California Healthline: Medicare

CMS Weighs in on Enrollment Question

Wed, 30 May 2012 08:00:00 GMT

Federal health officials have informed the state that CMS would favor passive enrollment with an opt-out provision but it does not support lock-in enrollment for the dual-eligible demonstration project in California.

That's according to Kevin Prindiville, deputy director of the National Senior Citizens Law Center in Oakland, who spoke to CMS officials on Friday.

"CMS has told us that's all they will allow," Prindiville said. "It's not a big surprise, but it's very welcome. We think the passive enrollment system is problematic in some ways, but CMS has said all along they would allow passive enrollment, but there would have to be a way to opt out at any time."

Senate Rejects Several Republican-Supported FY 2013 Budget Plans

Thu, 17 May 2012 08:00:00 GMT

The Senate voted down five different Republican-backed fiscal year 2013 budget resolutions yesterday. Lawmakers noted that Congress is unlikely to approve any budget proposals that include changes to Medicare and Medicaid until 2013. The Hill's "Floor Action Blog" et al.

Calif.'s Nursing Homes Face Deep Medicare Payment Cuts

Thu, 17 May 2012 08:00:00 GMT

In early 2013, California's skilled nursing facilities could face Medicare payment cuts totaling $75.9 million -- the largest amount of cuts among all states -- if Congress fails to overcome an ongoing budget stalemate, according to a recent study commissioned by the Alliance for Quality Nursing Home Care. Those cuts would come on top of a state proposal to rescind a recent payment hike to close California's $16 billion budget deficit. Payers & Providers.

Healthy Families, Seniors Initiatives Questioned

Thu, 17 May 2012 08:00:00 GMT

In the governor's May budget revision released this week, in addition to $2.5 billion in new cuts to health care in California, there were a couple of proposals that raised big red flags for many health care advocates.

In particular, two budget items took a lot of heat: the effort to move about 1 million dual-eligible Californians into managed care programs; and the state's plan to move 870,000 children out of the Healthy Families program and into Medi-Cal care.

In both cases, advocates said the state is taking on way too much, too quickly -- putting the two most vulnerable populations in California at real risk.

Obama, Romney Attempt To Distinguish Rival Medicare Reform Plans

Tue, 15 May 2012 08:00:00 GMT

In recent months, President Obama and Republican presidential candidate Mitt Romney have tried to differentiate their plans to reform Medicare. The two also have accused each other of supporting plans that would effectively dismantle the program. New York Times.

Study: Calif. Hospital Patients Costly to Medicare Program

Mon, 14 May 2012 08:00:00 GMT

Five out of the top 10 hospitals where patients cost Medicare the most money are located in California, according to a Kaiser Health News analysis of data published on the CMS Hospital Compare website. Kaiser Health News' "Capsules."

HHS Releases Final Rules To Ease Regulations for Health Care Providers

Fri, 11 May 2012 08:00:00 GMT

Yesterday, HHS released two final rules designed to eliminate unnecessary, outdated and duplicative regulations on health care providers. Federal officials estimate that the changes would generate more than $5 billion in savings over five years. The Hill's "Healthwatch" et al.

Risks, Rewards Higher for Managing Dual Eligibles

Mon, 07 May 2012 08:00:00 GMT

California health plan officials say the experience of shifting seniors and persons with disabilities into Medi-Cal managed care plans over the past year will help as the state moves dual eligibles -- beneficiaries of both Medicare and Medi-Cal -- into managed care this year.

AHIP Report Highlights Value of Medicare Advantage Plans

Mon, 07 May 2012 08:00:00 GMT

Minority and low-income seniors account for a substantial portion of individuals who are benefiting under Medicare Advantage plans, according to a recent report by America's Health Insurance Plans. The federal health reform law calls for more than $200 billion in spending cuts for the plans. Modern Healthcare.

Medicare Expected To Face Payment Issues if Reform Struck Down

Thu, 03 May 2012 08:00:00 GMT

According to the Obama administration, Medicare could face payment disruptions if the Supreme Court strikes down the health reform law. Former CMS administrators Don Berwick and Tom Scully disagree on how the ruling would affect payments. AP/San Francisco Chronicle.

Calif. Providers Charged in Nationwide Medicare Fraud Crackdown

Thu, 03 May 2012 08:00:00 GMT

Federal prosecutors have charged more than 100 medical professionals across the U.S. with defrauding Medicare of $452 million. Eight of those individuals are located in the Los Angeles area and are accused of bilking Medicare of $20 million. Payers & Providers, Los Angeles Times.

Health Plans' Quality for Duals in Question

Thu, 03 May 2012 08:00:00 GMT

Seven of the eight health plans in California's pilot project to shift dual eligibles into managed Medi-Cal have inferior quality ratings for treating Medi-Cal beneficiaries, according to a report released yesterday.

The ambitious plan for 1.1 million Californians eligible for both Medicare and Medi-Cal benefits will start with a pilot program in four counties -- Los Angeles, Orange, San Diego and San Mateo. The state hopes to expand the pilot project to as many as 10 counties, pending legislative approval.

The report from National Senior Citizens Law Center, citing the state Department of Health Care Services' own quality assessment, shows seven plans earned a rating of 1 out of 5 stars in overall Medi-Cal performance.

