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HEALTHCARE & GOVERNMENT:
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CALIFORNIA NEWS
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California Voters Give Medi-Cal Doctors a Raise by Passing Prop. 35 |
Doctors who serve California's poorest residents will get paid more, in some cases, for the first time in two decades, thanks to a ballot measure approved by voters last week. The Associated Press called Proposition 35 victorious after results showed it jumped to a sizable lead. The ballot measure asked voters to earmark between $2 billion and $5 billion of special tax revenue annually to Medi-Cal, the state's health insurance program for low-income residents and people with disabilities. The revenue comes from an existing tax on health insurers that lawmakers are currently able to spend in other ways. Nearly 15 million Californians, a third of the state's population, rely on Medi-Cal. Prop. 35 earmarks a majority of the state's Managed Care Organization Tax to raise rates for certain providers in an effort to improve access to health care. (https://calmatters.org/politics/elections/2024/11/election-result-proposition-35/)
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Newsom Calls for Special Legislative Session to Prepare for Conflicts with President Trump |
California Gov. Gavin Newsom is summoning the Legislature for a special session on Dec. 2 for more funding to defend California from anticipated challenges by President Trump to the state's civil rights, immigration and reproductive protections, and its environmental laws policies. The proclamation cites the need to defend "the assault on reproductive freedom" and access to abortion, the undoing of clean vehicle policies and other clean air and water protections, the repeal of the Deferred Action for Childhood Arrivals (DACA) that could throw the lives of hundreds of immigrants' lives in disarray, and the possible retribution against the state by withholding disaster aid - a concern that arose during Trump's first term. Newsom noted that the state filed 120 lawsuits challenging actions by Trump during his first term. (https://edsource.org/updates/newsom-calls-for-special-legislative-session-to-prepare-for-conflicts-with-president-trump) ALSO, see LA Times article, Food, Flouride and Funding - How Trump 2.0 Might Affect Health in California.
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Union Plans Strike at University of California |
AFSCME Local 3299, a union representing University of California service and patient care workers, has scheduled a systemwide strike for Nov. 20 and 21. The union represents about 26,000 healthcare workers and about 11,000 service workers across 10 UC campuses and five medical centers, a union spokesperson told Becker's. This includes phlebotomists, infusionists, operating room specialists, respiratory therapists, patient care assistants, pharmacy technicians, lab technicians, custodians, shuttle drivers and food service workers. The union and UC have been working to negotiate successor labor contracts for nearly a year, according to AFSCME Local 3299. (https://www.beckershospitalreview.com/hr/2nd-union-plans-strike-at-u-of-california.html)
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FEDERAL NEWS
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Subsidies to Buy Insurance from ACA Marketplaces Set to Expire End of 2025; If Not Extended, Coverage Could Become Unaffordable for Many |
Millions of Americans risk losing subsidies next year that help them pay for health insurance following President-elect Donald Trump's election win and Republicans' victory in the Senate. The subsidies - which expire at the end of 2025 - came out of the 2021 American Rescue Plan, and increased the amount of assistance available to people who want to buy health insurance through the Affordable Care Act. The American Rescue Plan also broadened the number of people eligible for subsidies, extending them to many in the middle class. The looming expiration date means that the incoming Congress and next president will need to decide whether to extend them. (https://www.nbcnews.com/health/health-news/millions-risk-losing-health-insurance-trumps-victory-rcna179146)
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RFK Jr Reviewing Resumes for Top Trump Health Jobs, Sources Say |
Robert F. Kennedy Jr, the former independent presidential candidate, is reviewing candidate resumes for the top jobs at the U.S. government's health agencies in Donald Trump's incoming administration, a former Kennedy aide and a source familiar with the matter told Reuters. Kennedy has been asked to recommend appointees for all regulatory health agencies, including the Department of Health and Human Services and the Food and Drug Administration, said Del Bigtree, who was director of communications for Kennedy's campaign and remains close to the former candidate. (https://www.msn.com/en-us/health/other/rfk-jr-reviewing-resumes-for-top-trump-health-jobs-sources-say/ar-AA1tLMOz) ALSO, see Roll Call's article, A look at those who could be on Trump's health team short list.
