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  • Website Launches Today Showing Drugmakers' Payments To Doctors

    The so-called Open Payments program is intended to shine a light on potential ethical conflicts and allow patients to look up their doctors online. The first batch of data, however, will be incomplete, covering only a few months at the end of 2013. Journalism website ProPublica says it has tracked 3.4 million payments to health professionals since 2009, totaling more than $4 billion.

    The Associated Press: Gov’t To Reveal Drug Company Payments To Doctors
    Striving to shine a light on potential ethical conflicts in medicine, the Obama administration is releasing data on drug company payments to tens of thousands of individual doctors. As conceived, the so-called Open Payments program was intended to allow patients to easily look up their own doctors online. That functionality won’t be ready yet. And although preliminary data to be released Tuesday will be incomplete, it’s expected to be useful for professional researchers (9/30).

    Propublica/NPR: 4 Years Of Lessons Learned About Drugmakers' Payments To Doctors
    On Tuesday, the federal government is expected to release details of payments to doctors by every pharmaceutical and medical device manufacturer in the country. The information is being made public under a provision of the 2010 Affordable Care Act. The law mandates disclosure of payments to doctors, dentists, chiropractors, podiatrists and optometrists for things like promotional speaking, consulting, meals, educational items and research. It's not quite clear what the data will show — in part because the first batch will be incomplete, covering spending for only a few months at the end of 2013 — but we at ProPublica have some good guesses. That's because we have been detailing relationships between doctors and the pharmaceutical industry for the past four years as part of our Dollars for Docs project (Ornstein, Grochowski Jones and Sagara, 9/29).

  • Senate Control Still Up In The Air As Democrats Shift Focus To Medicare, Other Popular Programs

    The strategy being employed by Democrats -- to nationalize the election by highlighting popular programs such as Medicare and Social Security as well as issues that resonate with younger voters -- is a regular approach during midterm elections. Meanwhile, in Virginia, Senate candidate Ed Gillespie promises to disclose specifics of his plans to replace the health law. 

    Los Angeles Times: As Election Nears, Control Of Senate Looks Surprisingly Uncertain
    Democrats have tried to shift the focus from a debate over big government, embodied by the unpopular national healthcare law, to the merits of popular programs, such as Social Security and Medicare, and issues that are especially resonant to minorities, young people and single women. All are Democratic-leaning voter groups that tend to sit out midterm elections. … That tactic — one party trying to nationalize the election, the other trying to make contests more localized and issue-specific — is also typical of midterm elections (Barabak and Mascaro, 9/29).

    Richmond Times-Dispatch: Gillespie Backs Debate, Vote On Use Of Force Against ISIL
    During an interview about five weeks before the election, [Virginia Senate candidate Ed] Gillespie also said he soon will disclose more specific proposals to replace the Affordable Care Act and to reform entitlement programs in order to preserve Social Security and Medicare for future generations (Cain, 9/29).

  • State Highlights: Calif. Health Laws Signed; Mass. Judge Considers Partners Deal

    A selection of health policy stories from California, Massachusetts, New York, the District of Columbia, Minnesota and Kansas.

    Kaiser Health News: Capsules: California To Launch Medicaid-Funded Teledentistry
    California Governor Jerry Brown has signed into law a bill that would require Medi-Cal, the state’s insurance program for the poor, to pay for dental services delivered by teams of hygienists and dentists connected through the Internet. California is among the first states to launch such teledentistry services, which are intended to increase the options for patients in remote and underserved areas. Other states, like Oregon, Colorado, Hawaii and West Virginia, are interested in creating their own teledentistry programs but are farther behind, advocates for the projects said (Hernandez, 9/29).

    California Healthline: Governor Agrees To Take $6M California Endowment Grant, Signs Many Health Bills
    Gov. Jerry Brown (D) signed a flurry of health-related bills at the end of last week including a bill to reverse the state's position on accepting a grant to help with Medi-Cal enrollment renewals. More than eight million Californians are up for renewal in the Medi-Cal program (California's version of Medicaid). New eligibility rules and new forms have slowed the response rate so far. The California Endowment offered the Department of Health Care Services a $6 million grant to help with the renewal effort that would be doubled by matching federal funding. The state turned down the $12 million money during May budget negotiations (Gorn, 9/29).

