislatures have enacted tort reforms, such as caps on damages, in an effort to reduce the volume and costs of malpractice litigation. ... In this Special Communication, we review recent national trends in medical liability claims and costs, which indicate a sharp reduction in the rate of paid claims and flat or declining levels in compensation payments and liability insurance costs over the last 7 to 10 years. ... Rates of paid claims against physicians have decreased since the early 2000s. For MDs, the rate decreased from 18.6 to 9.9 paid claims per 1000 physicians between 2002 and 2013. Regression analyses estimate an annual average decrease of 6.3% for MDs and 5.3% for DOs over this 12-year period. (Mello, Studdert and Kachalia, 10/30)

Journal of the American Medical Association: Association Between Hospital Conversions To For-Profit Status And Clinical And Economic Outcomes
We found that between 2002 and 2010, 237 US hospitals switched from nonprofit to for-profit status. This conversion was associated with better subsequent financial health but had no relationship to the quality of care delivered or to mortality rates at the converting hospitals. We also found no evidence that for-profit conversion was associated with any increase in Medicare payments or annual Medicare case volume or decrease in the provision of care to poor patients or to racial or ethnic minorities. Prior to conversion, we found that hospitals that would eventually become for-profit institutions were struggling financially, with negative total margins; this is in keeping with prior research2 and is likely why these hospitals were targeted for conversion. (Joynt, Orav and Jha, 10/22)

Journal of the American Medical Association: Physician Practice Competition And Prices Paid By Private Insurers For Office Visits
Less competition among physician practices is statistically significantly associated with substantially higher prices paid by private PPOs to physicians in 10 large specialties for office visits. ... Examining changes in prices between 2003 and 2010, we found that prices increased more rapidly in areas where practices were initially less competitive than in other areas. In some specialties, declining competition was also associated with larger increases in prices in areas that were initially more competitive. This pattern suggests the possibility that the results we observe in 2010 may be related to the ability of practices in low-competition areas to negotiate larger price increases over time as well as related to changes in competition over time. (Baker et al., 10/22)

JAMA Pediatrics: Improvement In Preventive Care Of Young Adults After The Affordable Care Act
Objective: To examine the ACA’s initial effects on young adults’ receipt of preventive care. ... After ACA, young adults had significantly higher rates of receiving a routine examination (47.8% vs 44.1%), blood pressure screening (68.3% vs 65.2%), cholesterol screening (29.1% vs 24.3%), and annual dental visit (60.9% vs 55.2%) but not an influenza vaccination (22.1% vs 21.5%). Full-year private insurance coverage increased (50.1% vs 43.4%), and rates of lacking insurance decreased (partial-year uninsured, 18.4% vs 20.7%; and full-year uninsured, 22.2% vs 27.1%). Full-year public insurance rates remained stable (9.4% vs 8.8%; P = .53). Insurance status fully accounted for the pre- and post-ACA differences in routine examination and blood pressure screening and partially accounted for year differences for cholesterol screening and annual dental visits. Covariate adjustment did not affect year differences. (Lau et al., 10/27)

JAMA Surgery: Variation In Readmission By Hospital After Colorectal Cancer Surgery
Hospital readmission after colorectal surgery is common, with reported 30-day readmission rates ranging from 10% to 14%. ... but it is unclear whether there is much difference in readmission among hospitals after appropriate risk adjustment. ... We studied 44 822 patients who underwent colorectal resection for cancer at 1401 US hospitals from January 1, 1997, through December 31, 2002. ... Looking at hospitals that performed at least 5 operations annually, we found marked variation in raw readmission rates, with a range of 0% to 41.2% (IQR, 9.5%-14.8%). However, after adjusting for patient characteristics, comorbidities, and operation types in a hierarchical model, no significant variability was found in readmission rates among hospitals (Lucas et al., 10/22)

Georgetown University Health Policy Institute/Robert Wood Johnson Foundation/Urban Institute: Federal And State Policy Toward Association Health Plans In Oregon
Before the Affordable Care Act (ACA), some state regulatory approaches created powerful incentives for health insurers to sell through associations to individuals and small employers, largely because they were exempt from key state consumer protections and requirements .... Some experts suggested these regulatory differences allowed for insurers to segment the market by separating healthier individuals and small groups from the less healthy .... Though many believed that the newly level playing field created by the ACA would effectively eliminate the incentive to market and sell health insurance through associations, this paper finds that associations in Oregon offering health insurance are claiming single large-group health plan status under ERISA, thus sidestepping the requirements under the ACA for the small-group market. (Lucia, Ahn and Corlette, 10/28)

