Four More Hospital Systems Quit ACO Program

Three years after the Centers For Medicare & Medicaid Services selected 32 groups to participate in the Pioneer Accountable Care Organization Model program, they are down to 19 players. Officials say that navigating the program’s rules has proved challenging.

<a href="http://online.wsj.com/articles/a-Medicare-program-loses-more-health-care-providers-1411685388?KEYWORDS=Medicare” target=”_blank” data-mce-href=”http://online.wsj.com/articles/a-Medicare-program-loses-more-health-care-providers-1411685388?KEYWORDS=Medicare“>The Wall Street Journal: A Medicare Program Loses More Health-Care Providers

Four more hospital systems recently have dropped out of the Pioneer Accountable Care Organization program, a key part of the federal health law, leaving just 19 of the original 32 participants. Accountable care organizations seek to curb costs by better coordinating care. Hospitals and groups of doctors who keep costs down for large groups of Medicare patients get to share in those savings. But navigating the program’s rules has proved challenging for some hospitals, even those long experienced in coordinated care (Beck, 9/25).

<a href="http://www.modernhealthcare.com/article/20140925/NEWS/309259938/Medicares-pioneer-program-down-to-19-acos-after-three-more-exit” target=”_blank”>Modern Healthcare: Medicare’s Pioneer Program Down To 19 ACOs After Three More Exit

Three years after CMS carefully selected 32 accountable care organizations deemed best able to manage the Pioneer program’s financial risks, three more decided they no longer want to. The new departures — the program is now down to 19 ACOs — suggest even the most sophisticated health systems may be unwilling to take losses as policymakers test new payment and delivery models. Franciscan Alliance in Indianapolis, Genesys PHO in Flint, Mich., and Renaissance Health Network in Wayne, Pa., have exited the program, which is now in its third year (Evans, 9/25).

Four More Hospital Systems Quit ACO Program

Four More Hospital Systems Quit ACO Program

Three years after the Centers For Medicare & Medicaid Services selected 32 groups to participate in the Pioneer Accountable Care Organization Model program, they are down to 19 players. Officials say that navigating the program’s rules has proved challenging.

<a href="http://online.wsj.com/articles/a-Medicare-program-loses-more-health-care-providers-1411685388?KEYWORDS=Medicare” target=”_blank” data-mce-href=”http://online.wsj.com/articles/a-Medicare-program-loses-more-health-care-providers-1411685388?KEYWORDS=Medicare“>The Wall Street Journal: A Medicare Program Loses More Health-Care Providers

Four more hospital systems recently have dropped out of the Pioneer Accountable Care Organization program, a key part of the federal health law, leaving just 19 of the original 32 participants. Accountable care organizations seek to curb costs by better coordinating care. Hospitals and groups of doctors who keep costs down for large groups of Medicare patients get to share in those savings. But navigating the program’s rules has proved challenging for some hospitals, even those long experienced in coordinated care (Beck, 9/25).

<a href="http://www.modernhealthcare.com/article/20140925/NEWS/309259938/Medicares-pioneer-program-down-to-19-acos-after-three-more-exit” target=”_blank”>Modern Healthcare: Medicare’s Pioneer Program Down To 19 ACOs After Three More Exit

Three years after CMS carefully selected 32 accountable care organizations deemed best able to manage the Pioneer program’s financial risks, three more decided they no longer want to. The new departures — the program is now down to 19 ACOs — suggest even the most sophisticated health systems may be unwilling to take losses as policymakers test new payment and delivery models. Franciscan Alliance in Indianapolis, Genesys PHO in Flint, Mich., and Renaissance Health Network in Wayne, Pa., have exited the program, which is now in its third year (Evans, 9/25).

Four More Hospital Systems Quit ACO Program

First Edition: September 26, 2014

Today’s headlines include a variety of political and health policy stories.

Kaiser Health News: Debate Grows Over Employer Plans With No Hospital Benefits

Kaiser Health News staff writer Jay Hancock reports: “As companies prepare to offer medical coverage for 2015, debate has grown over government software that critics say can trap workers in inadequate plans while barring them from subsidies to buy fuller coverage on their own. At the center of contention is the calculator — an online spreadsheet to certify whether plans meet the Affordable Care Act’s toughest standard for large employers, the ‘minimum value’ test for adequate benefits” (Hancock, 9/26). Read the story.