    WBUR: Judge Wrestles With Partners Deal
    Suffolk Superior Court judge Janet Sanders is wrestling with a decision that will shape the health care industry in Massachusetts for at least a decade. On the face of it, Sanders is reviewing a customary settlement in an anti-trust case. Partners HealthCare and Attorney General Martha Coakley reached an agreement to avoid a lengthy court fight. The agreement would allow Partners to acquire at least three hospitals and hire more physicians in exchange for limits on price increases and unchecked expansion through the next decade (Bebinger, 9/30).

    Boston Globe: Judge Delays Decision On Partner Accord
    A Superior Court judge raised serious concerns Monday about an increasingly controversial deal that would allow Partners HealthCare to acquire three community hospitals, and she moved her decision on the transaction until after the November election. Judge Janet L. Sanders scheduled the next hearing for Nov. 10, meaning Partners’ nearly three-year effort to merge with South Shore Hospital in Weymouth and its subsequent move to take over hospitals in Medford and Melrose could be delayed for months (McCluskey, 9/29).

    The New York Times: Cuomo’s Ad Faults Astorino On Health Care For Older Adults
    Gov. Andrew M. Cuomo has attacked his Republican opponent, Rob Astorino, over his views on issues like abortion rights, same-sex marriage and gun control. Now Mr. Cuomo is trying to focus attention on health care for older adults. While Mr. Cuomo holds a wide lead in polls, he has not relented in airing negative commercials about Mr. Astorino, and the advertisements appear to be working: In a statewide poll conducted by Siena College from Sept. 18-23, 29 percent of likely voters had a favorable view of Mr. Astorino, compared with 30 percent who had an unfavorable view of him (Kaplan, 9/29).

    The New York Times: De Blasio’s Executive Order Will Expand Living Wage Law To Thousands More
    Mayor Bill de Blasio plans to sign an executive order on Tuesday significantly expanding New York City’s living wage law, covering thousands of previously exempt workers and raising the hourly wage itself, to $13.13 from $11.90, for workers who do not receive benefits. … The executive order will immediately cover employees of commercial tenants on projects that receive more than $1 million in city subsidies going forward. Workers who receive benefits such as health insurance will earn $11.50 an hour, compared with $10.30 before (Flegenheimer, 9/29).

    The Washington Post: D.C. Government’s Infant-Mortality Program Eyed For Cuts As Mayor Touts New Initiative
    A loss of $4 million in federal funding is threatening to curtail District services to young mothers and infants, complicating the city’s efforts to care for its youngest residents even as officials tout a new focus on reducing infant mortality. Over two decades, the city received tens of millions of dollars in funding through the federal Healthy Start program. But that program recently changed its structure, dispensing with a long-standing preference for previous grantees and instituting a more competitive funding process (DeBonis, 9/29).

    Boston Globe: Charlie Baker’s Alternative Applies Sick Time Only To Larger Firms
    The [Massachusetts] Republican gubernatorial candidate, Charlie Baker, wants only those companies with 50 or more employees to be required to offer paid sick time to their workers, according to the “Alternative Paid Sick Leave Initiative” he issued Monday. A ballot question in November will ask Massachusetts voters if employees at companies with 11 or more workers would be allowed to earn and use paid sick time if they miss work for a variety of reasons dealing with their health or the health of a loved one (Johnson, 9/29).

    Minneapolis Star-Tribune: In Reform Effort, State Hospital Will Give Families A Seat At The Table
    Facing intense criticism from parents and patient advocates, the state’s largest psychiatric hospital is preparing to give families much greater say in the treatment of mentally ill patients. The move is part of a broad series of reforms at the embattled state hospital, which has struggled with staff turnover, incidents of patient maltreatment and serious security lapses. Hundreds of parents, siblings and spouses of patients will get letters this week from the state Department of Human Services, inviting them to become members of the first-ever family advisory council at the Minnesota Security Hospital in St. Peter. The council will advise the hospital, which houses about 225 of the state’s most dangerous and mentally ill patients, on everything from group therapy to patient security and room decor (Serres, 9/29).

