In This Edition:
From Kaiser Health News:
Of the 102 hospitals that received a five-star rating, few are among the elite generally praised for great care. (Jordan Rau, 7/27)
A single mom, a son with autism and a maddening search for the help she badly needed. (April Dembosky, KQED, 7/28)
Hepatitis C can be passed from mothers to babies, but it often is not diagnosed until much later in a person's life. Specialists are debating new screening practices to catch the disease earlier. (Elana Gordon, WHYY, 7/28)
Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Problem Solved'" by Brian Crane.
Here's today's health policy haiku:
THE HIGH STAKES OF EXPANSION IN KENTUCKY
Some skin in the game
For Medicaid expansion.
Jobs and premiums.
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Summaries Of The News:
Many of the nation's best-known hospitals fail to nab 5 stars. But some in the industry say the ratings are an oversimplified judgment of quality. “Hospitals cannot be rated like movies,” says Dr. Darrell Kirch, president of the Association of American Medical Colleges.
Kaiser Health News: Many Well-Known Hospitals Fail To Score 5 Stars In Medicare’s New Ratings
The Centers for Medicare & Medicaid Services rated 3,617 hospitals on a one- to five-star scale, angering the hospital industry, which has been pressing the Obama administration and Congress to block the ratings. Hospitals argue the ratings will make places that treat the toughest cases look bad, but Medicare has held firm, saying that consumers need a simple way to objectively gauge quality. Medicare does factor in the health of patients when comparing hospitals, though not as much as some hospitals would like. Just 102 hospitals received the top rating of five stars, and few are those considered as the nation’s best by private ratings sources such as U.S. News & World Report or viewed as the most elite within the medical profession. (Rau, 7/27)
Modern Healthcare: CMS Releases Star Ratings For Hospitals
The CMS published the much-anticipated Overall Hospital Quality Star Ratings on Wednesday after industry stakeholders and Congress pressured the agency to continue to delay their release. The ratings are a composite metric of one to five stars, with five being the best. They intend to convey the overall quality of nearly 4,000 hospitals in the U.S and are posted to the CMS' Hospital Compare site. (Whitman, 7/27)
Morning Consult: CMS Launches Online Overall Quality Star Ratings For Hospitals
CMS delayed the release of the ratings earlier this year to allow more time for outreach to hospitals to understand concerns. That delay came after lawmakers from both parties urged the agency to delay the release of the ratings because they did not consider factors like a patient’s socioeconomic status or patient complexity. (McIntire, 7/27)
The Hill: Feds Issue Controversial Star Ratings For Hospitals
On Monday, Reps. Jim Renacci (R-Ohio) and Kathleen Rice (D-N.Y.) introduced H.R. 5927, a measure to delay the ratings until July 2017 and to require a 60-day comment period on the ratings’ data and methodology. The agency defended its work, claiming that research shows higher-rated hospitals have lower readmission and death rates. The CMS also said it took industry concerns about the differences between hospital types and sizes into consideration after the initial delay. (Clason, 7/27)
Media outlets report on the ratings from the states —
St. Louis Post-Dispatch: Several St. Louis Area Hospitals Get Low Marks In Government's Controversial Star Rating System
Not all hospitals shine brightly on the one- to five-star rating system, especially the hospitals many would expect to do well. Academic medical centers that provide highly specialized care received some of the lowest ratings, frustrating hospital leaders of those institutions. In the St. Louis area, Barnes-Jewish Hospital, a highly regarded 1,158-bed teaching hospital, garnered only a two-star rating, with five stars being the highest score. St. Louis University Hospital, also a teaching hospital, received only one star. (Liss, 7/28)
Georgia Health News: Georgia Hospital Industry Fires Back At Feds’ Quality Ratings
A federal health care agency Wednesday released its first overall star ratings for the quality of hospitals, and just two Georgia facilities earned the top five-star designation: Gordon Hospital in Calhoun, and Northside Medical Center in Columbus. ...In Georgia, five hospitals received the lowest score of one star: Grady Memorial Hospital in Atlanta; the Medical College of Georgia Hospitals and Clinics in Augusta; Phoebe Putney Memorial Hospital in Albany; Piedmont Henry Hospital in Stockbridge; and WellStar Atlanta Medical Center. The hospital industry nationally has fought against the release of the ratings, saying that those facilities that treat the most difficult medical cases were put at a disadvantage. (Miller, 7/27)
The Dallas Morning News: How Did Your D-FW Hospital Fare In The Latest Federal Safety Ratings?