Kaiser Health News: DEA: Vicodin, Some Other Pain Meds Will Be Harder to Get

Kaiser Health News consumer columnist Michelle Andrews writes: “The Drug Enforcement Administration is reclassifying so-called ‘hydrocodone combination products’ from Schedule III to Schedule II under the Controlled Substances Act, which will more tightly restrict access. Vicodin, for example, is an HCP because it has hydrocodone and acetaminophen” (Andrews, 9/26). Read the story.

Kaiser Health News: Capsules: Consumer Group Sues 2 More Calif. Plans Over Narrow Networks ; For Gay Men, Gaps In HIV Knowledge, Treatment Persist

Now on Kaiser Health News’ blog, Julie Appleby writes about two California lawsuits regarding narrow networks : “Both cases allege that the insurers offered inadequate networks of doctors and hospitals and that the companies advertised lists of participating providers that were incorrect. Consumers learned their doctors were not, in fact, participating in the plans too late to switch to other insurers, the suits allege, and patients had to spend hours on customer service lines trying to get answers. Both cases seek class action status” (Appleby, 9/25). 

Also on Capsules, Jenny Gold reports on two reports that explore the HIV knowledge gap: “Just 30 percent of gay and bisexual men say they were tested for HIV within the last year as recommended; another 30 percent say they have never been tested. And even when they are tested, only half of those who have been diagnosed with HIV are receiving care and treatment for their infection” (Gold, 9/25). Check out what else is on the blog.

<a href="http://online.wsj.com/articles/a-Medicare-program-loses-more-health-care-providers-1411685388?KEYWORDS=Medicare” data-mce-href=”http://online.wsj.com/articles/a-Medicare-program-loses-more-health-care-providers-1411685388?KEYWORDS=Medicare“>The Wall Street Journal: A Medicare Program Loses More Health-Care Providers

Four more hospital systems recently have dropped out of the Pioneer Accountable Care Organization program, a key part of the federal health law, leaving just 19 of the original 32 participants. Accountable care organizations seek to curb costs by better coordinating care. Hospitals and groups of doctors who keep costs down for large groups of Medicare patients get to share in those savings. But navigating the program’s rules has proved challenging for some hospitals, even those long experienced in coordinated care (Beck, 9/25).

The Washington Post: Obamacare’s Small Business Exchanges Offer Cheaper Health Coverage, Study Shows

During the lead-up to the rollout of the health care law a year ago, President Obama was adamant that new insurance marketplaces for small businesses would provide a start-to-finish online shopping experience for employers, where they could compare and buy plans with the click of a mouse. In addition, he said, by placing rates from different insurers side-by-side and offering tax breaks, the marketplaces would provide less expensive plans that what had been available to small companies (Harrison, 9/24).

The New York Times: A Father’s Last Wish, And A Daughter’s Anguish

He was still her handsome father, the song-and-dance man of her childhood, with a full head of wavy hair and blue eyes that lit up when he talked. But he was gaunt now, warped like a weathered plank, perhaps by late effects of an old stroke, certainly by muscle atrophy and bad circulation in his legs. Now she was determined to fulfill her father’s dearest wish, the wish so common among frail, elderly people: to die at home. But it seemed as if all the forces of the health care system were against her — hospitals, nursing homes, home health agencies, insurance companies, and the shifting crosscurrents of public health care spending (Bernstein, 9/25).

The Associated Press: Senators: Widen Medicaid Program For Frail Seniors

More than a dozen U.S. senators from both parties are calling on the Obama administration to broaden a Medicaid program for the nation’s frailest seniors, calling it a proven alternative to pricier nursing home care as states seek to limit long-term medical costs. In a letter released Thursday, the senators urged the Centers for Medicare and Medicaid Services to follow through on plans to loosen restrictions on the Program of All Inclusive Care for the Elderly. PACE is open to Medicaid-eligible seniors and people with disabilities who need nursing home care (9/25).

