First Edition: March 23, 2015
Today's early morning highlights from the major news organizations.
Kaiser Health News:
FAQ: What’s In The House’s Proposal To Fix Medicare’s Payments To Doctors
It’s make-or-break time for a Medicare 'doc fix' replacement. The House is likely to vote this week on a proposal to scrap Medicare’s troubled physician payment formula, just days before a March 31 deadline when doctors who treat Medicare patients will see a 21 percent payment cut. Senate action could come this week as well, but probably not until the chamber completes a lengthy series of votes on the GOP’s fiscal 2016 budget package. (Carey, 3/23)
The New York Times:
Congress To Weigh A Plan To Protect Medicare Fees And Children’s Insurance
Lobbyists will descend on Congress this week as lawmakers near a bipartisan agreement to finance health care for the oldest and youngest Americans, by revamping the payment of doctors under Medicare and by extending the Children’s Health Insurance Program. The agreement, negotiated by Speaker John A. Boehner and the House Democratic leader, Nancy Pelosi, would repeal a Medicare formula that threatens to cut doctors’ fees each year. In its place, Congress would establish an “incentive payment system” to reward doctors who receive high performance scores from the government. Scores would be based on factors like the ability to keep patients healthy while controlling costs. (Pear, 3/22)
The Wall Street Journal:
Boehner, Pelosi Reach Across The Aisle On ‘Doc Fix’ Legislation
A House vote expected this week will be the first test of whether leaders of the two parties can win support for small structural changes in how the costs of Medicare are covered—a significant political shift for Congress, which has for years been at an impasse over entitlement programs. (Hughes, 3/22)
The Associated Press:
Potent Groups Take Sides On Bipartisan House Medicare Plan
A budding bipartisan deal to shelter physicians from Medicare cuts, championed by the House's two top leaders, is drawing powerful allies including the American Medical Association and a rainbow of conservative and liberal groups. ... The proposal is also attracting powerful foes and its fate is not guaranteed. ... On Saturday, all 12 Democrats on the Senate Finance Committee released a letter suggesting they might oppose the plan unless House leaders change it. They said a package extending the children's health program "would go a long way to achieving bipartisan support," and listed other concerns like its increased costs for some beneficiaries. (Fram, 3/21)
Politico:
Nancy Pelosi Tries To Stamp Out Abortion Fight On Medicare Fix
House Democratic Leader Nancy Pelosi is trying to head off an abortion dispute so it doesn’t derail a bipartisan permanent solution to the flawed Medicare pay formula for doctors, which Congress for years has been trying to repeal and repair. But she faced sharp words Friday from abortion rights groups who have been her traditional allies. ... Included in the tentative deal outlined Friday is $7.2 billion for community health centers — but it’s tied it to language banning the federal funding of abortions at the clinics, the so-called Hyde Amendment. ... Pelosi circulated a “Dear Colleague” letter Friday, saying that the abortion language regarding the community health clinics is basically how the centers operate now and that it’s important to get them the funds. (Pradhan and Mershon, 3/21)
The Associated Press:
FACT CHECK: GOP Budgets Rely On Higher Taxes To Balance
The new House and Senate Republican budgets make a big boast: They both balance the federal budget within 10 years, without raising taxes. Their own numbers, however, say millions of American families and businesses would have to pay more in taxes to make the math work — about $900 billion more over the next decade. Both budgets also claim big savings by repealing President Barack Obama's health law. But at the same time, they rely on more than $1 trillion in tax revenue from the health law that would supposedly be repealed. (Ohlemacher, 3/21)
The New York Times:
With Expansion Of Medicaid, Some States Are Identifying More New Diabetes Cases
The number of new diabetes cases identified among poor Americans has surged in states that have embraced the Affordable Care Act, but not in those that have not, a new study has found, suggesting that the health care law may be helping thousands of people get earlier treatment for one of this country’s costliest medical conditions. (Tavernise, 3/23)
The Washington Post:
How Does Obamacare Help Low-Income Diabetes Patients? First, It Finds Them.
