Health and Fitness

Congressional Leaders Urged To Reach Agreement On Health Reform

The American College of Physicians (ACP) has urged Congressional leaders to "reach agreement on a legislative pathway to provide affordable care to all Americans and ensure that they have access to primary care physicians and other specialties facing shortages." In a letter to key legislators, ACP President Joseph W. Stubbs, MD, FACP, said: "We agree with the President that Congress must complete the task of enacting comprehensive health reform legislation consistent with the above priorities. The bills passed by the House and Senate advance many of the elements needed to achieve a sustainable, affordable and high quality health care system for all Americans." "We also are aware that Congress now is considering a number of options to move health reform legislation forward in a way that would build upon but improve the existing bills, " Dr. Stubbs continued as he urged adoption of five ACP priorities: Create a pathway to providing affordable coverage to all Americans. The bills passed by the House and Senate would provide coverage to 94-96 percent of all legal residents.

States Deal With Small Budgets, Medicaid Cuts

Virginian-Pilot : Area hospitals are preparing "for a round of Medicaid spending cuts that executives say could be the worst in decades and lead to more cutbacks in their organizations. Rising health care costs and a surge in the number of Medicaid patients have increased the state's obligation to the government health insurance program for the poor and disabled by $777.7 million over two years. The state also must find $1.2 billion to replace stimulus money that the federal government provided last year to help Virginia cope with rising health care demands and declining state revenue. That funding stops at the end of this year." Former Gov. Timothy M. Kaine recommended in his budget proposal that Medicaid payment rates for hospitals be frozen. The General Assembly is trying to set a budget that deals with that as well as absorb a $1.9 billion shortfall in state revenues (Jeter, 2/8). In a separate article, the Virginian-Pilot reports that Medicaid funding for the disabled is also being cut: "Not only is there no additional funding for the Medicaid waiver program that helps families keep disabled or elderly relatives at home instead of at institutions, but there's a one-year freeze on the existing waivers.

Feeding Tube Use More Likely At Big, For-Profit Hospitals

Larger, for-profit hospitals may be using too many feeding tubes on patients with advanced dementia without improving the quality of their care, a study finds, according to HealthDay News/Business Week. "Our results suggest that decisions about feeding tubes are more about which hospital you go to than a decision-making process that really elicits and supports patient choice, " said the physician who led the study, which appears in today's Journal of the American Medical Association. "For-profit hospitals, along with facilities that had 310 beds or more and those that had the most use of intensive care during the last six months of a person's life, were more likely to use feeding tubes, " HealthDay reports. One reason that feeding tubes tend to be overused in general is that the Medicaid and Medicare systems include conflicting incentives. Nursing homes that receive Medicaid reimbursements have an incentive to send patients to hospitals, where Medicare will reimburse their care, the physician-researcher said (Gardner, 2/9).

Study: Medicare Bladder Cancer Treatment Policy Raises Health Costs

Reuters : " Medicare's move in 2005 to pay doctors to do bladder cancer surgery in their offices rather than in hospitals dramatically raised the number of procedures and overall health costs, U.S. researchers said on Monday. ... The findings reflect the complexity of cutting health costs in the United States, showing how in some cases Medicare -- the insurance program for the elderly and disabled -- gives doctors incentives to provide too much care, they said." "Bladder cancer is the most expensive of all cancers to treat, with an average cost from diagnosis to death ranging from $96, 000 to $187, 000, according to [Dr. Micah Hemani, a bladder cancer expert] and colleagues. In theory, the Centers for Medicare and Medicaid Services decision in 2005 to pay doctors extra to do the procedure in their offices would cost less than doing it in a hospital, he said. Instead, the number of outpatient bladder cancer procedures in Hemani's group practice doubled after the Medicare pay hike and costs to Medicare rose 50 percent overall.

Increased Co-payments For Doctor Visits Boost Health Care Costs For Seniors

For years many health experts believed that increasing insurance co-payments for routine doctor visits helped control costs. Patients faced with the higher price tag, they theorized, would simply cut back unnecessary visits, saving themselves and insurers money. Brown University researchers now believe that the practice of increasing co-payments for outpatient visits - at least for senior citizens - may actually make care far more expensive. They determined that patients faced with higher co-payments did cut back on their doctor visits. But those same elderly patients ultimately required expensive hospital care because their illnesses worsened. The finding, to be detailed in the Jan. 28, 2010, edition of The New England Journal of Medicine, has implications for insurers and politicians seeking ways to control costs but also improve quality of care. "It is a lose-lose proposition for most health plans, " said Dr. Amal Trivedi, the study's lead author. "Our study suggests that when you raise co-payments for ambulatory care among elderly beneficiaries, particularly those with low incomes, lower education and chronic disease, they do cut back on their outpatient care but are more likely to need expensive hospital care.

