Failure of Health IT Systems Hinders ACO Cost Savings

The inability of health IT systems to communicate with one another has hobbled the efforts of ACOs to improve care and save money, says a report by Premier Inc. and eHealth Initiative. Meanwhile, a health care executive tells why her organization quit the Pioneer ACO program, and New York’s Mount Sinai urges a judge to dismiss a lawsuit tied to a rule requiring providers to return government overpayments within 60 days.

CQ Healthbeat: ACOs Complain Current Health IT Systems Thwart Cost Savings

The Obama administration boasts of successes launching accountable care organizations and fostering adoption of health information technology systems. But the two aren’t coming together the way they are supposed to in an effort streamline the delivery of health care. That was the complaint in a survey of ACOs jointly released Wednesday by Premier Inc., a hospital consortium, and the eHealth Initiative, a nonprofit whose members include doctor, patient, insurer, public health and other groups. ACOs aim to deliver team based care using health IT systems to coordinate treatment, share medical histories and test results and order tests and prescriptions with fewer errors. But the failure of health IT systems to work together seamlessly blocks these goals, said Premier Senior Vice President Keith Figlioli (Reichard, 9/24).

California Healthline: Why One Pioneer ACO Quit The Program – And What It Reveals About The ACA

Allison Fleury is the CEO of Sharp HealthCare’s accountable care organization. She’s a senior vice president at the health system, but was trained as a CPA. And the more she looked at Medicare‘s Pioneer ACO program — arguably the government’s most ambitious accountable care pilot — the more she worried that the numbers weren’t adding up for her organization, one of the 32 original Pioneers (Diamond, 9/24).

Modern Healthcare: Mount Sinai Urges Court To Dismiss Suit Tied To Repayment Rule

Mount Sinai Health System, one of New York City’s largest not-for-profit healthcare organizations, has asked a federal court to throw out a first-of-its-kind case that involves refunding overpayments to the federal government in a timely manner. Under a little-discussed provision of the Patient Protection and Affordable Care Act, providers must return all Medicare and Medicaid overpayments within 60 days of when the overpayments were identified. Failing to do so results in liability under the False Claims Act, which carries stiff penalties: up to $11,000 for each “fraudulently delayed” claim multiplied by three. Hospitals, physicians and healthcare attorneys have slammed the rule, saying it could hurt providers for unintended actions.  Mount Sinai’s legal battle could have ramifications for other health systems, according to Shannon DeBra and Beatrice Nokuri, healthcare attorneys with Bricker & Eckler (Herman, 9/24).

Failure of Health IT Systems Hinders ACO Cost Savings

Californians Divided Over Health Law, According To Survey

In other news about how health policies are playing in this campaign season, fact checkers examine statements from the Wisconsin governor’s race and a West Virginia congressional contest. Meanwhile, abortion continues to be a topic on the Texas gubernatorial campaign trail.

Sacramento Bee: Poll: Obamacare Support Sliding, Jerry Brown, Water-Bond Up Big

The Affordable Care Act continues to divide Californians, who remain skeptical four years after its passage despite the state’s relatively smooth launch in which more than 1.2 million people enrolled in health insurance coverage. A new survey released late Tuesday found some 42 percent of state residents generally view the law favorably, while 46 percent harbor unfavorable opinions. Support is down somewhat since May, before a wave of targeted TV ads began in a handful of competitive congressional districts (Cadelago, 9/23).

PolitiFact Wisconsin: Mary Burke ‘Supports Obamacare Unequivocally’ And Wants To Expand It, Says Scott Walker

[Gov. Scott] Walker provided no evidence that [Mary] Burke has expressed unequivocal support for the Affordable Care Act, and we are not aware of any. At the same time, Burke does back the law and she supports expanding it through making more people eligible for Medicaid. Walker’s statement is partially accurate but leaves out important details. We rate it Half True (Tom Kertscher, 9/23).

Other health policy issues are in play, too –

Dallas Morning News: Wendy Davis And Greg Abbott Clash Over Abortion And Other Women’s Issues

The candidates for governor renewed their fight over women’s issues Tuesday, with Wendy Davis charging that Greg Abbott had belittled women with his strict abortion stance and Abbott countering that Davis was playing politics instead of helping solve issues important to women. Speaking at a Dallas luncheon sponsored by Annie’s List, a group that promotes progressive female candidates, Davis blistered Abbott for supporting a ban on abortion in all cases except when the woman’s life is at risk (Jeffers, 9/23).