The Wall Street Journal’s Washington Wire: With Holder Leaving, Verrilli Is Back in the Spotlight

U.S. Solicitor General Donald Verrilli Jr., who successfully defended President Barack Obama’s signature health-care law in 2012, is among the possible candidates to succeed Attorney General Eric Holder, who is expected to announce Thursday that he will step down. Mr. Verrilli, 57 years old, is a veteran appellate lawyer who in private and government practice has argued numerous high-profile Supreme Court cases. In addition to defending the Affordable Care Act, Mr. Verrilli has represented the U.S. government in major cases before the high court on same-sex marriage, voting rights and this year’s challenge to contraception-coverage requirements under the health law (Adamy and Henderson, 9/25).

The Washington Post: Brady To Battle Ryan For Ways And Means Chairmanship

Rep. Kevin Brady (R-Tex.) said Thursday that he will seek the chairmanship of the powerful House Ways and Means Committee, scrambling what was expected to be a smooth ascension to the post by Rep. Paul Ryan (R-Wis.), the 2012 GOP vice-presidential nominee and the party’s architect of fiscal policy in the House. Brady said in an interview that after months of weighing his options, he has decided to battle Ryan for the gavel. The move could force Ryan’s hand on a 2016 presidential run (Costa, 9/25).

The New York Times: Ad Attacks Skinny-Dipping Congressman

The commercial refers to an incident in which Representative Kevin Yoder went skinny-dipping in the Sea of Galilee with other Republican members during a trip to Israel last year. Ms. Kultala’s ad features sound bites from conveniently covered skinny-dippers lounging at a pool, as nude puns abound about Mr. Yoder’s record. “The naked truth is Yoder voted to cut Medicare for seniors,” says one elderly couple, sidling up to the side of the pool for cover (Corasaniti, 9/25).

Los Angeles Times: Gov. Brown Signs Bills On Birth Control, Inmate Rights

Gov. Jerry Brown on Thursday signed into law bills requiring most health plans to cover a variety of contraceptive methods, banning forced or coerced sterilizations of inmates in California prisons and giving felons behind bars easier access to DNA tests that could prove their innocence. The birth control bill covers contraceptive drugs, devices and products for women, as well as related counseling, follow-up services and voluntary sterilization procedures (McGreevy and Mason, 9/25).

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First Edition: September 26, 2014

Underinsured Enrollees Flood Community Health Centers

Some low-income consumers who bought bronze plans with low premiums but high deductibles are discovering they still can’t afford health care and are turning to the community health centers which cannot turn anyone away. Meanwhile, a study finds insurance costs for small businesses are lower through the SHOP exchanges, and South Dakota lifts a $2M cap on employees’ lifetime health costs.

Modern Healthcare: Underinsured ACA Enrollees Strain Community Health Centers

Obamacare enrollees are straining the finances of community health centers around the country, some health center leaders say. The issue is that many lower-income patients with insurance coverage through the federal and state exchanges bought bronze-tier plans with lower premiums but high deductibles, coinsurance and copayments and no federal cost-sharing subsidies. When these patients face high out-of-pocket costs for care that falls below the deductible, they can’t afford it.  So the centers are subsidizing that care by offering them means-tested sliding-scale fees. When the centers, which are not allowed to turn away patients for inability to pay, try to get the insurers to pay, the claims are usually denied, and the centers have to write it off as uncompensated care (Dickson, 9/25).

The Washington Post: Obamacare’s Small Business Exchanges Offer Cheaper Health Coverage, Study Shows

During the lead-up to the rollout of the health care law a year ago, President Obama was adamant that new insurance marketplaces for small businesses would provide a start-to-finish online shopping experience for employers, where they could compare and buy plans with the click of a mouse. In addition, he said, by placing rates from different insurers side-by-side and offering tax breaks, the marketplaces would provide less expensive plans that what had been available to small companies. … It appears, based on one new study, that the exchanges are delivering [on the second promise] (Harrison, 9/24).