The Kaiser Family Foundation: The ACA Primary Care Increase: State Plans For SFY 2015
To increase support for physicians providing primary care for Medicaid beneficiaries, and to improve access to primary care as Medicaid coverage expands, the Affordable Care Act (ACA) increased Medicaid payment rates for many primary care services to Medicare fee levels in 2013 and 2014. ... Fifteen states indicated that they will continue the primary care fee increase in 2015, at least in part. The 100% federal funding for rate increase ends on December 31, 2014, so these states will continue the increase at their regular federal matching rate. For states that were paying primary care physicians close to 100% of Medicare rates even before the ACA (such as Alaska, whose rates were 124% of Medicare rates), extending the ACA increase does not impose significant new costs. However, most states noted a sizable increase in state funds required to continue the primary care increase. (Snyder, Paradise and Rudowitz, 10/28)

The Kaiser Family Foundation: Preventive Services Covered By Private Health Plans Under The Affordable Care Act
A key provision of the Affordable Care Act (ACA) is the requirement that private insurance plans cover recommended preventive services without any patient cost-sharing. ... However, costs do prevent some individuals from obtaining preventive services. ... While the number of individuals who have gained coverage for no-cost preventive services is large, public awareness of the preventive services requirement is relatively low. In March 2014, three and half years after the rule took effect, less than half the population (43%) reported they were aware that the ACA eliminated out-of-pocket expenses for preventive services. (10/28)

Urban Institute: Monitoring The Impact Of The Affordable Care Act On Employers
In this report, we analyze recent trends in the employer health insurance market and the anticipated effects of the Affordable Care Act on employers, with a particular focus on small firms with fewer than 50 workers. ... we find the following: Employers have a strong economic incentive to offer health insurance .... Before the Affordable Care Act, most of the nonelderly population had health coverage through an employer, but rates of employer-sponsored insurance (ESI) decreased nearly every year since 2000. The decline in ESI was even more drastic among small-firm workers .... While nearly all larger firms offered ESI in 2012—99.5 percent of employers with 1,000 or more employees and 94.1 percent of those with 100–999 employees—only 35 percent of small firms with fewer than 50 workers offered coverage to their employees. Small firms have lower offer rates than larger firms because of the additional costs and challenges they face. (Blavin et al., 10/23)

Brookings: Pharma Pays $825 Million To Doctors And Hospitals, ACA’s Sunshine Act Reveals
The purpose of [the Sunshine Act] is to increase the transparency in the health care market by requiring doctors, hospitals, pharmaceutical companies, and medical device manufacturers to disclose their financial relationships. ... Teaching hospitals and physicians together received $669,561,563 in general payments from 949 different medical manufacturers. Interestingly, close to 70 percent ($460,369,403) of this amount was paid to individual physicians and the rest was paid to teaching hospitals. More than half of the total general payments were made by only 20 companies led by Genentech .... Two hundred and ninety-four manufacturers awarded 23,225 research grants to teaching hospitals and physicians. The total value of these grants was $155,815,828. About 70 percent ($107,969,961) of these grants were awarded to teaching hospitals and the rest were awarded to physicians (Yaraghi, 10/23)

Other news sources also reported:

Medscape: Reminders May Trigger Advance Care Conversations Earlier
A simple trigger reminder to oncologists at key times during the course of care of a seriously ill cancer patient may prompt earlier discussions regarding advance care planning (ACP) for the end-of-life phase, according to preliminary research presented at the inaugural Palliative Care in Oncology Symposium, held in Boston, Massachusetts, October 24-25. (Hand, 10/28)

Reuters: Knowing Prices Tied To Lower Healthcare Spending
People who search and compare the prices of common healthcare services tend to spend a bit less than people who don’t, according to a new study. The overall amount of money people and their employers spent on office visits, laboratory services and imaging tests was between $1 and $125 less than normal when they looked up the prices ahead of time, researchers found. (Seaman, 10/23)

Medscape: No Drop In Malpractice Payments When Caps Rise To $500K
Putting in place noneconomic damage caps appears to reduce payouts more than not having caps, but when caps increased to $500,000, the effect on payments was neutralized, new research shows. Specifically, any cap trimmed average payments by 15% ($42,980) compared with no cap, and a $250,000 cap reduced average payments by 20% ($59,331), researchers report in an article published online October 22 in Health Affairs. However, when caps reached $500,000, they no longer had a significant effect, compared with no cap. (Frellick, 10/24)

Politico Pro: Study: Not All Assumptions About Narrow Networks Hold True
A narrow network plan isn’t the only way to get lower premiums yet still have access to highly ranked hospitals, according to a study released Thursday. Research from the Urban Institute found that the relationship between network size and cost does not always hold. In the six cities examined, some broad networks have low premiums and some narrow networks have high premiums — an inverse relationship that runs counter to most people’s assumptions in picking a health plan. (Villacorta, 10/30)

Editorials And Opinions

Viewpoints: Ebola Errors; McConnell's Mixed Message; Shifts In Mental Health Care

A selection of opinions on health care from around the country.