Health Law Reduced Medicare Beneficiaries' Rx Spending

Wed, 02 May 2012 08:00:00 GMT

On Monday, CMS released new data showing that Medicare beneficiaries in the first quarter of 2012 spent an average of $837 less on prescription drugs because of the federal health reform law. According to the data, beneficiaries have spent $3.4 billion less on prescription drugs since the overhaul was enacted in March 2010. The Hill's "Healthwatch," Washington Times.

'The Passage of Power' and the Passage of Medicare

Wed, 02 May 2012 08:00:00 GMT

A long-awaited biography of Lyndon Johnson goes inside White House strategy in the early 1960s. Does the battle to pass Medicare hold any lessons for today?

GOP Leaders Back Off From Proposed Changes to Medicare, Medicaid

Wed, 25 Apr 2012 08:00:00 GMT

Instead of trying to push Rep. Paul Ryan's proposed Medicaid and Medicare changes through the Democrat-controlled Senate, Republican lawmakers are promoting less controversial ideas, such as cutting funding to the federal health reform law. AP/Washington Times et al.

Medicare Hospital Trust Fund Still Expected To Be Insolvent in 2024

Tue, 24 Apr 2012 08:00:00 GMT

A report from the board of trustees for Medicare and Social Security predicts that Medicare's hospital insurance trust fund will become insolvent in 2024. The projected insolvency date has stayed stable since last year. AP/Washington Post et al.

CMS Actuary Foresees Medicare Savings From Health Care Reform Law

Tue, 24 Apr 2012 08:00:00 GMT

According to a report from CMS' Office of the Actuary, provisions of the health reform law that curb excessive payments to some private insurers and enact new anti-fraud policies could help curb Medicare spending by more than $200 billion through 2016. Modern Healthcare et al.

Medicare Trustees To Release Report; Program Still Facing Insolvency

Mon, 23 Apr 2012 08:00:00 GMT

The Medicare trustees' annual financial reports are scheduled to be released today. Although growth in Medicare spending has slowed, the program still is headed toward insolvency. About 10,000 baby boomers become eligible for Medicare each day. AP/San Francisco Chronicle.

GAO Report: U.S. Should Abandon Bonus Program for Medicare Advantage

Mon, 23 Apr 2012 08:00:00 GMT

A new report from the Government Accountability Office calls for canceling a demonstration program that provides quality bonus payments to Medicare Advantage plans. The report contends that the program is unlikely to "produce meaningful results." New York Times et al.

Medicare Competitive Bidding Pilot Reduced Costs by 42%, CMS Says

Thu, 19 Apr 2012 08:00:00 GMT

A new CMS report finds that a yearlong Medicare competitive bidding pilot program conducted in nine metropolitan areas curbed costs by 42% without reducing care quality. However, the American Association for Homecare disputed the report's findings. New York Times et al.

House Uses Procedural Move to Approve Rep. Ryan's Budget Proposal

Wed, 18 Apr 2012 08:00:00 GMT

With no support from Democrats, the House yesterday used a procedural move to pass Rep. Paul Ryan's fiscal year 2013 budget proposal. Meanwhile, Sen. Kent Conrad intends to introduce a version of the Simpson-Bowles bipartisan budget plan. Los Angeles Times et al.

Lawmakers To Hold Slew of Hearings on Expiring Health Care Policies

Mon, 16 Apr 2012 08:00:00 GMT

Today, Congress returned from recess to a series of hearings aimed at addressing expiring health care policies. Lawmakers will examine an update to prescription drug and medical device user fees, medical malpractice legislation and other issues. The Hill's "Healthwatch."

Experts See Challenges in New Medicare Payment System for Physicians

Mon, 16 Apr 2012 08:00:00 GMT

The Physician Value-Based Payment Modifier program, set to begin in 2015, will give higher payments to Medicare physicians who provide high-quality care at a lower cost. Experts say it will be difficult to accurately assess doctors' quality of care. Kaiser Health News/Washington Post.

Calif. Hospitals Set To Receive Funds From CMS Settlement

Fri, 13 Apr 2012 08:00:00 GMT

CMS has agreed to a settlement with about 2,200 hospitals to end lawsuits related to an error in reimbursement rates. More than 200 California hospitals are set to share more than $310 million from the settlement. Los Angeles Times, Modern Healthcare.

CMS Announces First 27 Participants in Medicare Shared Savings Program

Wed, 11 Apr 2012 08:00:00 GMT

Yesterday, CMS announced the first participants in Medicare's Shared Savings Program, which provides incentives for health care providers to form accountable care organizations. Two of the first 27 participants in the ACO program are based in California. Modern Healthcare et al.

MedPAC Approves Plan To Limit Out-of-Pocket Costs for Beneficiaries

Fri, 06 Apr 2012 08:00:00 GMT

The Medicare Payment Advisory Commission has approved a plan for limiting out-of-pocket costs for Medicare beneficiaries. The proposal recommends creating a new fee-for-service design that would include a combined deductible for inpatient and outpatient services. Modern Healthcare et al.

Harbor-UCLA Makes Changes After Failing Medicare Probes

Thu, 05 Apr 2012 08:00:00 GMT

Last week, County Harbor-UCLA Medical Center officials said they have taken steps to improve patient care after failing Medicare inspections in recent years. They also said that inspectors who conducted a review in January found that problems cited during earlier visits had been resolved. Contra Costa Times.

