Georgia Chapter, American Academy of Pediatrics: November 2012

Thursday, November 29, 2012

Wednesday, November 28, 2012

Steep Cigarette Tax Hike Could Save Lives, Money: Report

Some EHRs in danger of missing data connections - amednews.com

Editorial - Organized medicine moves to block end run on prompt pay for physicians - amednews.com

Patient satisfaction: When a doctor's judgment risks a poor rating - amednews.com

AMA meeting: Delegates adopt physician employment principles - amednews.com

Tuesday, November 27, 2012

Whooping Cough Vaccine Less Effective Over Time: Study

Medical Questions About Gun Ownership Come Under Scrutiny - Kaiser Health News

RN-T.com - Floyd Medical Center approves NICU expansion budget

OB/GYNs back over-the-counter birth control pills | Online Athens

Times-Georgian - Health care budget to be top issues in upcoming Assembly

Medicaid expansion would bring state $33 billion, cost it $2.5... | www.ajc.com

Grant funding brings produce to school cafeterias | Online Athens

Monday, November 26, 2012

Report takes new look at Medicaid expansion costs | Georgia Health News

Supreme Court Considers Whether GeorgiaHospital Merger Creates Monopoly

Supreme Court Considers Whether Georgia

Hospital Merger Creates Monopoly

By Jane Norman, CQ HealthBeat Associate Editor

Supreme Court justices Monday probed just how far a Georgia public hospital can go in acquiring another facility before the purchase raises federal antitrust concerns, in a case that’s gotten the attention of the hospital industry at a time of many mergers and consolidations.

The justices didn’t seem to reveal their opinions one way or the other. At one point, Justice Stephen G. Breyer declared: “I’m not at all decided.” Justice Ruth Bader Ginsburg pressed a Department of Justice lawyer to explain how a Georgia state law should have been worded to allow a hospital to acquire other properties.

The Federal Trade Commission has challenged the Hospital Authority of Albany-Dougherty County’s 2011 purchase of a competing private facility, Palmyra Park Hospital. The FTC says such a sale creates a monopoly that will drive up prices for consumers since they are the only two hospitals in a wide geographic area.

But the hospital authority contends that the merger was needed to provide enough beds for low-income patients and that Georgia law allows the purchase, even if it’s anti competitive, and so federal law doesn’t apply.

The two sides wound up at the high court after the FTC appealed a decision by the U.S. Court of Appeals for the 11th Circuit in favor of the hospital and a district court decision that also backed the hospital.

Justices asked questions about the reach and intent of a 1941Georgia state law that allowed the creation of county hospital authorities so that localities could better serve the poor. Under that law, the Albany-Doughterty County authority was formed, and it bought Phoebe Putney Memorial Hospital to operate as a public hospital. The authority ran the hospital until December 1990, when it formed two nonprofit corporations and one corporation leased the hospital operations to the other.

Though the hospital is now run as a corporation and through leases, its lawyers argue that the state law exempts it from federal antitrust laws through what’s known as the “state action” doctrine developed mostly in the courts. That essentially means the state in its laws has allowed certain conduct by its entities, in this case hospital mergers.

“In the specific area of local hospital services, the Georgia legislature has adopted a model of local public choice, including the choice to reduce or eliminate competition,” Seth Waxman, the lawyer for theGeorgia health system, said in his argument before the court.

Hospital Needed Beds

Waxman said Phoebe Putney, as it grew and handled more low-income patients, faced a need for more capacity. A new hospital could have been built, if permitted by the state. “Or we can talk with the private hospital about whether they would like to be acquired. And the record shows that they did that for many, many years, even before the Phoebe Putney entities were created,” Waxman said.

Chief Justice John G. Roberts Jr. noted that there were likely few hospitals in rural areas of Georgia in 1941 when the law was enacted, so there must have been an anticipation that monopolies might be created. “When this law was passed, giving them the power to acquire hospitals, wasn’t it the case that there would likely be only one other hospital or two, so that any acquisition of another hospital would have the merger consequences that this one had?” Roberts asked.

Benjamin J. Horwich, an assistant to the solicitor general arguing on behalf of the FTC, said that the justification for the state action doctrine is that the state is trying to pursue a policy that is part of its traditional prerogatives to regulate its own economy.