The Washington Post’s The Fact Checker: A Sleazy Attack Puts Words In The Other Candidate’s Mouth

Our colleagues at FactCheck.org have already done yeoman work in untangling issues involving black lung benefits in the West Virginia race between Rep. Nick Rahall and challenger Evan Jenkins (R). But we don’t want to pass this one up. How often does a candidate literally put words in another candidate’s mouth? (Kessler, 9/24).

Californians Divided Over Health Law, According To Survey

HCA Faces Class-Action Lawsuit For Allegedly Concealing Revenue Declines

A Nashville district court judge allowed the shareholders’ case to move forward by rejecting the hospital chain’s arguments that the plaintiffs had missed ‘multiple opportunities’ to learn more about the company before buying shares.

Reuters: U.S. Hospital Chain HCA Must Face Class Action Over 2011 IPO

HCA Holdings Inc., one of the largest U.S. hospital chains, must face a shareholder class-action lawsuit accusing it of concealing revenue declines and its routine performance of unnecessary cardiac procedures prior to its $4.35 billion initial public offering in March 2011. U.S. District Judge Kevin Sharp in Nashville, Tennessee, rejected HCA’s claim that the plaintiffs had missed “multiple opportunities” to learn more about the company before buying their shares, including from media reports, conference calls, and disclosures during the IPO road show. Shareholders alleged that HCA, its directors, its former private equity owners and its investment banks concealed how the company was seeing adverse trends in Medicare revenue including cardiology, and Medicaid revenue per admission and accounted improperly for a 2006 reorganization and a 2010 restructuring (Stempel, 9/23).

Meanwhile, the CEO of a growing medical lab steps down amid a federal probe –

<a href="http://online.wsj.com/articles/health-diagnostic-laboratory-ceo-to-step-down-1411500521?KEYWORDS=Medicare“>The Wall Street Journal: Health Diagnostic Laboratory CEO Resigns

The chief executive officer of a fast-growing medical laboratory that has collected hundreds of millions of dollars from Medicare resigned amid a federal investigation into its payments of blood-sample fees to doctors. Health Diagnostic Laboratory Inc. CEO Tonya Mallory ceded the reins of the Richmond, Va., company to Joe McConnell, a former Mayo Clinic scientist who co-founded HDL with her five years ago. Ms. Mallory will remain on HDL’s board and serve as an adviser to Dr. McConnell, she said in a note to employees (Carreyrou, 9/23).

HCA Faces Class-Action Lawsuit For Allegedly Concealing Revenue Declines

HHS: Health Law Brings Down Hospitals' Uncompensated Care Costs

As part of a report released Wednesday, Obama administration officials cited evidence that hospitals are projected to save $5.7 billion in uncompensated care costs as previously uninsured patients gain coverage through the health law. The savings are most significant in states that expanded their Medicaid programs.

The New York Times: Affordable Care Act Reduces Costs For Hospitals, Report Says

The Obama administration increased the pressure on states to expand Medicaid on Wednesday, citing new evidence that hospitals reap financial benefits and gain more paying customers when states broaden eligibility. In states that have expanded Medicaid, the White House said, hospitals are seeing substantial reductions in “uncompensated care” as more patients have Medicaid coverage and fewer are uninsured (Pear, 9/24).

Kaiser Health News: Administration Says Hospitals Will Save $5.7B From Unpaid Bills Due To Health Law

Hospitals are projected to save $5.7 billion this year as previously uninsured patients gain coverage through the 2010 health care law, the Department of Health and Human Services said Wednesday. States that have expanded their Medicaid programs will see about 74 percent of those savings, an HHS report said. While 27 states and Washington, D.C. have expanded the federal-state insurance program for the poor to date, the survey was done when 25 states and D.C. had done so (Carey, 9/24). 

The Washington Post’s Wonkblog: HHS: Obamacare Coverage Is Reducing Hospitals’ Unpaid Bill

Millions more people with Health Insurance means fewer uninsured patients are coming through hospitals’ doors. That means fewer costs from bad debt or charity care from people unable to pay their bills, which amounted to about $50 billion for the nation’s hospitals in 2012 (Millman, 9/24).

The Associated Press: Report: Admission Of Uninsured At Hospitals Dips

The announcement of the findings is part of the Obama administration’s continuing effort to persuade states that have declined to expand their Medicaid coverage to reconsider their objections. So far, 27 states and the District of Columbia have agreed to provide Medicaid to people with income higher than poverty levels, as permitted under the health care law. What’s more, the report comes seven weeks before the start of a new round of open enrollment, a critical test for the health care law. Obama administration officials said both the Medicaid expansion and the law’s requirement that individuals obtain insurance had contributed significantly to the decrease in the number of uninsured Americans (9/24).

