Most states have limited laws or no laws at all to guarantee patient access to information on hospital and clinic prices, according a newly released report that found poor disclosure and incomplete information in three dozen states.

The report, released by the Catalyst for Payment Reform and the Health Care Incentives Improvement Institute (PDF), awarded an F to 29 states—including seven without any price laws whatsoever—and gave another seven states a D. State laws were graded on how easily disclosed prices could be seen by the public; whether laws required disclosure of prices or discounts paid by insurers; and how many providers and procedures were included.

Even among two states that earned an A, Massachusetts and New Hampshire, disclosure was lacking, the reports’ authors said.

“We graded on a curve,” said Suzanne Delbanco, executive director of the Catalyst for Payment Reform, an employer group. “I think there’s room for improvement, even among the As.”

via Modern Healthcare | continue reading

The Obama administration said on Tuesday that it will operate federal online health insurance marketplaces in 26 of the 50 U.S. states with little or no input from local state officials.

The U.S. Department of Health and Human Services announced that a total of 24 states, including six with Republican governors, plus the District of Columbia, are on track to run their own marketplaces, known as healthcare exchanges, or to do so in partnership with the federal government.

The new tally, which follows a Feb. 15 deadline for states to request a federal partnership exchange, underscores the logistical challenge facing the administration as it moves to set up federal marketplaces less than eight months before the Oct. 1 opening of plan enrollment.

“No matter where a qualified consumer lives, he or she will have access to coverage through a marketplace,” Health and Human Services Secretary Kathleen Sebelius said in a government blog post.

She also emphasized that states which have not opted for a state-run or federal partnership exchange will still be able to apply to run their own in future years.

via
| continue reading

News outlets parse the particulars of how the fiscal deal will impact the health care system, and how the health industry is bracing for the next rounds in the budget battles.

Kaiser Health News: Behind The Fiscal Cliff Deal, A Prolonged Hospital Finance Fight
After Congress’ fiscal cliff deal this week dug into hospitals’ pockets to avert a drop in Medicare payments to physicians, industry associations screamed. The president of the American Hospital Association said the reductions — nearly $15 billion over a decade — “will make it harder for patients to access the care they need.” The president of the Federation of American Hospitals also said patients would suffer because lawmakers had decided to “rob hospital Peter to pay for fiscal cliff Paul” (Rau, 1/3).

The Hill: Public Hospitals Seek To Ward Off Cuts
The lead advocate for public hospitals is already making the case that safety-net providers cannot sustain cuts as part of a deficit-reduction deal this spring. Bruce Siegel, who leads the National Association of Public Hospitals and Health Systems, congratulated lawmakers and the White House for avoiding the worst effects of the “fiscal cliff” (Viebeck, 1/3).

Kaiser Health News: Rural Hospitals Get Relief In Fiscal Cliff Deal
While much of the hospital industry has lamented the deal reached between Congress and the White House because it will pay about half the $30 billion bill to avert a 27 percent Medicare fee cut for physicians, the agreement was cause for celebration for about 200 small, rural hospitals. That’s because it also extended for one year a program that pays hospitals such as Jones Memorial up to several millions of dollars each year because they have fewer than 100 beds, are located in rural areas and treat a high proportion of Medicare patients (Galewitz, 1/4).

NPR: Bargain Over Fiscal Cliff Brings Changes To Health Care
The bill that prevented the nation from plunging over the fiscal cliff did more than just stop income tax increases and delay across-the-board spending cuts. It also included several provisions that tweaked Medicare and brought bigger changes to other health care programs (Rovner, 1/4).

Politico: Health Care Guide To Debt Limit Battle
Congress’s most recent spending battle left the health industry with some nicks and scratches, but it’s leery of having to hand over even bigger savings in the next battle looming two months from now. From hospitals to doctors to insurers to drug makers, industry players are expecting they’ll come up in the mix as lawmakers search for ways to pay for another deal to avert sequestration and increase the debt limit (Haberkorn and Cunningham, 1/3).

In the background, controversial ways to find savings continue to percolate -

Minneapolis Star Tribune: Health Beat: In Health Care, An Rx For Deficits?
Relief over the new federal budget deal has turned to cynicism almost overnight, with many saying that Washington has merely kicked its problem down the road. But Jonathan Gruber, a respected health economist from MIT, suggests there’s a solution down that road — if Congress is willing to tackle health policy for the second time in three years. His suggestion: Change the tax deduction that employers get for offering their workers health insurance. Lawmakers have long considered it untouchable, for fear they would jeopardize a system that provides 60 percent of Americans with their health insurance. Along with the mortgage-interest deduction, it’s one of the biggest and most popular federal tax breaks (Hage, 1/3).

via Kaiser Health News Daily Report

The state plans to expand its Medicaid program as much as the federal health law envisions, without spending any extra money to make it happen.