State Names Four Counties for Duals Project

Thu, 05 Apr 2012 08:00:00 GMT

California took a big step yesterday, officially unveiling the four counties that will kick off the three-year project to eventually shift 1.1 million dual eligibles -- Californians eligible for both Medi-Cal and Medicare -- to a Medi-Cal managed care program.

The first four participants in the Coordinated Care Initiative are Los Angeles, Orange, San Diego and San Mateo counties. The Department of Health Care Services currently has authority to start the program in those counties, but legislation is pending in Sacramento that would expand authority for the number of participating counties -- up to 10 of them by 2013.

The trailer bill language for that legislation has been finalized. The trailer bill is expected to be included in the budget package in June, DHCS officials said.

Federal, State Officials Investigate SCAN Health Plan for Overbilling

Wed, 04 Apr 2012 08:00:00 GMT

SCAN Health Plan is being investigated by state and federal authorities for allegedly double-billing Medi-Cal and Medicare for treating the same pool of patients and intentionally hiding its actions. SCAN recently set aside $125 million for resolving the allegations. California Watch.

President To Criticize Ryan's GOP Budget Plan as 'Social Darwinism'

Tue, 03 Apr 2012 08:00:00 GMT

According to the White House, President Obama in a speech today is expected to say that Rep. Paul Ryan's budget proposal is "nothing but thinly-veiled social Darwinism." Ryan's plan would repeal the health reform law and alter Medicare and Medicaid. Washington Post's "44" et al.

Calif. To Announce Counties Heading Managed Care Pilot

Tue, 03 Apr 2012 08:00:00 GMT

On Wednesday, California officials will announce the four counties that will pilot a managed care program for residents eligible for both Medicare and Medi-Cal. The program is designed to streamline care and save $1 billion in fiscal year 2013-2014 by reducing unnecessary hospitalizations, emergency department visits and nursing home stays. Ten California counties -- including Alameda, Contra Costa, San Mateo and Santa Clara -- are seeking to be among the four selected to run the program. Oakland Tribune/Contra Costa Times.

Mortality Rates No Better in Pay-for-Performance Project

Fri, 30 Mar 2012 08:00:00 GMT

Mortality rates for older patients with common serious conditions were no better at hospitals participating in a Medicare pay-for-performance demonstration project than at hospitals with traditional payment models, according to a study published in the New England Journal of Medicine. MedPage Today.

House Approves Ryan's FY 2013 Budget Proposal, Axes Separate GOP Plan

Fri, 30 Mar 2012 08:00:00 GMT

Yesterday, the House approved House Budget Committee Chair Paul Ryan's fiscal year 2013 budget proposal, which would repeal the health reform law and alter Medicaid and Medicare. The House rejected a budget plan by the Republican Study Committee. Wall Street Journal et al.

Opinion: House GOP Budget Plan 'Would End Medicare'

Thu, 29 Mar 2012 08:00:00 GMT

In a Sacramento Bee opinion piece, U.S. Rep. John Garamendi argues that the House Republican fiscal year 2013 budget blueprint "would end Medicare" by allowing seniors to "choose between using a capped coupon to purchase private insurance or stick with traditional Medicare." He writes, "Make no mistake, if this plan ever becomes law, it will mark Medicare's death by a thousand coupons." Sacramento Bee.

House Rejects Several Alternative Fiscal Year 2013 Budget Proposals

Thu, 29 Mar 2012 08:00:00 GMT

Yesterday, the House voted 382-38 to reject a bipartisan budget plan that was introduced as an alternative to Rep. Paul Ryan's fiscal year 2013 budget blueprint and unanimously voted down a proposal based on President Obama's $3.6 trillion budget plan. AP/U-T San Diego et al.

Ironing Out Details of Duals Conversion

Thu, 29 Mar 2012 08:00:00 GMT

State officials met with stakeholders in Sacramento yesterday to answer questions and work out the final details of the duals demonstration project -- an ambitious plan to enroll an estimated 700,000 dual-eligible Californians in 10 counties into Medi-Cal managed care.

Enrollment will be mandatory for beneficiaries eligible for both Medi-Cal and Medicare. Jane Ogle, deputy director of health care delivery systems at the Department of Health Care Services, was quick to point out that beneficiaries would keep their own physician, even if that physician is not in the Medi-Cal network, and that beneficiaries have the power to opt out of the demonstration project, if they want.

"There is no need to assign a new doctor to people," Ogle said. "There just is no need to do that."

Democrats Target Sacramento Area Voters on Medicare Issue

Tue, 27 Mar 2012 08:00:00 GMT

The future of Medicare has become a leading campaign issue in the Sacramento region as Democrats try to reclaim the 7th Congressional District seat from Republican Rep. Dan Lungren. In recent weeks, Democrats have targeted the district's swing voters with a series of robocalls highlighting a proposal in the House GOP's fiscal year 2013 budget blueprint that would alter Medicare. Sacramento Bee.

Republicans Promoting Health Care Changes in Ryan's Budget Blueprint

Mon, 26 Mar 2012 08:00:00 GMT

GOP lawmakers are working to build support for House Budget Committee Chair Paul Ryan's new budget plan, which would repeal the health reform law and alter Medicare and Medicaid. Republicans aim to present the plan as the only option for saving Medicare. Washington Post et al.