Research Roundup: Medicare Spending, Community Health Centers, Children's Dental Services

Health Affairs : Prices Don't Drive Regional Medicare Spending Variations - "Per capita Medicare spending is more than twice as high in New York City and Miami than in places like Salem, Oregon. How much of these differences can be explained by Medicare's paying more to compensate for the higher cost of goods and services in such areas?" After performing a price-adjustment analysis on Medicare spending in 306 Hospital Referral Regions, the authors - most from Dartmouth Institute for Health Policy - found that "utilization - not local price differences - drives Medicare regional payment variations, along with special payments for medical education and care for the poor." The study "has also demonstrated there are also substantial variations in what Medicare pays for the same medical services across regions - particularly for Part A hospital services" (Gottlieb et al., 1/28). Kaiser Family Foundation : Medicare Advantage 2010 Data Spotlight: Benefits and Cost-Sharing - "This data spotlight examines trends in benefits and cost-sharing for Medicare Advantage plans in 2010, including the wide variations found across plans.

Landrieu Defends 'Louisiana Purchase' In Senate Remarks

Sen. Mary Landrieu, D-La., won a $300-million Medicaid bonus for her state during health overhaul negotiations, spawning a wave of criticism that Democratic leaders needed to make the so-called "Louisiana purchase" to secure her support for their reform bill. On Thursday, she defended the action, saying during a Senate floor speech, "I make no apologies for leading this effort. I do not back up an inch, " The (New Orleans) Times-Picayune reports. She challenged Republican senators to confront her on the spot Thursday or "keep their mouths shut" (Tilove, 2/4). The remarks came after conservative talk show hosts Glenn Beck and Rush Limbaugh called Landrieu a "prostitute" for cutting the deal, the Associated Press/Washington Post reports. She maintains that her vote for the health overhaul was not connected to the $300-million boost. The state's Republican governor, Bobby Jindal, supported Landrieu's efforts to obtain the Medicaid funding, but opposed the bill and dodged questions about the propriety of Landrieu's getting the money included in the Senate overhaul bill, saying "'I'm not a member of Congress.

Dems May Add Health Provisions - Including COBRA Subsidies And Medicare Fixes - To Jobs Bill

Lawmakers may include a number of Medicare "fixes" in the jobs bill, now that the health overhaul bill has stalled, The Hill reports. They would include restoring Medicare provisions that expired Jan. 1 or are set to expire later this year. "Nursing homes and rehabilitation therapy providers, along with patient groups, are pushing legislation to undo a hard-dollar cap on Medicare coverage of physical, speech and occupational therapy. Hospitals are seeking to restore special payments to large rural and small urban hospitals. Physicians also are pursuing the reinstatement of bonuses to rural doctors. Doctors are also clamoring for action to prevent a 21 percent cut in their Medicare payments that looms March 1." Senate Finance Committee Chairman Max Baucus, D-Mont., is preparing an "extenders" package to deal with the issues, and the House Ways and Means Committee is drafting its own extender (Young, 2/7). The physician's change may be possible because of an exception to Congress's new "pay-as-you-go" rules, McKnight's reports.

Millions More Children Added To Medicaid, CHIP Rolls In 2009

Kaiser Health News staff writer Phil Galewitz reports on a federal study released yesterday. Its findings offered the following message regarding previously uninsured children: "Just because Congress hasn't passed a health overhaul bill doesn't mean there hasn't been any expansion of health coverage" (Kaiser Health News). Read entire story. This information was reprinted from with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at © Henry J. Kaiser Family Foundation. All rights reserved.

N.J., Tenn. And Florida Battling Growing Medicaid Costs; Need For Health Care For Parolees In Calif.

Medicaid costs in many states are expanding deficits while lawmakers and the public struggle to keep up with the growth in health costs. NJBIZ reports, New Jersey's budget deficit has grown $170 million to $180 million because of Medicaid costs, according to a legislative budget officer. "Savings in the Medicaid program that were projected for this year have not materialized, according to David J. Rosen, budget and finance officer for the nonpartisan Office of Legislative Services. ... Rosen said the amount of sales tax revenue collected in December will likely grow, which would be the first month of year-over-year growth this year" (Kitchenman, 2/4). In Tennessee, some hospitals could face closure because of the fiscal struggles of TennCare, that state's Medicaid program, the Nashville Business Journal reports. The program has been targeted for $201 million in cuts. "With the budget on the table, Middle Tennessee hospitals are crunching numbers to determine what impact the proposed TennCare cuts - the largest in the program's 16-year-history - will have on their bottom lines.

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