In this case, though, the FTC argues that all the state did was grant general corporate powers to the local hospital authorities to buy property, and it’s too broad of an authority to construe as permitting the merger and allowing a monopoly.

“If the state is not actually trying to advance some other policy with respect to the particular conduct at issue, then it can’t be said that the state has done something that federal law should stand aside for,” Horwich said.

In an analysis of the case, Peter C. Carstensen, a professor of law at the University of Wisconsin Law School, says that it represents the first time in nearly 20 years that the high court has looked at its standards for exemptions under the state action standard.

In the meantime, some lower courts have taken a broad view and exempted actions from antitrust law whenever the competitive harm was something that could reasonably have been foreseen by lawmakers. In other cases, courts have tried to figure out whether the question of competition was central in lawmakers’ minds.

The American Hospital Association and Georgia Hospital Association said in their brief that it’s important that valuable work by hospitals not be impeded by worries over antitrust issues. “AHA has a specific interest in this case, because many of its member hospitals are publicly owned and operated by state and local governments,” their brief said.

“More generally, the AHA has a longstanding interest in how the antitrust laws are applied to hospital mergers, which often foster, rather than diminish, competition, and in many cases are necessary for hospitals to deliver care effectively,” the brief said.

States Face Higher Medicaid Costs Even if They Don’t Expand Program, Kaiser Report Finds

States Face Higher Medicaid Costs Even if They Don’t Expand Program, Kaiser Report Finds

By Rebecca Adams, CQ HealthBeat Associate Editor

State officials who are hoping to avoid high Medicaid costs from the health care law by not expanding the program might be in for an unpleasant discovery: Other Medicaid-related mandates in the overhaul will mean higher state spending regardless of whether a state expands, according to a state-by-state analysis the nonpartisan Kaiser Family Foundation released Monday.

The report shows that if all states expand coverage, as allowed under the 2010 health care law, they would collectively spend $76 billion more from 2013 to 2022 on Medicaid than if the measure had never been enacted. That’s only about $8 billion more than states would pay under the law if none of them expand.

Most of the increase in Medicaid spending over the decade will come even if a state chooses not to broaden coverage. That’s because millions of people who are already eligible for the program are expected to sign up in 2014 when there’s likely to be massive campaigns to tell people about the new law. States also will have to spend more money updating their IT systems, changing their enrollment and eligibility procedures and helping people understand the new system, which is supposed to allow for seamless coverage.

The report also suggests that state costs for expansion would be modest compared to the amount that the federal government would pay. That $8 billion in additional investment would allow states to draw $800 billion more in federal funding than they would get under the law, if no states expanded.

Moreover, the report finds that some states would actually save money on the expansion, considering that they would have fewer uncompensated care costs to fund. States and localities bear about 30 percent of the costs of uncompensated care when uninsured patients don’t pay all of their medical bills. The report estimates that nationally, state and local spending on uncompensated care would decline by $18 billion — turning the total $8 billion cost to states under expansion into $10 billion in savings.

But each state would be affected differently, and some individual states would not fare as well as the national picture indicates.

“That might be true in the aggregate, but states are going to run the numbers themselves,” said former Congressional Budget Office Director Douglas Holtz-Eakin, who conducted a similar analysis earlier this year for the American Action Forum.

For example, if Mississippi decided to expand Medicaid, it would cost the state about 6.2 percent more than if the state does not expand, a higher percentage increase than any other state, the Kaiser report estimated. But the authors concluded that because the state would save money on uncompensated care costs, the true net increase would be 3.8 percent.

The report also found that the financial incentives were best for states in the New England and Mid-Atlantic regions, while they were least attractive in the Mountain and Pacific regions.

The 61-page report was conducted by Urban Institute researchers including John Holahan and Matt Buettgens.

The report could be helpful to governors and state legislators preparing for their 2013 legislative sessions and trying to decide whether to expand Medicaid under the 2010 law.