Kaiser Health News: Capsules: Colorado Will Expand Medicaid, Governor Announces
Gov. John Hickenlooper said Colorado will expand its Medicaid program as much as the federal health care law calls for, and he said the state won’t have to spend any extra money to make it happen. The federal health overhaul law requires states to significantly expand the health care program for the poor, but when the U.S. Supreme Court ruled on the Affordable Care Act last June, it said states couldn’t be forced to take the new Medicaid money, essentially making that expansion optional (Whitney, 1/3).

Denver Post: Colorado Plans Medicaid Expansion, Claims Cost Savings In Process
Colorado plans to expand Medicaid coverage next year to cover more than 160,000 additional low-income adults, aided by cost-control savings of more than $280 million over the next 10 years, Gov. John Hickenlooper announced Thursday. “This is a step toward what we have talked about for a couple of years: How can we make sure we’re making Colorado the single healthiest state in America?” Hickenlooper said. Through 2016, the federal government covers the entire cost of the expansion, which comes under provisions of the Affordable Care Act. The governor said he anticipates that even when federal funding for the expansion is reduced, “not one dollar of general-fund money will be used to replace it” (Simpson, 1/3).

via Kaiser Health News

The University of Missouri Health Care system says several of its facilities have achieved a top national ranking for their efforts to implement electronic medical records.

The university says the Ellis Fischel Cancer Center, Missouri Orthopaedic Institute, Missouri Psychiatric Center, Women’s and Children’s Hospital and University Hospital have received the highest ranking from a group that tracks progress on electronic medical records.

The university says the hospitals are among just 97 of more than 5,300 nationwide to achieve that distinction.

The evaluation model for electronic medical records is run by Chicago-based HIMSS Analytics.

via Modern Healthcare

Kansas has become the first state in the country to connect to the national disease outbreak surveillance system via a digital health information exchange.

Officials at BioSense — the syndromic surveillance system at the Centers for Disease Control and Prevention (CDC) — said that the Kansas Health Information Network on Friday became the first HIE to begin contributing data. Various individual hospitals nationwide already are linked to the system.

Previously just one Kansas hospital — St. Luke’s South in Kansas City, Kan. — was connected to the CDC system, which keeps constant tabs on 89 syndrome categories as mandated by the Public Health Security and Bioterrorism Preparedness Response Act of 2002.

More hospitals contributing

With KHIN joining the system, 10 more Kansas hospitals are now submitting surveillance data to BioSense. And as more Kansas hospitals connect to KHIN, outbreak surveillance in the state will expand, a state health official said.

Kansas state epidemiologist Charlie Hunt said that his office at the Kansas Department of Health and Environment connected to BioSense this spring, but — with just one hospital contributing data — its usefulness for detecting an outbreak in Kansas was limited.

“The highway was built but there was only one car on it. Now there are a lot more cars traveling the highway and we’ll be able to utilize the information better. As more facilities begin submitting data to BioSense through KHIN obviously the scope, the breadth and depth of information will be better for us,” Hunt said.

via Kansas Health Institute | continue reading

Federal officials say New Jersey inappropriately claimed some Medicaid payments totaling more than $100 million for five hospitals that didn’t meet federal requirements.

The claim is cited in a report being issued Monday by the Health and Human Services Department.

The department’s Inspector General office has recommended that New Jersey pay back about $50 million. But New Jersey’s Human Services Department, which administers the Medicaid program, says it should only have to refund about $3.5 million.

The agency says two of the five hospitals cited met the federal requirements during part of the audit period. It also says valid claims for payments to other hospitals in the state exceeded its federal allotment during some of the audit period and should be considered as an offset to the payments in question.

via Beaumont Enterprise

Utah hospitals and clinics would have to disclose on privacy notices their practice of sharing patients’ personal information with the state under a bill that cleared its first legislative hurdle on Wednesday.

The measure was pitched by Sen. Stuart Reid, R-Ogden as a remedy to last year’s massive health data breach. Hackers, exploiting a factory password, broke into a Utah Medicaid server and stole the personal information of about 780,000 Utahns, including nearly a quarter-of-a-million Social Security numbers.

Because of providers’ practice of “pinging” the server to test patients’ eligibility for Medicaid, the information of countless retirees on Medicare and people with private health insurance was exposed.

