In this summary, you’ll find information on New York’s Essential Health Benefits plan, the growing health care needs of the Baby Boomer generation, efforts to move disabled patients from institutional care settings to community settings and more!
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We hope you enjoy your “Weekly Dose of Health News.”
Affordable Care Act
Politico highlights two provisions of the Affordable Care Act that took effect this week. One program will change the way Medicare reimburses hospitals in an effort to reward hospitals that perform well on clinical quality measures and surveys of patients’ experience. A second initiative, aimed at reducing the expensive problem of hospital readmissions, will reduce Medicare payments by 1 percent to hospitals that have high readmission rates (Norman, 10/1).
The New York Times reports that the Centers for Medicare and Medicaid Services (CMS) urged states to take advantage of enhanced federal funding available for Medicaid expansion under the Affordable Care Act. This is the first guidance from CMS on this issue since the Supreme Court’s decision that required CMS to offer states a real choice on whether to grow Medicaid programs. Indeed, CMS’s letter make it clear that states may chose to reverse their decision to expand Medicaid at any point (Pear, 10/2).
New York formally submitted its Essential Health Benefits benchmark plan to the Health and Human Services Administration on October 1st. The state selected the Oxford EPO as the benchmark. The benchmark plan will form the basis of the essential health benefits for New York’s individual and small group markets, both inside and outside the exchange, in 2014 and 2015. In its letter to CMS, the state has indicated the coverage areas in which benefits will be supplemented in order to meet the requirements of the Affordable Care Act.
The Wall Street Journal reports that CMS is weighing whether nurse anesthetists should be directly reimbursed by Medicare for evaluating, diagnosing and treating pain with injections or prescription painkillers. The existing Medicare guidelines do not clarify whether nurse anesthetists can help people manage chronic pain problems or are limited to treating pain within the operating room. The proposed guidelines would reimburse nurse anesthetists at the same rate as physicians and have drawn sharp criticism from American Medical Association and advocacy groups concerned about prescription drug abuse (Martin, 10/3).
USA Today highlights the growing need for nurses and home health aides to serve the aging Baby Boomer population. The demand for new health care workers could be due in part to the retirement of older professionals and the need to find new skilled workers (Malcolm, 10/3).
The AARP Public Policy Institute and the United Hospital Fund released a report this week based on the results of an online survey of family caregivers to determine what medical and or nursing tasks they perform. Nearly half of caregivers said they performed medical or nursing tasks, including giving injections or intravenous therapy, or performing wound care or incontinence care. The report recommends actions including: encouraging health care professionals and providers to reassess the way they interact with caregivers, ensuring that they are well trained and prepared to perform difficult tasks, revising how care giving tasks are labeled and identified, and including family caregivers’ needs in the development of new models of care.
A new report from the Census Bureau found that Americans of working age are going to the doctor less frequently than they were 10 years ago. In 2010, people age 18 to 64 made an average of 3.9 visits to doctors, nurses and other medical professionals, down from 4.8 visits in 2001. The reasons for the decline are unclear and could be due to changing demographics of the American population and economic conditions.
The New York Times profiles efforts by a number of states to move disabled patients from institutional care settings into community based settings. The story focuses on Georgia’s transition of patients to residential settings and highlights the benefits and difficulties of these changes for individuals with disabilities (Swarns, 9/29).
Changes to the DSM-IV criteria for autism spectrum disorders will not reduce the proportion of children found to have the disorder. A report in The American Journal of Psychiatry concluded that roughly 10 percent of children currently on the autism spectrum would be excluded under the new definition. This is significantly less than the original estimate of 45 percent of children that would be excluded. Many parents and advocacy groups were concerned that the new definition would narrow the eligibility for state-financed services for children with autism spectrum disorders.
Advances in testing may help speed the diagnosis of rare genetic mutations in newborns. The new testing method uses a computer program to search for genes based on the infant’s symptoms. The demonstration, published this week in Science Transitional Medicine, found that it was possible to quickly scan a baby’s entire DNA and identify a disease-causing mutation in a few days instead of weeks or months.
A breakthrough study on the benefits and risks of hormone therapy in post menopausal women indicates that that hormone therapy started soon after menopause can ease many unpleasant symptoms that women face, without increasing risks for cardiovascular disease. Although the researchers acknowledged that the sample size was too small to draw significant conclusions, these findings could prompt physicians to re-evaluate the use of hormone therapy for their patients (ABC News, Lupkin, 10/3).
-Jaime Venditti, 10/5/12