USA Today: HHS: Health Law Will Lead To Big Drop In Free Hospital Care

Burwell’s announcement was paired with one by Jason Furman, chairman of the Council of Economic Advisers, about the reductions in health care spending increases that the administration says are attributable to the health law. The three years after the ACA took effect in 2010 had the slowest growth in real per capita national health spending on record, Furman said. Furman called the ACA “one of most important developments in the economy in recent years,” and one that has major implications for job growth. The slower growth in premiums for employer coverage will make it easier for companies to hire workers and pay good salaries, he said (Jayne O’Donnell, 9/24).

Reuters: Obamacare To Save U.S. Hospitals $5.7B In Uncompensated Care

The report is the latest in a series of administration releases intended to show that President Barack Obama’s healthcare reform law is working. Wednesday’s announcement came weeks before the November mid-term elections, in which Republicans hope voter dislike for the Affordable Care Act will aid their efforts to win control of the U.S. Senate. Reducing the cost of “uncompensated care” among hospitals, particularly those with large populations of poor people, is a major goal of Obamacare, which offers federally subsidized private insurance to consumers in addition to expanding Medicaid (Morgan and Rampton, 9/24).

Politico Pro: Report: Hospitals To Save $5.7B In Uncompensated Care

Obamacare will save hospitals $5.7 billion this year in uncompensated care costs, with three-quarters of that going to facilities in states that expanded Medicaid eligibility, according to an HHS report released Wednesday. … In states that did not expand Medicaid, savings will total $1.5 billion (Wheaton, 9/24).

CNN: Some Hospital Costs Fall In Affordable Care Act’s First Year, Report Finds

Days ahead of the one-year anniversary of the rollout of HealthCare.gov, the Affordable Care Act’s health care exchange website that was originally plagued with numerous technical glitches, the Department of Health and Human Services has released a report highlighting the impact of the law on hospital costs (Hartfield, 9/24).

Dallas Morning News: White House Says Texas Forgoes Huge Sum By Not Expanding Medicaid

Texas taxpayers and hospitals pay a steep price for the state’s refusal to expand Medicaid, top White House officials said Wednesday, citing fresh cost projections for treating the uninsured. Hospitals nationwide will see uncompensated care drop $5.7 billion this year, according to a Department of Health and Human Services report. Three-fourths of that savings will go to the states that expanded Medicaid (Gilman, 9/24).

HHS: Health Law Brings Down Hospitals' Uncompensated Care Costs

Drug Firms Shift Sales Calls From Doctors To Administrators Controlling Hospital Formularies

Since many hospitals now work to help keep costs down by watching what drugs are used, pharmaceutical representatives must include administrators in their sales pitches. Also in the news, new concerns about the government’s plan to open a database next week on drug makers’ payments to doctors.

The Wall Street Journal: As Doctors Lose Clout, Drug Firms Redirect The Sales Call

Kendall French used to pitch drugs to doctors who could prescribe them. But many of those doctors now work for hospitals that don’t give them final say over what is on the menu of medicines they can pick. So when the GlaxoSmithKline saleswoman began plugging two new lung-disease drugs to a big San Diego hospital system this spring, it was to an administrator who doesn’t see patients but helps write the menu, also called a “formulary,” of approved medications. Ms. French urged the administrator in the system, Sharp HealthCare, to consider the two drugs’ effectiveness. It was the kind of pitch she once used to persuade doctors to write prescriptions (Rockoff, 9/24).

The Wall Street Journal’s Pharmalot: Pharma Pushes CMS For Transparency On Sunshine Database, Again

With just one week left before the launch of the controversial Open Payments database – which will reveal how much money doctors receive from drug and device makers – three of the biggest industry trade groups are complaining they have not had an opportunity to review important background information about relationships with physicians. And the trade groups – the Pharmaceutical Research and Manufacturers of America, BIO and AdvaMed – are reiterating concerns expressed last month that the Centers for Medicare and Medicaid Services has still not explained why one-third of the payment information submitted by drug and device makers, as well as group purchasing organizations, was removed from the database (Silverman, 9/24).

Drug Firms Shift Sales Calls From Doctors To Administrators Controlling Hospital Formularies

Some Small Businesses Help Workers Buy Individual Coverage

The Associated Press examines Health Insurance costs from different perspectives — that of a small businessman who provides workers with additional compensation to purchase their own coverage, rather than offering a company health plan, and that of a middle-class family facing mounting financial pressure which includes health premiums.

