Category Archives: Doctors

High court considers if providers can sue states for higher Medicaid pay

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Top row (left to right): Associate Justice Sonia Sotomayor, Associate Justice Stephen G. Breyer, Associate Justice Samuel A. Alito, and Associate Justice Elena Kagan. Bottom row (left to right): Associate Justice Clarence Thomas, Associate Justice Antonin Scalia, Chief Justice John G. Roberts, Associate Justice Anthony Kennedy, and Associate Justice Ruth Bader Ginsburg.

Top row (left to right): Associate Justice Sonia Sotomayor, Associate Justice Stephen G. Breyer, Associate Justice Samuel A. Alito, and Associate Justice Elena Kagan. Bottom row (left to right): Associate Justice Clarence Thomas, Associate Justice Antonin Scalia, Chief Justice John G. Roberts, Associate Justice Anthony Kennedy, and Associate Justice Ruth Bader Ginsburg.

By Phil Galewitz
KHN

The U.S. Supreme Court heard arguments Tuesday in a case that could block hospitals, doctors — or anyone else — from suing states over inadequate payment rates for providers who participate in the Medicaid program for low-income Americans.

Many doctors avoid seeing Medicaid recipients, saying the program pays too little. That can lead to delays and difficulties in getting care for millions of poor people.

Federal law requires Medicaid, which covers 70 million people, to provide the same access to care as that given to people with private insurance. But many doctors avoid seeing Medicaid recipients, saying the program pays too little. That can lead to delays and difficulties in getting care for millions of poor people.

In Armstrong vs. Exceptional Child Center, several providers for developmentally disabled Medicaid patients sued the state of Idaho after officials failed to increase Medicaid payments as required under a formula approved by the federal government.

An appellate court upheld a judgment in favor of the providers last year, noting that Idaho had conceded that it held rates flat since 2006 for “purely budgetary reasons.”

The issue before the high court is whether the U.S. Constitution gives providers the right to sue the state to increase their pay. And the court appeared split on that issue based on their remarks Tuesday. Continue reading

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Only a few Obamacare experiments to cut readmissions successful so far

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Photo: Steve Woods

By Jay Hancock
KHN

Obama administration officials have warned that ambitious experiments run by the health law’s $10 billion innovation lab wouldn’t always be successful. Now there is evidence their caution was well placed.

Only a small minority of community groups getting federal reimbursement to reduce expensive hospital readmissions produced significant results compared with those from sites that weren’t part of the $300 million program, according to partial, early results.

The closely watched program is one of many tests to control costs and improve care being run by the Center for Medicare and Medicaid Innovation, which was created by the Affordable Care Act.

Dozens of community agencies on aging, from Ventura County, Calif., to southern Maine were offered money to try to ensure that seniors leaving the hospital received care that reduced their chances of being readmitted within a month.

But an early evaluation found that only four groups out of 48 that were studied in the Community-based Care Transition Program significantly cut readmissions compared with those of a control group. Continue reading

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US bishops take aim at sterilization

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US catholic bishops-LogoBy Nina Martin
ProPublica

The Vatican has an absolute prohibition on sterilization for the purposes of birth control. The U.S. Catholic bishops consider the procedure “intrinsically immoral,” on par with abortion.

Yet for years, Genesys Health System, a Catholic medical center near Flint, Mich., allowed doctors delivering babies there to tie the tubes of new mothers who wanted to ensure they never got pregnant again.

A toughening of Catholic medical directives could include enforcing a ban on tubal ligations.

Genesys’s policy wasn’t hard to fathom: Performing a tubal ligation immediately after childbirth is the long-established standard of care, especially if a woman is having a cesarean section.

“She’s already cut open — her tubes are right there,” said Sarah Ward Prager, an associate professor in obstetrics and gynecology and director of family planning at the University of Washington Medical School.

Subjecting a new mother to a second surgery carries “unnecessary risk,” Prager said. “It is simply unethical to say, ‘I’m going to make you come back to a different hospital to have another surgery in six weeks because the bishop says I can’t tie your tubes right now.”

Then, seemingly out of the blue, Genesys reversed course. Starting November 1, sterilization with the “direct” aim of preventing pregnancy — as opposed to for some other medical (“indirect”) reason — was banned.

Patients who had planned to have the procedure after childbirth were left scrambling; their irate doctors were, too.

Genesys won’t say why it allowed sterilizations to go on for so long or why it has forbidden them now. In a statement to ProPublica, the hospital acknowledged only that it had “updated its policy on tubal ligations to comply with current Church teaching.”

