Archived California Healthcare News

A new survey by TransUnion Healthcare concludes that the majority of Americans are confused by the bills they receive from their medical providers, and that few receive any meaningful cost estimates in advance.

A federal program designed to allow certain safety net hospitals and clinics to save money on drug purchases is under fire from critics who say the facilities are using that money to pad profits rather than help patients. The 340B drug pricing program lets thousands of hospitals, community health centers and family planning clinics buy outpatient prescription medications from manufacturers at an estimated 25% to 50% discount. Participants can then charge higher rates to insured patients and keep the additional revenue.

In a move to push greater price transparency in the healthcare setting, the California Department of Insurance has selected UC San Francisco to construct a price and quality database to help patients discover how much their healthcare services cost. The DOI obtained a $5.2 million grant from the U.S. Department of Health and Human Services last year to promote price transparency in healthcare. As part of an interagency agreement, much of that money will be furnished to the Philip R. Lee Institute for Health Policy Studies at UCSF to construct a database of what the department termed “common medical procedures and episodes of care.” The average pricing for those procedures would be posted online for consumers to review.

The federal government has joined a lawsuit against IPC The Hospitalist Co. that accused the North Hollywood firm of systematically upcoding charges for patient care submitted to the Medicare program.

Some cancer patients and their insurers are seeing their bills for chemotherapy jump sharply, reflecting increased drug prices and hospitals’ push to buy oncologists’ practices and then bill at higher rates. Patients say, “‘I’ve been treated with Herceptin for breast cancer for several years and it was always $5,000 for the drug and suddenly it’s $16,000 -- and I was in the same room with the same doctor same nurse and the same length of time’,” said Donald Fischer, M.D., chief medical officer for Highmark, the largest health plan in Pennsylvania.

Although controversial in many parts of the country, the Affordable Care Act has been a boon in Minnesota, as the federal reform law helped reduce the number of uninsured by more than 40%. A new study by State Health Access Data Assistance Center (SHADAC) at the University of Minnesota concluded that the number of uninsured statewide dropped by 40.6% between September of last year and the start of last month.

Enrollees in both the Medicare and Medi-Cal programs want their coverage to remain consistent as the state of California moves them into managed care health plans. That was the conclusion of UCLA researchers, who interviewed 39 seniors who are being migrated into managed care coverage under the Cal MediConnect program. Altogether, about 455,000 dual-eligibles in eight counties statewide began being moved into the program on April 1 in order to better coordinate the care they receive and reduce costs.

Kaiser Permanente researchers have been able to aggregate large volumes of data to better evaluate the risk of sepsis in newborns.

While an unprecedented 6 million people have gained Medicaid coverage since September, mostly as a result of the Affordable Care Act, more than 1.7 million more are still waiting for their applications to be processed—with some stuck in limbo for as long as eight months, according to officials in 15 large states. The scope of the problem varies widely. California, the most populous state to implement the health law’s expansion of Medicaid, accounts for a lion’s share of the backlog with 900,000 applications still pending as of early June. The next biggest pileup is in Illinois, with 283,000 cases, while New York has no backlog at all.