Kaiser Health News: Debate Grows Over Employer Plans With No Hospital Benefits

As companies prepare to offer medical coverage for 2015, debate has grown over government software that critics say can trap workers in inadequate plans while barring them from subsidies to buy fuller coverage on their own. At the center of contention is the calculator — an online spreadsheet to certify whether plans meet the Affordable Care Act’s toughest standard for large employers, the ‘minimum value’ test for adequate benefits (Hancock, 9/26).

The Associated Press: State Lifts $2M Cap On Employee Health Care Costs

South Dakota can no longer limit how much it pays out in health care coverage over the lifetime of state employees, but officials say for now that shouldn’t raise costs. Laurie Gill, the commissioner of the state’s Bureau of Human Resources, briefed legislators this week on how changes mandated by the Affordable Care Act will affect the state’s health plan. The Affordable Care Act prohibits health care plans from capping the amount of benefits employees incur over a lifetime. South Dakota had capped lifetime expenses at $2 million per individual, meaning any health care costs incurred over that amount weren’t covered. The change means the state could end up paying out more, but Tom Steckel, the state’s director of employee benefits, said in the past it’s been rare for an employee to reach the $2 million limit. Steckel said his office has been looking into how many workers surpassed the cap. So far, he said, he wasn’t aware that any had reached it last year (Burbach, 9/25).

Underinsured Enrollees Flood Community Health Centers

Four More Hospital Systems Quit ACO Program

Three years after the Centers For Medicare & Medicaid Services selected 32 groups to participate in the Pioneer Accountable Care Organization Model program, they are down to 19 players. Officials say that navigating the program’s rules has proved challenging.

The Wall Street Journal: A Medicare Program Loses More Health-Care Providers

Four more hospital systems recently have dropped out of the Pioneer Accountable Care Organization program, a key part of the federal health law, leaving just 19 of the original 32 participants. Accountable care organizations seek to curb costs by better coordinating care. Hospitals and groups of doctors who keep costs down for large groups of Medicare patients get to share in those savings. But navigating the program’s rules has proved challenging for some hospitals, even those long experienced in coordinated care (Beck, 9/25).

Modern Healthcare: Medicare’s Pioneer Program Down To 19 ACOs After Three More Exit

Three years after CMS carefully selected 32 accountable care organizations deemed best able to manage the Pioneer program’s financial risks, three more decided they no longer want to. The new departures — the program is now down to 19 ACOs — suggest even the most sophisticated health systems may be unwilling to take losses as policymakers test new payment and delivery models. Franciscan Alliance in Indianapolis, Genesys PHO in Flint, Mich., and Renaissance Health Network in Wayne, Pa., have exited the program, which is now in its third year (Evans, 9/25).

Four More Hospital Systems Quit ACO Program

Viewpoints: 'Feud' Over Health Care Compact; Humane End-Of-Life Care

Kansas City Star: Inside The Feud Over The Kansas Health Care Compact Law

Never has an issue of The Best Times, Johnson County’s monthly magazine for seniors, been so eagerly awaited. I know I’ve been on the edge of my seat. At first the draw was to read the article that had gotten some Kansas legislators so worked up that 11 of them stormed en masse into a meeting to berate the volunteer members of the Johnson County Commission on Aging for writing it. The Legislature last session passed a bill potentially enabling Kansas to shuck off Obamacare and other regulation-laden federal programs and join other states in a “health care compact.” Naturally, lawmakers would expect federal money to do this. Gov. Sam Brownback signed the bill. Members of the Commission on Aging, who advise county leaders, looked at the new law and found it alarming. They penned their concerns in an article for the October edition of The Best Times (Shelly, 9/25).

The New York Times’ Room For Debate: Finding Humane Care At The End Of Life

As the story of Joseph Andrey’s last month’s shows, many Americans will end their lives in surroundings that only add to their misery. Those who hoped to die in their own beds are often forced into nursing homes, some of which mistreat patients. Even if home care is arranged, it too can be substandard, even abusive. And those who hope for government guidance can find unreliable information (9/25). 

Los Angeles Times: Despite Obamacare, U.S. Healthcare System Still Dysfunctional

Obamacare was supposed to make our healthcare system friendlier to patients, and in many ways it’s succeeded. But we still have a long way to go. For almost her entire life, Maria Rogers has been the picture of health. …. In May, however, Rogers was diagnosed with Stage 3 cancer of the abdomen. … Rogers’ experience illustrates the challenges we face not just getting affordable healthcare but keeping it while dealing with a life-threatening illness (David Lazarus, 9/25). 