House Passes Measure To Repeal Independent Payment Advisory Board

Fri, 23 Mar 2012 08:00:00 GMT

Yesterday, the House approved legislation that would repeal the federal health reform law's Independent Payment Advisory Board. The measure is not expected to clear the Senate, and President Obama has vowed to veto the legislation if it reaches his desk. AP/USA Today et al.

Procedural House Vote Advances Bill To Repeal Health Reform's IPAB

Thu, 22 Mar 2012 08:00:00 GMT

Yesterday, the House took a procedural vote to advance a bill that would repeal the federal health reform law's Independent Payment Advisory Board. The bill is expected to pass the House in a final floor vote but is unlikely to receive Senate approval. The Hill's "Healthwatch."

House Committee OKs Ryan's Budget Blueprint for Fiscal Year 2013

Thu, 22 Mar 2012 08:00:00 GMT

The House Budget Committee has approved Committee Chair Paul Ryan's new budget plan, which includes proposals to repeal the health reform law and alter Medicare and Medicaid. GOP leaders say they expect the full House to pass the measure. The Hill's "On the Money" et al.

House To Consider Bill To Repeal Reform Law's Payment Advisory Board

Wed, 21 Mar 2012 08:00:00 GMT

Today, the House is scheduled to consider legislation that would repeal the Independent Payment Advisory Board created under the federal health reform law. President Obama has pledged to veto the IPAB repeal measure if it reaches his desk. The Hill's "Healthwatch" et al.

MedPAC Report Stumps for SGR Repeal, 1% Hospital Pay Increase

Fri, 16 Mar 2012 08:00:00 GMT

The Medicare Payment Advisory Commission has reiterated its support for overhauling the sustainable growth rate formula. The group also recommended increasing hospital inpatient and outpatient care payments by 1% in fiscal year 2013. Modern Healthcare et al.

MA Funding Changes Have Varying Effect on States

Wed, 14 Mar 2012 08:00:00 GMT

Funding cuts to Medicare Advantage plans under the federal health reform law have a varying effect on beneficiaries, with some receiving additional benefits and others receiving no extra coverage, according to a new Avalere Health report. The cuts affect beneficiaries differently because MA benefits and cost-sharing vary by state. The report found that beneficiaries in California, Florida, Louisiana, Missouri, Nevada, New Mexico, New York, Texas and Washington, D.C., received extra benefits. The Hill's "Healthwatch," Kaiser Health News' "Capsules."

CBO: Medicare Spending To Nearly Double Over Next Decade to $1.058T

Wed, 14 Mar 2012 08:00:00 GMT

The Congressional Budget Office estimates that Medicare spending will nearly double from $563.3 billion in fiscal year 2011 to $1.058 trillion in fiscal year 2022. It also estimates that Medicaid spending will jump from $275 billion in FY 2011 to $622 billion in FY 2022. Modern Healthcare.

Legislature Examines Duals Transition

Mon, 12 Mar 2012 08:00:00 GMT

Toby Douglas took a good amount of heat last Wednesday at an Assembly joint hearing of the committee on Aging and Long-Term Care and the Budget subcommittee on Health and Human Services.

Douglas -- director of the state Department of Health Care Services -- with a full array of budget cuts, program transitions and agency reorganization on his plate, has been making presentations and fielding questions at a number of legislative hearings recently. None of them has been a cakewalk, but this hearing was a little more barbed than most.

Complaints and concerns ranged from a perceived lack of choice to worry over rapid-fire changes.

House Ways and Means Committee Approves IPAB Repeal Measure

Fri, 09 Mar 2012 08:00:00 GMT

The House Ways and Means Committee has passed a bill to repeal the health reform law's Independent Payment Advisory Board. A Congressional Budget Office report estimates that repealing IPAB would add $3.1 billion to the deficit over a decade. The Hill's "Healthwatch" et al.

More People May Be Eligible for Adult Day Services

Thu, 08 Mar 2012 08:00:00 GMT

There was a glimmer of good news for the 35,000 adult day health care Medi-Cal patients in California. It looks like a much higher percentage of them than previously estimated will be eligible to receive the new benefit called Community Based Adult Services.

Department of Health Care Services Director Toby Douglas originally said he expected about 50% of current ADHC patients to qualify for the new program. ADHC will be eliminated as a Medi-Cal benefit on Mar. 31 and the CBAS program starts Apr. 1.

Now it looks like 70% to 80% of those receiving the ADHC benefit will qualify for CBAS, according to Catherine Blakemore, executive director of Disability Rights California, which is monitoring the state's assessment and placement of ADHC patients.

House Committee OKs Bill To Repeal Reform Law's Payment Board

Wed, 07 Mar 2012 08:00:00 GMT

Yesterday, the House Energy and Commerce Committee passed legislation that would repeal the federal health reform law's Independent Payment Advisory Board. The measure now goes to the House Rules and Ways and Means committees for mark ups. The Hill's "Healthwatch" et al.

CMS To Introduce New User-Friendly Billing Statements for Medicare

Wed, 07 Mar 2012 08:00:00 GMT

This weekend, CMS plans to release new Medicare billing statements designed to make it easier for beneficiaries to review their forms and detect fraudulent charges. The new statements will use large font and plain English descriptions. Kaiser Health News/Washington Post.

