late-breaking news from your medical association volume XXI / no. 5 December 2014
local A For-Profit Hospital in San Mateo County? Daughters of Charity Health System continues its effort to sell its six hospitals. These hospitals include Seton and Seton Coastside, as well as Saint Louise in Gilroy, O’Connor Hospital in San Jose, and two others in the Los Angeles metropolitan area. The buyer best suited to purchase these facilities is Prem Reddy, MD, CEO of for-profit Prime Healthcare system, as the for-profit is well-funded. The SEIU is challenging this sale, suggesting that Prime Healthcare is an industry black sheep; however, the sale must go through or the facilities will face foreclosure. The sale must be approved by state Attorney General Kamala Harris. One of the issues facing approval of the sale by the AG is the fact that SEIU has lined up a slew of legislators opposing the sale, including three members of Congress, dozens of state legislators, even S.F. Mayor Ed Lee and incoming S.F. Assemblyman David Chiu, and seven other unions besides SEIU. The Daughters believes these political leaders are uninformed in their opposition to the sale, and hope to educate them in order to avoid the dire consequence of having the hospitals close. The Seton location, sitting on top of a hill in Daly City overlooking the Bay, would be of particular interest to developers who would likely turn the site into a condominium city. The AG must make her decision by February 9, 2015. In the meantime, public hearings will be held in January. Note: A class action lawsuit by workers against the Daughters selling off the property allege that their pension plan is underfunded. The workers claim the system evaded Federal pension law requirements and underfunded its plan by an estimated $229 million by erroneously claiming to have a “church plan” exempt from certain laws requiring adequate funding and obligations to pension plan participants. Whatever happens with this court action, it is anticipated that Dr. Reddy will accept responsibility for past and current pension obligations.
state We Think We’ve Earned Your Membership CMA spent $8 million of CMA reserves to defeat Proposition 46 and keep MICRA intact, and was instrumental in raising an additional $52 million from healthcare and medical malpractice carriers for the No-on-46 campaign. The advocacy efforts of CMA/SMCMA also held off a 10 percent across-the-board Medi-Cal cut for three years and ensured that the cut would not have to be repaid, and kept optometrists from practicing ophthalmology.
state (continued) California Supreme Court Opinion in Rashidi v Moser The California Supreme Court decided that, in a medical professional negligence case where there is no evidence at trial of the proportionate liability of other defendants, Section 333.2 applies only to the amount of non-economic damages awarded in court and does not require an offset of amounts received in settlement. In other words, a defendant who goes to trial can be held liable for $250,000 in non-economic damages even if the plaintiff recovered non-economic damages before trial from settling defendants. The court’s language did not question or undermine the broad scope of MICRA or its constitutionality, but instead was very focused on interpreting the narrow legal question at issue.
Can California’s Stem Cell Institute Survive Without New Cures? The California electorate in 2004 approved $3 billion in state bonds for stem cell research. The California Institute for Regenerative Medicine (CIRM) was formed to administer the funds. Now ten years later CIRM has spent $2.2 billion of that money. The future of the stem cell institute depends on finding a cure. CIRM is overhauling itself with a new business-friendly approach aimed at speeding therapies to patients’ bedsides. The move is critical for the millions of people with a wide range of diseases who could be helped, as well as for the future of the stem-cell institute itself. The road from research to the clinic is unavoidably long and winding, but with the CIRM leaders talking about another round of cash—possibly asking taxpayers for $5 billion—they need a high-profile medical victory in the next 24 months if they want to make their case to the electorate. In all, there are 285 programs in CIRM’s portfolio aimed at curing disease. Thirteen of the highest-funded institutions are all tied to academic institutions, with Stanford having received $298.3 million, followed by UCLA receiving $215.3 million. There is some progress, with Menlo Park’s Asterias Biotherapeutics receiving FDA approval to start a study of its experimental stem cell therapy for spinal cord therapy for spinal code injury patients, and ViaCyte of San Diego which received FDA approval to start testing its treatment for Type 1 diabetes. It may take five years or more, however, to progress through the clinical trials to FDA approval.
national Health Costs Continue to Rise A recent study published by the Commonwealth Fund showed that, between 2003 and 2012, health insurance premiums rose 60 percent, employee premium contributions rose 93 percent, and incomes grew only 11 percent. Find the study at www.commonwealthfund.org/publications/press-releases/2014/dec/employer-premium-growth.
HIV/AIDS: Global Snapshot A report from the Kaiser Family Foundation revealed that 35 million people are living with HIV, and half of them are unaware they are infected. There are 6,000 new infections per day, or 2.1 million in 2013, a 38 percent decline since 2001. Of all HIV cases, 68 percent are in Sub-Saharan Africa. HIV remains the number one cause of death in Africa. There are 3.2 million children with HIV, and 40 percent of new infections occur in people under 25 years old. HIV is the leading cause of death for reproductiveaged women worldwide. In Africa, young women are two times more likely to contract it than men. The CDC reports that, in 2011, 1.2 million Americans were living with HIV, of which 66 percent had been diagnosed but were not engaged in regular HIV care, and 20 percent did not yet know they were infected.