The overhaul law allows states to expand coverage for people whose household income is at or below 138 percent of the federal poverty level, which in 2012 is $15,415 for an individual and $26,344 for a family of three. The federal government will pick up most of the costs, starting at 100 percent for the newly eligible in the first three years and phasing down to 90 percent of costs. The June 28 Supreme Court decision made it clear that states would be able to choose whether or not to expand Medicaid without jeopardizing their federal matching money for their entire Medicaid programs. Since then, governors and state legislators have been weighing whether to broaden their Medicaid programs.

A Closer Look at the Numbers

The details work like this: Assuming all the states participate in the Medicaid expansion, their total projected costs would increase by $76 billion from 2013-2022, an average increase of about 3 percent nationally over current costs. For that investment, the states would gain $952 billion in federal funding to help pay for coverage for an additional 21.3 million people, the report said. Of that $952 billion, the federal government would have had to pay $152 billion in higher Medicaid costs even if the law hadn’t been passed.

Even if none of the states expand coverage, they still would be on the hook for a collective $68 billion over the same time period, because of other requirements in the law. If a state chooses not to broaden coverage, it still will have to simplify enrollment and eligibility procedures and help people understand their coverage options. Under that scenario, about 5.7 million people who are currently eligible but not enrolled in Medicaid would be expected to come out of the woodwork to sign up for coverage.

State officials who look at the Kaiser report will be asking themselves whether they can afford a slightly higher investment in order to significantly expand the number of people who will get coverage.

“It’s very easy to have a little sticker shock at the potential cost,” said Alan Weil, the executive director of the NationalAcademy for State Health Policy. Weil noted that even a 1 percent increase can seem like a lot to officials in states whose fiscal climate is still recovering. For years, many state officials have complained about the burden that Medicaid costs impose on their state budgets.

But Weil, who spoke on a conference call organized by Kaiser, said that the report does a good job of putting the spending burden that states will face in the context of overall spending.

“Many states will be surprised at the results showing that the costs to them of the coverage expansion in the ACA come largely from things that they must do” and not from the optional expansion, Weil said.

He suggested, as he has said before, that state officials will come under tremendous pressure from medical providers and patient advocates to consider the expansion.

Of course, the Obama administration also is pushing state officials to expand.

Holtz-Eakin said the administration’s interest gives states leverage they could use to strike deals on Medicaid or the exchanges with federal officials. For instance, GOP governors have sent the administration a list of ideas that they would like to pursue in Medicaid, and they might press federal officials harder to accept them. Republicans who have said they will rely on the federal exchange in their states also might be persuaded to work on a federal-state partnership if the administration shows a little more flexibility in Medicaid.

“I think that the major takeaway from this report and what we did is that the Medicaid expansion is not a no-brainer. States will have to think about it from their own narrow financial point of view,” he said. “The Supreme Court decision really did deal the states back in, and they can use that leverage.”

Link to full report: http://www.kff.org/medicaid/upload/8384.pdf

Wednesday, November 21, 2012

Grady could have big loss in Medicaid stand-off | www.ajc.com

Gov. Bentley says Alabama won't set up exchange, expand Medicaid

By Kim Chandler | kchandler@al.com The Birmingham News
on November 13, 2012 at 1:38 PM,

BIRMINGHAM, Alabama -- Gov. Robert Bentley, in a show of continued resistance to the Affordable Care Act, said this afternoon that he will not set up a state health care exchange and he will not expand Medicaid under the federal healthcare overhaul.

"I will not set up a state exchange in Alabama," Bentley said during a speech to the Birmingham Business Alliance.

States have a Friday deadline to inform the U.S. Department of Health and Human Services if they plan to set up a state-run exchange, essentially a marketplace for people and businesses to shop for insurance. If states don't set up their own exchange, either alone or in federal partnership, then the federal government will step in and design it.

Bentley said he has been in communication with other governors -- including peers in Texas, Florida andLouisiana -- about the exchange decision. He expected multiple governors to show a united front of resistance to the Affordable Care Act.

"If we stand together, I do believe Congress is going to have to look at this again," Bentley said.

Bentley said he expected other governors to announce similar decisions.

"That will send a clear signal to all of our elected leaders in Washington that the health care bill should be changed," Bentley said.

