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May 15, 2013 | 5:00 AM | By

Brown Backs State-Run Medi-Cal Expansion

By Mina Kim

(Justin Sullivan/Getty Images)

(Justin Sullivan/Getty Images)

Gov. Jerry Brown’s revised budget plan is a mixed bag for health advocates and some county officials.

Brown said the state would take the lead on a key provision of the federal health law — expanding Medi-Cal to more than one million Californians. Brown scrapped earlier plans to consider a more complicated, county-based system.

But Brown anticipates recouping more than $300 million from the counties next fiscal year – money that pays for public health programs and care for the uninsured. Brown’s rationale? With the full implementation of federal health reform next year, more people will enroll in Medi-Cal and fewer people will show up to county emergency rooms.

Farrah McDaid Ting with the California State Association of Counties says Brown’s proposal makes no sense. She says plenty of people will still rely on county services in 2014.

They are “people who qualify for Medi-Cal but don’t sign up, people who have a hard time signing up or staying on programs, the undocumented in our communities and those who are in between private health plans,” McDaid Ting said. “We need to retain enough funds to serve those people.” Continue reading →

FILED UNDER: Money, Policy, Reform, Affordable Care Act, California Budget, Medi-Cal
April 3, 2013 | 5:14 PM | By

Schools Struggle to Provide Dental Health Safety Net

Dental disease at the intersection of school performance and health for thousands of California children

By Jane Meredith Adams, EdSource Today

Students learn how to care for their teeth and receive preventive care at a dental clinic at James Madison Middle School in Oakland. (Photo/Alameda County Public Health Department)

Students learn how to care for their teeth and receive preventive care at a dental clinic at James Madison Middle School in Oakland. (Photo/Alameda County Public Health Department)

As California educators grapple with boosting student achievement across economic lines, the teeth of poor children are holding them back.

Hundreds of thousands of children suffering from dental disease, some with teeth rotted to the gum line, are presenting California school districts with a widespread public health problem.

Increasingly, dental health advocates are looking to school districts to help solve the crisis. Innovative oral health care projects have been launched in school districts around the state that provide students with no-cost dental screening or treatment. Insurance companies are billed whenever possible.

Dental disease is at “epidemic” levels among California children, according to the U.S. Surgeon General, and low-income children are disproportionately affected. They are 12 times more likely to miss school because of dental problems than children from higher-income families.

Students with toothaches were almost four times as likely to have a lower grade point average than students with healthy teeth.
“The issue is huge,” said Gordon Jackson, director of the state Department of Education’s division which oversees health, counseling and other support programs provided at schools. “Tooth decay remains one of the most chronic diseases for children and adolescents. As we’re having the conversation about California’s future and student academic achievement, we have to have a conversation about oral health as well.”

But many districts lack the resources, or balk at being asked to provide dental care on top of a rigorous curriculum.

“It’s a great idea to bring universal prevention programs of all types, including dental, to schools,” said Kimberly Uyeda, director of student medical services for the Los Angeles Unified School District. “Whether there’s enough time in the day is another question.” Continue reading →

FILED UNDER: Money, Place Matters, Children's Health, Dental Health, School Health Centers
March 27, 2013 | 11:49 AM | By

Chart of the Day: Health Care’s ‘Financial Burden’ on Families

It seems that “32 percent” is the number of the day today. First, actuaries believe that medical claims costs will go up 32 percent, and now the Centers for Disease Control tells us that 32 percent of U.S. families are having trouble paying their medical bills:

(Centers for Disease Control)

(Centers for Disease Control)

Nearly one in four children ages birth to 17 live in families that are struggling to pay medical bills, according to CDC data from the National Health Interview Survey, from January – June, 2011.

Here are more findings. In the first six months of 2011: Continue reading →

FILED UNDER: Money, Health Care Costs
March 27, 2013 | 10:06 AM | By

Health Care Overhaul: Study Say Costs Could Go Up 32 Percent

(401(k)2012/Flickr)

(401(k)2012/Flickr)

Now the actuaries are weighing in.

In a new analysis, the Society of Actuaries says insurance companies will pay an average 32 percent more for medical claims under the health care overhaul.

That means premiums could go up, especially in the individual market.

The Obama Administration isn’t convinced, though, saying the report didn’t consider all the ways in which the administration says the Affordable Care Act will reduce costs.