A total of 276 hospitals in the state- including 56 in the North Texas counties of Dallas, Collin, Denton and Tarrant- were rated by the Centers for Medicare & Medicaid Services. The scores were released Wednesday. The good news is that no hospital in the state got one star, the lowest overall score. (Rice, 7/27)
The insurance giant tops analysts' expectations for the second quarter. It says that the planned $45 billion merger with Cigna is needed to help provide leverage to negotiate better prices for consumers and make it easier for the company to keep selling plans on the health law's online marketplaces.
The Wall Street Journal: Anthem: Getting Past Cigna Merger Blues
Anthem hasn’t given up on its merger with Cigna just yet. But second-quarter results suggest the backup plan isn’t a bad alternative. Anthem, the second-largest U.S. health insurer by membership, reported sales of $19.9 billion and adjusted earnings of $3.33 a share on Wednesday morning. That topped analyst estimates, but the stock traded lower. Higher-than-expected medical expenses were to blame. Those amounted to 84.2% of premium revenues, more than 2 percentage points higher than a year ago. Anthem blamed the squeeze in part on margin pressure in its Medicaid business, which is Anthem’s fastest-growing membership segment. (Grant, 7/27)
The Associated Press: Anthem Prepping For Hardball Fight With Feds Over Cigna Deal
Anthem has no intention of backing away quietly from its plan to buy rival Cigna in the face of federal opposition, and the company looks ready to play hardball. The health insurer told analysts Wednesday that it is preparing to fight the government's move to block its deal, and the company said its participation in the government's health insurance exchanges — a sore subject for the Obama administration that is trying to stop the acquisition — may be at stake. (Murphy, 7/27)
Reuters: Anthem To Fight For Cigna Deal, Sees Obamacare Losses
Anthem has argued that its planned $45-billion purchase of Cigna will give it greater leverage to negotiate better prices from healthcare providers and pass on those savings to consumers, including those signing up for "Obamacare" plans on public insurance exchanges. "To be clear, our board and executive leadership team at Anthem is fully committed to challenging the (U.S. Department of Justice's) decision in court," Chief Executive Joseph Swedish told analysts on a conference call. (Berkrot and Penumudi, 7/27)
Bloomberg: Anthem Tells Judge Cigna Deal Helps Health Insurance Markets
Anthem Inc. said its proposed $48 billion merger with rival health insurer Cigna Corp. will lower consumer costs and extend coverage to more people, in response to a U.S. lawsuit seeking to block the deal. The Indianapolis-based company also said the combined carrier would fortify the online insurance exchanges created under the Affordable Care Act at a time when other insurers are withdrawing from them, according to papers filed late Tuesday in federal court in Washington. (Harris, 7/27)
Modern Healthcare: In Answer To DOJ Lawsuit, Anthem Argues Cigna Deal Would Boost ACA Exchanges
Anthem threw punches back at the U.S. Justice Department's attempt to block the insurer's acquisition of Cigna Corp. The response signals Anthem will indeed litigate the case to the end even though many analysts and policy experts say the company is unlikely to win. In a newly filed legal response, Anthem's lawyers argued the deal to buy Cigna is “procompetitive” and specifically would allow Anthem to expand its presence on the Affordable Care Act's insurance exchanges. (Herman, 7/27)
The Wall Street Journal: Anthem Projecting Losses On Affordable Care Act Plans This Year
Anthem Inc. said it is now projecting losses on its Affordable Care Act plans this year, a turnaround for a major insurer that had maintained a relatively optimistic tone about that business. Anthem said it now believed it would see a “mid-single-digit” operating margin loss on its ACA plans in 2016, due to higher-than-expected medical costs. It expects better results next year, because it is seeking substantial premium increases. (Wilde Mathews, 7/27)
The diagnostic-testing company, which is in the middle of trying to sell itself to Abbott Laboratories, received a subpoena seeking information on its efforts to collect copayments from patients.