Tag Archives: Kaiser Medicare News

Home Health Care Agencies May See $180M In Medicare Cuts In 2017

The Tennessean:
Lawmakers Head To DC To Present Health Care Plan To Feds

A small group of lawmakers will head to Washington, D.C., Tuesday to meet with federal regulators as part of an effort to work toward improving access to health care coverage for uninsured Tennesseans.
The group — formally known as the “3-Star Healthy Project” — will meet with officials from the U.S. Centers for Medicare and Medicaid Services and present a plan that will include creating a two-phased approach that will focus on finding ways to address the needs of uninsured veterans and those struggling with behavioral health issues, Rep. Cameron Sexton, R-Crossville, told The Tennessean Monday. (Ebert, 6/27)

Viewpoints: Resistance To Insurance Mega-Mergers; Different Takes On Medicare Part B Drug Cost Experiments

Cleveland Plain Dealer:
AIDS Drugs Come With Their Own Set Of Problems: Robert Toth

Nowadays people with HIV, like myself, are not dying of rare exotic parasites or cross-species diseases anymore. It’s the simple things like stroke, heart attack, diabetes, kidney failure, things “old folks” are supposed to get, not 50-year-olds. Now there’s talk of HIV-related hearing and memory loss. For many of us long-term survivors of AIDS, our gears are being shredded by the very treatments that are keeping us alive but accelerating old age. (Robert Toth, 6/26)

State Highlights: Colo.’s Licensing For Health Care Workers Doesn’t Require Background Checks; In Philadelphia Area, For-Profits Are Moving Into Nursing Home Market

Outlets report on health news from Colorado, Pennsylvania, New Jersey, Missouri, Florida, California, Texas, Tennessee and Ohio.

The Philadelphia Inquirer:
For-Profits Are Snapping Up Nursing Homes

Nonprofits sell facilities for many reasons: They need the money, change their mission, or succumb to financial pressures on the industry largely caused by heavy reliance on the federal government’s low-paying Medicaid program. Whatever the reason, the shift of 5,000 beds comes at a critical time. (Brubaker, 6/24)

St. Louis Post Dispatch:
Welcome To Death Café, A Place To Discuss End-Of-Life Decisions

Death Café was founded in London in 2011 by Jon Underwood, who was concerned that discussions about death had been co-opted by doctors, funeral directors and religious leaders. He wanted everyone to feel comfortable talking about one of life’s most important events. The groups have expanded worldwide, including outposts in St. Louis County, St. Charles and Belleville. (Bernhard, 6/27)

Florida Cracks Down On Troubled For-Profit Facility For The Disabled

After years of tepid action, Florida officials are moving to intensify monitoring and remove residents from a sprawling complex for the disabled that has a long history of abuse and neglect. The state is taking the unusual step of stationing an investigator at the Carlton Palms Educational Center and forming a special team to closely watch over staff and residents, documents obtained by ProPublica show. Residents will eventually be relocated to new homes. (Vogell, 6/24)

San Francisco Chronicle:
Meningococcal Outbreak Prompts SF Warning On Pride Weekend

A meningococcal outbreak in Southern California that has mostly infected gay men prompted San Francisco health officials Friday to issue a warning on the eve of Pride weekend and a plea for people to get inoculated against the disease. The warning came after state health officials announced that nine people in the Los Angeles and Orange County area have tested positive for the bacterial disease, which is spread through nose and throat secretions. One of them died from the infection. “Here in San Francisco it is Pride week, with lots of visitors from around the state, the country and the world coming to town to celebrate,” Dr. Naveena Bobba, deputy health officer for San Francisco, said in a statement. (Veklerov, 6/24)

The Austin Statesman:
UT To Open Medical School In Austin After 135 Years

The University of Texas will open an Austin medical school in July nearly 135 years after the university was founded in the city without one, the Austin American-Statesman reported Saturday. When the university system was established in 1881, Texas voters decided the main university would be in Austin and the medical school in Galveston, then the largest Texas city, where it remains. The medical school’s backers say that it will improve health care for Austin’s low-income residents and spur economic development. (6/25)

Houston Chronicle:
Houston Area Seen As A Major Hub For Medicare Fraud

The “patients” were rounded up at McDonald’s near the downtown bus station, lured by the promise of $50 or $100 and a free ride to a Houston clinic if they reported neck, back or hip pain, or other vague complaints. The clinic physician noted the symptoms and ordered costly diagnostic tests – renal ultrasounds, electrocardiograms, anal sphincter exams – at Medicare’s expense. (Banks, 6/24)

The Tennessean:
Nashville Health-Care Entrepreneurs, Village Capital Team Up

Village Capital, an investment nonprofit focused on global issues, will be working with Nashville health-care entrepreneurs to provide digital solutions targeting low-income patients as part of a partnership with the Nashville Entrepreneur Center. Village Capital, along with Michigan-based The Kresge Foundation, chose Nashville, Philadelphia and San Francisco for its initiative.(McGee, 6/24)

The Dallas Morning News:
Second Texas Man Could Lose Leg To Flesh-Eating Bacteria