    Kansas Health Institute News Service: Democrats Call For Special Committee To Vet KanCare Contracting
    The top Democrats on the KanCare Oversight Committee on Monday called for a separate committee to be appointed to study whether any legal or ethical boundaries were crossed when Gov. Sam Brownback's administration contracted with three managed care organizations to privatize Medicaid. Rep. Jim Ward, D-Wichita, and Sen. Laura Kelly, D-Topeka, said the request was spurred by the months-old news of FBI agents interviewing Capitol denizens for information on allegations of corruption within the administration. The FBI has not confirmed the investigation, per agency policy, but some of those interviewed have told news outlets that the $3 billion KanCare contracts are at the center of the questions. Sen. Laura Kelly, left, and Rep. Jim Ward, the top Democrats on the KanCare Oversight Committee, on Monday requested that a special committee be appointed to study whether any legal or ethical boundaries were crossed when Gov. Sam Brownback's administration contracted with three managed care organizations to privatize Medicaid (Marso, 9/29).

    Kansas Health Institute News Service: Ruling On In-Home Medicaid Services Creates Questions For Providers, Beneficiaries
    Karen Barezinsky is looking for an answer to what she says is a simple question: Are the people who run the state’s Medicaid program planning to cut the supports she and her husband use to keep her son, Ray Santin, who’s paralyzed from his neck down, out of a nursing home? “I can’t find out anything,” said Karen, 62, who lives in Scranton with her husband and son. “I leave messages with Ray’s case manager, but nobody calls me back.” Karen is worried because she’s read news stories about Gov. Sam Brownback and Kansas Department for Aging and Disability Services Secretary Kari Bruffett warning legislators that a recent ruling by the U.S. Department of Labor could cause reductions of in-home services for some people with disabilities and frail elders (Ranney, 9/29).

  • More Insurers Change How They Pay Medical Providers

    Commercial insurers are moving rapidly from the old system of paying health providers for every test or procedure they do toward payments based on the value rather than volume of services, according to a report by Catalyst for Payment Reform, a business coalition focused on health care costs.

    Marketplace: How Insurers Are Adjusting Payment To Medical Providers
    Commercial insurers are ditching or at least tweaking the way they pay medical providers, according to a report out Tuesday from the group Catalyst for Payment Reform. For years, commercial insurers as well as state and federal governments have paid doctors and hospitals under what’s called fee-for-service. To many in the healthcare world, fee-for-service is seen as one of the key drivers behind the run-up in healthcare costs, because it offers providers a financial incentive to provide extra services that may not be needed (Gorenstein, 9/30).

    Dallas Morning News: Quick Uptake For New Health Care Payment Plans
    Health insurance companies, hospitals and physicians are moving with alacrity toward new payment models that promote value rather than volume of care. The Catalyst for Payment Reform, a business coalition concerned with the high cost of medical care, reported Tuesday that 40 percent of insurance plan payments are now made with methods that stress affordability and quality. Last year, the survey found 10.9 percent of payments to hospitals and doctors were made with value-based payments (Landers, 9/30).

    Modern Healthcare: Incentive-based Contracts Thriving In Commercial Insurance Market
    Health plans that cover two-thirds of commercially insured Americans used incentives this year to motivate hospitals and doctors to improve quality and manage costs, according to a new survey. Those contracts were responsible for 40% of insurers' medical spending.  The survey is the second by Catalyst for Payment Reform, a health policy not-for-profit founded and funded by employers, and the results offer a snapshot of how some of the nation's largest insurers use the promise of financial gain or loss to influence the way providers deliver care and run their businesses.  Four of the five largest U.S. insurers were among 39 health plans that responded to the survey, and together they cover 101 million lives, Catalyst said. About 15% of the enrollees had providers with incentive-based contracts, the survey found (Evans, 9/30).

