Latest California Healthline Stories
Misreporting of Health Billing Down
Bruce Lim was pretty happy. He’s the deputy director in charge of audits and investigations for the Department of Health Care Services. A biannual review of potential fraud in fee-for-service medical billing found that — across the board — there were far fewer financial red flags than in the past.
“Bottom line, the trend lines are very favorable,” Lim said. “The total potential exposure to errors and to potential fraud has decreased. If you look at the positive numbers, 94.5% were billed and paid appropriately, that’s extremely positive.”
The outlier, Lim said, was the adult day health care program, which he said had trouble making sure patients fit “medical necessity” criteria.
A consumer advocacy group took on the chair of the Senate Health Committee at the end of last week, and it has stirred up Sacramento.
The ad was in reaction to the legislative decision to delay a vote on AB 52 by Mike Feuer (D-Los Angeles) and Jared Huffman (D-San Rafael), the proposal to regulate health insurance rate increases.
According to Jamie Court of Consumer Watchdog, Sen. Ed Hernandez (D-West Covina) was responsible for a lot of the resistance to that measure. Watchdog ran a television advertisement that attacked Hernandez for financial ties to Kaiser Permanente and for how he treated one member of the public at a hearing.
Caregivers’ Stress Remains Hot Topic
UCLA researcher Geoff Hoffman is a little alarmed. His study took a look at the health risks of caregivers in California and found that the emotional and financial load of stress on caregivers in California may be causing the caregivers themselves to develop chronic health conditions.
“There appears to be a high level of distress and risky health behaviors in caregivers,” Hoffman said. “Smoking, binge drinking and poor diet.”
Ironically, it may be the caregivers themselves who face an unhealthy future, he said.
New Law Allows Physicians To Move Children From Acute Care
Physicians in California are not allowed to transfer children who are under care of the state and in acute care facilities, even if moving them to a subacute facility would be a better option for them.
Assembly member Holly Mitchell (D-Los Angeles) wanted to change that with AB 667. Yesterday, Gov. Jerry Brown (D) agreed and signed that bill into law.
“AB 667 basically updates state law,” Charles Stewart in Mitchell’s office said. “In a number of cases, when a child [under the state’s care] is in an acute facility, the physician did not have the option to say this child doesn’t need to be in the ICU. Being in the ICU can be very restrictive — it’s harder for family members to visit, it’s very restrictive on the child.”
Relief and Rolled-Up Sleeves for Officials at Healthy Families
Gov. Jerry Brown (D) signed ABX1 21 by Bob Blumenfield (D-Woodland Hills) on Friday, which extends a tax on managed health care organizations.
That money helps fund Healthy Families, a program serving 870,000 children in California. Without passage of that bill, Healthy Families officials were staring at a budget shortfall of $130 million in state general fund dollars — and factoring in the 2-to-1 federal match, that becomes a deficit of $390 million.
That would’ve been 37% of the program’s entire budget, and the state was considering massive enrollment cuts in Healthy Families.
Federal MSSP Waiver Expansion Cut From Transition Plan
In its transition plan for eliminating the adult day health care benefit, the California Department of Health Care Services had been planning to expand the Multipurpose Senior Services Program, a federal waiver program aimed primarily at case management. The state planned to expand that program by 1,000 slots.
Yesterday it abandoned that idea in part because of the long waiting list that currently exists within that program, according to Norman Williams of DHCS. The state couldn’t offer new slots to current ADHC patients, he said, not with 1,400 people already waiting long periods of time to join the MSSP program. So the state will move on without it, Williams said.
“The MSSP was an important consideration, a building block of the transition plan,” Williams said. “But we do believe we have the capacity and the resources to provide services for these people, without the MSSP piece.”
Prescriptions, Lab Results, Clinical Care Data Top Priorities for Cal eConnect
Implementing electronic prescribing in California may prove a whole lot less challenging than instituting electronic transfers of lab results and sharing patient care information across unaffiliated health organizations. But all three goals of a network of health information exchanges in the state are going to take a whole lot more effort and coordination.
That was the message emanating from a conference conducted via webinar and telephone Friday hosted by Cal eConnect, the agency leading promotion and coordination of electronic health records in the state.
Cal eConnect is the state-designated not-for-profit organization charged with disbursing $38.8 million in money from the Health Information Technology for Economic and Clinical Health Act. The act was part of the 2009 economic stimulus package.
New ‘Benefit Corporation’ Status Could Benefit Health Care Companies
Companies that deliver health care services and make products in California should be taking a close look at legislation on the governor’s desk that allows creation of a new type of corporation, one that puts social responsibility over profit maximization and shareholder value.
AB 361, by Assembly member Jared Huffman (D-San Rafael), would create a new category of business, one called a “benefit corporation,” or B corp as it has become more commonly known.
Huffman says that California is an incubator for businesses that emphasize social responsibility and environmental awareness but that those businesses lack legal protections for directors and officers who put the greater good above their fiduciary duty to maximize profits for shareholders.
Legislation Aims To Cut Wait for Prescription Drugs
New legislation designed to make the paper trail for prescription drug authorization simpler and shorter is awaiting signature by Gov. Jerry Brown (D).
While it is expected to have little effect on regular issuance of prescriptions, it likely will speed up the process for patients whose doctors prescribe other specialized medicines that are not covered by a health plan’s formulary.
These include brand-name medicines with generic alternatives, expensive medications, drugs not usually covered but deemed medically necessary by the prescribing physician, and drugs that usually are covered but are being used at a dose higher than normal.
Santa Barbara Allowed To Levy Temporary Tax
Santa Barbara County will be able to increase penalties on drunk driving fines in order to fund emergency services as a result of a new state law that barely escaped veto by Gov. Jerry Brown (D).
In the waning hours of the legislative session last week, Brown issued a letter that criticized the method of generating emergency department revenues, although he stopped just short of blocking the bill that had received wide support in the Assembly and Senate.
AB 412 introduced by Das Williams (D-Santa Barbara) becomes law without Brown’s signature. And Santa Barbara County can on Jan. 1 begin collecting an extra surcharge on tickets issued for driving under the influence offenses. An extra $5 for every $10 of base fines can be assessed as a penalty to fund ED services.