Changing News Archive - May, 2010

The federal government will bear virtually the entire cost of expanding Medicaid under the new health-care law, according to a new study by the Kaiser Family Foundation that rebuts governors' protests about the impact on strapped states.

Roughly half of the increase in health insurance coverage under the new law is expected to come from expanding Medicaid in 2014 with a new nationwide eligibility threshold of 133 percent of the poverty level -- $14,400 for a single adult or $29,300 for a family of four, under the current guidelines. A disproportionate share of the 16 million people expected to enroll in the expanded Medicaid live in states in the South and West that have stringent eligibility rules for low-income adults.

Governors of many of those states predict fiscal calamity, and some have cited the Medicaid expansion in the lawsuits they have filed against the new law, saying it violates their states' rights. But the Kaiser study released Wednesday predicts that the increase in states' spending will be relatively small when weighed against the broad expansion of health coverage for their residents and the huge influx of federal dollars they will receive.

An ugly and very public fight between the prestigious City of Hope Medical Center and its 187-member group of cancer specialists threatens the reputations and stability of both as it has frightened many of the patients in their care.

The American Medical Association yesterday released its new Code of Conduct, a list of dos and don'ts that it says all health insurers should enforce.

The physician group says it hopes to publish a scorecard showing which plans play by these rules in a few years, in time for the launch of health exchanges enabled by health reform legislation.

WASHINGTON – The Premier healthcare alliance is launching two collaboratives designed to help hospital systems prepare and qualify to participate in accountable healthcare organizations (ACOs).

The ACO Implementation Collaborative and the ACO Readiness Collaborative will include 19 health systems in 15 states, involving 70 hospitals, more than 5,000 physicians and 1.2 million patients, according to Premier President and CEO Susan DeVore. The development of ACOs is supported by the healthcare reform law and is one of the latest ideas for promoting efficient quality healthcare, said Sen. Max Baucus (D-Mont.) at a press conference Thursday.

DeVore called the ACO movement "the next layer in healthcare."

Non-profit hospital chiefs who think they've been dragged through the wringer with the credit crunch and the recession should not think the worst is over, according to a new Moody's Investor Service report, which could be summed up in short:

Brace yourselves for more bad news and changes for many years ahead.

"The degree of change facing hospitals under healthcare reform and other industry structural shifts is even more fundamental" than the change hospitals experienced with the DRG payment transition in the 1980s, Moody's says, "touching all aspects of hospital operations and capital strategies."

SEATTLE – The average total 2010 medical spending for a "typical American family of four" reached $18,074, an increase of $1,303 over last year, according to new research by actuarial firm Milliman, Inc. The total-dollar increase is the highest in the history of this study.

The Milliman Medical Index (MMI) tracks the changes in average yearly healthcare costs when the family of four is covered by an employer-sponsored preferred provider organization (PPO).

The Centers for Disease Control and Prevention (CDC) has recently confirmed the 11th case of vancomycin resistant Staphylococcus aureus (VRSA) infection since 2002 in the United States. This serves as a reminder about the important role of clinical laboratories in the diagnosis of VRSA cases to ensure prompt recognition, isolation, and management by infection control personnel. This is an important opportunity for all laboratories to revisit their step-by-step problem-solving procedure or algorithm for detecting VRSA that is specific for their laboratory. A sample algorithm is available at http://www.cdc.gov/ncidod/dhqp/ar_visavrsa_algo.html and highlights the recommended testing methodologies for detecting VRSA and actions based on testing results.

President Obama plans to nominate Solicitor General Elena Kagan to be the 112th justice of the Supreme Court, sources said late Sunday night.

Obama is expected to make the announcement mid-morning Monday in the East Room, accompanied by Kagan. He informed his advisers about the choice on Sunday, after spending nearly a month looking at candidates. But he settled relatively early on Kagan, whom he had considered during the last Supreme Court vacancy, said sources familiar with the process, who spoke on the condition of anonymity because the decision has not been announced.

A compromise state health plan for the very poor, on the verge of collapse just a few days ago, was rescued this week when the Pawlenty administration changed course and negotiated with participating hospitals to limit the number of patients each will see.

As a result, Hennepin County Medical Center and three other metro hospitals will participate in a slimmed-down version of General Assistance Medical Care (GAMC), a health plan for thousands of Minnesota's poorest and sickest residents. The four hospitals serve about 47 percent of the current 36,426 enrollees, none outstate. The remaining 144 Minnesota hospitals will treat patients and dip into a $20 million fund for that purpose.

WASHINGTON – Health and Human Services Secretary Kathleen Sebelius has written to governors and state insurance commissioners urging them to re-examine any WellPoint health insurance rate increases in their states.

The letter comes after Anthem Blue Cross, a WellPoint affiliate, withdrew its plan to raise premiums in California by as much as 39 percent when auditors found the rate hikes were based on unreasonable assumptions about the rate at which medical costs are increasing.

LifePoint Hospitals, Brentwood, Tenn., announced the proposed acquisition of a bankrupt four-hospital system in northern Tennessee just days after the investor-owned operator confirmed the purchase of another hospital in Kentucky.

The 49-hospital LifePoint announced today it intends to purchase Sumner Regional Medical Center, which is based in Gallatin, Tenn., and owns a critical-access hospital and three larger acute-care providers. Sumner declared bankruptcy on April 30, which means the purchase will be governed by a court-directed bidding process and subject to a judge's approval. LifePoint hopes to finish the deal by the end of the summer.