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Monday, June 23, 2014

Health Care Reform Articles - June 23, 2014

Ballot measure won't disrupt Obamacare in California, backers say

In response to concerns raised by California's health exchange, backers of a statewide ballot measure on health insurance rate regulation insisted Thursday that the measure would not disrupt how Obamacare works in the state.
Consumer groups and California Insurance Commissioner Dave Jones are pushing for more authority over health premiums for consumers and small businesses. In November, voters will decide whether to give the insurance commissioner veto power over rate increases.



Officials at the Covered California exchange, which signed up 1.4 million people under the federal health law, say they won't take a position for or against the ballot measure. But the exchange has expressed a number of operational concerns if the measure passes, from delays in getting new rates approved to what happens if an insurer's premiums are rejected just before open enrollment.
There were also questions raised about whether the stricter rate review could apply to co-payments, benefits and the scope of medical networks offered by insurers.
In a report issued to the exchange's five-member board Thursday, the state agency said contracting with health plans and negotiating rates is a "tightly choreographed sequence that begins anew at the beginning of each calendar year" and "under the current timelines there is very little flexibility in the event there are major delays."
Peter Lee, the exchange's executive director, said the agency's analysis of the ballot initiative is still ongoing.
"There are a lot of questions we need to sort through," he said.

US creates new CEO position for Obamacare insurance marketplace

Posted June 20, 2014, at 1:40 p.m.
WASHINGTON — President Barack Obama’s new health secretary moved swiftly on Friday to shore up administration oversight of Obamacare with a series of management changes to address weaknesses blamed for last year’s crash of the federal website, HealthCare.gov.
U.S. Health and Human Services Secretary Sylvia Burwell named Optum executive Andy Slavitt, who led day-to-day operations to fix the faulty website, to a new No. 2 post at the Centers for Medicare and Medicaid Services, giving him authority for policy and operational coordination for the agency’s initiatives.
In a long-anticipated response to some of Obama’s top outside health advisers, she also announced the creation of a new chief executive position to oversee the federal government’s private health insurance exchange, as well as a permanent marketplace chief technology officer.
“These actions will bolster our team and further instill ongoing accountability for reaching milestones, measuring results and delivering results for the American people,” Burwell said in a statement that came two weeks after she was confirmed in her job by the U.S. Senate.
CMS, the Department of Health and Human Services agency responsible for implementing Obama’s healthcare reform law, has been widely blamed for missteps that led to last year’s botched rollout of HealthCare.gov, the federal marketplace portal for millions of new health insurance policyholders in 36 states.
Outside experts blamed a lack of management oversight for the debacle, which pushed Obama’s signature domestic policy achievement to the brink of failure before an emergency rescue operation salvaged the website from paralyzing technical problems, enabling millions of Americans to obtain subsidized private health coverage.
Burwell’s creation of a marketplace CTO makes permanent the tech czar role that was filled temporarily by Obama adviser Jeffrey Zients and former Microsoft executive Kurt Delbene.
Some administration allies, including former Obama adviser Dr. Ezekiel Emanuel and the Center for American Progress think tank, have seen the appointment of a new marketplace CEO as crucial to the long-term success of the policy.

June 16, 2014

Most Americans Remain Satisfied With Healthcare System

Little change in satisfaction since mid-March

by Frank Newport
PRINCETON, NJ -- Sixty-six percent of Americans in the first half of June are satisfied with the way the healthcare system is working for them, in line with attitudes since mid-March. Gallup's seven-day rolling average on this measure shows confidence during that time has varied only slightly, increasing to 70% in mid-April, just after the enrollment period ended for purchasing insurance under the provisions of the Affordable Care Act. That modest increase was short-lived; satisfaction has averaged about 65% since mid-May.
Gallup began asking this question nightly on March 21 as a continuous measure of the way changes in the nation's healthcare system are affecting average Americans. There are no comparable data for 2013 or previous years, before the ACA's individual insurance mandate helped lead to a significant drop in the uninsured population in the U.S. However, these readings serve as a baseline for assessing the effect the ACA is having on people's healthcare experiences as they interact with the system going forward.
Americans' satisfaction with the healthcare system is highly related to their health insurance status, although having health insurance does not guarantee satisfaction. Nearly three in 10 Americans with insurance say they are dissatisfied with the way the healthcare system is working for them. Among those without insurance -- currently about 13.4% of Americans -- six in 10 are dissatisfied.
Higher percentages of Americans aged 65 and older are satisfied (79%) with how the system is working, with satisfaction ranging from 61% to 66% among those between the ages of 18 and 49. This elevated level of satisfaction among older Americans reflects that most in this group are covered by Medicare. Along these same lines, slightly higher-than-average proportions of individuals who have government-paid insurance -- including not only Medicare, but Medicaid and military or veterans insurance -- are satisfied with the way the healthcare system is treating them.