A Buda man who traveled to Port Aransas to enjoy the Father’s Day weekend with his family is now fighting an infection from a flesh-eating bacteria…Within a few days, [his rash] got worse and a doctor diagnosed him with Vibrio vulnificus — a bacteria caused by eating under-cooked shellfish or getting contaminated water into a cut or open wound. (Cardona, 6/27)

The Columbus Dispatch:
Central Ohio School Districts Weigh Later Starts To School Day

The drumbeat for later starting times for school seems to be getting louder. This month, the American Medical Association joined the American Academy of Pediatrics in calling on middle schools and high schools to start no earlier than 8:30 a.m. Chronic sleep deprivation among teenagers, the groups say, can impair immune systems and lead to unhealthy body weight, poor memory and mood disorders. (Gilchrist, 6/27)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Colon Cancer Screening: Five Things To Know

Story updated at 10:02 am

It’s a predictable passage in life: Hit 50, get lots birthday cards with old-age jokes, a mailbox full of AARP solicitations — and a colonoscopy.

But millions of Americans — about one-third of those in the recommended age range for colon cancer screening — haven’t been tested. Some avoid it because they are squeamish about the procedure, or worried about the rare, but potentially serious, complications that can occur as a result of it.

Now, an influential panel has added some new choices, aiming to get more Americans screened for colorectal cancer, which is the second leading cause of cancer death in the U.S.

Here are five things you need to know:

1. Getting tested — in any of a variety of ways — is a good thing.

Following its review of all the available medical evidence, the U.S. Preventive Services Task Force — an independent blue-ribbon panel of medical experts — updated its colorectal cancer screening guidelines last week. The panel gave an “A” rating to screening all adults between ages 50 to 75 years at average risk of the disease, saying the benefits are “substantial.” People with a family history or other risk factors might want to start earlier — and those older than 75 should talk with their doctors about whether to continue screening.

Noting that not enough Americans are getting screened, the panel essentially said the best test is the one that patients will take: “The goal is to maximize the total number of persons who are screened because that will have the largest effect on reducing colorectal cancer deaths.”

2. Two less-invasive tests may qualify for free preventive screening.

The biggest change from prior guidelines is the panel’s inclusion of two more ways to screen for the disease, including “virtual colonoscopies,” like President Barack Obama underwent in 2010. Also called computed tomography (CT) colonography, the test uses special X-ray machines to examine the colon. The panel also added a $650 home test called Cologuard, which checks stool for elevated levels of altered DNA that could indicate cancer. Those tests join several others that were part of the panel’s previous recommendations: the full colon exam called colonoscopy; sigmoidoscopy, which uses a lighted tube and camera to examine just the lower portion of the colon; and two other types of home stool tests, fecal occult-blood tests (gFOBT) and fecal immunochemical tests (FIT). Because of the task force’s “A” rating for colon cancer preventive screening these tests generally must be offered to insured patients without a copayment or deductible under the rules put in place by the Affordable Care Act.

3. Don’t expect all insurers to drop co-pays on the new tests right away.

While Medicare already covers Cologuard as a preventive screening tool, many private insurers do not. Of people with private insurance who are in the target age range, about one in four currently have coverage for the test, said Kevin Conroy, president and CEO of Exact Sciences, which makes the test. “That’s going to change,” he said, “because health plans have told us that they will follow the task force’s guidelines.”

When it comes to virtual colonoscopies, some insurers — including Cigna — cover them, but Medicare does not. In 2009, Medicare said there was insufficient medical evidence to determine if such tests should be covered nationally.

Now Medicare will likely be asked by proponents of virtual colonoscopy to revisit that decision.

Under the ACA, insurers have up to a year to incorporate “A”-or “B”-rated screening tests into their benefit packages without a copayment. But there is some ambiguity in this case because the screening itself – not the individual tests – was given the A rating. While many experts believe insurers must offer all the types of tests, that isn’t entirely clear. Insurers and patient advocate groups both say they will seek additional clarity from the Obama administration.

4. The task force didn’t pick favorites.

The panel did not rank the tests, noting a lack of head-to-head comparisons showing any one method has the most net benefit. All tests have pros and cons. For example, getting a colonoscopy every 10 years has the advantage that, if potentially cancerous polyps are detected, they can be removed during the procedure. But it also carries a small risk of harmful complications, such as anesthesia-related cardiac problems, bowel perforations or abdominal pain. Sigmoidoscopy at 5-year intervals has a lower rate of complications, but can miss some cancers because it doesn’t reach the entire colon. Annual stool tests, which don’t themselves carry any risk, reduce colorectal cancer deaths, the panel noted. The newer FIT immunochemical stool tests are a bit better at spotting cancers than FOBT, which studies show can correctly identify cancers 62 percent to 79 percent of the time. Cologuard — recommended every one to three years — detects existing cancers 92 percent of the time, but has a higher false-positive rate than FIT. Virtual colonoscopies, which expose patients to X-ray radiation, spot existing cancers of 10 millimeters or larger 67 percent to 94 percent of the time. The exam can also lead to additional, sometimes unnecessary testing because it flags potential problems outside the colon 40 percent to 70 percent of the time, with only about 3 percent of those concerns ultimately needing some form of treatment, the panel noted. The guidelines also mentioned a blood test, SEPT9, but noted that it detected only 48 percent of existing cancers.

