Category Archives: Health care reform

Acronyms, health care and the poor: Understanding hospital safety net payments

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Joanne Kenen

The months-long controversy between Florida and the federal Medicaid program over funding for hospitals and clinics that serve uninsured low-income people drew attention to these uncompensated care pools. In Florida the arrangement is called the Low-Income Pool – better known as “LIP” (a gift to headline writers).

So what are these payments? And how do they differ from a Disproportionate Share Hospital (DSH) arrangement?

At least nine states, including Florida, have some kind of Medicaid waiver arrangement with the federal government that involves payments to safety net hospitals and, in at least some states, community health centers.

Joanne Kenen, AHCJ’s core topic leader on health reform, explains in a new tip sheet. Read more.

Spotlight on sepsis: Reporting on ‘dirty little hospital horror’

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Cheryl Clark

Cheryl Clark

As senior quality editor for HealthLeaders Media for more than six years, Cheryl Clark wrote more than 1,300 stories about hospitals’ efforts to improve quality and safety and related issues.

Rates of sepsis seemed to be one more dirty little hospital horror to explore, one that the Joint Commission said cost hospitals about $16.7 billion annually. Yet hospitals’ efforts to tackle it seemed hidden behind improvement initiatives attracting more attention, such as reducing hospital-acquired infections, and preventable readmissions, lowering emergency room wait times and raising patient experience scores.

The story she wrote for the June 2014 issue of HealthLeaders’ print magazine, on how U.S. hospitals are improving recognition and treatment of sepsis — which is diagnosed in 750,000 patients a year and kills 40 percent — won the 2015 National Institute of Health Care Management prize in the trade print category. They said the story was “most likely to save a life.”

In a new article for AHCJ, she explains how she did her reporting, despite a lack of data and sources who didn’t want to talk. Read more.

Three CMS proposals would shift basis of payments from volume to value

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

GraphicStock

GraphicStock

Announcements from the U.S. Department of Health & Human Services last week on rules about bundled payments for hip and knee replacement surgeries, home care, and physician payment reform, move the agency forward in its goal to move 50 percent of fee-for-service Medicare payments into alternative payment models by the end of 2018.

To recap: In January, the U.S. Department of HHS announced that it aimed to shift 30 percent of fee-for-service Medicare payments into alternative payment models by the end of the year. By the end of 2018, it plans to have shifted 50 percent to alternative payment models. We explained that under alternative payment models, the federal Centers for Medicare & Medicaid Services rewards physicians, hospitals and other providers who focus on quality and value, such as in accountable care organizations or bundled payment arrangements. Continue reading

Health insurance discrimination persists for those with HIV, cancer and other conditions, despite ACA

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Over the past two years, patient advocacy groups, researchers and consultants have said health insurers have discriminated against their members with high-cost conditions.

A number of journalists have covered these stories. The Marketplace’s Tim Fitzsimons reported in June that the federal Department of Health and Human Services was addressing complaints against insurers whose benefit programs were designed to drive away members with costly pre-existing conditions. Wes Venteicher of the Chicago Tribune reported on efforts by health insurer Coventry to make HIV treatments more affordable after patient advocates complained that costs for HIV drugs were too high. Continue reading

A look at how states are addressing balance billing abuses

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

service-invoiceWe’ve all read about patients who were careful to choose an in-network doctor or hospital but still ended up with some care provided out of network – and unanticipated bills.

One of the most memorable accounts was in Elisabeth Rosenthal’s “Paying Till It Hurts” New York Times series, when she recounted the story of the patient who – unbeknownst to him – had an out-of-network assistant surgeon alongside his carefully selected in-network surgeon. The assistant submitted a $117,000 bill. Continue reading

Things to keep in mind about the King v. Burwell SCOTUS ruling

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

  • The court ruled that the subsidies were integral to the functioning of insurance markets under the ACA, and that Congress constructed the law with that in mind. The Court did not use an alternative legal argument to uphold the subsidies – saying that the law was ambiguous but the executive branch (in this case the IRS) had the right to interpret it so that subsidies are available in both state and federal exchanges. This is not a minor distinction – that latter interpretation (used by one of the lower courts) would have meant that a future administration could come in and change the subsidy policy. The 6-3 court ruling bars a future administration from doing so. (A future Congress could still change the law regarding subsidies but a future administration couldn’t just flip a switch and stop them.) Continue reading

Notes and quotes from King v. Burwell decision

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

By Steve Petteway, Collection of the Supreme Court of the United States (Roberts Court (2010-) - The Oyez Project) (Public domain), via Wikimedia Commons

By Steve Petteway, Collection of the Supreme Court of the United States (Roberts Court (2010-) – The Oyez Project) (Public domain), via Wikimedia Commons

Here are just a few notes, key quotes and links to coverage of the Supreme Court’s decision to uphold the subsidies in the Affordable Care Act.

The decision is here.

The phrase “death spiral” appears three times in the majority opinion. Also from the majority opinion: Continue reading

Things to keep in mind as we anticipate the King v. Burwell ruling

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Photo by dbking via Flickr

Photo by dbking via Flickr

We’ve put up a tip sheet and written about the King v. Burwell case, but now that the ruling is imminent, we wanted to bring one more good one-stop-shopping resource to your attention and share a few tips.

The Alliance for Health Reform has issued a very good four-page tool kit – links to background articles, think tank papers, issue briefs and lots of sources. One caveat – it says that 7.5 million are subsidized in the affected states but the most recent government numbers are 6.4 million.

Other things to remember

There are 37 states using HealthCare.gov (with Hawaii, soon 38). But the reason you keep reading that 34 states are affected is that 34 are federal exchanges. Continue reading

Health care delivery reform and what it means in the delivery room

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

Courtesy of Neel Shah, M.D.

Courtesy of Neel Shah, M.D.Health reformers are grappling with how to bring down the high rate of cesarean section deliveries in the United States. The U.S. isn’t the only country in the world overusing the procedure, but it does have one of the highest rates.

I recently heard Neel Shah, M.D., an obstetrician at Beth Israel Deaconess Medical Center, the founder of Costs of Care, and associate faculty at Ariadne Labs (more about all of that here) speak about health care quality and delivering babies.

We’ve all heard about unnecessary cesarean sections (and elective induced early births, although that’s a related but not identical set of challenges). Many of us tend to think of it as a doctor-centered issue. Some doctors perform more C-sections than others and there are a host of reasons, ranging from how and where they were trained to how they assess and tolerate maternal risk to time management and financial considerations.

But Shah challenged me to think of unnecessary C-sections as a hospital management or system engineering problem – not just a problem created by individual doctors. Continue reading

Covering how King v. Burwell decision could affect subsidies

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Lauren Sausser

Lauren Sausser

Lauren Sausser of The Post and Courier in South Carolina was surprised by an email from a reader asking her to write more about Medicaid expansion in South Carolina – specifically, the state’s refusal to expand the low-income health insurance program under the Affordable Care Act.

This year, health insurance subsidies have played a much more prominent role in The Post and Courier’s health care coverage. Like other news outlets, her newspaper is waiting to find out what the Supreme Court decides in King v. Burwell. If the court rules in favor of the plaintiffs, subsidies will end in states using the federal exchange.

In South Carolina, a King victory would mean that coverage will become unaffordable for an estimated 200,000 people who have purchased subsidized policies through the federal insurance marketplace. It’s been a big story. Meanwhile, Medicaid expansion, with a few exceptions, is relatively stagnant there.

Read more about her reporting on the topic.