Profit margins at hospitals rise as charity care falls in the St. Louis region

http://www.stltoday.com/business/local/profit-margins-at-hospitals-rise-as-charity-care-falls-in/article_6f0b2ae6-46e9-5435-a40a-0334122ff8dc.html

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Profit margins at St. Louis area hospitals rose to 4.5 percent in 2014 due to increased emergency room and outpatient visits and steep declines in charity care, according to a new report from the St. Louis Area Business Health Coalition, an organization that represents area employers.

While profits increased, hospitals were less charitable, the organization found. In 2014 area hospitals spent 2.1 percent of their operating revenue on charity care, or free or reduced care for low-income individuals. In the previous year, area hospitals spent 2.93 percent of operating revenue on charity care. That’s a nearly 28 percent decline in charity care in the region, according to Karen Roth, author of the report.

For some health care advocates, a decrease in charity care is problematic because nonprofit hospitals are tax-exempt based on an expectation that they provide free care to those in need. However, the Internal Revenue Service and the state of Missouri do not have any requirements regarding how much charity care a nonprofit hospital must provide.

Medicaid Expansion: Driving Innovation In Behavioral Health Integration

http://healthaffairs.org/blog/2016/07/05/medicaid-expansion-driving-innovation-in-behavioral-health-integration/

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Safety-net providers in states that have accepted the federal funding available for Medicaid expansion under the Affordable Care Act (ACA) are experiencing a positive ripple effect, where increased insurance coverage rates among patients and thus greater financial security for safety-net institutions are translating into better care. We found that safety-net providers in states that expand Medicaid are delivering more services and better-coordinated care than what is available in states rejecting the expansion.

Of particular interest is the effect of Medicaid expansion on attempts to integrate behavioral health services with primary health care — long a thorny issue for safety-net providers. Research has shown that the Affordable Care Act (ACA) has increased access to behavioral health services. We present case studies from two provider systems that illustrate some of the innovative approaches that are improving the quality of behavioral health care at safety-net institutions.

Photographer: Getty Images Hospitals That Mess Up Are Urged to Confess

http://www.bloomberg.com/news/articles/2016-06-10/hospitals-that-mess-up-are-urged-to-confess

Transparency is touted as better for patients, families, and the bottom line. Some malpractice lawyers are skeptical.

http://www.bloomberg.com/view/articles/2016-07-05/make-hospitals-come-clean-about-errors?_hsenc=p2ANqtz-8ZpJHzsW6ezhTNDzhthaaXe6weEgaxabXDhTr3Tnr4tY83AkIxknJyohj6Vu-VhfX2tS0Xo3ep8RxBlqIckVnwVBZmPQ&_hsmi=31344233&utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_content=31344233&utm_medium=email&utm_source=hs_email

Bill Gates Calls U.S. Drug Pricing System ‘Better Than Most’

http://www.bloomberg.com/news/articles/2016-06-30/bill-gates-calls-u-s-drug-pricing-system-better-than-most?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=31344233&_hsenc=p2ANqtz-_IwIHqZOj5Uimtit1dADkgETVDbXoDQwj9rnv-X62TCgc0moUvyuIvvz78lEeOdY3_XlQXobqra8EKSy-AP-8omkHofA&_hsmi=31344233

Billionaire Bill Gates, whose foundation seeks to spread modern medicine through the developing world and wipe out diseases of the poor such as malaria, said he supports the U.S. drug pricing system even as politicians have intensified their criticism of high costs.

“The current system is better than most other systems one can imagine,” Gates said in an interview on Bloomberg Television. “The drug companies are turning out miracles, and we need their R&D budgets to stay strong. They need to see the opportunity.”

The Fundamentally Different Goals of the Affordable Care Act and Republican ‘Replacement’ Plans

http://blogs.wsj.com/washwire/2016/06/07/the-fundamentally-different-goals-of-the-affordable-care-act-and-republican-replacement-plans/?utm_campaign=KFF-2016-June-Drew-ACA-GOP-alternatives&utm_medium=email&_hsenc=p2ANqtz-9Uqf60gdSQ_FC57uSLNkYvFicHfqEALEVvadSgR8xY01bL5QFOrYsCgcl6KB_N5PVHy5G8fwynf8MEywb7m1kUxPljFQ&_hsmi=30331935&utm_content=30331935&utm_source=hs_email&hsCtaTracking=7825060e-e865-4738-ba5a-68a31a8904b6%7C192993c0-5763-4c2a-b289-c32fd7a5274a

Rep. Pete Sessions and Sen. Bill Cassidy introduced legislation last month calling for replacing elements of the Affordable Care Act. A House task force established by SpeakerPaul Ryan is expected to follow with more health-care proposals. These Republican health plans are generally referred to as “replacements” for the ACA–in the spirit of “repeal and replace”–as though they would accomplish the same objectives in ways that conservatives prefer. But the proposals are better understood as alternatives with very different goals, trade-offs, and consequences. Whether they are “better” or “worse” depends on your perspective.