Bentley questioned the constitutionality of the federal government stepping in and setting up essentially a state agency through a federally designed exchange. Oklahoma has filed a lawsuit alleging that it is unlawful for the federal government to establish an exchange within a state, Bentley noted.

"We believe the federally facilitated system they will try to set up, we believe that is unconstitutional," Bentley said.

Bentley said a state study commission had estimated previously that a state exchange would cost up to $50 million annually to operate. He said the state cannot afford that. The commission estimated that the cost to operate an exchange in 2015 would range between $34 million and $49.6 million.

The exchanges -- whether run by the state or the federal government -- are supposed to be in place by 2014.

Bentley said he will also refuse to expand Medicaid as it currently exists under the Affordable Care Act. The expansion would have been paid for almost entirely by the federal government, but Bentley questioned the long-term cost to both the state and nation.

"I will not expand Medicaid as it exists under the current structure because it is broken," Bentley said." We just cannot afford it. The people of America cannot afford it."

Bentley, who is a doctor, said his decision to resist the Affordable Care Act was based on a difference of philosophy, not politics.

"It is, in my opinion, truly the worst piece of legislation that has ever been passed in my lifetime," Bentley said of the ACA.

Senate Minority Leader, Roger Bedford, D-Russellville, criticized the governor's decision on both the exchange and Medicaid expansion.

"It's a total shame. It's a complete failure of leadership by the Republican supermajority. What this means is Washington will run Alabama's healthcare system not Alabama," Bedford said.

Bedford said the state should also grab an opportunity to expand Medicaid with the federal government picking up most of the tab.

"There are 350,000 people that could get preventive care rather than showing up in an emergency room,"Bedford said.

Speaker of the House Mike Hubbard, R-Auburn, said he applauded Bentley's "principled stand against Obamacare." Hubbard said implementing the Affordable Care Act would bloat government and putAlabama on a path to "fiscal disaster."

"The governor is in discussions with roughly two dozen of his counterparts in other states to coalesce against Obamacare and push back against its mandates. It's my hope that this coalition can send a wake-up call to Washington and reverse the dangerous trend of liberal policies and directives that Obama and Congressional Democrats are pushing so hard to implement," Hubbard said.

An advocacy group for low-income families expressed disappointment in Bentley's decisions.

"We're disappointed that the governor would close these doors for now. We think Alabamians deserve as good a deal from healthcare reform as folks in other states are getting, " Jim Carnes, communications director for Arise Citizens' Policy Project.

In Alabama about 351,000 people, including 244,804 previously uninsured, would join Medicaid under an expansion, according to 2010 estimates from the Henry J. Kaiser Family Foundation.

The suggested expansion would open Medicaid to adults younger than 65 with an income of less than 133 percent of the federal poverty level, which would be $14,856 for individuals and $30,657 for a family of four. The federal government would pay 100 percent of the cost of services for new enrollees for the first three years, but that eventually would drop to 90 percent.

"This offers us the opportunity to get hundreds of thousands who have no healthcare into preventive care. These are working people. They work in industries we all utilize every day -- restaurants, construction," Carnes said.

Bentley said people had assumed that after the election, the ACA could not be stopped.

"They're wrong," Bentley said.

He said the two key portions of the law are the Medicaid expansion and the exchanges.

"If we have a large enough number of states who refuse to do it, it is going to be very difficult for them," Bentley said

Fla. Gov. opens up to health care reform

Fla. Gov. opens up to health care reform

Nov 13, 2012 6:19 PM EST

By GARY FINEOUT and KELLI KENNEDY Associated Press

TALLAHASSEE, Fla. (AP) - Florida Gov. Rick Scott is dropping his staunch opposition to federal health care reform.

Scott, a vocal critic of "Obamacare," said Tuesday that he now wants to negotiate with the federal government in a way that could help families.

Scott previously stated that he would not go along with parts of health care reform that the state controls. But the governor said that in the wake of the re-election of President Barack Obama he is now open to discussing it.

Scott told The Associated Press in an interview that he remains concerned about the potential costs that health care reform will mean for both families and state government.

States are supposed to tell the federal government by Friday if they intend to set up health insurance exchanges

Thursday, November 29, 2012

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