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Bill won’t control health care costs in California, but it will devastate hospitals

Last week, a bill that would dismantle California’s health care delivery system as we know it was introduced in the Legislature. Assembly Bill 3087 would penalize millions of patients through massive cuts in services and result in as many as 175,000 hospital workers losing their jobs.

The sponsors of AB 3087 – which is to be heard Tuesday by the Assembly Health Committee – falsely believe that this bill would lower health care costs by imposing a mandatory rate-setting system on doctors, hospitals, dentists and insurers.

They claim their proposal is based on a similar system that operates in Maryland. As the former head of the Maryland Hospital Association, I know that nothing could be further from the truth.

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AB 3087, introduced by Assemblyman Ash Kalra, D-San Jose, is entirely different from Maryland’s rate-setting process. The bill simply caps payment rates for services covered by commercial health insurance and does not address the chronic payment shortfalls that plague Medicare and Medi-Cal.

Carmela Coyle

Maryland has had “all payer” system in which the state sets payment rates for hospital services for all payers – Medicare, Medicaid, private insurers and the uninsured. No matter who is paying the bill, a hospital receives the same amount for the same service in the same hospital. That’s a huge contrast with the California proposal.

In our state, Medi-Cal pays hospitals only 68 cents for every dollar of care provided to patients, and Medicare roughly 77 cents for every dollar. AB 3087 does nothing to increase the rates paid by these programs, resulting in huge losses for California hospitals.

Another difference: In Maryland, the state is required o pay rates that at least cover the cost of care delivered by efficient providers. AB 3087, by contrast, ties payment rates to a percentage of what Medicare pays. Medicare rates, set by Congress, are often based on political priorities in Washington, D.C., not California.

The Maryland system also was designed to control the annual rate of increase in the cost of inpatient hospital services. The California proposal is not about controlling the rate of increase at all. Instead, it would actually cut and “re-base” amounts paid to providers and plans to some unspecified percentage of Medicare payments.

In Maryland, payment rates were based originally on the different costs of different types of hospitals – urban, rural, academic research facilities and community facilities. AB 3087 creates a one-size-fits-all payment rate, regardless of whether the hospital is in Chico or Los Angeles. That makes no sense.

Finally, Maryland’s rate-setting commission is selected based on experience in health policy, not political constituencies. But it, like the one proposed in California, allows a handful of people to exert enormous control over the economics of health care.

Based on nearly 10 years of experience in Maryland, I can say that one of the most impractical parts of AB 3087 is its so-called appeals process. This clumsy approach would set all payment rates the same and then force doctors, dentists and hospitals to appeal for more equitable payments. In reality, the appeals process is an empty promise because the bill’s stated goal is to cut payments to hospitals, doctors and other caregivers without regard to the actual cost of care.

AB 3087 will cripple patient access to care and do nothing to reduce health care costs.

 

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Carmela Coyle is president CEO of the California Hospital Association. She can be contacted at ccoyle@calhospital.org.

Article source: http://www.sacbee.com/opinion/op-ed/soapbox/article209460344.html

Why this family blames mental health system for teen’s suicide

Jordie’s older brother, Tony Binion, says they were best friends growing up.

“I was the older brother, but sometimes I felt like the younger brother because he was the one that was like, “Let’s go do this, let’s jump off this, let’s dive into this,’ ” said Tony Binion. “He was a fun kid.”

But around the age of 15, Jordie changed.

“Sometimes he started to withdraw from family and friends — he isolated himself a lot,” said his mother. “He just wasn’t functioning like his usual self. His grades were slipping a little bit.”

Tuesday on “NBC Nightly News,” see how the Binions are changing the lives of tens of thousands of high school students though a creative new mental health curriculum.

His mother thought he was depressed.

Jordie went to a family physician, who prescribed him an antidepressant. But after a few months, his parents say, he seemed to be having other issues.

“We would catch him at times talking to himself, and then he would laugh out loud, sometimes inappropriately,” said Will Binion.