USA Today: Despite Errors, Ebola Fails To Spread Here: Our View
The battle to contain Ebola has not been pretty. The developed world let the disease fester in West Africa until it became a global threat, and when — inevitably — the first case arrived in the United States, it was greeted with a disturbing mix of incompetence and panic. ... The whole train of events is embarrassing. But there is another way to look at it as well. Pretty much everything that could go wrong did go wrong; the virus was given every chance to spread. Yet it has not. (10/30)

USA Today: Stop Transporting Host And Virus: Opposing View
We've learned from the Ebola outbreak of 2014 that to stop pandemics, we must regulate the transport of host and virus alike. Public transmission and cellular invasion depend on the unimpeded traffic of people across borders and viruses across cell membranes. Barring the traffic of people across the Atlantic from Liberia would certainly have prevented the first three cases of Ebola in the United States. Blocking the traffic of virus in human cells would have prevented thousands of cases worldwide. (Gerald Weissmann, 10/30)

The Wall Street Journal: A Lesson From My Great-Aunt
An American nurse returns from Sierra Leone after treating Ebola patients. She did that on her vacation. We are proud of her. After she lands at Newark Airport she is hustled into quarantine. She is greatly shocked and indignant, loudly protests in the media. Her rights are being violated, her treatment is “inhumane.” By that she perhaps meant uncomfortable—a tent, paper scrubs, no shower. It was all on-the-fly and disorganized, a state scrambling to do what the federal government would not. ... Should she have been quarantined? Of course. (Peggy Noonan, 10/30)

USA Today: Ebola Nurse Kaci Hickox Isn't Spreading Disease Like You Do
Public fury is building as Maine authorities try to maintain quarantine for an asymptomatic nurse returning from caring for Ebola patients in West Africa. While the nurse, Kaci Hickox, insists she poses no risk to others, since even Ebola-infected persons are not contagious prior to developing symptoms — a position that is supported by the CDC, the NIH, the WHO, and many of the world's leading Ebola experts —others believe that she is expressing willful disregard for the health of the general public. (Elizabeth Oelsner, 10/30)

The New York Times: The Prospect Of A Republican Senate
In a rare fit of realism on Tuesday, Senator Mitch McConnell, the Republican leader, admitted he would be unable to repeal the Affordable Care Act if Republicans win the Senate next week and he becomes majority leader. That would take 60 votes, he said, and no one thinks Republicans will get that many. But conservatives reacted with anger to what they considered a demonstration of weakness, and on Thursday Mr. McConnell was forced to backtrack. Yes, his spokesman told The Washington Examiner, Mr. McConnell remains “committed to the full repeal of Obamacare” with only a simple majority, through a parliamentary procedure known as reconciliation. (10/30)

The Washington Post: Do Republicans Have A Plan For The Country? The Answer Is ‘No’.
For the activist far right — already brimming with fear, anxiety and ire to spare — GOP candidates promise to obliterate Obama’s most significant achievement, the Affordable Care Act. This pledge has always been shamefully dishonest. Even if Republicans capture the Senate and manage to pass one of the umpteen House bills repealing all or part of Obamacare, the president will simply veto the measure. ... Republicans talk about “repeal and replace” but feel no obligation to elaborate on the “replace” part. If they were being honest, they would admit that the need to keep the consumer-friendly parts of Obamacare. (Eugene Robinson, 10/30)

The Washington Post: Sending The Mentally Ill From Group Homes To An Uncertain Future
The federal government is pushing two initiatives that will radically change how mental health services are delivered. Both are long overdue. So why, as the father of an adult son with a mental illness, am I skeptical? ... If the Justice Department is going to force states under Olmstead to empty group homes, the federal government must guarantee that suitable housing is available. We should not repeat the debacle of unplanned deinstitutionalization. If the government pushes a shift to private insurance, it must define acceptable community care. (Pete Earley, 10/30)

The New York Times' Opinionator: Looking A Dangerous Disease In The Mouth
What’s the most common chronic childhood disease in the United States? It’s worth remembering on Halloween that the answer is tooth decay, which is five times more common than asthma and 20 times more common than diabetes. Tooth decay affects children from all backgrounds, but it’s concentrated among low-income and rural populations, who have the most difficulty accessing and affording dental care. (David Bornstein, 10/30)

The New England Journal of Medicine: Accountable Care Organizations — The Risk Of Failure And The Risks Of Success
Despite rapid growth, the success of the ACO movement is far from certain. The performance of ACOs to date has been promising but not overwhelming. Although some ACOs have gained a substantial return on their investment in improving the health of their patients, many have not. Furthermore, unless and until a high percentage of their patients — including privately insured patients — are covered by ACO contracts, hospitals and physicians will be in the difficult position of dealing with diametrically opposed sets of payment incentives. ... The ACO movement is unlikely to succeed unless health insurance plans dramatically increase their number of ACO contracts and unless CMS modifies specifications for its ACO programs — a course that the agency is considering. (Lawrence P. Casalino, 10/30)