For the study, researchers analyzed test results, stripped of identifying information, of Medicaid recipients diagnosed with diabetes in the first half of 2014. They found that diabetes cases jumped 23 percent from the year before in the 26 states and the District of Columbia, all of which expanded their Medicaid programs. In the nonexpansion states, the increase was less than 1 percent. The analysis is being published online in Diabetes Care, the official publication of the American Diabetes Association. (Sun, 3/23)
Los Angeles Times:
Diabetes Study Shows Benefits Of Expanded Medicaid Under Obamacare
Low-income patients with diabetes are getting better access to medical care in states that have expanded Medicaid coverage through the Affordable Care Act, suggests a new study that provides one of the first indications of the sweeping law's health effects. Residents of other states are at risk of being left behind. The number of Medicaid patients with newly identified diabetes surged 23% in states that expanded their programs, an option provided by the law, but there was virtually no increase in states that declined to expand coverage, researchers found. (Levey, 3/23)
The New York Times:
Health Care Systems Try To Cut Costs By Aiding The Poor And Troubled
More than 11 million Americans have joined the Medicaid rolls since the major provisions of the Affordable Care Act went into effect, and health officials are searching for ways to contain the costs of caring for them. Some of the most expensive patients have medical conditions that are costly no matter what. But a significant share of them — so-called super utilizers like Mr. Pate — rack up costs for avoidable reasons. Many are afflicted with some combination of poverty, homelessness, mental illness, addiction and past trauma. (Tavernise, 3/22)
The Associated Press:
On 5th Anniversary Of Health Care Law, No End To Debate
When President Barack Obama signed the Affordable Care Act five years ago, he visualized a time when the political hyperbole would be silenced and ordinary people would see that the health care law improved their lives. The White House ceremony on March 23, 2010, was an applause-filled celebration. "When I sign this bill," Obama said, "all of the overheated rhetoric over reform will finally confront the reality of reform." (Alonso-Zaldivar, 3/22)
The New York Times:
Under Health Care Act, Many Tax Filers Are Discovering Costly Complications
This filing season, for the first time, millions of Americans are facing tax implications — and new forms that even seasoned preparers are finding confusing — related to their health insurance status. The changes are not only complicating things for tax filers, but also costing many of them money. Under the Affordable Care Act, people who remained uninsured last year must either pay a penalty with their taxes, one of the most contentious elements of the law, or claim an exemption. ... And people who did get insurance but, like Mr. Ciesielski, underestimated their income for 2014 — the figure on which subsidies are calculated — are being required to pay back part of their subsidy. (Goodnough, 3/21)
The Wall Street Journal:
Many Uninsured Choose Penalty Over Enrollment Offer Under Health Law
A special enrollment period to obtain health insurance for millions of uninsured people who owe a tax penalty under the Affordable Care Act is off to a slow start. The health law requires most Americans to have insurance or pay a fine at tax time. The open enrollment period under the health law ended Feb. 15, but the Obama administration said it would allow people who discover they owe a fine to sign up for coverage through April, at the end of the tax season. Major tax-preparation firms say many customers are paying the penalty and not getting health insurance. (Armour, 3/20)
The Associated Press:
Small Businesses Struggle With Health Care Law
Complying with the health care law is costing small businesses thousands of dollars that they didn't have to spend before the new regulations went into effect. Brad Mete estimates his staffing company, Affinity Resources, will spend $100,000 this year on record-keeping and filing documents with the government. He's hired two extra staffers and is spending more on services from its human resources provider. (Rosenberg, 3/22)
The Wall Street Journal:
Paul Ryan Urges State Lawmakers Not To Set Up Health-Insurance Exchanges
Rep. Paul Ryan urged state lawmakers to resist setting up state insurance exchanges if the Supreme Court rules that key parts of the Affordable Care Act can only continue if they do so. “Oh God, no…The last thing anybody in my opinion would want to do, even if you are not a conservative, is consign your state to this law,” the Wisconsin Republican told state legislators Thursday during a conference call organized by the Foundation for Government Accountability, a conservative think-tank. The foundation provided a recording of the call. (Radnofsky, 3/20)
The Associated Press:
Healthcare.gov Sending Out Corrected Forms
The Obama administration said Friday it's making progress trying to correct a tax-form error that affected 820,000 customers of HealthCare.gov. Administration officials said 740,000 corrected forms have gone out to consumers in the federal insurance marketplace, and another 80,000 will be mailed next week. (3/20)
The Associated Press:
Divisive Issue Of Abortion Stalls Human Trafficking Bill
The Senate's 100 members don't agree on much. They agreed they wanted legislation to help the victims of sex trafficking. Then the bill got caught up in the emotional and uncompromising politics of abortion. Now the Justice for Victims of Trafficking Act is stalled, its outlook uncertain. Democrats are insisting Republicans remove an abortion funding provision. Republicans are refusing to do so and demanding that Democrats back down. (Werner, 3/21)
The Wall Street Journal:
Tenet Healthcare Nearing Deal To Buy United Surgical Partners
Tenet Healthcare Corp. is nearing a deal to buy United Surgical Partners International Inc., as a number of hospital networks seek mergers amid sweeping changes in the U.S. health-care system. A deal between the companies, which could be valued at more than $2.5 billion, including debt, might be announced as early as Monday, according to people familiar with the matter. It is also possible the deal could fall apart at the last minute. (Tan and Cimilluca, 3/22)
The Wall Street Journal:
Should The U.S. Move Away From Fee-for-Service Medicine?