But this much is clear: The Genesys decision is almost certainly a sign of things to come. Continue reading

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The two things that rarely happen after a medical mistake

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Physician and Nurse Pushing GurneyBy Olga Pierce and Marshall Allen
ProPublica

This story was co-published with NPR’s Shots blog.

Patients who suffer injuries, infections or mistakes during medical care rarely get an acknowledgment or apology, researchers at the Johns Hopkins University School of Medicine report.

The study was based on responses of 236 patients who completed ProPublica’s Patient Harm Questionnaire during the one-year period ending in May 2013 and who agreed to share their data.

Results of the study, led by professor of surgery Marty Makary and conducted independently from ProPublica, were published online Nov. 13 by the Journal of Patient Safety. The study found:

  • It was common for health care providers to withhold information about medical mistakes. Only 9 percent of patients said the medical facility voluntarily disclosed the harm.
  • When officials did disclose harm it was often because they were forced to. Nine percent of respondents said the harm was only acknowledged under pressure.
  • Apologies were infrequent. Only 11 percent of patients or their family members reported getting an apology from a provider.
  • More than 30 percent reported paying bills related to the harm. The average cost: $14,024.

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Is your heart doctor out? If so, you may be better off.

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Heart monitor tracingBy Jordan Rau
KHN

If your cardiologist is away at a conference when you’re having a stabbing feeling in your chest, don’t fret. You may be more likely to live.

study published Monday in the journal JAMA Internal Medicine found frail patients admitted to teaching hospitals with two common types of heart problems were more likely to survive on days when national cardiology conferences were going on.

The researchers also discovered that heart-attack patients who were at higher risk of dying were less likely to undergo angioplasties when conferences were occurring, yet their mortality rates were the same as similar patients admitted at other times.

An angioplasty—in which a doctor unblocks an artery with an inflatable balloon inserted by a small tube—is one of the most common medical procedures for cardiac patients.

The conclusions about teaching hospitals surprised even the authors, who had begun their inquiry anticipating that death would be more common during cardiology meetings because hospital staffs were more short-handed than usual. Finding the opposite, the researchers speculated that for very weak patients, aggressive treatments may exceed the benefits. Continue reading

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Medicaid’s raise for primary care docs to disappear

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Twenty-dollar bill in a pill bottleBy Michael Ollove
Stateline

A temporary bump in Medicaid fees paid to primary care doctors, an Affordable Care Act provision intended to get more physicians to accept Medicaid patients, will expire at the end of this month.

Congress did not extend the higher rates, so unless states take action themselves or the new Congress revisits the issue, primary care doctors in Medicaid will see their fees fall by an average of nearly 43 percent starting in January, according to a new report from the Urban Institute.

Unless action is taken primary care doctors in Medicaid will see their fees fall by an average of nearly 43 percent starting in January.

Whether the expiration of the fee increase will make a difference in physician participation in Medicaid is unknown. That is because there hasn’t been enough time to analyze whether the hike actually convinced primary care doctors to take Medicaid patients.

“It’s expiring before it’s been evaluated,” said Sandra Decker, a researcher at the National Center for Health Statistics, an arm of the Centers for Disease Control and Prevention.

Decker, who has published widely on the Medicaid physician workforce, said she will analyze the impact of the fee increase, but doubts her results will be complete before the end of next year.

Still, she noted, past evidence indicates that Medicaid pay increases spur participation by physicians. She predicted that the lower fees will make it harder for Medicaid patients to find doctors willing to see them or that they will have to endure long waits to see doctors who accept Medicaid patients.

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Vera Whole Health to run employee clinic for City of Kirkland

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Screen Shot 2014-12-17 at 12.35.36 PMVera Whole Health has signed an agreement with the City of Kirkland to offer primary, preventive and acute care to City of Kirkland employees at a new worksite clinic.

The Seattle-based company offers on-site and near-site health clinics for organizations. Employers pay monthly fee for their employees to receive unlimited primary care, acute care and health coaching.

The company staffs the clinics with physicians, nurse practitioners, medical assistants and health coaches. The goal of the employer-funded clinics is to help employees develop and maintain healthy lifestyles, reversing the trend of rising overall health care costs, the company says.

In the Puget Sound region, the company maintains clinics for Seattle Children’s Hospital, the Bill & Melinda Gates Foundation, Trident Seafoods in Ballard and a Seattle-based investment company.