California Hospitals Seek To Treat Fewer Patients Under Federal Overhaul

Mon, 05 Mar 2012 08:00:00 GMT

California hospitals are trying to keep patients out of their facilities in preparation for new federal health reform law rules. The law provides higher reimbursements for hospitals with better patient outcomes and penalizes facilities for preventable readmissions. Los Angeles Times.

KFF Poll: U.S. Residents Divided on Support for Federal Health Reform

Thu, 01 Mar 2012 08:00:00 GMT

A new poll from the Kaiser Family Foundation finds that about 42% of U.S. residents favor the federal health reform law, while about 43% view it unfavorably. According to the poll, most U.S. residents say they support keeping Medicare "as it is today." Kaiser Health News et al.

Texas Physician, Others Charged With $375M in Home Health Care Fraud

Wed, 29 Feb 2012 08:00:00 GMT

A Texas doctor and the owners of five home health care agencies have been arrested for allegedly defrauding Medicare and Medicaid of nearly $375 million. The Obama administration said it is the largest case of home health care fraud ever committed. Washington Post et al.

Romney Offers Proposal To Gradually Increase Medicare Eligibility Age

Mon, 27 Feb 2012 08:00:00 GMT

On Friday, Republican presidential candidate Mitt Romney introduced a proposal that would increase the Medicare eligibility age by one month per year starting in 2022. According to Romney, the eligibility age would increase on pace with life expectancy. Wall Street Journal, AP/Contra Costa Times.

Inspector General Finds Wide Variation in How MA Plans Detect Fraud

Mon, 27 Feb 2012 08:00:00 GMT

Medicare Advantage plans differ widely in how they define and detect fraud, according to a report from the HHS Office of Inspector General. Meanwhile, the Obama administration is pursuing new policies aimed at reducing improper payments to Medicare Advantage plans. Modern Healthcare, AP/UT-San Diego.

President Obama Signs Measure on Payroll Tax Cut, Medicare 'Doc Fix'

Thu, 23 Feb 2012 08:00:00 GMT

Yesterday, President Obama signed legislation to extend a payroll tax cut and delay scheduled cuts to Medicare physician payments. When the "doc fix" expires at the end of 2012, physicians would face a nearly 32% cut in Medicare payment rates. The Hill's "Blog Briefing Room" et al.

LAO: Brown's Expansion of Managed Care Pilot Would Be 'Premature'

Wed, 22 Feb 2012 08:00:00 GMT

The Legislative Analyst's Office has reviewed Gov. Brown's plan to quickly expand a pilot program shifting residents eligible for both Medi-Cal and Medicare into managed care plans. LAO said the state should evaluate the results of the pilot program before expanding the initiative statewide. California Watch.

GOP Lawmakers Blast HHS for Touting 'Free' Preventive Services

Tue, 21 Feb 2012 08:00:00 GMT

Earlier this month, a group of 10 GOP senators sent a letter to HHS Secretary Kathleen Sebelius criticizing HHS for promoting preventive services under Medicare as "free." The senators said that taxpayers assume the cost of such services. American Medical News, Fierce Healthcare.

Bill on Payroll Tax, 'Doc Fix' Clears Congress, Heads to Obama's Desk

Fri, 17 Feb 2012 08:00:00 GMT

Today, both the House and Senate voted to pass legislation that would extend the payroll tax cut, continue unemployment benefits and delay scheduled cuts to Medicare physician payments. The bill now goes to President Obama, who has pledged to sign it "right away." Politico et al.

Panel Reaches Deal on Extension of Payroll Tax Cut, Medicare 'Doc Fix'

Thu, 16 Feb 2012 08:00:00 GMT

Late last night, a congressional committee approved a 10-month deal to extend a payroll tax cut and delay scheduled cuts to Medicare physician payments. The "doc fix" would be offset through cuts to certain hospital payments and a public health fund. New York Times et al.

New GOP Proposal Aims To Overhaul Medicare, Increase Eligibility Age

Thu, 16 Feb 2012 08:00:00 GMT

Today, two Republican senators plan to unveil a proposal that would shift many Medicare beneficiaries into private coverage and gradually raise the program's eligibility age. The plan also would impose higher premiums on middle- and high-income beneficiaries. AP/U-T San Diego.

Can Health Equity Be a Moneymaker?

Thu, 16 Feb 2012 08:00:00 GMT

Sometimes the right thing might also be the financially beneficial thing.

Physician groups are gathering today in Sacramento for a conference on disparities in health care related to race, language and geography. This time, the debate is not just about the moral imperative to promote equity in health care, but also about the clinical and financial impetus to make that move.

"The thing that has changed, as more people are brought into systems of care with accountability, health organizations are going to be looking at avoidable cost as well as avoidable risk," according to Wells Shoemaker, medical director of the California Association of Physician Groups, which organized the conference."It's sort of the low-hanging fruit when you're looking for avoidable costs."

Lawmakers Close to Deal on Payroll Tax Cut, Medicare 'Doc Fix'

Wed, 15 Feb 2012 08:00:00 GMT

A conference committee has reached a tentative deal to extend the payroll tax cut, continue unemployment benefits and delay scheduled cuts to Medicare physician reimbursement rates. The final agreement could be announced today and approved by Friday. New York Times et al.