Fee-for-service medical care, in which providers charge fees for specific services, is a prime battleground for policy makers in health care. If providers stand to make more money the more tests and procedures they perform, critics of the system say it’s no wonder that health-care costs have skyrocketed in recent years. Efforts are under way to reimburse providers based on the value, not the volume, of care—including paying doctors to keep patients healthy. Medicare plans to shift 50% of its payments to such programs by 2018. (3/22)
Los Angeles Times:
How Did Hospital Bills Get So Complicated?
As recently as 1969, delivering a baby in Morristown, N.J., could cost parents as little as $235.65 — a flat, all-inclusive rate for a three-day hospital stay and doctors' fees. I know this because that was the price on the receipt from my birth at Morristown Memorial Hospital. My father recently found it in a pile of old papers. ... The simple, one-page document lists my parents' names, the total cost of care and just three options for payment: cash, check or money order. There were no co-pays, co-insurance or deductibles to meet. My parents didn't receive an onslaught of bills once they left the hospital. (Zamosky, 3/22)
The Wall Street Journal:
What Measures Should Be Used to Evaluate Health Care?
The push to pay for quality, not quantity in health care is rapidly accelerating. Doctors and hospitals are being evaluated on myriad quality metrics by rating services, insurance companies, professional groups and government programs—with results increasingly tied to financial penalties or bonuses. But payers, providers and patients don’t always agree on what quality means, and there is no official set of standards. (Beck, 3/22)
The Wall Street Journal:
Do The FDA’s Regulations Governing Medical Devices Need To Be Overhauled?
Medical devices can save lives, but in recent years it has become clear how hazardous they are when they malfunction: metal hips that fail; bloodstream filters that fracture and prove lethal; defibrillator wires that break down. The Food and Drug Administration works at striking the proper balance between insisting on safety but not standing in the way of innovative products that promote health and well-being. In doing so, it’s dealing with increasingly complex products of the software and digital age, including some aimed directly at consumers, such as medical apps. (Burton, 3/22)
The New York Times:
Biogen Reports Its Alzheimer’s Drug Sharply Slowed Cognitive Decline
An experimental drug for Alzheimer’s disease sharply slowed the decline in mental function in a small clinical trial, researchers reported Friday, reviving hopes for an approach to therapy that until now has experienced repeated failures. The drug, being developed by Biogen Idec, could achieve sales of billions of dollars a year if the results from the small trial are replicated in larger trials that Biogen said it hoped to begin this year. Experts say that there are no really good drugs now to treat Alzheimer’s. (Pollack, 3/20)
The Wall Street Journal:
Biogen’s Alzheimer’s Drug Impresses In Early Trial
A Biogen Idec Inc. drug that targets plaque buildup in the brain slowed cognitive decline in patients with early and mild forms of Alzheimer’s disease in a small, early-stage study, lifting the company’s stock to all-time highs and adding to the debate on how to treat the debilitating disease. (Walker, 3/20)
The Wall Street Journal:
Charges Against Sen. Robert Menendez Expected As Early As This Week
The Federal Bureau of Investigation has been investigating Mr. Menendez for more than two years, these people said. The specific charges weren’t immediately clear, but the agency has been probing whether Mr. Menendez took things of value from a friend and donor Salomon Melgen, a prominent Florida eye doctor who is facing a probe into his billing practices, according to people familiar with the probe. After the investigation began, Mr. Menendez paid Dr. Melgen back nearly $60,000 for two round-trip flights on a private plane to the Dominican Republic, trips that the senator didn’t initially report on disclosure forms, aides have said. The FBI has also examined whether the senator improperly sought to help the doctor in his billing probe and whether Mr. Menendez may have improperly used his influence with the Department of Homeland Security on behalf of the doctor on an unrelated issue, according to people familiar with the investigation. (Barrett, 3/22)
The New York Times:
Prosecution Of Senator In 2008 Looms Over Menendez Case
Charges are expected against Mr. Menendez in the next few weeks, and comparisons to the Stevens case are sure to follow. But officials and others close to the investigation say Mr. Menendez’s case diverges in crucial ways from the one brought against Mr. Stevens, which was dismissed after prosecutors were found to have withheld evidence.
