Archived California Healthcare News

The good news: California enrolled about one out of every three Americans last month into health plans as part of the rollout of the Affordable Care Act. The bad news: The initially low enrollment numbers for the Covered California health insurance exchange means it may face a challenge meeting its first-year goals when the open enrollment period ends on April 30.

Kaiser Permanente reported a significant gain in revenue for the third quarter ending Sept. 30, but the Oakland-based integrated healthcare organization\'s bottom line took a hit overhaul. Kaiser reported revenue for the quarter of $13.2 billion, up 5.6% from the $12.5 billion reported in the third quarter of 2012. But net income was down more than 20%, to $635 million, compared to $803 million in the year-ago quarter.

Marketing campaigns to promote the new health insurance exchanges hit a speed bump the size of a boulder last month. The problem-plagued launch of healthcare.gov on Oct. 1 made it all but impossible for most people to sign up for insurance on the exchanges.

Munson Healthcare, the seven-hospital not-for-profit system in Northern Michigan, has reached a three-year contract with Michigan Blue Cross Blue Shield that includes a variety of value-based incentives at three of its facilities. Included in the three-year pact is a shared-savings program between Munson and the Michigan Blues intended to improve care and outcomes for patients. The focus will be on preventing readmissions within 30 days of discharge, as well as the reduction of care that is either overused or inefficient.

Sutter Health has agreed to settle a long-running lawsuit stemming from the way the Sacramento-based hospital operator bills for anesthesiology services. Under the terms of the settlement, announced earlier this week by the California Department of Insurance, Sutter will pay $46 million to settle allegations that first surfaced four years ago that it had been charging patients for anesthesiology services already been baked into its basic operating room charges.

Long Beach-based insurer Molina Healthcare more than doubled its earnings for the quarter ending Sept. 30, buoyed by recent market entries in the three states. Molina, which specializes in managed care plans in the Medicaid market, reported net income in the quarter of $7.6 million on revenue of $1.6 billion. That compares to net income of $3.3 million on revenue of $1.4 billion for the third quarter of 2012.

The Democratic and Republican leaders of two key congressional committees have agreed on a framework to scrap the problematic Medicare payment formula for physicians and replace it with one that would link physician reimbursement to the quality of care provided, a step that could put an end to the annual \"doc fix\" debate. The discussion draft released Thursday by the Senate Finance and House Ways and Means committees would do away with the Sustainable Growth Rate, or SGR. That formula, adopted as part of the deficit reduction law in 1997, will reduce Medicare physician payments by nearly 25 percent next Jan. 1 unless Congress intervenes. Stopping scheduled payment cuts caused by the SGR has become a yearly ritual on Capitol Hill, leading to doctors’ frustration with the system and a growing budget problem because each deferral increases the size and price tag of the next fix.

The Ohio Supreme Court has designated fast-track status to litigation over whether the Buckeye State should be allowed to expand Medicaid eligibility under the Affordable Care Act. The parties who had filed the lawsuit – six state GOP lawmakers and two Ohio-based right-to-life groups – had argued for an expedited hearing because the plan to provide Medicaid coverage to an additional 275,000 Ohioans would go into effect on Jan. 1.

The California Department of Public Health issued 10 administrative penalties to nine hospitals and fines totaling $775,000 last week for lapses in care or medical errors that either killed patients or placed their lives in danger. Community Regional Medical Center in Fresno received its first two penalties, both for incidents that occurred in 2012 where physicians ordered physician assistants to perform tasks for which they were not properly trained. In one instance, a physician assistant improperly removed an epidural catheter, leading to a collection of blood near the patient\'s spinal cord and leading to their paralysis below the waist. In another incident, a cardiovascular surgeon ordered a physician assisrant to close the chest incision of a patient undergoing the repair of an aortic aneurysm and left the hospital premises. The patient began to bleed uncontrollably after the incision was closed, leading to a level of blood loss that required the patient to be placed on life support.