5. You might still get hit with a copayment.

Although preventive screening is covered without copayments or deductibles, some patients still end up with a bill. Medicare, most notably, requires a 20 percent copayment if a polyp is found during a screening colonoscopy and removed. That payment averages $272, although advocates say they have seen far higher bills. Most private insurers do not charge patients if a polyp is found during a preventive screening, following Obama administration clarifications on the topic.

Two bills in Congress aim to apply those same rules to Medicare.

Another way consumers can get hit with a copayment is if a stool test, sigmoidoscopy or other exam indicates cancer might exist. A colonoscopy is then performed and some insurers consider that test a “diagnostic” exam, rather than a preventive screening. The American Cancer Society Cancer Action Network says it has asked the administration to clarify what happens in such a case. “If a patient has a positive test, the next step is colonoscopy, and therefore should be covered without cost-sharing,” said Caroline Powers, director of federal relations with ACSCAN. “We’re trying to get more people screened.”

Categories: Aging, Cost and Quality, Insurance, Medicare, Syndicate

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300 Charged In Largest Takedown Of Medicare, Medicaid Fraud In U.S. History

Los Angeles Times:
Nation’s Biggest Healthcare Fraud Probe Nets 301 People, Including 22 In Southern California

In Southern California, five physicians were among those arrested in cases involving $125 million in elaborate fraud schemes that targeted Medicare and the military’s medical plan and involved medical billing, unnecessary procedures and high-priced specialized compound medications. The charges in 13 criminals cases filed in federal courts in Los Angeles and Santa Ana include conspiracy, money laundering, kickback schemes and identity theft, according to several federal indictments. (Winton, 6/22)

Viewpoints: Possible Increases Ahead For Medicare’s Part B Premiums; Health Care As A Driver Of Wage Inequality

The Wall Street Journal:
House Republicans Have A Better Idea

Donald Trump has already squandered six weeks by insulting a “Mexican” judge born in Indiana, offering conspiracy theories, and needlessly attacking defeated rivals. His fundraising is dismal and his staffing inadequate. All this comes at the expense of focused attention on his Democratic opponent. … Meanwhile, the Republican House is methodically laying out a comprehensive agenda to spread prosperity, protect the nation, uphold the Constitution, reform health care. … Last week, the House GOP also released a detailed proposal to replace ObamaCare with a package of reforms centered on the patient and doctor. These include making health insurance portable so workers can take it from job to job, increasing the use of health savings accounts, permitting insurance sales across state lines, allowing small businesses and individuals to band together to get lower prices, expanding wellness programs and reforming medical liability. (Karl Rove, 6/22)

Medicare Fund Could Be Depleted By 2028, Trustees Say

The New York Times:
Medicare And Social Security Trustees Warn Of Shortfalls

The Obama administration said Wednesday that the financial outlook for Medicare’s hospital insurance trust fund had deteriorated slightly in the last year and that Social Security still faced serious long-term financial problems. The report, from the trustees of the two programs, could inject a note of fiscal reality into a presidential campaign that has given scant attention to the government’s fiscal challenges as the population ages. Hillary Clinton, the presumptive Democratic presidential nominee, has proposed increasing Social Security benefits and allowing people age 55 to 64 to “buy into” Medicare, while Donald J. Trump, the presumptive Republican nominee, has repeatedly said he would not cut either program. (Pear, 6/22)

State Highlights: N.H. Hospital Using New Strategies To Reduce Stays; In Vt., Insurers Must Cover Vasectomies

Georgia Health News:
Marietta-Based Firm To Build Lee County Hospital

Although many of the details surrounding Lee County’s plan to build a $50 million, 50-bed hospital on the property now occupied by Grand Island Golf Club are still unknown, it appears one of the parties involved is one of the nation’s foremost developers of medical and health care facilities. Henry Johnson, chief strategy officer of Marietta’s Freese Johnson LLC, confirmed Friday that his company “has been engaged” to build the new hospital. Johnson said that due to the many nuances of the project, and the fact that everything is still in the early stages, he could not share specific details about the county’s future hospital. (McEwen, 6/18)

Research Roundup: Changing Doctors’ Practices; ACO Performance; Nursing Home Abuse

The New England Journal Of Medicine:
Two-Year Costs And Quality In The Comprehensive Primary Care Initiative

The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 2012 to determine whether several forms of support would … improve the quality and reduce the costs of care at 497 primary care practices in seven regions across the United States. Support included the provision of care-management fees, the opportunity to earn shared savings, and the provision of data feedback and learning support. … During the first 2 years, initiative practices received a median of $115,000 per clinician in care-management fees. … Midway through this 4-year intervention, practices … have reported progress in transforming the delivery of primary care. However, … these practices have not yet shown savings in expenditures for Medicare Parts A and B after accounting for care-management fees, nor have they shown an appreciable improvement in the quality of care or patient experience. (Dale et al., 6/16)