More from the AP: Continue reading →

FILED UNDER: Money, Reform, Affordable Care Act, Medical Claims
February 22, 2013 | 9:38 AM | By

When Artificial Hips Go Bad: Thousands Sue over ASR XL by Johnson & Johnson Subsidiary

Michael Kelly, attorney for plaintiff Loren Kransky, holds up an ASR XL hip implant made by Johnson & Johnson during his opening statement to the jury at the trial of Kransky v. DePuy, at California Superior Court in Los Angeles, on Friday, Jan. 25, 2013. (Credit: Patrick T. Fallon/Bloomberg)

Michael Kelly, attorney for plaintiff Loren Kransky, holds up an ASR XL hip implant made by Johnson & Johnson during his opening statement to the jury at the trial of Kransky v. DePuy, at California Superior Court in Los Angeles, on Friday, Jan. 25, 2013. (Credit: Patrick T. Fallon/Bloomberg)

In recent weeks, a jury in Los Angeles Superior Court has been diving deep into the world of artificial hips. They’re hearing the case of a Montana man whose hip implant went bad –- but they’re also laying the legal groundwork for what’s expected to be a massive settlement between the maker of the hip and more than 10,000 Americans.

De Puy, a subsidiary of Johnson and Johnson, stands accused of producing a defective design, failing to warn doctors and patients when word first came trickling back the hip was failing at high rates, and then moving too slowly to recall the product.

The ASR hip went to market in Europe in 2003; in the US, in 2005. Within a year or two of when it was first sold in Europe, concerns about the ASR began filtering back to J&J through surgeons. Continue reading →

FILED UNDER: Money, Artificial Hips, ASR XL, Hip Replacement
February 19, 2013 | 9:04 AM | By

Self-Screening Stations Coming to Walmart — 2,500 of Them

(Illustration by Kaiser Health News from photo by Walmart via Flickr)

(Illustration by Kaiser Health News from photo by Walmart via Flickr)

By Julie Appleby, Kaiser Health News

Perched by a computer monitor wedged between shelves of cough drops and the pharmacy in a bustling Walmart in Sterling, Va., Mohamed Khader taps out answers to questions such as how often he eats vegetables, whether anyone in his family has diabetes and his age. He tests his eyesight, weighs himself and checks his blood pressure as a middle-aged couple watches at the blue-and-white SoloHealth station advertising “free health screenings.”

Such programs raise a red flag for some consumer advocates who worry the “advice” might be an advertisement.

“You may not go to the doctor every year, but you come to Walmart often,” says the fit-looking 43-year-old Khader who lives in nearby Ashburn, Va. “I get bored while my wife is shopping. This is a time killer. I’ll come back in two months or so, and track my results.”

A burgeoning consumer health industry is betting that millions of consumers will do just that. Continue reading →

FILED UNDER: Money, Self-Screening, Walmart
February 14, 2013 | 11:05 AM | By

Systems Can Work: Rooting Out Variation and Saving Millions in San Diego

By Russ Mitchell, Kaiser Health News

Among other changes, Scripps Health streamlined its ER admission process, slashing wait times and saving $29 million. (Taber Andrew Bain/Flickr)

Among other changes, Scripps Health streamlined its ER admission process, slashing wait times and saving $29 million. (Taber Andrew Bain/Flickr)

A hundred managers at Scripps Health jam shoulder-to-shoulder into a break room in San Diego. CEO Chris Van Gorder goes at them like a football coach down by 3 at halftime.

“What are we trying to do in our health care system?”

“Reduce costs!”

“Why?”

“Health care is too expensive.”

“The solution is going to come from Washington D.C., right?”

There was a cost difference of $6,000 between two Scripps hospitals performing the same cardiac procedures.
“Ha ha ha ha.”

“Sacramento then, right?”

“Ha.”

“The solution,” says Van Gorder, pumping an index figure toward his team, “is going to come from right here.”

Van Gorder, an ex-cop turned hospital executive, rescued troubled Scripps from near insolvency a dozen years ago as its new CEO. Now, he’s put Scripps in the middle of a cultural transformation aimed at saving hundreds of millions of dollars a year by – get this – coaxing physicians and managers at Scripps to work together, and standardizing care across every hospital in the system.

