Viewpoints: Doctors' sway over Medicare pay; hospital rankings not all they seem; legal immigrants' health needs overlooked

Jul 26 2013

The Washington Post: Do Doctors Have Too Much Sway Over Medicare Payouts?
Reporters Peter Whoriskey and Dan Keating have opened Post readers' eyes to the fact that Medicare pays for physician services -; a $69.6 billion item in 2012 -; according to an arcane and little-known price list, over which doctors themselves exercise considerable and less-than-totally-transparent influence (7/24).

The Wall Street Journal: Medicare By The Scary Numbers
Even before the latest Medicare trustees report came out at the end of May, the White House spin masters had already crafted a story to go with it. Medicare's finances have improved, we're being told. The trust fund will last longer. The unfunded liability is lower. One of the reasons is said to be ObamaCare. The core of the new health reform doesn't kick in until next year, but already it's improving things for seniors? Here's the real story (John C. Goodman and Laurence J. Kotlikoff, 7/24).

The Wall Street Journal: Those Hospital Rankings Could Use A Healthy Dose Of Skepticism
The U.S. News & World Report "Best Hospitals" rankings for 2012-13 were released last week, followed by the usual media hoopla and a few chest-thumping press releases from hospitals at the top of the list. Whether the rankings actually mean anything is an entirely different story. The highest-ranked hospitals are always quick to tout their rankings in hopes of attracting new patients who will pay top dollar (Ezekial J. Emanuel and Andrew Steinmetz, 7/24).

Los Angeles Times' Capital Journal: Big-Bucks Battle Shaping Up Over Bid To Raise Malpractice Award Limit
You don't need to be a Nobel economist to understand that dollars today aren't anything close to their worth four decades ago. Gasoline, real estate, medical care-;they've all skyrocketed in cost. Everything's gone up, that is, except damage awards for pain and suffering caused by medical malpractice (George Skelton, 7/24). 

The New England Journal of Medicine: Observation Care -; High-Value Care Or A Cost-Shifting Loophole?
Current CMS policy on observation care promotes cost shifting without rewarding higher value, since payment is time-based and does not reward the use of evidence-based clinical pathways or hospital units designed to provide efficient care for this group of patients. ... Not all observation care is the same; payment reforms should protect patients from excessive out-of-pocket expenses and reward the efficient care delivered in observation units, which prevents prolonged hospitalizations (Drs. Christopher W. Baugh and Jeremiah D. Schuur, 7/25).

The New England Journal of Medicine: Stuck Between Health And Immigration Reform -; Care For Undocumented Immigrants
Although there are valid perspectives on multiple sides of the immigration debate, there are stark public health implications of continuing to permit the existence of a medical underclass comprising more than 10 million people. Neither the recent national health reform law nor the immigration bill currently being considered solves these vexing problems; indeed, these policies may increase the barriers for some undocumented immigrants. For the foreseeable future, undocumented immigrants will remain on the outskirts of our public programs and safety net, a controversial reminder of ongoing inequities in our health care system (Dr. Benjamin D. Sommers, 7/24).

The New England Journal of Medicine: Holes in the Safety Net -; Legal Immigrants' Access to Health Insurance
While Congress debates whether publicly supported health care should be available to undocumented immigrants who may be placed on a path to citizenship under immigration reform, the health care needs of already legal immigrants continues to be overlooked. More than 12 million immigrants are lawfully present in the United States. ... Public policies that deny legal immigrants equal access to public insurance programs leave lawful residents and their health care providers unnecessarily vulnerable when injuries and illness strike. By encouraging immigrant-only programs, such policies also perpetuate needless complexity in the health care system (Wendy E. Parmet, 7/24).

The New England Journal of Medicine: Rationing Lung Transplants -; Procedural Fairness In Allocation And Appeals
The well-publicized cases of two pediatric candidates for lung transplants have shaken the transplant community with emergency legal injunctions arguing that current lung-allocation policy is "arbitrary and capricious." Although the resulting transplantation seemingly provided an uplifting conclusion to an emotional public debate, this precedent may open the floodgates to litigation from patients seeking to improve their chances of obtaining organs. These cases questioned the potential disadvantaging of children and the procedural fairness in lung allocation. But legal appeals exacerbate inequities and undercut public trust in the organ-transplantation system (Keren Ladin and Dr. Douglas W. Hanto, 7/24).