His worried parents took him to Seattle Children’s Hospital, which has a psychiatric unit for children and adolescents.

The next day, Jordie wanted to leave. Washington State law permits people 13 or older to decide whether they will stay in a psychiatric facility. The Binions said someone from the hospital called them and told them to either come get Jordie or the hospital would “release him to walk the streets of Seattle.” The Binions picked their son up.

What they didn’t know was that the law allowed them to force Jordie to stay — an option that they say the hospital never gave them.

NBC News called all 50 states and learned that nearly 40 percent give minors — some as young as 12 — the power to consent to treatment. Designed in the 1970s to protect young people, the laws can have the opposite effect. Deb Binion says they were handed Jordie’s clothes “and basically that was it.”

The hospital, while saying it could not comment on Jordie’s case due to privacy laws, called his death a “terrible tragedy.” The hospital said it was committed to improving mental health care for children and adolescents and had taken several steps to improve care at its facility and in the region. “There is a tremendous need for improved access to mental health care and resources for children and youth all across the country, and we share the community’s concern about the increasing issue of suicide in youth.”

At home, Jordie was still struggling. The very night they got back from the hospital, his parents say, he was lying on the floor of his bedroom crying and holding his head saying he had “hurt so many people.”

Jordie saw a doctor when he got home, but his parents say it took them five months to schedule a full psychiatric evaluation. One reason is a shortage of child and adolescent psychiatrists in the country — only 8,300 to help an estimated 17 million kids who need it.

The day before that long-awaited appointment, Jordan Binion took his own life.

His parents believe that the mental health system let Jordie, and them, down, and resolved to change that. They went to the Washington State Legislature and successfully petitioned for a change to the law, which now requires that parents be informed that they can petition to keep a child in an evaluation and treatment center for 72 hours over the child’s objection.

Article source: https://www.nbcnews.com/news/us-news/why-family-blames-mental-health-system-teen-s-suicide-n868496

4 New Exemptions To The Tax Penalty For Lacking Health Insurance

The new exemptions will mostly apply to penalty payments tied to 2018 taxes and to the previous two years.

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The new exemptions will mostly apply to penalty payments tied to 2018 taxes and to the previous two years.

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There already have been more than a dozen reasons U.S. consumers can use to avoid paying the penalty for not having health insurance. Now the federal government has added four more.

These “hardship exemptions” let people off the hook if they can’t find a marketplace plan that meets not only their coverage needs but also reflects their view if they are opposed to abortion.

Your 2018 Health Plan Must Comply With ACA Rules Or You Risk Tax Penalties

It’s unclear how significant the impact will be, policy analysts say. That’s because starting in tax year 2019 the penalty for not having health insurance will be eliminated, so the new exemptions will mostly apply to penalty payments for 2018 taxes and in the previous two years.

“I think the exemptions … may very marginally increase the number of healthy people who don’t buy health insurance on the individual market,” says Timothy Jost, emeritus professor of law at Washington and Lee University in Virginia, whose specialty is health law.

Under the new rules, people can apply for a hardship exemption that excuses them from having to have health insurance if they:

  • Live in an area where there are no marketplace plans.
  • Live in an area where there is just one insurer selling marketplace plans.
  • Can’t find an affordable marketplace plan that doesn’t cover abortion.
  • Experience “personal circumstances” that make it difficult for them to buy a marketplace plan, including not being able to find a plan in their area that gives them access to specialty care they need.

The first new exemption isn’t relevant for consumers in 2018. Since the Affordable Care Act’s marketplaces opened, there have been no “bare” counties that lack insurers.

However, in about half of the U.S. counties — in which 26 percent of enrollees live — there is only one marketplace insurer this year, according to the Kaiser Family Foundation.

As for the abortion exemption, in many places it won’t be an issue either. Women in 31 states didn’t have access to a marketplace plan that covered abortion in 2016, according to another Kaiser Family Foundation analysis.

Still, a few states — California, New York and Oregon — generally require abortion coverage in their marketplace plans, and women who live there might have trouble finding a plan that excludes that coverage, according to people who have studied the situation.

