Latest California Healthline Stories
Five Key Lines in the Circuit Court Rulings on Reform
Questions about the Affordable Care Act’s constitutionality took center stage again this week, as a fourth appeals court rendered its decision and the Supreme Court prepares to conference on whether to take the case.
Chronic Care Becoming a Chronic Problem
To lower costs and increase quality of care, policymakers in California need to address how to better treat the chronically ill — those patients at the center of health care spending in the state.
That was the conclusion of a health care panel discussion last week in the Capitol Building in Sacramento, put on by the Center for Health Improvement as part of the California Health Policy Forum.
“This is a huge worldwide epidemic,” according to panelist Sophia Chang. “About two in five Californians have at least one chronic condition — and half of these people have two or more of these conditions.”
Access Issues Behind ADHC Exemptions
The Department of Health Care Services recently exempted 69 adult day health care centers from the 10% reimbursement cut. Because the cutback is retroactive to June 2011, it spared payback of a large amount of retroactive money for those mostly rural ADHCs.
“That is really good news for Contra Costa County,” Debbie Toth — executive director of the Mt. Diablo Center for Adult Day Health Care in Pleasant Hill — said. “We would have had to pay back a lot of money through June. And we’ve already gone through our reserves, so we wouldn’t have been able to do that.”
The 10% cut would’ve put centers in Contra Costa County over the edge, Toth said. “Our direct care staff is required by regulation, so there’s no way … I couldn’t reduce my cost by 10%.”
Assembly Hearing Laments a Torn Safety Net
It’s not just the 10% payment cut to a range of Medi-Cal services in California that have legislators and providers lining up in protest, according to Assembly member Holly Mitchell (D-Los Angeles), it’s the combined effect of all the cuts that came before as well.
“We are here to hear and understand the actual impact of the cuts we made this year,” Mitchell said yesterday at a hearing convened by Assembly Budget Subcommittee No. 1 on Health and Human Services. “And we also need to hear the cumulative impacts of cuts from previous years,” she said. “This economic crisis has hit our children very hard, and we need to hear what these cuts will do to those children.”
Down the street from the Capitol Building hearing, protesters representing the developmentally disabled gathered outside the offices of the Department of Health Care Services, the agency implementing the state’s cuts and that worked with CMS to get federal approval of the cutbacks.
New Cost Tool Aims To Boost Pay-for-Performance Model of Care
In an effort to measure value in health care transactions, the Integrated Healthcare Association is introducing a “Total Cost of Care” metric to be used in its pay-for-performance program. IHA hopes the new tool will speed up improvements in clinical quality by providing financial incentives to physicians.
Which Providers Get 10% Reimbursement Cuts?
Toby Douglas did not bring good tidings. Yesterday, the director of the Department of Health Care Services outlined the recently approved 10% cuts for California providers of Medi-Cal services.
“This is really hard,” Douglas said. “These are extremely painful reductions.”
The California Hospital Association on Tuesday filed a lawsuit in federal court in Los Angeles seeking to halt the implementation of Medi-Cal rate cuts approved last week by CMS.
Austerity Won’t Help Physician Shortage, Experts Predict
Cutbacks in Medicare and Medicaid could make it more difficult to deal with a physician shortage in California that threatens to become more severe as millions of newly insured people join the reformed health care system. California groups are lobbying to streamline and subsidize the training of new primary care doctors.
Exchange Board Has Little Interest in Health Care Co-Ops
The federal government is ready to hand out $3.8 billion in loans to start up not-for-profit, member-governed health plans called consumer-operated and -oriented plans, or co-ops.
A deadline recently passed for the first round of applications, with a number of states taking up the idea, but not California.
So far, California has been pretty cool on the idea. At the August meeting of the Health Benefit Exchange board, concern was raised over what a co-op’s market share would be, and that a co-op might undermine what the exchange wants to do by dividing up its pool of participants.
Follow the Money: How Industry Is Lobbying To Preserve Reform Law
New reports on health sector lobbying reveal that the industry continues to donate generously to President Obama and Democrats, despite public criticism of last year’s health reform law.
Effort for Settlement of ADHC Lawsuit
State officials and advocates for seniors and the disabled are meeting today trying to work out a settlement of a lawsuit over adult day health care.
Today’s settlement conference comes exactly one week before a federal hearing of the suit brought by Disability Rights California, scheduled Nov. 8. The court is asked to determine whether the state’s transition plan is adequate to handle the needs of roughly 35,000 frail, elderly and disabled patients. The state’s ADHC program ceases to be a Medi-Cal benefit on Dec. 1.
Yesterday, advocates took to the sidewalk outside of the Ronald Reagan State Office Building in Los Angeles, marching up and down in front of the government center with “Stop Elimination” signs.