    Meanwhile, The Charlotte Observer reports on how one large physician practice is moving from 'volume to value' -

    Charlotte Observer:  OrthoCarolina Of Charlotte To Bundle Knee, Hip Replacement Costs
    Hospital leaders in Charlotte talk a lot about transforming the health-care system and moving from “volume to value.” By that, they mean a future where doctors and hospitals get paid, not just for treating patients each time they get sick, but for keeping them well. Still, the current system relies mostly on so-called “fee-for-service” reimbursement, under which patients and insurance companies pay for each appointment, test or procedure. The more services, the more payments. Instead of waiting for change to be imposed, doctors at Charlotte’s OrthoCarolina, one of the region’s largest physician groups, have taken the lead in adopting a system to simplify billing and improve coordination of care. Patients undergoing knee and hip replacements can get a single bill with a “bundled payment” that covers preoperative care, surgery, followup appointments, 90 days of physical therapy and the services of a “patient navigator” who serves as a guide through the process (Garloch, 9/29).

  • Drug And Device News: Study Questions Medical Devices' Safety Evidence

    Elsewhere, The Associated Press reports on a new advertising approach for Viagra -- a TV commercial that targets women.  

    The Wall Street Journal: Medical Devices Lack Safety Evidence, Study Finds
    The majority of moderate- to high-risk medical devices approved by the U.S. Food and Drug Administration lack publicly available scientific evidence to verify their safety and effectiveness despite requirements in the law, according to a study released Monday (Burton, 9/29).

    The Associated Press: Viagra Ads Target Women For 1st Time
    The maker of the world's top-selling erectile dysfunction drug on Tuesday will begin airing the first Viagra TV commercial that targets the less-obvious sufferers of the sexual condition: women. In the new 60-second ad, a middle-aged woman reclining on a bed in a tropical setting addresses the problems couples encounter when a man is impotent (9/30).

  • Federal Database On Physician Quality Ratings Comes Up Short, Experts Say

    The database, which was created by the health law, offers only the most basic information, according to USA Today. 

    USA Today: Federal Doctor Ratings Face Accuracy, Value Questions
    Consumers searching this fall for the best doctor covered by their new public or private insurance plan won't get very far on a federal database designed to rate physician quality. The Affordable Care Act requires the Centers for Medicare and Medicaid Services to provide physician quality data, but that database offers only the most basic information. It's so limited, health care experts say, as to be useless to many consumers (O’Donnell, 9/29).

    Meanwhile, critical access hospitals are not yet part of the federal government's push for improving quality -

    Kaiser Health News: Many Rural Hospitals Are Excluded From Government's Push For Better Quality
    The Department of Health and Human Services has not yet incorporated the 1,256 primarily rural, "critical access" hospitals such as [Crawford Memorial Hospital, in rural Robinson, Ill.] into Medicare's pay-for-performance programs. With no more than 25 beds, these hospitals are generally located in isolated areas, making them the only acute-care option for local residents. Medicare repays them their cost plus 1 percent, more than it pays other hospitals, to ensure they do not close. While some of the facilities deliver exemplary care, a study published last year by Harvard School of Public Health researchers found that death rates at critical access hospitals in 2010 were higher than at other small, rural hospitals and the industry overall (Rau, 9/30).

  • Today Is The Deadline For Thousands To Provide Information To Keep Subsidies

    The administration has notified more than 300,000 people that they need to provide documentation to keep their health insurance subsidies. Also in news on the health law, supporters are weighing a new focus on the individual mandate, and the administration promises changes to the ACO rules.

    The Wall Street Journal: Hundreds Of Thousands Face Health Law Subsidy Deadline
    Hundreds of thousands of Americans face a Tuesday deadline to verify their income and are at risk of losing or having to pay back their federal health-insurance subsidies under the Affordable Care Act. The need for people to pay back the government could become a headache during next year's tax season, when Americans are expected to pay back any subsidies they weren't eligible for. The Obama administration has told more than 300,000 individuals who obtained coverage through the federal HealthCare.gov site that they may lose some or all of the subsidies if they don't provide additional income information that jibes with Internal Revenue Service data. That information includes tax returns, wages and tax statements, pay stubs and letters from employers (Armour, 9/29).