Most important, prosecutors never charged Mr. Stevens with doing anything in return for his gifts. The Justice Department’s case against Mr. Menendez, by contrast, appears to be going much further. Prosecutors believe Mr. Menendez used his office to help Salomon Melgen, a Florida eye surgeon who was a major donor to Mr. Menendez and the national Democratic Party. The department is weighing charges of bribery or accepting gratuities, according to people close to the case. (Apuzzo, 3/23)
Los Angeles Times:
Sen. Robert Menendez Case Tests Justice Department's Anti-Corruption Unit
A decision to file criminal charges against Menendez and a Florida doctor, Salomon Melgen, is expected soon, according to government officials briefed on the case. Menendez is suspected of receiving gifts in return for helping Melgen's business interests in the Caribbean. Both men deny any wrongdoing. Supporters of the anti-corruption unit say it has learned from its mistakes. It has sharpened its prosecutorial skills with dozens of state and local cases, and shifted its focus away from plea bargains toward winning cases at trial. The [Sen. Ted] Stevens case unraveled in part because the defense moved for a quick trial, catching the prosecution by surprise. (Serrano and Phelps, 3/22)
The Washington Post:
2015 Is Already The Year Of The Health-Care Hack — And It’s Only Going To Get Worse.
Last year, the fallout from a string of breaches at major retailers like Target and Home Depot had consumers on edge. But 2015 is shaping up to be the year consumers should be taking a closer look at who is guarding their health information. Data about more than 120 million people has been compromised in more than 1,100 separate breaches at organizations handling protected health data since 2009, according to Department of Health and Human Services data reviewed by The Washington Post. (Peterson, 3/20)
ProPublica:
Despite Wave Of Data Breaches, Official Says Patient Privacy Isn’t Dead
The task of investigating medical data breaches falls to the Office for Civil Rights, a small agency within the Department of Health and Human Services. Its staff of about 200 investigates thousands of complaints every year, large and small. Last month, ProPublica reported how, as the number of breaches has increased, the office infrequently uses its authority to fine organizations and health providers that fail to safeguard patient records. ... [The office’s director, Jocelyn Samuels,] sat down with ProPublica to talk about the current state of health privacy. (Ornstein, 3/20)
NPR:
Wireless Sensors Help Scientists Map Staph Spread Inside Hospital
Staph infections are common problems in health care facilities, and many Staphylcoccus aureus bacteria are now resistant to drug treatment. ... But wouldn't it be cool to track in detail how staph moves from person to person in the real world? Some French researchers tested a way to do it. They outfitted 261 health care workers and all 329 patients in a long-term care hospital with wireless sensors that recorded their interactions with one another every 30 seconds. (Henley, 3/20)
Los Angeles Times:
Blue Shield Seeks To Avoid Disclosing Its Price For Care1st
Nonprofit insurer Blue Shield of California, already under scrutiny for its huge cash reserves and lack of disclosure, is refusing to say how much it's spending to acquire a Monterey Park insurance company and is seeking confidentiality from state regulators. The California Department of Managed Health Care said Friday it was still weighing Blue Shield's request for confidentiality after receiving a public-records request from The Times and being asked to hold a public hearing on the deal by a former company official. (Terhune, 3/20)