Patients Increasingly Value Electronic Health Records Of those patients with online access to their health records, 86 percent used their online records at least once in the last year, while 55 percent used them three or more time a year, according to a study reported by the National Partnership.
Obstetrics Claims Account for 36 Percent of Hospital Professional Liability Claims This 36 percent represent claims greater than $2 million. Forty-five percent of claims greater than $5 million are also obstetrics claims, accordingly to a report by Basle Press and Aon Risk Solutions.
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national (continued) Healthcare Provisions in the Current Congressional Budget Congress narrowly passed a $1.1 trillion federal budget that will fund most of the federal government through September 2015. Below is a summary of key healthcare provisions in the bill: •
Congress asks CMS to reconsider the bundling of surgical codes in the final rule of the Medicare Physician Fee Schedule.
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The budget includes $5.4 million of emergency funding to prepare for and respond to the Ebola outbreak.
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NIH will receive $30.3 billion (an increase of $150 million) including $83 million for Ebola-related research.
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CMS will receive no increase in funding over the last year ($3.6 billion).
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CDC will receive money to combat prescription drug abuse around the country.
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The bill looks at the Medicare RACs and how audits may be reducing patient access to care.
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The bill urges the ONC for HIT to decertify EHR products that block the sharing of information and to certify only those products that meet current meaningful use program standards.
UnitedHealthcare and MD Anderson Pilot Program on Bundled Payments in Cancer Two private sector payers, UnitedHealthcare and MD Anderson, have launched a three-year pilot program with a fixed-payment structure for 150 cancer care patients with certain types of head and neck cancer. The pilot is United’s concerted push toward more value-based payment mechanisms. The insurer has about $36 billion in annual provider payments tied to some kind of bundled-care payment models and away from FFS payments for oncology care.
Walgreens Tests Virtual Doctor Visits Walgreens is testing a telemedicine service that lets patients see a doctor without leaving home or even visiting any of the drugstore chain’s clinics. Patients in California and Michigan can contact a physician around the clock through Walgreens’ mobile application for smartphones or tablets. The visits cost $49, and doctors can diagnose and treat conditions that don’t require a physical exam, such as asthma, diabetes, high cholesterol or pink eye. They can also write prescriptions. Walgreens runs 420 in-store clinics.
Death Rate Falls According to the CDC report, “Mortality in the U.S., 2012,” from 2011 to 2012, the age-adjusted death rate fell 1.8 percent for heart disease, 1.5 percent for cancer, 2.4 percent for chronic lower respiratory disease, 2.6 percent for stroke, 3.6 percent for Alzheimer’s disease, 1.9 percent for diabetes, 8.3 percent for influenza and pneumonia, and 2.2 percent for kidney disease. The rate for suicide rose 2.4 percent and the rate for unintentional injuries remained the same.
Large U.S. Companies Drop Retirees from Health Plans Large U.S. companies are limiting or ending company-sponsored health care plans for retirees eligible for Medicare. In 1988, 66 percent of companies employing more than 200 workers offered retiree health benefits. This figure declined dramatically last year to 28 percent. Among businesses employing more than 5,000 employees, fewer than half offered these benefits to workers in 2013.
AMA Develops Tool Kit to Help Doctors in Training to Decide Where to Practice The AMA’s Health Workforce Mapper enables users to map practice locations of physicians and non-physicians by specialty; distinguish workforce deficiency and overlap areas, and helps prioritize undeserved areas. It also displays ratios of physicians and non-physician clinicians to national and regional populations. A reduced view of this tool is open to anyone who wishes to view basic regional information and data. AMA members and medical association executives have access to layered physician data that drills down to medical specialty and practice type and overlays the other mapping data for a complete picture of the selected location. Visit www.ama-assn.org and in the search bar enter “Health Workforce Mapper.”
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national (continued) Employers Will be Motivated to Offer High Deductible Health Plans under ACA Under the Affordable Care Act, employers in 2018 that offer plans that cost more than $10,200 for an individual or $27,500 for a family will be charged a 40 percent tax on the amount exceeding the threshold. Employers that raise deductibles and lower premiums will lower their chance of triggering the tax.
medicare Medicare to start Compensating to Manage Chronic Care Beneficiaries Medicare has adopted a new code that pays physicians for the ton of work the physicians and their staffs provide for their sicker patients with two or more chronic conditions, when the patients are not seated in front of them. Until January 1, a face-to-face encounter has been required for doctors to get paid. The new code covers the time primary care physicians spend on reviewing lab reports and specialist consults, talking with family and patients by phone, arranging referrals and correcting misinformation, straightening out nursing home issues, and more. The payment amount ($42.60 a month, CPT Code 99490), while not significant, is at least a start.
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