    Politico: Obamacare: New Messaging Hurdles Ahead
    The second Obamacare enrollment season could go negative — but not because of the health care law's critics. Obama administration allies are weighing a focus on the loathsome individual mandate and the penalties that millions of Americans could face if they don't get covered. It would be a calculated approach to prompt sign-ups, a task that the law's supporters expect to be more difficult, or at least more complex, than in its coverage's inaugural year (Haberkorn, 9/29).

    Politico: Obamacare's Surprises
    Most of the debate over the Affordable Care Act has focused on its coverage provisions: the health-care exchanges where Americans can shop for insurance, the controversial mandates for employers and individuals and the expansion of Medicaid in the states. But in a 900-plus-page landmark bill, there are bound to be a few surprises. Here are some of Obamacare’s hidden corners (Kenen and Wheaton, 9/29).

    CQ Healthbeat: Medicare Officials Prepare To Issue Proposed Changes To ACOs
    The Centers for Medicare and Medicaid Services will soon release a rule updating the main program that pays groups of hospitals and doctors that coordinate patients' care through accountable care organizations, a top agency official said Monday. CMS Deputy Administrator Sean Cavanaugh told insurance industry executives gathered at a conference sponsored by the America's Health Insurance Plans trade group that the so-called "shared savings" program will be modified through a proposed regulation. When asked for more information after the briefing, he did not elaborate (Adams, 9/29).

    Connecticut Mirror: CT Hospitals Say Obamacare Hasn't Cut Uncompensated Care
    A recent federal report says hospitals saw a major decrease in uncompensated care after the rollout of key provisions of the federal health law this year. But so far, that’s not what Connecticut hospitals are experiencing, according to their association. From January to June of this year, after the major coverage expansion provisions of Obamacare took effect, uncompensated care provided by Connecticut hospitals represented 2.4 percent of total patient revenue, according to the Connecticut Hospital Association (Levin Becker, 9/29).

  • Viewpoints: Shop Around For Health Coverage; 'Gaming' Obamacare; FDA And Painkillers

    The New York Times' The Upshot: Auto-Renewing Your Health Plan May Be Bad For You, And For Competition
    My colleagues Margot Sanger-Katz and Amanda Cox wrote recently that shopping around for the best price can be crucial for people renewing their coverage on the health insurance exchanges this fall. But evidence suggests that many people probably won’t do that. Not only is that bad for them, but it can also harm competition, which is bad for everyone. A basic truth about health insurance, as with many other things, is that people hate to shop around and change products. They have a status quo bias. That bias can be exacerbated by a large number of plan choices, as consumers in some exchanges face (Austin Frakt, 9/29).

    The Wall Street Journal’s Washington Wire: The Flaw In Using Medicare Price Caps As A Cost-Control Model
    Recent articles have suggested capping health-care prices at a percentage above Medicare payment levels as a way to bring down health costs. But evidence suggests that, rather than reducing overall spending levels, Medicare's price caps don't effectively control health costs (Chris Jacobs, 9/29). 

    The Wall Street Journal: How To Game ObamaCare
    Liberals are suddenly everywhere claiming that the GOP's "worst nightmare" is coming true: ObamaCare is working, premiums are rising only modestly or even falling, and more insurers are choosing to participate. But this new optimism papers over some unusual market dynamics that suggest a business strategy to game ObamaCare's rules (9/29).

    Bloomberg: Runaway Obamacare Spending Will Cost Democrats 
    [A] new study out ... from Bloomberg Government threatens to bring the Affordable Care Act back to center stage -- and in a way that will likely hurt the electoral chances of incumbent Democrats, all of whom voted for the law. The study found that federal spending on Obamacare and related legislation has far exceeded anyone’s estimates (or imaginations). To date, the report concludes that the health-care law has cost taxpayers $73 billion. And that number doesn’t include projected spending on the law’s Medicaid expansion, which if included would bring costs to more than $90 billion. The study’s estimate is even higher than the Congressional Budget Office’s "high" cost projection for the law -- $71.2 billion by the end of 2014 (Lanhee Chen, 9/26).