Los Angeles Times: When They Would Rather Let You Die Than Let You Have An Abortion

Have you ever wondered what a world without abortion might actually look like? Let me amend that: There will obviously never be a world without abortion. Have you ever wondered what a world without legal abortion would look like? (Robin Abcarian, 9/25). 

The Wall Street Journal‘s Washington Wire: Behind The Increase In HIV Infections Among Gay And Bisexual Men

Gay and bisexual men represent an estimated 2% of the U.S. population but more than half of all people living with HIV and 66% of new HIV infections. They are the only population group in the United States for which HIV infections are rising. Projections have shown that if current trends continue, half of all gay and bisexual men will be HIV-positive by age 50 (Drew Altman, 9/25).

Baltimore Sun: Primary Care Providers Can Handle Hepatitis C Prescriptions

The release of an extremely costly medicine (sofosbuvir) for the treatment of chronic hepatitis C illustrates a great number of dilemmas facing health care policy in America: how to appropriately manage our financial resources in caring for populations, how to ascertain which patients will benefit the most from expensive treatments, and even how other countries have gotten the same drugs — reportedly priced at about $84,000 in the U.S. for one three-month cycle of treatment — for less (Loftus, 9/25).

Los Angeles Times: No On Proposition 46 Campaign Tries To Start A Hacker Panic

Even by the political world’s low standards of truthiness, a new commercial being aired by the No on Proposition 46 campaign is jaw-droppingly deceptive. The proposition would make three major changes in the laws related to the practice of medicine in California. It would quadruple the cap on “pain and suffering” damages in medical malpractice lawsuits, require many physicians to be tested for drug and alcohol use, and force physicians and pharmacists to consult an existing state prescription database before prescribing or distributing certain medications to a patient for the first time (Jon Healey, 9/25). 

Viewpoints: 'Feud' Over Health Care Compact; Humane End-Of-Life Care

Calif. Governor Vetoes Bill To Protect Assets From Medi-Cal

This story is part of a partnership that includes Capital Public Radio, NPR and Kaiser Health News. It can be republished for free. (details)

With the stroke of a pen, Gov. Jerry Brown rejected an effort to protect the estates of Medicaid beneficiaries in California, the San Jose Mercury News reported Friday. The bill, which the Democratic governor vetoed on Thursday, would have shielded the assets of people who receive Medicaid, known as Medi-Cal in California, from being recouped by the state after their deaths.

In a three-paragraph letter to the state senate, Brown advised legislators to consider the issue during the budget process. Brown wrote: “Allowing more estate protection for the next generation may be a worthy policy goal. The cost of this change, however, needs to be considered alongside other worthwhile policy changes in the budget process next year.”

The issue is important to people like Anne-Louise Vernon, who recently signed up for Medi-Cal under the Affordable Care Act’s expansion of the program. Vernon told Pauline Bartolone of Capitol Public Radio that she fears using her new coverage.  “I feel so unsettled about this whole estate recovery thing that I’m afraid to go to the doctor,” she said.

The law has been on California’s books for two decades, but with the expansion of Medi-Cal it now has the potential to affect many more people.

More from Pauline Bartolone’s story for Kaiser Health News and Capitol Public Radio:

Elizabeth Landsberg of the Western Center on Law and Poverty said it turns what was intended to be a safety net program into a long-term loan program and undermines the security that families might pass on to the next generation.

“So in most cases it’s modest family homes that we’re talking about, and so the state will most often come back and put a lien on that home, and unfortunately it does force the kids to sell the homes sometimes,” said Landsberg.

Landsberg said the law is unfair under the Affordable Care Act, because other people buying insurance and getting premium subsidies through Covered California aren’t subject to the same rules.

“For the first time people have to have health coverage. So it’s created an inequity where the lowest income people could lose their assets, and other higher income people who are also getting publicly-subsidized health coverage have no worries,” said Landsberg.

Calif. Governor Vetoes Bill To Protect Assets From Medi-Cal