To boil down to the most basic differences: The central focus of the Affordable Care Act is expanding coverage and strengthening consumer protections in the health insurance marketplace through government regulation. By contrast, the primary objective of Republican plans is to try to reduce health-care spending by giving people incentives to purchase less costly insurance with more “skin in the game,” with the expectation that they will become more prudent consumers of health services. They also aim to reduce federal spending on Medicare and Medicaid and the federal government’s role in both programs. Elements of the ACA were designed to reduce costs, such as the law’s Medicare payment reforms, and elements of Republican plans such as tax credits aim to expand access to insurance, but the primary aims of the ACA and the Republican plans differ.

The Next Big Debate in Health Care

http://blogs.wsj.com/washwire/2016/06/30/the-next-big-debate-in-health-care/?utm_campaign=KFF-2016-Drew-WSJ-June-30-adequacy-coverage&utm_medium=email&_hsenc=p2ANqtz–xQ5m7mTzVOQDJ-gEuLbZl7pkPEfb_Iw0ezewQc1ln7AN8seXIMO73B28qbm9dojkj8aBYyKmMoIvL46iTkyv7FWksVw&_hsmi=31195410&utm_content=31195410&utm_source=hs_email&hsCtaTracking=ed044791-0cff-437c-b853-bcb03570f762%7C6f34b697-a7d1-4d2a-b580-e9d37afa69ac

Source: Kaiser Family Foundation analysis of Truven Health Analytics MarketScanCommercial Claims and Encounters Database, 2004-2014; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 2004-2014 (April to April).

With 91% of the population now covered by some form of health insurance, and the coverage rate higher in some states, the next big debate in health policy could be about the adequacy of coverage. That particularly means rising payments for deductibles and their impact on family budgets and access to care. This is about not just Obamacare but also the many more people who get insurance through an employer.

It’s not clear whether deductibles will continue to rise as they have over the past decade. Rising cost-sharing is not employers’ preferred strategy  for containing health costs, but it’s the one they resort to when they need to quickly reduce their annual premium increase. If the economy weakens again employers will feel greater pressure to reduce their health-benefits costs, and the trend toward higher deductibles will be more likely to continue. The question of how much cost-sharing is too much, and what to do about it, could be the next big debate in health care–once the political world moves on from its focus on the ACA.

The rural hospital closure crisis: 15 key findings and trends

http://www.beckershospitalreview.com/finance/the-rural-hospital-closure-crisis-15-key-findings-and-trends.html

http://www.ivantageindex.com/vulnerability-index/

Click to access Rural-Vulneravbility-2016_FINAL.pdf

Appeals Panels Affirm Injunction Against Fixed Indemnity Regulation, Turn Back Challenge To ‘Administrative Fix’

http://healthaffairs.org/blog/2016/07/03/appeals-panels-affirm-injunction-against-fixed-indemnity-regulation-turn-back-challenge-to-administrative-fix/

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On July 1, the D.C. Circuit decided two appeals challenging aspects of the implementation of the Affordable Care Act, accepting one challenge and rejecting the other. In Central United Life v. Burwell, a three-judge panel of the D.C. Circuit Court of Appeals affirmed a lower court injunction against a 2014 HHS regulatory prohibition on the sale of fixed indemnity insurance unless the purchaser attests that he or she already has minimum essential coverage. And in West Virginia v. HHS, a different panel of the D.C. Circuit rejected a challenge brought by the state of West Virginia to the “administrative fix” announced by HHS late in 2013. Under this arrangement, HHS deferred for 2014 enforcement of eight of the ACA’s insurance market reform requirements against existing insurance plans in the individual and small group market.

An inside look at the world of drug presentations

http://www.scpr.org/news/2016/07/01/62183/an-inside-look-at-the-world-of-drug-presentations/

Critics say the system is flawed because it’s paid for by drug makers with a financial stake in the outcome.

Presentations sponsored by pharmaceutical companies only focus on one drug and do not include all the options available, including generics, says R. Adams Dudley, Director of the Center for Healthcare Value at the University of California San Francisco.

“They’re going to emphasize the education aspect of it but they wouldn’t pay for it if it did not lead to sales,” he says.

 

California Nurse Practitioners Lose Battle For Independent Practice, Again

California Nurse Practitioners Lose Battle For Independent Practice, Again

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Expanding the medical role of nurse practitioners has long been opposed by doctors – some say for economic reasons. Proponents of the idea say it can help address the shortage of primary care doctors in the state by making treatment more accessible — and more affordable.

Under current state law, nurse practitioners can independently provide basic primary care, such as assessing a patient’s health status or diagnosing ailments. But they must follow physician-approved guidelines to prescribe medication, order tests or otherwise manage patients.

Nurse practitioners are among the most highly trained nursing professionals and must have at least a master’s degree. Registered nurses, are only required to hold an associate’s degree at minimum, and they don’t diagnose or prescribe on their own. Nurse practitioners say they provide quality care that’s comparable to that provided by physicians. They want California lawmakers to allow them to practice without the supervision of a doctor.