From its inception, the ACA has allowed several different types of exemptions from the penalty for not having coverage. Among them are exemptions for not being able to find coverage that is considered affordable or being without insurance for less than three consecutive months in a year.

People claim these more common exemptions when they file their tax returns.

In addition, hardship exemptions that were already on the books protected people who faced eviction, had filed for bankruptcy or had racked up medical debt, among other difficulties. Consumers apply for these exemptions by submitting an application to the ACA insurance marketplace.

A Health Plan 'Down Payment' Is One Way States Try Retooling Individual Mandate

The new hardship exemptions apply to people in all 50 states, according to an official at the federal Centers for Medicare Medicaid Services, which oversees the health law’s insurance marketplaces. To apply, people generally need to provide a brief explanation of the circumstances that made it a hardship for them to buy a marketplace plan, along with any available documentation, when they submit their application to marketplace officials. They can apply for the current calendar year or going back two years, to 2016.

It’s difficult to gauge how many people will try to take advantage of the changes, says Tara Straw, a senior policy analyst at the Center on Budget and Policy Priorities.

“People aren’t sure how to apply, or if they’re eligible, and that discourages them from applying,” Straw says.

The penalty for not having health insurance in 2018 is the greater of $695 or 2.5 percent of household income.

During the 2017 filing season, there were more than 106 million tax returns reporting that all family members had health insurance, and nearly 11 million tax returns that claimed an exemption from the requirement to have it, according to a report from the Treasury Department’s inspector general for tax administration.

In addition, more than 4 million returns reported paying penalties totaling nearly $3 billion for not having health insurance.

People often don’t realize they may owe a penalty until it’s time to do their taxes, says Alison Flores, a principal tax research analyst at HR Block’s Tax Institute. HR tax preparers first check to see if clients can qualify for an exemption that can be claimed on their tax returns, Flores says. If that doesn’t work, they move on to the hardship exemptions.

The preparers help people get the hardship exemption application, but it’s up to consumers to send it to the marketplace and get the exemption certificate.

The federal guidance about the new exemptions was released April 9, shortly before the end of the income tax filing season. People who’ve already filed their taxes and qualify for the new exemptions for tax years 2016 or 2017 and get marketplace approval can file an amended tax return to receive a refund of any penalty they paid, says Katie Keith, a health policy consultant who writes regularly about health reform.

“You have to really be motivated,” Keith says.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter @mandrews110.

Article source: https://www.npr.org/sections/health-shots/2018/04/24/605007498/4-new-exemptions-to-the-tax-penalty-for-lacking-health-insurance

NY health officials warn on possible measles exposure

The tourists are believed to have visited three locations between April 15-17.

The tourists are believed to have visited three locations between April 15-17.

 (AP)

Authorities in New York issued a warning about possible measles exposure after it was discovered that two infected tourists traveled to several different locations last week. New York State health officials said the specific locations were in Brooklyn, Patterson and Tuxedo Park.

The tourists, from Europe, visited three Jehovah’s Witness facilities during their travels, CBS New York reported. Officials are urging anyone who may have been exposed to contact their health care provider immediately.

CONNECTICUT UNIVERSITY CLOSES AFTER VIRUS SICKENS 100

Symptoms of measles can present as fever, cough, runny nose and red or watery eyes. It may take up to 14 days for symptoms to present, and it could turn deadly without medical treatment. It’s a highly contagious disease that lives in the nose and throat mucus of an infected person. It can be prevented with the MMR vaccine, which is recommended for children and adults.

 

 

Article source: http://www.foxnews.com/health/2018/04/23/ny-health-officials-warn-on-possible-measles-exposure.html

Adventist Health and St. Joseph Health to form regional joint operating company

Adventist Health and St. Joseph Health plan to integrate their Northern California clinical operations through a new joint operating company, the organizations announced Monday.