Survey: Patients, Physicians Not Discussing End-of-Life Care

Tue, 14 Feb 2012 08:00:00 GMT

A California HealthCare Foundation survey finds that about 80% of residents would want to talk to their physicians about end-of-life care if they became seriously ill. However, only 7% of residents have done so. Contra Costa Times, San Francisco Chronicle.

House GOP To Push Bill To Extend Payroll Tax Break Without 'Doc Fix'

Tue, 14 Feb 2012 08:00:00 GMT

House Republicans plan to introduce a stand-alone bill to extend the payroll tax break through the end of the year. Democrats said they would prefer to pursue a single bill that addresses the payroll tax break, "doc fix" and unemployment benefits. Wall Street Journal et al.

Federal Gov't Recovered $4.1B in Health Care Fraud Judgments in 2011

Tue, 14 Feb 2012 08:00:00 GMT

This morning, federal officials announced that they recovered a record-high $4.1 billion in health care fraud judgments last year. Officials attributed the increased recovery rate to new tools and methods used for detecting fraudulent Medicare claims. AP/Washington Post.

Obama's Budget Likely Will Not Include Major Changes to Entitlements

Fri, 10 Feb 2012 08:00:00 GMT

President Obama is not expected to propose major Medicare and Medicaid changes in his new budget proposal next week. Despite supporting program cuts, he likely will abstain from such proposals to retain the support of elderly residents in the election. Wall Street Journal.

Health Care May Play Part in California Political Makeover

Thu, 09 Feb 2012 08:00:00 GMT

With retirements on both sides of the aisle, new congressional districts and new voting rules, California's political makeup is headed for change in both Washington, D.C., and Sacramento. A couple of health care issues -- a controversial Medicare plan in Congress and a state ballot proposal to regulate health insurance premiums -- could play a part in how those changes happen.

Democrats To Unveil Plan To Fund Payroll Tax Cut, Medicare 'Doc Fix'

Thu, 09 Feb 2012 08:00:00 GMT

Today, Democrats likely will release a plan to offest the cost of a payroll tax cut extension and a delay to scheduled Medicare reimbursement cuts. Earlier this week, Democrats rejected a set of GOP proposals. Modern Healthcare, CQ Today.

Court: Social Security Beneficiaries Cannot Drop Medicare Eligibility

Wed, 08 Feb 2012 08:00:00 GMT

A court ruled that U.S. residents enrolled in Social Security cannot forgo Medicare eligibility. The plaintiffs sought to give up their eligibility because their health plans limit benefits for those who qualify for Medicare. The Hill's "Healthwatch," AP/San Francisco Chronicle.

Patients Confused by ACO Outreach Letters, Doctors Say

Mon, 06 Feb 2012 08:00:00 GMT

Several Ventura County physicians have expressed concern about letters that some of their Medicare patients have received about a new Southern California-based accountable care organization program. The letters from Heritage California ACO tell Medicare beneficiaries -- some of whom are treated by doctors who are not part of the Heritage Provider Network -- that they automatically will be enrolled in the ACO program unless they opt out. Ventura County Star.

Committee Weighs New Strategies on Payroll Tax Cut, Medicare 'Doc Fix'

Mon, 06 Feb 2012 08:00:00 GMT

A conference committee is considering new approaches to extend the payroll tax cut and delay planned Medicare physician payment cuts. Lawmakers hope to reach a deal before the end of February, when the previous two-month agreement expires. The Hill's "Healthwatch" et al.

Rep. Camp Airs Concerns About Plan To Put War Savings Toward 'Doc Fix'

Fri, 03 Feb 2012 08:00:00 GMT

House Ways and Means Committee Chair Dave Camp says a panel tasked with extending a payroll tax cut and delaying Medicare payment cuts might lack authority to fund such measures with savings from ending the wars in Afghanistan and Iraq. Kaiser Health News' "Capsules" et al.

Reform Law Reduced Medicare Enrollees' Rx Costs by $2.1B in 2011

Fri, 03 Feb 2012 08:00:00 GMT

Yesterday, the Obama administration announced that the health reform law reduced prescription drug costs by $2.1 billion for the 3.6 million Medicare beneficiaries who were in the "doughnut hole" in 2011, amounting to about $604 in savings per beneficiary. Los Angeles Times et al.

HHS: Premiums Decline, Enrollment Up in MA Plans

Fri, 03 Feb 2012 08:00:00 GMT

On Wednesday, HHS announced that premiums for Medicare Advantage plans decreased by 7% and enrollment increased by 10% in the last year. HHS said the data show that the federal health reform law has not weakened the program, but insurers argued that significant program cuts are still to come. The Hill's "Healthwatch."

Report: Data Lacking on Physicians Leaving Medicare

Tue, 31 Jan 2012 08:00:00 GMT

Medicare contractors do not adequately track the number of physicians who opt out of the program, making it difficult to determine their reasons for leaving, according to a report from the HHS Office of Inspector General. The number of physicians who opted out of Medicare increased annually between 2006 and 2010, but investigators could not determine why physicians were leaving Medicare because of insufficient data. MedPage Today, Modern Healthcare.