The Associated Press: Small Businesses Helping Workers Buy Health Plans

When Monty Hagler learned his employee insurance premiums could rise as much as 38 percent, the small business owner decided he couldn’t afford coverage that complies with the health care overhaul. He considered a variety of plans from different carriers, but they were too expensive or bare-bones. “Unless we dramatically changed our plan and went with the most basic plan, I said, ‘this is not sustainable,'” says Hagler, owner of RLF Communications, a Greensboro, North Carolina-based marketing company. So Hagler told his 12 staffers he would give them money starting in May to buy their own insurance coverage, likely to be better than what he could offer. He joined a growing number of small business owners who are forgoing coverage and paying staffers more to compensate for the lost benefits (Rosenberg, 9/24).

The Associated Press: Money Employers Give For Insurance Can Be Taxed

When employers give workers money to help pay for Health Insurance, the cash may be subject to taxes for both employer and employee. The IRS treats money given to workers as compensation, even if it’s intended to replace a benefit like insurance, says Steven Friedman, an attorney with Littler Mendelson, a New York-based firm that specializes in employment law (9/24).

The Associated Press: Middle-Class Squeeze: From Day Care To Health Care

Three years ago, Jason Prosser was stunned to discover the cost of child care for his newborn son — so much so that he and his wife postponed having a second child. The day care center they found near their Seattle home tops $10,000 a year. Next year, their son, now 3, can attend a Catholic preschool less than half as costly. He and his wife are among legions of middle-class families who are straining under the weight of accelerating costs for a range of essential services from day care to health care. And now a study by the Center for American Progress shows just how heavy the burden has grown: For a typical married couple with two children, the combined cost of child care, housing, health care and savings for college and retirement jumped 32 percent from 2000 to 2012 — and that’s after adjusting for inflation  (Rugaber, 9/25).

Meanwhile, Reuters focuses on how medical information is of more value than credit cards to hackers –

Reuters: Medical Records Worth More To Hackers Than Credit Card

Your medical information is worth 10 times more than your credit card number on the black market. Last month, the FBI warned healthcare providers to guard against cyber attacks after one of the largest U.S. hospital operators, Community Health Systems Inc, said Chinese hackers had broken into its computer network and stolen the personal information of 4.5 million patients. Security experts say cyber criminals are increasingly targeting the $3 trillion U.S. healthcare industry, which has many companies still reliant on aging computer systems that do not use the latest security features (Humer and Finkle, 9/24). 

Some Small Businesses Help Workers Buy Individual Coverage

State Highlights: N.C. Lawmakers Still Talking About Medicaid Revamp

A selection of health policy stories from North Carolina, Louisiana, Florida, Illinois, Texas, Georgia, New York, Maryland and Colorado.

The Associated Press: NC Lawmakers Talking More About Medicaid Overhaul

Legislators who couldn’t agree this year on how to overhaul North Carolina’s Medicaid program plan to spend more time talking about the issue before the General Assembly reconvenes early next year. A legislative oversight panel subcommittee charged with examining Medicaid reform and reorganization scheduled its first meeting Wednesday. Another oversight panel also examining Medicaid governance held its first meeting this month. The House and Senate approved differing versions of legislation to change how Medicaid pays for medical expenses by shifting risk from the state to either medical provider networks or private managed-care companies (9/24).

The Associated Press: La. Lawmakers Hold Hearing In Health Insurance Dispute

Controversy over Health Insurance changes planned for state workers, teachers and retirees is the focal point of a hearing expected to draw a crowd to the Louisiana Capitol. Gov. Bobby Jindal’s administration says changes are needed to address the rising costs of health care caused by medical inflation and federal law changes. But many workers and retirees are accusing the administration of mismanagement, improperly dropping premiums in past years to help balance the state budget. The insurance program is spending more money than it receives each month and is draining a reserve fund to cover costs (9/25).

Health News Florida: HCA Closing Hospital Due To Less Inpatient Occupation

For the first time since 2012, a hospital in Florida is closing its doors. HCA West Florida announced Tuesday the 38-year-old Edward White Hospital in St. Petersburg will close by the end of November and consolidate services to three nearby hospitals it also owns. Officials said operating costs at the aging facility continued to grow. And it pointed to a glut of hospital beds in the area: more than 1,000 in southern Pinellas County alone. “In this era where healthcare is migrating to the outpatient setting, we are seeing a significant rise in unoccupied licensed hospital beds throughout the region,” HCA West Florida President Peter Marmerstein said in a statement. This announcement marks the first time since 2010 any of the state’s 301 licensed hospitals closed, and just the fifth time in four years that it’s happened at all, Agency for Health Care Administration records show (Shedden, 9/24).