The partnership would align the two not-for-profits’ facilities in Humbolt, Mendocino, Sonoma, Lake, Napa and Solano counties. The affiliation applies to assets and services associated with Adventist Health Howard Memorial, Adventist Health Ukiah Valley, Adventist Health Clear Lake, Adventist Health St. Helena and Adventist Health Vallejo Center for Behavioral Health and Home Health, St. Joseph Hospital Eureka, Redwood Memorial Hospital, Santa Rosa Memorial Hospital, Queen of the Valley Hospital and the St. Joseph Home Care Network.

“Patients will benefit from more access points, better health outcomes and controlled costs by coordinating their care across the spectrum of their health needs,” Jeff Eller, Adventist president of the Northern California region, said in a statement.

Providence St. Joseph Health, St. Joseph’s parent company, recently announced a new strategic direction that includes exploring strategic partnerships along the care continuum that could benefit its population health efforts.

Adventist includes a network of home care agencies, hospices and retirement centers, which will add to Providence St. Joseph’s integrated Northern California network of four acute-care hospitals, a home health agency, hospice care, outpatient services and community clinics.

The agreement excludes the other 15 Adventist Health hospitals in the western United States and the other 50 Providence St. Joseph Health hospitals located throughout the western United States and Texas, according to a news release.

Adventist and St. Joseph would retain existing hospital names, licenses, capital assets and employees. The deal is expected to close later this year after the customary regulatory review.

Article source: http://www.modernhealthcare.com/article/20180423/NEWS/180429965

Minors can refuse mental health treatment in some US states

 

NBC News called all 50 states and discovered about 40 percent of them give minors the power to consent to treatment – sometimes as young as 12. Designed in the 1970s to protect young people, the law sometimes turns out to have the opposite effect.

Article source: https://www.nbcnews.com/nightly-news/video/minors-can-refuse-mental-health-treatment-in-some-u-s-states-1217467459924

Your letters: Good health depends on policy and income security

Article source: https://www.thestar.com/opinion/letters_to_the_editors/2018/04/24/your-letters-good-health-depends-on-policy-and-income-security.html

Kids’ good HEALTH | News, Sports, Jobs – The Mining Journal

“The goal is basically to teach the kids in our community healthy lifestyle choices and healthy decisions that are going to improve their overall well-being and health,” said YMCA sports coordinator Emmy Holt.

The event was open and free to the public and covered issues like nutrition, fitness, physical activity and mental health.

“We want to teach them young, (and) give them information at this age to help develop them into older children who are going to make really good decisions — want to get outside, want to take care of themselves, want to think about what they eat and how that’s going to affect them in the long run,” Holt said.

Beyond teaching kids about being healthy and thinking about their wellness, Holt said the goal is also to “reach out to the parents of the community and let them know what’s available. We have a super community full of super awesome organizations that want to help kids and better kids’ overall well-being. To be able to connect the two is our goal.”

“We have a ton of organizations … who came and are sponsors or came to be a vendor,” Holt said. Main sponsors of the event were Dental Associates of Marquette, Radio Results Network, Tadcyh’s EconoFoods and Thrivent Financial. Other organizations that set up informational tables included the Marquette Food Co-Op, sharing information about healthy food choices, UP Health System trauma department, which gave away bike helmets, and the Upper Peninsula Children’s Museum.

Michigan State Police troopers had a booth for creating child identification CDs as well as K-9 unit demonstrations. At noon, representatives of the U.S. Coast Guard gave a presentation on water safety.

On top of informational tables, a variety of games and activities were available to get kids thinking and moving.

Holt said that although YMCA of Marquette County has held a Healthy Kids Day for years, she saw this year’s event as a “revamped and ramped up” version.

“We’re trying to make it a bigger event than it has been in the past, to really connect those organizations that want to help serve kids in our community and try to get them together,” Holt said. “We try to do a few events every year that are open for the community, so you don’t have to be a member of the Y, all you’ve got to do is show up and enjoy the service.”