Just this week, we’ve seen how lack of standardization leads to a nearly-inexplicable price range of $11,000 to $125,000 for a standard hip replacement across the country. Continue reading →

FILED UNDER: Money, Reform, Evidence Based Medicine, Price Variation
February 13, 2013 | 2:03 PM | By

ACA Updates: Covered California Benefit Plans and Calculate Your Premium Online

California is first state to announce benefit plans including co-pays, deductibles

California's insurance marketplace, Covered California, will open in October, 2013. People will be able to buy insurance, which will take effect January 1, 2014.

California’s insurance marketplace, Covered California, will open in October, 2013. People will be able to buy insurance, which will take effect January 1, 2014.

Calling today a “game changer for California and a game changer for the nation,” Peter Lee, executive director of Covered California, the state’s marketplace for health insurance, announced benefit plans that will be featured in the exchange.

He also unveiled its updated website (in English and Spanish) where consumers can access what is sure to be a very popular premium calculator. People with incomes up to 400 percent of poverty are eligible for subsidies from the federal government to help purchase insurance. The calculator gives an estimate of what you will pay after the subsidy.

An estimated 2.6 million Californians are expected to qualify for the subsidy. People who receive Medi-Cal or employer-based health insurance are not eligible and will continue to receive health insurance through their current plans.

Calculate your monthly premium here.
California is the first state in the nation to release benefit packages for the public to review. ”The most important aspect of these plans is that they’re standardized. … Consumers will be able to make apples-to-apples comparisons that they haven’t been able to make in the past,” Lee said in a press conference. Continue reading →

FILED UNDER: Money, Reform, ACA, Affordable Care Act, Premium Subsidy
February 11, 2013 | 5:11 PM | By

How Much for A Hip Replacement? Good Luck Trying to Find Out

X-ray showing a new artificial hip. No, I don't know how much the patient paid for it. (okadots/Flickr)

X-ray showing a new artificial hip. No, I don’t know how much the patient paid for it. (okadots/Flickr)

If you want to buy a new car, you can probably figure out a price range within a matter of minutes with a google search. The same is true for many other products. But in health care, forget it.

In a new study published today in JAMA Internal Medicine, researchers called more than 100 hospitals across the country. They included a range of both top-ranked centers and community hospitals and inquired about a common elective surgical procedure — a hip replacement — for a fictitious 62-year-old grandmother.

First off, only 10 percent of the non-top-ranked hospitals and 45 percent of the top-ranked hospitals were even able to provide a price. Researchers were a bit more successful when they called the hospital and physician separately.

“It is time we stop forcing people to buy health care services blindfolded.”

And just what was the price range? $11,100 on the low end to $125,000 on the high end.

“Patients seeking elective (hip replacement) may find considerable price savings through comparison shopping,” the authors write. No kidding — except that half of the institutions couldn’t even provide a price. Continue reading →

FILED UNDER: Money, You're the Boss, Health Care Costs, Price, Quality, Reference Pricing, Threshold Price
February 5, 2013 | 10:53 AM | By

Quake Breakdown: Hospitals Balk Over Sharing Disaster Preparedness Data

By Deborah Schoch, CHCF Center for Health Reporting

The Kaiser Permanente clinic in Granada Hills, CA was severely damaged in the 1994 Northridge earthquake. (Photo/NOAA)

The Kaiser Permanente clinic in Granada Hills, CA was severely damaged in the 1994 Northridge earthquake. (Photo/NOAA)

In early 2011, federal and state officials asked 200 Southern California hospitals to provide information about their ability to survive a catastrophic earthquake along the southern San Andreas Fault.

Among other things, the hospitals were asked how many back-up generators they had on hand, what fuel they use and whether their water tanks could survive a major quake long predicted for one of the nation’s most dangerous faults.

The survey was aimed at speeding post-earthquake recovery efforts, such as rushing backup power generators, fuel and water to damaged hospitals struggling to care for patients. The concept was approved by the Federal Emergency Management Agency (FEMA), which would coordinate the federal response to such a disaster.

“These hospitals are getting hundreds of millions –- maybe billions –- of dollars from Medicare and Medicaid every year, and they can’t fill out a questionnaire?”
Sounds like a great idea, right?

But nearly two years later, almost half of the hospitals still have not responded, leaving some disaster officials frustrated over their inability to help the hospitals plan for the worst.

The unsuccessful effort casts a harsh light on the potential pitfalls of forging public-private partnerships among health care facilities to plan for earthquakes, floods and other natural disasters. Continue reading →

FILED UNDER: Money, Disaster Preparedness, Earthquakes