Stateline: Nursing Home Cameras Create Controversy

Over the years, Illinois Attorney General Lisa Madigan has consistently heard “horror stories” about the abuse or neglect of nursing home residents. Now she is trying to bring such cruelty out of the shadows and into clear view. Madigan’s office is drafting legislation, likely to be introduced in 2015, which would allow Illinois nursing home residents and their families to place cameras in their rooms to help protect them. If the measure is approved, Illinois would join at least four other states—New Mexico, Oklahoma, Texas and Washington—that have laws or regulations allowing residents to maintain cameras in their rooms. In Maryland, cameras can be placed in a resident’s room, but only if the facility permits them, according to state guidelines (Bergal, 9/25).

Texas Tribune: Disability Groups Hope Turnover Leads To Reform

As an entirely new roster of politicians takes statewide office next year, disability rights advocates are asking those future Texas leaders to work with lawmakers to address a struggling system of care for the state’s most vulnerable population. But while their traditional allies in elective office — Democrats — appear up and down the ballot, those candidates are running well behind their Republican counterparts. And at a statewide candidates forum in Austin on Wednesday hosted by the disability rights groups Coalition of Texans with Disabilities, ADAPT of Texas and The Arc of Texas, not a single Republican candidate made an in-person appearance. Attorney General Greg Abbott, the Republican front-runner for governor who uses a wheelchair after being paralyzed three decades ago by a falling tree, submitted a questionnaire in his stead, citing a prior engagement (Walters, 9/25).

Georgia Health News: Report: Disabilities System Reform Needs More Work

State health officials have major work ahead to meet a July 2015 deadline with the federal government on improving care for Georgians with mental illness and developmental disabilities. That’s a key message of a report this month from an independent reviewer regarding the state’s five-year settlement agreement with the U.S. Department of Justice, reached in 2010 (Miller, 9/24).

The Associated Press: NY Mandates Insurance Coverage For Ostomy Supplies

New York will require health insurers to provide coverage for equipment and supplies for treating ostomies, intended to help ease the financial burden for people with the chronic condition. The amendments, signed this week by Gov. Andrew Cuomo, take effect Jan. 1. An ostomy is a surgically created opening in the body for the discharge of waste (9/24).

Kaiser Health News: Personal Attention Seen As Antidote To Rising Health Costs

Kevin Wiehrs is a nurse at a busy doctor’s office in Savannah, Ga. But instead of giving patients shots or taking blood pressure readings, his job is mostly talking with patients like Susan Johnson. Johnson, 63, a retired restaurant cook who receives Medicare and Medicaid, has diabetes, and she already met with her doctor. Afterwards, Wiehrs spends another half hour with her, talking through her medication, exercise and diet (McCammon, 9/25).

Baltimore Sun: Telemedicine Program Aims To Decrease Student Absences, Improve Performance

In the coming weeks, students at five Howard County elementary schools won’t even need to leave the school building to consult with a doctor if they have a sore throat, a skin rash or an eye or ear infection. Instead, they’ll have the opportunity to talk with a University of Maryland Children’s Hospital Pediatrician remotely through Howard County’s new telemedicine technology unveiled Monday. County officials expect the program to decrease absentee rates, improve students’ educational performances and improve access to health care for students (Ames, 9/23).

Denver Post: Clinic Gets Health Services To Poor Kids

Concerned about the many students with no access to health care, two Jeffco Public School nurses set out to make sure children from low-income families could get high-quality care. Twenty-one years later, Karen Pramenko and Karen Conner appear to have accomplished their goal after the 1993 creation of Carin’ Clinic, an Arvada-based nonprofit providing medical care to underserved youth that’s getting bigger every year(Briggs, 9/25).

The Associated Press: Concerns Over Cost, Ethics Halt Texas Database Project

Plans for a massive health database have been postponed again after Texas health officials cited cost concerns, as well as the possibility that the company that won the tentative contract was receiving inside information from a state negotiator. The Health and Human Services Commission has further delayed the decades-old plan by ending negotiations this month with Truven Health Analytics of Ann Arbor, Mich., the Houston Chronicle reported. The “enterprise data warehouse” project is expected to be rebid, a process that could take months and cost the state tens of thousands of dollars in staff time (9/24).

State Highlights: N.C. Lawmakers Still Talking About Medicaid Revamp