Next up this year, Holt said the Y is excited to begin its summer day camp. Kids ages 6-12 can be signed up on a weekly basis to enjoy swimming, field trips, sports, arts and crafts, Spanish lessons and career exploration. Summer day camp begins June 11, but registration is now open, Holt said. More information can be found at ymcamqt.org.

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Article source: http://www.miningjournal.net/news/front-page-news/2018/04/kids-good-health/

In good health: Three critically endangered red wolf pups – two male …

Five months after their move to Durham, the Museum of Life and Science’s red wolf pair are parents. The museum celebrated the birth of three red wolf pups on Saturday. After a checkup on Sunday, the museum announced that the pups are doing well and include two males and a female.

Less than 300 red wolves, once a top predator in the southeastern United States, live in captivity or in the wild. Now there are three more to add to their ranks.

“We’re so excited. We couldn’t be more thrilled to do our part in the recovery of this critically endangered species,” said Sherry Samuels, the Museum of Life and Science’s Animal Department Director and member of the Red Wolf Species Survival Plan Management Team. “The first 30 days are a particularly critical time and we will continue regular monitoring.”

Pups arrive a year after previous litter

The births come a year after the museum’s previous red wolf pair gave birth to six red wolf pups. Four pups ultimately survived from that litter. And three went on a brief adventure when they escaped from their enclosure in June before safely returning home. In November, that red wolf family moved the Wolf Conservation Center in Salem, N.Y.

At about the same time, a new breeding pair took their place in the museum’s wolf habitat. They include a male born in May 2010 at the Wolf Conservation Center who had sired two litters of pups, along with a female, who was born in August 2014 at N.C. State’s College of Veterinary Medicine and was later transferred to the N.C. Zoo.

  • See pictures of the red wolf pups

This is the fourth time in 25 years that successful breeding of red wolves has occurred at the Museum of Life and Science, according to a press release. The museum received its first red wolf in November 1992, followed by a litter of pups in May 1993 and April 2002. After 15 years with no pups, the museum welcomed in new litter in April 2017.

In good health

A checkup on Sunday found that all three pups were doing well and in good health, according to a post on the museum’s Facebook page. The red wolf family remains on exhibit in the Explore the Wild enclosure, which is open to visitors for now, according to a museum press release, but they might not always be easy to spot.

Pups typically begin to open their eyes about 10 to 14 days after they are born and often venture out of the den for short periods of time around three weeks of age, the press release says.

At around six weeks, they will begin to spend longer amounts of time out of the den, but the public should not plan to see much of them before early June.

Even then, they may be difficult to spot; red wolves are notoriously shy and can be quite reserved around crowds and loud noises, according to the museum. Museum staff will be present at the wolf habitat throughout the summer to answer questions and help guests stay calm, quiet and observant, the release says.

“Like last summer, it should be another amazing ride for everyone in the Museum family,” Samuels said. “This is a wonderful opportunity for our visitors to practice the skills used by wildlife biologists observing red wolves in the wild. Quiet observation and patience will be key when viewing our new pups.”

The pups also are in for lots of checkups. The museum’s animal care staff will continue to monitor the health of both the pups and the adult wolf pair over the coming weeks. Pup checks will occur throughout the first week. A preventative medicine protocol of deworming, vaccines, and general checks will occur approximately every two weeks until they reach 16 weeks of age, according to the museum.

Article source: https://www.wral.com/in-good-health-three-critically-endangered-red-wolf-pups-two-male-one-female-doing-well-at-museum-of-life-and-science/17504049/

Healthy Living: Blocking Blue Light

Most of us can’t live without our cellphones, tablets and laptops.

On average, we spend more than nine hours a day staring at one screen or another.

Blue light comes from all of them and doctors say it’s dangerous, especially years from now.

In Healthy Living, we learn about how to cope with that blue light now and down the line.

Some insurance companies cover the cost of the Blue Blocker, otherwise it’s around $100, depending on the prescription.

Dr. Mendelson adds it’s important to protect children’s vision as well, saying they should watch screens from at least three feet away.


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Article source: http://www.9and10news.com/2018/04/23/healthy-living-blocking-blue-light/