The City of Kirkland clinic is expected to open in the spring of 2015 and will be located in the Totem Lake area.

 

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As controlled substance use rises in Medicare, prolific prescribers face more scrutiny

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pills-spill-out-of-bottle

By Charles Ornstein and Ryann Grochowski Jones
ProPublica

This story was co-published with USA Today and NPR’s Shots blog.

Despite a national crackdown on prescription drug abuse, doctors churned out an ever-larger number of prescriptions for the most-potent controlled substances to Medicare patients, new data shows.

In addition, ProPublica found, the most prolific prescribers of such drugs as oxycodone, fentanyl, morphine and Ritalin often have worrisome records.

In 2012, the most recent year for which data is available, Medicare covered nearly 27 million prescriptions for powerful narcotic painkillers and stimulants with the highest potential for abuse and dependence.

That’s up 9 percent over 2011, compared to a 5 percent increase in Medicare prescriptions overall.

Even taking into account an increase in the number of Medicare enrollees, the prescribing rate rose slightly for these drugs, which are classified as Schedule 2 controlled substances by the Drug Enforcement Administration.

Twelve of Medicare’s top 20 prescribers of Schedule 2 drugs in 2012 have faced disciplinary actions by their state medical boards or criminal charges related to their medical practices, and another had documents seized from his office by federal agents.

The No. 1 prescriber 2014 Dr. Shelinder Aggarwal of Huntsville, Ala., with more than 14,000 Schedule 2 prescriptions in 2012 2014 had his controlled substances certificate suspended by the state medical board in March 2013. He surrendered his medical license four months later. (Aggarwal could not be reached for comment.)

Prescribing high volumes of Schedule 2 drugs can indicate a doctor is running a pill mill, said Dr. Andrew Kolodny, chief medical officer of Phoenix House, a New York-based drug treatment provider. Government regulators should do more to monitor prescribing patterns and intervene proactively if they appear aberrant, he said.

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How safe are outpatient surgery centers?

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Popularity Of Outpatient Surgery Centers Leads To Questions About Safety

Woman_doctor_surgeonBy By Sandra G. Boodman
KHN and Washington Post

Wendy Salo was alarmed when she learned where her doctor had scheduled her gynecologic operation: at an outpatient surgery center.

“My first thought was ‘Am I not important enough to go to a real hospital?’ ” recalled Salo, 48, a supermarket department manager who said she felt “very trepidatious” about having her ovaries removed outside a hospital.

Before the Sept. 30 procedure, Salo drove 20 miles from her home in Germantown, Md., to the Massachusetts Avenue Surgery Center in Bethesda for a tour. Her fears were allayed, she said, by the facility’s cleanliness and its empathic staff.

Salo later joked that the main difference between the multi-specialty center and Shady Grove Adventist Hospital — where she underwent breast cancer surgery last year — was that the former had “better parking.”

Salo’s initial concerns mirror questions about the safety of outpatient surgery centers that have mushroomed since the highly publicized death of Joan Rivers.

The 81-year-old comedian died Sept. 4 after suffering brain damage while undergoing routine throat procedures at Yorkville Endoscopy, a year-old free-standing center located in Manhattan.

Federal officials who investigated Rivers’ death, which has been classified by the medical examiner as a “therapeutic complication,” found numerous violations at the accredited clinic, including:

  • a failure to notice or take action to correct Rivers’ deteriorating vital signs for 15 minutes;
  • a discrepancy in the medical record about the amount of anesthesia she received;
  • an apparent failure to weigh Rivers, a critical factor in calculating an anesthesia dose;
  • and the performance of a procedure to which Rivers had not given written consent.

In addition, one of the procedures was performed by a doctor who was not credentialed by the center.

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States focus on ‘super-utilizers’ to reduce Medicaid costs

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Sign for an emergency room.By Michael Ollove
Stateline

In health policy circles, they are called “super-utilizers,” but the name isn’t meant to connote any special powers. Just the opposite.

They are people whose complex medical problems make them disproportionately heavy users of expensive health care services, particularly emergency room treatment and in-patient hospitalizations.

At least 15 states, including Washington established “health homes,” or teams of providers responsible for coordinating the care of most complicated and costly of patients.

The cost of treating them is huge: Just 5 percent of Medicaid’s 68 million beneficiaries account for 60 percent of the overall spending on the program.

Using a provision of the Affordable Care Act, many state Medicaid agencies are trying to diminish use of medical services by super-utilizers by better managing their care.

The goal is to not only reduce costs, but to achieve better health outcomes for these patients.