Government Health Care Spending To Reach $1.8T by 2022, CBO Predicts

Tue, 31 Jan 2012 08:00:00 GMT

Today, the Congressional Budget Office released an economic outlook predicting that the cost of government health care programs will more than double over the next 10 years to $1.8 trillion, representing about 7% of the U.S. economy. The Hill's "Healthwatch," Wall Street Journal.

Report Finds Overpayments in Medicare Advantage Plans

Mon, 30 Jan 2012 08:00:00 GMT

A new Government Accountability Office report shows that Medicare Advantage plans were overpaid by between $1.2 billion and $3.1 billion in 2010. The report found that MA plans tend to classify their beneficiaries as being sicker than those in fee-for-service Medicare plans, thereby triggering higher payments. House Democrats said the federal government could save billions of dollars annually by adjusting the coding formula used to determine MA payments. The Hill's "Healthwatch" et al.

Medicare Poised To Be Major Issue in 2012 Congressional Races

Mon, 30 Jan 2012 08:00:00 GMT

Medicare is likely to be a major issue in congressional races this year. Democrats plan to criticize the GOP for supporting House Budget Committee Chair Paul Ryan's Medicare proposal, while Republicans plan to attack Medicare cuts in the federal health reform law. New York Times.

Elderly Health Program Viewed as Model To Cut Costs, Improve Care

Thu, 26 Jan 2012 08:00:00 GMT

State and federal policymakers are looking to the Program of All-Inclusive Care for the Elderly as a potential model to save money and improve health care for the elderly and individuals with disabilities. California has five PACE organizations that operate 18 centers. San Francisco Chronicle.

President's State of the Union Address Skimps on Health Care Issues

Wed, 25 Jan 2012 08:00:00 GMT

During his State of the Union address last night, President Obama spent little time discussing health care issues. Senate Minority Leader Mitch McConnell said he thought Obama "would rather not discuss" the federal health reform law during his re-election campaign. Politico et al.

Conference Committee Discusses Payroll Tax Cut, Medicare 'Doc Fix'

Wed, 25 Jan 2012 08:00:00 GMT

Yesterday, a bipartisan conference committee met to discuss a yearlong measure to extend a payroll tax cut and delay scheduled reductions to Medicare physician payments. A short-term deal on the payroll tax cut and Medicare "doc fix" expires at the end of next month. AP/U-T San Diego et al.

House Republicans Talk About Strategies for Overhauling Medicare

Tue, 24 Jan 2012 08:00:00 GMT

House Republicans recently outlined their 2012 agenda, pledging to focus on Medicare reform and other issues. House Budget Committee Chair Rep. Paul Ryan said the GOP likely would pursue a plan to offer subsidies for Medicare beneficiaries to purchase coverage. CQ Today et al.

CBO: Medicare Cost-Cutting Programs Fall Short of Goals

Fri, 20 Jan 2012 08:00:00 GMT

Pilot programs established under the federal health reform law to study Medicare payment reform did not produce significant savings or improve health care quality, according to a Congressional Budget Office brief. On average, the 34 programs that were part of six demonstration projects to improve care coordination for patients with chronic diseases had little or no effect on hospital admissions or Medicare spending. Meanwhile, only one of four programs that offered financial incentives for higher quality care reduced spending, according to CBO. The Hill's "Healthwatch," Modern Healthcare.

Lawmakers Seek Smooth Passage of Longer-Term Medicare 'Doc Fix' Bill

Wed, 18 Jan 2012 08:00:00 GMT

Democrats and Republicans both have agreed to concessions to facilitate the passage of a yearlong measure that would extend a payroll tax cut and delay scheduled reductions to Medicare physician reimbursements. The current two-month "doc fix" expires at the end of next month. New York Times et al.

CVS To Pay $5M To Settle Allegations of Deceptive Drug Prices

Fri, 13 Jan 2012 08:00:00 GMT

CVS Caremark has agreed to pay $5 million to customers of CVS and Walgreen pharmacies to settle an investigation of charges that it misrepresented the price of certain Medicare prescription drugs. CVS will send checks to affected beneficiaries. Wall Street Journal et al.

What's Best Enrollment Process for Dual Eligibles?

Thu, 12 Jan 2012 08:00:00 GMT

State officials face a key decision in orchestrating a shift into managed care for more than one million Californians who are beneficiaries of both Medicare and Medi-Cal: How to enroll people in the new plans. We asked stakeholders and experts to discuss pros and cons of various enrollment options.

U.S. Rep. Herger of California To Retire After 13 Terms

Wed, 11 Jan 2012 08:00:00 GMT

On Tuesday, U.S. Rep. Wally Herger announced that he will not seek re-election when his 13th term in Congress ends at the end of this year. Herger, 66, who represents the 2nd congressional district in northern California, said he was retiring from politics to spend more time with his family. He also noted some of his accomplishments in Congress and his role as a "leading opponent of Obamacare." House Ways and Means Committee Chair Dave Camp praised Herger for his leadership in the GOP's opposition to the federal health reform law "while also pursuing efforts to protect and strengthen Medicare for the future." Herger has endorsed state Sen. Doug LaMalfa to succeed him. Modern Healthcare, AP/San Francisco Chronicle.