Reid’s bill would not put a halt to the billing practice. Instead, it would put patients on guard by notifying them that a given provider has, or may, share their “personally identifiable” information with Medicaid.

“Is it right that hospitals ping the system as a matter-of-course, even when patients have private insurance? I’m not sure that it is,” said Reid, whose wife’s information compromised. “But in some ways they’re trapped. A lot of patients don’t know what their insurance covers or whether they qualify for Medicaid.”

The bill directs the Utah Department of Health to draft model disclosure language and to verify that providers’ privacy notices comply.

It also subjects the Utah Department of Technology Services to routine audits to ensure its servers are up to national security standards.

The bill passed the interim Health and Human Services Committee unanimously, despite concerns that it was either overkill or didn’t go far enough.

How much it will cost large health systems to change their privacy notices isn’t clear. But Reid’s bill has the backing of the Utah Hospital Association.

via The Salt Lake Tribune

State might even run its own health insurance marketplace. Even governor easing up on opposition.

The U.S. Supreme Court has ruled, President Barack Obama has won re-election and a majority of Florida voters rejected Amendment 1, the effort to etch into the state constitution a permanent ban on mandatory health insurance.

With the Affordable Care Act more certain than ever, some lawmakers are calling for a careful look at how to implement it here. Even Florida Gov. Rick Scott, a staunch opponent, appeared to be softening his longstanding refusal to acknowledge the law.

“Just saying ‘no’ is not an answer,” he said in a statement released by his press office late Friday. “We need to focus on how Obamacare affects each of our families,” he said, adding he is concerned about the impact for cost, access and quality of care.

“I am looking forward to working with legislators and others on specific ways to address these issues,” he said.

The U.S. Department of Health and Human Services has given states reason to set up and operate the online marketplaces where consumers will buy insurance starting next fall. States with their own exchanges will have more leeway to decide how much coverage plans sold on the exchanges must offer. More generous base benefits likely would raise the cost of premiums, though.

“I am concerned about how it affects patients, jobs and taxes on Floridians,” Scott said.

On Wednesday, hours after Republican presidential candidate Mitt Romney had conceded, Scott sounded a more combative tone, saying it would cost too much to expand Medicaid and set up health insurance exchanges.

“No one has been able to show me that that health care exchange is going to do anything rather than raise taxes, raise the cost of our companies to do business,” Scott told the Sarasota Herald-Tribune.

In July, he told Fox News: “We’re not going to implement Obamacare in Florida. We’re not going to expand Medicaid.”

The health care law requires consumers to carry insurance beginning in 2014 — a little more than 13 months from now — or pay a penalty. That coverage will be purchased through online health marketplaces, if consumers lack employer-provided insurance, Medicaid or Medicare. Some who can’t afford insurance will be eligible for subsidies.

If Florida doesn’t establish its own online marketplace, the federal government will do it for the state. The deadline for governors to decide on running their own state’s insurance exchange is Friday. States planning to do so must supply a blueprint by Dec. 14.

via Palm Beach Post | written by Stacey Singer | continue reading

The Obama administration gave states extra time to work toward setting up new health insurance exchanges on Friday, three days after President Barack Obama’s re-election ensured the survival of his healthcare reform law.

The move is seen as a concession to dozens of states that delayed compliance with the Patient Protection and Affordable Care Act until after the November 6 election. Republican governors in some states had hoped to see a victory for the party’s presidential challenger Mitt Romney, who had vowed to repeal the law.

But with a November 16 deadline to declare their plans looming, many need more time to prepare for the exchanges, which are complex marketplaces designed to allow working families the chance to purchase private insurance at subsidized rates beginning in 2014.

In cases where states decide not to participate at all, the federal government says it will go in and build an exchange on its own. Since Tuesday’s election, governors in seven states – including Texas, Kansas, Virginia and Florida – have said they will refuse to proceed with an exchange.

“The administration would like to do whatever it can to bring states in,” said Larry Levitt, a healthcare policy expert with the nonpartisan Kaiser Family Foundation, which tracks health issues.

“It’s always been expected that if the president got reelected, a lot of states sitting on the sidelines would realize they don’t want the federal government building a state health insurance system. That’s what we’re seeing happening.”

U.S. Health and Human Services Secretary Kathleen Sebelius said in a November 9 letter to governors that the administration still expects states to declare whether they intend to operate their own exchanges by next Friday. But they now have until December 14 to file blueprints showing how they would operate the marketplaces. So far, about 13 states are well on their way to setting up their own exchanges.

via Reuters | continue reading