First Edition: October 31, 2011

Oct 31 2011

In today's headlines, news reports about a key medical group's take on accountable care organizations and how a "merger wave" is hitting the health care sector.  

Kaiser Health News: Big Insurer Fights Back In Court Against Regulation Of Profit Margin
Kaiser Health News staff writer Julie Appleby, working in collaboration with The Washington Post, reports: "A lawsuit challenging Maine's authority over health insurers' profit margins is drawing national attention from state regulators worried about the impact on their power to hold down rate increases" (Appleby, 10/29).

Kaiser Health News: Capsules: Medical Schools Say Magazine's Ratings Get An Incomplete; Doctor-Patient Relationship Has Starring Role In AMA Ad
In a post done as part of a reporting partnership that includes Kaiser Health News, WNYC and NPR, WNYC reporter Fred Mogul writes: "Deans from some of the nation's top medical schools met Thursday -; not to talk about training doctors or weathering economic challenges -; but to size up the people who grade them" (10/28). Also on the blog, KHN's Christian Torres reports: "Keep an eye out during the evening news, or even your favorite show on Lifetime, because the American Medical Association is taking to primetime news and cable to fight Medicare physician payment cuts. Doctors face a 29.5 percent payment cut Jan. 1 if Congress doesn't intervene. The AMA ran ads explicitly against the cut in a campaign that ended last week, but now the group is running a different, much-less-direct campaign through Nov. 20" (10/28). Check out what else is on the blog.

Kaiser Health News also tracked weekend health policy news, including reports about weighing the cost and benefits of screenings and MRIs.

Los Angeles Times: Deficit Reduction Panel Reaches Crucial Juncture
The super committee has until Thanksgiving to reach an accord. A deal to reduce the deficit has eluded Congress this year because of a simple stalemate: Republicans refuse new taxes and Democrats will agree to cut federal programs only if new revenues are in the mix. If the committee fails, a series of automatic spending cuts is set to kick in to reduce military and domestic spending. Lawmakers from both parties also fear that a failure could cause turmoil in financial markets (Mascaro, 10/29).

Politico: Deficit Reduction Still A Devil Deal
Washington shows every sign of heading backward, running away from once promising talks between Boehner and President Barack Obama last summer rather than trying to build upon them. … Thus, Democrats on the deficit supercommittee proposed a $3 trillion package last week that would tackle Medicare and Social Security but would demand so much in taxes -; $1.3 trillion -; that it was quickly dismissed by Republicans. At the same time, the speaker was remarkably coy at his weekly press conference Thursday, saying nothing about the GOP's own counteroffer that moves far to the right of where he stood last summer. The smaller, $2.2 trillion Republican package would demand nearly twice the health savings accepted by the White House and would reduce the tax revenue target to a fraction of what Boehner and Obama had discussed (Rogers, 10/30).

The New York Times: Obama Tries To Speed Response To Shortages In Vital Medicines
President Obama will issue an executive order on Monday that the administration hopes will help resolve a growing number of critical shortages of vital medicines used to treat life-threatening illnesses, among them several forms of cancer and bacterial infections (Harris, 10/31).

The Associated Press/Washington Post: Key Medical Industry Group Says Obama's Medicare Quality Plan Changed For The Better
An influential medical group's change of heart is boosting President Barack Obama's plan to use Medicare to promote higher quality, less expensive care. The American Medical Group Association represents premier organizations like the Mayo Clinic, the models for the proposed "accountable care organizations" in Obama's health care overhaul law. The networks of doctors and hospitals will collaborate to keep patients healthier (10/28).

The Wall Street Journal: A Merger Wave Hitting Health Care
If you can't beat 'em, join 'em. Big managed health-care companies are starting to take that idea to heart. These insurers, which try to coordinate patients' medical providers to keep a lid on costs, are facing the double whammy of market saturation and margin-squeezing health-care reform. As a result, giants like Aetna, Cigna and Humana have started snapping up smaller players to keep earnings growth alive (Blumenthal, 10/30).

NPR: Corporations Offer Help In Trimming The Waist
As companies feel the financial burden of the obesity epidemic, some are trying to help their bottom line by helping employees with their waistline. One of the largest such efforts is at the Dow Chemical Company, which has operations in Michigan, Texas, Louisiana and West Virginia -; all states with some of the highest obesity rates in the nation (Ludden, 10/28).

Los Angeles Times: Hard Times Beset Hospital In San Pablo
Doctors Medical Center in San Pablo is among the most troubled hospitals in California. By 2006, it was so strapped financially that it turned to San Quentin prison for patients -; knowing that the state, at least, would pay its bill. That backfired when a sex offender serving 100-plus years managed to undo his manacles and briefly escape through a fire door, causing a top police official to accuse administrators of skimping on safety for easy money (Garrison, 10/31).

The Associated Press/Wall Street Journal: NY Medicaid Auditors Save Millions On A Hunch
On a hunch, state auditors Mike Ernst and Joe Gagnon decided to go beyond their usual work of searching out intricate fraud schemes and double check some of the most basic data in the massive Medicaid bureaucracy: The patient's address. They found a nearly $60 million mistake. The auditors in the Medicaid Inspector General's Office discovered that managed care companies often inaccurately billed the government health program based on where patients got care, not where they lived (10/29).