    Los Angeles Times: Why So Many Injury Claims From L.A. Public Safety Workers?
    Los Angeles' police and firefighters take paid injury leave at significantly higher rates than public safety employees elsewhere in California. Why? Is it more strenuous or stressful to work in the city of Los Angeles, compared with L.A. County or Long Beach? Does the city have an older workforce more prone to injury? Or is it just so easy to game the system in L.A. that filing an injury claim has become a routine matter in the police and fire departments? (9/29). 

    The Washington Post: Reverends Like Us Should Never Oppose Access To Abortion Or Sex Ed
    It is a cliché — and a false one — that the community of faith has only one opinion about reproductive rights. Believers often feel compelled to offer compassion and support to individuals and families who are making the profound decision whether to continue a pregnancy, become a parent, plan for adoption, or seek an abortion. But just as people from different traditions (and even people inside the same tradition) hold varying views on these issues, so do their clergy (Harry Knox and Alethea Smith-Withers, 9/29). 

    USA Today: FDA Undermines Painkillers Fight: Our View
    The most prescribed drugs in America — painkillers containing addictive opioids — are also driving the deadliest drug problem in America. On average, 46 people a day die from painkiller overdoses, and 1,150 more land in emergency rooms. Deaths from illegal drugs don't even come close. Last year alone, doctors wrote about 180 million prescriptions for hydrocodone and oxycodone, nearly one for every adult in the United States (9/29). 

    USA Today: FDA: Combating Opioid Abuse
    Today, more Americans tragically die from drug overdoses than from any other form of death by injury. A staggering 40% of those deaths involve prescription opioids. Identifying solutions to prevent prescription opioid abuse while ensuring that patients with debilitating pain have access to effective treatment is a top priority for FDA. As a public health agency, FDA reviews drugs using a scientific approach within our legal framework and not only considers those who abuse opioids, but also those who use them responsibly (FDA Commissioner Margaret A. Hamburg, 9/29). 

    The New York Times: A New Attack On Antibiotic Resistance
    Antibiotic-resistant germs are an increasing threat, causing at least 23,000 deaths and two million illnesses in the United States each year, and requiring treatment costing $20 billion in direct medical expenses. The Obama administration announced some good measures this month that should help reduce the overuse of antibiotics in humans and much, though perhaps not all, of the overuse in animal husbandry that together are fueling the emergence of drug-resistant germs (9/29). 

    JAMA Internal Medicine: The Strange Allure Of State "Right-To-Try" Laws
    Right-to-try laws revive a decades-long debate about balancing early access to unapproved medications
    for terminally ill patients with requirements for demonstrated safety and effectiveness. ... The problem is that all these efforts are unlikely to actually help the patients with life-threatening diseases. Indeed, these laws may be harmful if they draw attention and resources away from efforts to develop effective treatments, engender confusion about the FDA pathway for compassionate use of medications, or create false hopes for terminally ill patients. ... At a time when the federal government is increasingly unpopular, an agency that oversees opioids, abortifacients, and other controversial drugs may be an appealing target for state politicians. ...  expertise-based federal regulation should be improved, not targeted (Patricia J. Zettler and Henry T. Greely, 9/29).

    JAMA Internal Medicine: Improving Medical Device Regulation
    The FDA has regulatory responsibility for a wide range of products, from simple and low-risk tools, such as crutches, to more complex and higher risk devices, such as implantable cardioverter defibrillators. ... The mission of the FDA is to protect the public health by providing reasonable assurance that marketed medical devices are safe and effective and to promote the public health by streamlining regulatory processes and eliminating unnecessary barriers to medical device innovation. At times, the agency has rightfully been criticized for pursuing one goal at the expense of the other. In recent years, the FDA's Center for Devices and Radiological Health has been actively undertaking reforms to advance both goals simultaneously and to improve the scientific rigor of its operations (Elisabeth M. Dietrich and Dr. Joshua M. Sharfstein, 9/29).

  • Political Cartoon: 'Timely Recognition?'

    Kaiser Health News provides a fresh take on health policy developments with 'Timely Recognition?' By David Fitzsimmons.

    And here's today's health policy haiku:


    Door opens a crack
    Open Payments database
    Let the sunshine in

    If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.