Electronic health records: A 'clunky' transition
By: Arthur Allen
June 15, 2014 10:46 PM EDT
The government-led transformation of health information is driving doctors to distraction, igniting nurse protests and crushing hospitals under debt.
Most health care professionals accept the inevitability of going electronic and see its value. But they have a message for the administration’s multibillion-dollar push: not so fast.
The government has already delayed parts of the program, but the American Medical Association and others want more relaxation of the rules, and warn of disaster if they aren’t heeded.
Doctors largely supported the Obama administration’s $30 billion incentive program to switch the nation’s medical records from paper to electronic starting in 2009. They understood the potential of using health IT to reduce medical errors, increase efficiency and give patients and caregivers access to complete, portable and up-to-date records.
If that vision isn’t motivating enough, there’s also cash on the line. Doctors can get up to $44,000 per year for digitizing and meeting criteria for “meaningful use” of health technology. Those who cling to their paper records could face penalties next year.
But the transition has proved painful. Paperless records still don’t flow smoothly among doctors, hospitals and patients and they won’t for some time. Nor have measurable savings or widespread improvements been seen yet.
And there’s a difference between liking the idea of electronic health records, or EHRs, and liking the particular systems in use. Even Karen DeSalvo, who as national coordinator of health IT is responsible for implementing national use of EHRs, notes that her own husband, an emergency room physician, considers his EHR “clunky.”
In short, the current generation of EHRs has about as many fans in medicine as Barack Obama at a tea party convention.
When the Department of Health and Human Services opened the taps to pay for the records systems, after incorporating a health IT law in the 2009 stimulus law, the technology on the market wasn’t ready to respond. Many records systems were built atop software designed in the 1970s for billing, not for comprehensive tracking of 21st-century patient care.
Top HHS tech officials recognize the shortfalls.
“Government payment incentives forced people into early adoption of technology that in most of our views is not optimal for what people want to do with it,” said Greg Downing, director of innovation at HHS.
Many EHR products designed to meet federal guidelines are not user-friendly. They take months to learn, require lengthy data entries and often don’t communicate with other computer systems. Doctors complain that because of EHR design flaws, they spend so much time “clicking” that their hands hurt.


Consumer Group Urges Hospitals To Stop Promoting Questionable Screenings

By Julie Appleby
JUNE 19TH, 2014, 12:24 PM
Consumer advocacy group Public Citizen on Thursday called on 20 hospital systems to stop partnering with companies that offer low-cost screenings for heart disease and stroke risk, saying the promotions are “unethical” and the exams are more likely to do harm than good.
In recent years, more hospitals have paired withfirms offering such testing packages, partly to build community goodwill and referrals.  Hospitals say residents benefit from the testing packages, which can cost less than $150, because some will discover they are at higher risk for heart problems or stroke early enough to take steps to reduce their risks.
But some medical groups and consumer advocates object to the programs, saying they are a waste of money for most consumers.
Public Citizen argues “the promotions rely on fear mongering and erroneously suggest that for most adults in the general population, these screening tests are useful in the prevention of several potentially life-threatening cardiovascular illnesses.”
It sent letters to hospitals in eight states, including Inova in the Washington, D.C. area, Scottsdale Healthcare in Arizona, Dignity Health in California and the University of Iowa Health Alliance, urging them to stop promoting such tests.
The programs are advertised on websites, in newspapers or through direct mail. Screenings — often performed in specially equipped buses — include  ultrasound tests for blockages of the carotid artery and weak spots in the abdominal aorta, a resting electrocardiogram, or EKG, a test of elasticity of the arteries and another for blockages in arteries serving the legs, a condition called peripheral arterial disease.
What the promotions don’t say, generally, is that most of the tests are not recommended for people without risk factors or symptoms.  Widespread screening of people without the risk factors could lead to misleading results and potentially even unnecessary surgery. Other medical experts warn that the tests could needlessly raise health-care spending.http://capsules.kaiserhealthnews.org/index.php/2014/06/consumer-group-urges-hospitals-to-stop-promoting-questionable-screenings/


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