The New England Journal of Medicine: Accountable Prescribing
As insurance coverage expands, we must ensure that greater access to prescription drugs confers better health, not harm. The need to advance performance measures as health care reform proceeds is well recognized. Ideally, we should assess outcomes valued by patients, but for reasons of feasibility, many measures focus instead on surrogate end points. To improve health, such end points must be based on strong evidence, and how you get there matters (Drs. Nancy E. Morden, Lisa M. Schwartz, Elliott S. Fisher and Steven Woloshin, 7/25). 

The New York Times: Justice For The Mentally Disabled
Gov. Andrew Cuomo closed out a shameful period in New York's history earlier this week when he agreed to give about 4,000 mentally ill people held in highly restrictive institutional settings the option of moving into supported housing, where they can live independently with the help of social service organizations. The agreement, outlined in a consent decree filed in federal court in New York City, ends a long legal battle and could bring a new day for people isolated in inadequate, for-profit residences that make their disabilities that much harder to bear (7/24).

The New York Times: Realities In Global Treatment Of H.I.V.
The World Health Organization recently issued aggressive new guidelines for treating people infected with H.I.V., the virus that causes AIDS. The guidelines are a welcome step forward but fall short of the treatment goals that could and should be set (7/24). 

JAMA: Why Obamacare Needs Millenials
One of the primary goals of the Affordable Care Act (ACA)-;now known more commonly as Obamacare-;is to make health insurance more accessible, particularly for people with preexisting conditions. … This focus on reaching young and healthy people is almost strangely ironic in that the new health insurance exchanges and Obamacare proponents appear to be engaging in the same "cherry picking" for which they have criticized insurers (Larry Levitt, 7/24).

National Journal: The Unprecedented – And Contemptible – Attempts To Sabotage Obamacare
When Mike Lee pledges to try to shut down the government unless President Obama knuckles under and defunds Obamacare entirely, it is not news-;it is par for the course for the take-no-prisoners extremist senator from Utah. When the Senate Republicans' No. 2 and No. 3 leaders, John Cornyn and John Thune, sign on to the blackmail plan, it is news-;of the most depressing variety (Norm Ornstein, 7/24).

Chicago Tribune: Looking Back To 2013
On Monday, Gov. Pat Quinn signed into law the state's massive Medicaid expansion. With that flick of his pen, 342,000 low-income Illinois citizens will be newly eligible for Medicaid starting in January. State officials also expect as many as 171,000 others who are now eligible but haven't signed up to do so as an Obamacare marketing campaign rolls out. If so, the number of Medicaid recipients would grow from today's 2.8 million to 3.3 million -; more than 1 in 4 Illinoisans. ... We also hope that, a decade or two from now, Illinois citizens don't look back to 2013 and say: What were they thinking? How could the politicians be so willfully blind to the billions that the Medicaid expansion would cost taxpayers? (7/24).

Pittsburgh Post-Gazette: Much Is At Stake For Minorities In Medicaid Debate
As Pennsylvania decides whether to expand its Medicaid program, a new study says the decision will have a major impact on the state's racial and ethnic minorities. A Kaiser Family Foundation analysis found that 15 percent of African Americans in Pennsylvania are without health insurance and nearly two-thirds of them would qualify for coverage under federal poverty level criteria set out by the Affordable Care Act if Medicaid were expanded (Steve Twedt, 7/25).

Sacramento Bee: Use Health Law To Fight Tooth Decay In Kids
Tooth decay is the most common chronic health problem in children, according to the Centers for Disease Control and Prevention. More than a quarter of kids have decay in their baby teeth by the time they enter kindergarten. Nearly 68 percent of teenagers 16 to 19 have decay in their permanent teeth. The Affordable Care Act provides an opportunity to improve children's access to dental care starting in January 2014 – if the California state health exchange, called Covered California, does things right (7/25). 

The Huffington Post: Decline In Cost Of Health Care In America
Undeniably, over the past several years the singular focus of conversation among policy makers has shifted from simply more care and better quality of care to better value in health care, where value is defined as quality over cost. ... Yet if history is any indicator, as our economy strengthens costs of health care will rise once again. So, last month the Bipartisan Policy Center (BPC) made 50 bold recommendations on how to sustain the lower growth of health care costs (Dr. Manoj Jain and Dr. Bill Frist, 7/24).