Four Resolutions We Hope Lawmakers Will Keep This Year

Wed, 11 Jan 2012 08:00:00 GMT

The Republicans have promised a replacement for the health reform law. The Democrats had planned a payment advisory panel. Both parties want a "doc fix." Will this be the year lawmakers stick to their promises?

CBO: Raising Medicare Eligibility Age Would Save $148B Over Decade

Wed, 11 Jan 2012 08:00:00 GMT

A new Congressional Budget Office report estimates that gradually raising Medicare's eligibility age from 65 to 67 would save the federal government about $148 billion over a decade. The savings would come in part by shifting costs to seniors. The Hill's "Healthwatch" et al.

Health Net To Sell Medicare Rx Business to CVS for $160M

Tue, 10 Jan 2012 08:00:00 GMT

On Monday, Woodland Hills-based Health Net announced plans to sell its Medicare Part D prescription drug plan business to CVS Caremark for $160 million. Health Net said it expects to net $140 million cash from the sale of its PDP business, which has about 400,000 customers in 49 states and the District of Columbia, and generates about $490 million in annual revenue. The acquisition, which requires CMS approval, is expected to close in the second quarter of this year. Los Angeles Business Journal, Dow Jones/Wall Street Journal.

GOP Candidates Discuss Entitlement Cuts, Health Insurance, Reform Law

Mon, 09 Jan 2012 08:00:00 GMT

Over the weekend, many GOP presidential candidates discussed health care issues in New Hampshire. Former Sen. Rick Santorum said he would shift Medicaid responsibility to the states, and Rep. Ron Paul said he would repeal the federal health reform law. AP/Washington Post et al.

Report: Many Hospitals Not Reporting Medical Errors, Adverse Events

Fri, 06 Jan 2012 08:00:00 GMT

A new report from the HHS Office of Inspector General finds that hospital workers are reporting only one out of every seven adverse events involving Medicare beneficiaries. Medicare officials say they plan to develop a list of events that must be reported. New York Times.

Gov't Programs Account for More of Private Insurers' Revenue

Thu, 05 Jan 2012 08:00:00 GMT

A new Bloomberg Government study finds that the top U.S. private health insurers have experienced substantial revenue growth in recent years, in part because they are playing a larger role in government health insurance programs such as Medicare and Medicaid. Washington Post.

Obama Signs Two-Month Reprieve for Medicare Reimbursement Cuts

Wed, 04 Jan 2012 08:00:00 GMT

On Dec. 23, President Obama signed a two-month payroll tax cut extension that includes a two-month delay to scheduled Medicare payment cuts for physicians. A conference committee is expected to resume work on a longer-term deal. New York Times et al.

Democrats' Medicare Claims Named 2011 'Lie of the Year'

Thu, 22 Dec 2011 08:00:00 GMT

The fact-checking website PolitiFact has conferred its annual "Lie of the Year" for 2011 to Democrats for suggesting that a House GOP Medicare reform proposal would "end" the program. The proposal -- which House Budget Committee Chair Paul Ryan unveiled in April and the House approved as part of the GOP fiscal year 2012 budget resolution -- would have altered Medicare from a fee-for-service program to one that would have beneficiaries purchase coverage on the private market. According to PolitiFact, Democrats' claim that the Ryan plan would "end Medicare" overlooks the fact that the proposed changes would not affect current beneficiaries or seniors ages 55 and older who would enter the program in the next decade. The Hill's "Healthwatch" et al.

Democrats Rebuff Idea for Standalone Bill To Delay Medicare Pay Cuts

Thu, 22 Dec 2011 08:00:00 GMT

Democratic leaders say they are not interested in a standalone measure to put off scheduled Medicare doctor reimbursement cuts. They are urging the House to pass a two-month extension of a payroll tax break package that includes a delay to the Medicare cuts. The Hill et al.

House Seeks Negotiation on Tax Break, 'Doc Fix' Bill, but Senate Adjourns

Wed, 21 Dec 2011 08:00:00 GMT

Yesterday, the House voted to request conference committee negotiations with the Senate on a bill to extend a payroll tax break and delay scheduled Medicare physician payment cuts. However, the Senate has adjourned for recess for the rest of the year. AP/Washington Post et al.

House Delays Floor Vote on Amended Payroll Tax Break, 'Doc Fix' Measure

Tue, 20 Dec 2011 08:00:00 GMT

House Republicans have postponed a vote on an amended bill to extend a payroll tax break and delay scheduled Medicare physician payment cuts for two months. House lawmakers will vote on taking the bill to conference committee, but the Senate is unlikely to reopen negotiations. Politico et al.

Editorials Discuss Bipartisan Plan To Overhaul Medicare

Tue, 20 Dec 2011 08:00:00 GMT

A Washington Post editorial "congratulat[es] Sen. Ron Wyden and Rep. Paul Ryan for" their recent proposal to provide Medicare beneficiaries with "premium support" to purchase traditional coverage or a private plan. "Unfortunately, instead of welcoming the effort, the White House chose to stomp on it," which "is not a constructive or adequate response to a serious proposal," according to the editorial. Meanwhile, a New York Times editorial notes that while the plan "deserve[s] careful scrutiny, ... we are skeptical that any of the proposals for premium support that have been floated by Republicans can rein in Medicare spending without harming beneficiaries, financially or medically." Washington Post, New York Times.