GOP GOVERNORS WALK BALANCE BEAM ON HEALTH LAW
ATLANTA (AP) -- Florida Gov. Rick Scott, who made a fortune as a health care executive, long opposed President Barack Obama's remake of the health insurance market. After the Democratic president won re-election, the Republican governor softened his tone. He said he wanted to "have a conversation" with the administration about implementing the 2010 law. With a federal deadline approaching, he also said while Florida won't set up the exchange for individuals to buy private insurance policies, the feds can do it.
In New Jersey, Gov. Chris Christie held his cards before saying he won't set up his own exchange, but he's avoided absolute language and says he could change his mind. He's also leaving his options open to accept federal money to expand Medicaid insurance for people who aren't covered. The caveat, Christie says, is whether Health Secretary Kathleen Sebelius can "answer my questions" about its operations and expense.
Both Republican governors face re-election in states that Obama won twice, Christie in 2013 and Scott in 2014. And both will encounter well-financed Democrats.
Paying for results, not treatments
New models that change the improper incentive in fee-for-service Medicare promise significant savings, but there are big issues still to work through.
December 31, 2012
Nowhere are these weaknesses more acute than in Medicare, which pays most participating doctors and hospitals on a fee-for-service basis. Shifting Medicare to new payment methods that encourage quality and efficiency is crucial to sustaining the program, which is the biggest driver in the federal government's long-term fiscal problems. As the baby boom generation enters its dotage, the ranks of Medicare beneficiaries are expected to swell from the current 50 million to 80 million in 2030. Unless the government can motivate the industry to treat these patients more effectively at lower cost, the pressure will only grow to shrink Medicare benefits or cover fewer of the elderly and disabled.
The ideal payment system would give providers a stake in the savings generated by more efficient care, as well as in the financial risk of ineffective treatments. Prodded by the 2010 healthcare law, Medicare is moving in that direction, as are private insurers. Part of Medicare's focus is on improving the quality of care delivered on a fee-for-service basis, on the theory that it will reduce the demand for treatment. To that end, it launched a value-based purchasing program that ties a portion of a hospital's payments to how well it meets specific quality targets, and it has begun reducing payments to hospitals that quickly readmit too many of the patients they treat
http://www.latimes.com/health/la-ed-medicare-ending-fee-for-service-20121231,0,1403915,print.story
DYING FOR RELIEF | A TIMES INVESTIGATION
KAMALA HARRIS HASA POWERFUL TOOLFOR IDENTIFYING RECKLESS DOCTORS,BUT SHE DOESN'T USE IT.
As California's attorney general, Harris controls a database
that tracks prescriptions for painkillers and other commonly abused drugs
from doctors' offices to pharmacy counters
and into patients' hands.
December 30, 2012
The system, known as CURES, was created so physicians and pharmacists could check to see whether patients were obtaining drugs from multiple providers.
Law enforcement officials and medical regulators could mine the data for a different purpose: To draw a bead on rogue doctors.
But they don't, and that has allowed corrupt or negligent physicians to prescribe narcotics recklessly for years before authorities learned about their conduct through other means, a Times investigation found.
Prescription drug overdoses have increased sharply over the last decade, fueling a doubling of drug fatalities in the U.S. To help stem the loss of life, the federal Centers for Disease Control and Prevention recommends that states use prescription data to spot signs of irresponsible prescribing, and at least six states do.
California is not one of them.
By monitoring the flow of prescriptions, authorities can get an early jump on illegal or dangerous conduct by a doctor. Among the telltale signs: writing an inordinate number of prescriptions for addictive medications or for combinations of drugs popular among addicts.
Harris' office keeps CURES off-limits to the public and the news media. But information from a commercial database containing the same kind of data illustrates how valuable CURES could be as an investigative tool.
What We Give Up for Health Care
By EZEKIEL J. EMANUEL
WHEN it comes to health care, most liberals are committed above all to ensuring that every American has insurance. In their view, the greatest achievement of the health care reform act passed under President Obama is to finally erase the moral stain of the United States' being the only major developed country without universal coverage. But we also hold the questionable distinction of having the world's most expensive health care system - what about cost control? For many liberals, that just sounds like a cover for heartless conservatives who care only about cutting benefits and not about helping people in need.
But liberals are wrong to ignore costs. The more we spend on health care, the less we can spend on other things we value. If liberals care about middle-class salaries, public education and other state-funded services, then they need to care about controlling health care costs every bit as much as conservatives do.
Over the past 30 years, health care inflation has been a major reason average wages have remained stagnant. For employers, the cost of labor is total compensation - wages plus benefits. As the cost of benefits rises, wages tend not to rise, or to rise much more slowly. According to the Bureau of Labor Statistics, as health care costs skyrocketed between 2000 and 2009, workers' total compensation increased by 1.3 percent per year, but workers' hourly wages alone increased by just 0.7 percent per year, significantly below the rate of inflation.
During those 30 years, the only sustained period when real hourly earnings increased was 1990 through 1998 - which coincided almost exactly with a period of unusually low increases in health care costs.
The middle and working classes are also hit by the rising price of health care when states are forced to cut other services to pay for it. Last year, Medicaid spending was estimated to account for nearly a quarter of total state spending - the largest portion of their budgets - and it's getting only more expensive. States really have just three ways to make ends meet: restrict Medicaid eligibility (which most have done already), raise taxes or reduce funding for other programs to pay more for health care.
EMMC wraps up deal to integrate Bangor cardiology practice
Posted Dec. 31, 2012, at 7:08 p.m.
BANGOR, Maine — Eastern Maine Medical Center has finalized plans to integrate Northeast Cardiology Associates, the last sizeable private cardiology practice remaining in the state, into the hospital’s heart center.
The deal between EMMC and Northeast, a Bangor physician practice, was reached Monday after about a year of serious negotiations, according to James Raczek, EMMC’s chief medical officer and senior vice president of operations.
The agreement will lead to more coordinated care and give heart patients better access to services, he said Monday.
Northeast Cardiology’s roughly 100 employees, including 17 physicians, are now employed by EMMC. The hospital purchased the practice’s assets, including equipment and supplies, but not Northeast’s building at the Maine Business Enterprise Park, where the practice will remain.
EMMC said it paid fair market value for the assets, but did not disclose the purchase price.
The move comes as the federal government, in an effort to improve health care while lowering costs, increasingly ties shrinking Medicare reimbursements to how efficiently health providers deliver care. Many cardiology practices across the country have joined with hospitals to adapt to that shift, said Robert Hoffmann, executive medical director and lead cardiologist at Northeast Cardiology.
“By us being integrated, we’re going to be able to provide more efficient care, more timely care,” he said.
Across the nation, an increasing numbers of private heart doctors, faced with slashed Medicare payments over the last several years, have sold their practices to hospital systems to stay afloat. Under Medicare’s payment system, hospitals receive more generous reimbursements than individual doctors for some specialty services, including cardiac treatment.
The deals can lead to better care, but also have been criticized for giving hospitals the clout, through controlling most of the cardiac services in a region, to negotiate higher reimbursement from private insurers.
The Maine Attorney General’s Office is monitoring EMMC’s deal with Northeast to ensure that EMMC and nearby St. Joseph Hospital maintain a level playing field in treating cardiac patients, said Linda Conti, who heads the AG’s consumer protection division.
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