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Is there really a looming doctor shortage?

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Question markSome Experts Dispute Claims Of Looming Doctor Shortage

By Julie Rovner
KHN

You hear it so often it’s almost a cliché: The nation is facing a serious shortage of doctors, particularly doctors who practice primary care, in the coming years.

But is that really the case?

Many medical groups, led by the Association of American Medical Colleges, say there’s little doubt. “We think the shortage is going to be close to 130,000 in the next 10 to 12 years,” says Atul Grover, the group’s chief public policy officer.

While few dispute the idea that there will be a growing need for primary care in the coming years, it is not at all clear whether all those primary care services have to be provided by doctors.

But others, particularly health care economists, are less convinced. “Concerns that the nation faces a looming physician shortage, particularly in primary care specialties, are common,” wrote an expert panel of the Institute of Medicine (IOM) in a report on the financing of graduate medical education in July. “The committee did not find credible evidence to support such claims.” Continue reading

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US to fund $840 million initiative to improve patient care and lower costs

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All interested clinicians are invited to participate in the initiative.

stethoscope doctor's bag chest x-rayUS Health and Human Services Secretary Sylvia M. Burwell today announced an initiative that will fund successful applicants who work directly with medical providers to rethink and redesign their practices, moving from systems driven by quantity of care to ones focused on patients’ health outcomes, and coordinated health care systems.

These applicants could include group practices, health care systems, medical provider associations and others.

This effort will help clinicians develop strategies to share, adapt and further improve the quality of care they provide, while holding down costs.

Strategies could include:

  • Giving doctors better access to patient information, such as information on prescription drug use to help patients take their medications properly;
  • Expanding the number of ways patients are able communicate with the team of clinicians taking care of them;
  • Improving the coordination of patient care by primary care providers, specialists, and the broader medical community; and
  • Using electronic health records on a daily basis to examine data on quality and efficiency.

To learn more about the the initiative go here.

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Even before Ebola, hospitals struggled to beat far more common infections

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Clostridium difficile

Clostridium difficile

This KHN story also ran on NPR.

While Ebola stokes public anxiety, more than one in six hospitals — including some top medical centers — are having trouble stamping out less exotic but sometimes deadly infections, federal records show.

Nationally, about one in every 25 hospitalized patients gets an infection, and 75,000 people die each year from them—more than from car crashes and gun shots combined.

Nationally, about one in every 25 hospitalized patients gets an infection, and 75,000 people die from them each year.

 from themA Kaiser Health News analysis found 695 hospitals with higher than expected rates for at least one of the six types of infections tracked by the federal Centers for Disease Control and Prevention.

In 13 states and the District of Columbia, a quarter or more of hospitals that the government evaluated were rated worse than national benchmarks the CDC set in at least one infection category, the KHN analysis found.

The missteps Texas Health Presbyterian Hospital made this month in handling an Ebola patient echo mistakes hospitals across the nation have made in dealing with homegrown infections. Continue reading

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California Prop. 46, inspired by tragedy, pits doctors against lawyers

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Bob and Carmen Pack with their children Troy and Alana, who were killed by an impaired driver.

Bob and Carmen Pack with their children Troy and Alana, who were killed by an impaired driver.

This story is part of a partnership that includes KQEDNPR and Kaiser Health News.

Troy and Alana Pack had spent the day at their neighborhood Halloween party in Danville.

Ten-year-old Troy went as a baseball player, and 7-year-old Alana was a good witch.

In the afternoon, they changed out of their costumes and set out for a walk with their mother. Destination: Baskin Robbins 31 Flavors.

“Alana, she liked anything with chocolate,” says their father, Bob Pack. “Troy, for sure, bubble gum ice cream, ’cause he liked counting the bubble gums that he would get.”

Bob Pack stayed home. His family made it only half a mile down the road before his phone rang: “I received a call from a neighbor screaming there’d been an accident. And I raced down there.”

An impaired driver had veered off the road and hit Troy and Alana head-on. Pack was doing CPR on Troy when the paramedics arrived.

“I remember telling them I love them, and hang on. Just praying that they could hang on,” he says

I needed to take action for justice.

Troy and Alana were pronounced dead at the hospital. In the months after their death, Pack’s wife, Carmen, retreated into her Catholic faith. Bob Pack was angry.

“I think, for me to get through, I needed action,” he says, “and I needed to take action for justice for Troy and Alana, and also for doing something that I thought maybe I could change to benefit others in the future.” Continue reading

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