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Medicare Advantage Stocks Soar Following Trump Win |
Medicare Advantage insurers' stocks rallied upon news of Donald Trump's impending return to the White House, Bloomberg reported Nov. 6. Analysts expect a second Trump administration to boost rates for MA plans, Bloomberg said. The Trump administration may also be more friendly to health industry mergers, according to Bloomberg, which previously reported a potential merger between Cigna and Humana would likely move ahead only if Mr. Trump was elected. Cigna CEO David Cordani appeared to dismiss the rumored merger on an Oct. 31 earnings call, saying the company was focused on pursuing stock buybacks. (https://www.beckerspayer.com/payer/medicare-advantage-stocks-soar-following-trump-win.html)
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The Reach of ACO REACH is Uncertain |
While ACO REACH, Medicare's largest ACO, saved CMS $695 million in net savings in 2023, CMS hasn't committed to sustaining the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) model beyond its scheduled end in 2026. According to CMS, the ACO REACH model was designed as a time-limited test to evaluate its effectiveness in improving care quality and reducing costs. The model's first performance year began on January 1, 2023, and is scheduled to conclude on December 31, 2026. (https://www.modernhealthcare.com/accountable-care/aco-reach-model-savings-extension-cms)
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HEALTHCARE & TECHNOLOGY
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Top 2 Healthcare AI Inventions of '24, per Time |
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Zoom & Suki Partner to Deploy AI Clinical Documentation |
Zoom is partnering with Suki to add artificial intelligence-backed clinical documentation to its offerings for healthcare organizations, the companies have announced. Zoom will use Suki's AI engine, called Suki Platform, to record conversations between clinicians and patients, and draft a note. The deal is primed for Zoom's telehealth business, but providers using Zoom for in-person care can also use the AI documentation tool, according to a Suki spokesperson. Almost 140,000 healthcare institutions across the globe use the Zoom platform, according to a press release. (https://www.healthcaredive.com/news/suki-zoom-ai-documentation-partnership/730861/)
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HEALTHCARE PROVIDER & PATIENT NEWS
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Amazon One Medical's 19 Health System Partners |
Cleveland Clinic is the latest health system to partner with Amazon One Medical on clinically and digitally integrated care. The hybrid primary care company now has specialty care referral agreements with 19 health systems; local markets include: Providence (Renton, WA) - for Orange County, CA, and Portland, OR, markets; UC San Diego Health; and Dignity Health for their Phoenix market. (https://www.beckershospitalreview.com/digital-health/amazon-one-medicals-19-health-system-partners.html)
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Young Doctors Want Work-Life Balance; Older Docs Say That's Not the Job |
A question dividing the medical profession right now: Is being a doctor a job, or a calling? For decades, doctors accepted long hours and punishing schedules, believing it was their duty to sacrifice in the name of patient care. They did it knowing their colleagues prided themselves on doing the same. A newer generation of physicians is questioning that culture, at times to the chagrin of their older peers. Nearly half of doctors report feeling some burnout, according to the AMA. Work-life balance and predictable hours shouldn't be at odds with being an M.D., say doctors who are pushing against what they view as outdated expectations of overwork. In interviews with nearly two dozen physicians, many said that medicine's workaholic culture was overdue for a correction. Others said when physicians are less committed to their work, their peers and overall quality of patient care can suffer. Physicians work an average of 59 hours a week, according to the AMA, and while the profession is well-compensated - the average physician makes $350,000, a recent National Bureau of Economic Research analysis found - it comes with high pressure and emotional strain. (https://www.wsj.com/lifestyle/careers/young-doctors-want-work-life-balance-older-doctors-say-thats-not-the-job-6cb37d48)
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Not All Sampled Hospitals Complied with the Hospital Price Transparency Rule |
According to the OIG, only 63 of the 100 hospitals in the OIG's stratified random sample of selected hospitals made their standard charges available to the public as required by the Federal Hospital Price Transparency (HPT) Law's requirements. The balance, of 37 hospitals, did not complying with one or both of the HPT requirements associated with publishing comprehensive machine-readable files or associated with displaying shoppable services in a consumer-friendly manner. Therefore, on the basis of these sample results, the OIG estimated that 46% of the 5,879 hospitals that were required to comply with the HPT rule did not comply with the requirements to make information on their standard charges available to the public. In response, CMS has intensified enforcement efforts, issuing civil monetary penalties to non-compliant hospitals and is implementing stricter oversight measures to ensure adherence to transparency requirements. (https://oig.hhs.gov/reports/all/2024/not-all-selected-hospitals-complied-with-the-hospital-price-transparency-rule/) (https://www.modernhealthcare.com/providers/hospital-price-transparancy-compliance-oig)
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AMA Calls for Tougher Oversight of Nonprofit Hospitals |
The federal government should require nonprofit hospitals to justify their tax-free status with standardized charity care programs, the American Medical Association says. What exactly are the benefits of being a nonprofit hospital? ChatGPT lists 8 ways NFPs benefit over their "for profit" (tax-paying) peers:
Nonprofit hospitals receive several key benefits due to their tax-exempt status, as they're generally required to provide community benefits in return. Here's an overview of the main advantages they enjoy:
1) Tax Exemptions: Nonprofit hospitals are exempt from federal income tax, state and local income tax, property tax, and sales tax. These exemptions save hospitals substantial funds, allowing them to reinvest in services for the community.
2) Access to Tax-Exempt Bonds: Nonprofit hospitals can finance construction and capital improvements with tax-exempt bonds, which generally carry lower interest rates than taxable bonds, reducing their borrowing costs.
3) Reduced Operating Costs: With tax exemptions, nonprofits avoid many expenses associated with tax obligations, potentially allowing them to allocate more funds toward patient care, community programs, or facility improvements.
4) Philanthropic Donations: Nonprofit hospitals can accept charitable donations, which may come from individuals, foundations, and corporations. These donations are often tax-deductible for the donors, providing an incentive to contribute.
5) Government Grants and Funding: Nonprofit hospitals may be eligible for federal and state grants or other types of funding that are not available to for-profit institutions, which can help fund research, community health programs, and other initiatives.
6) Medicare and Medicaid DSH Payments: Many nonprofit hospitals serve low-income communities, making them eligible for Disproportionate Share Hospital (DSH) payments from Medicare and Medicaid, which help cover the costs of treating uninsured and underinsured patients.
7) Enhanced Community Trust and Support: Nonprofit hospitals often enjoy strong community support, as they are seen as dedicated to public health rather than profit. This trust can lead to better relationships with patients, support from local governments, and an easier time recruiting healthcare providers.
8) Training Programs and Partnerships: Some nonprofits receive government support or other assistance for running training programs for healthcare providers, which can improve staff quality and hospital operations. (https://www.modernhealthcare.com/policy/ama-american-medical-association-prior-authorization-charity-careand and ChatGPT)
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Bariatric Surgeries Plunge in GLP-1 Era: New Study |
Between 2022 and 2023, prescriptions for GLP-1 drugs soared 132.6% while bariatric surgery rates fell 25.6%, according to a new study from researchers at Harvard Medical School and Brigham and Women's Hospital. The findings offer a clearer picture of how the growing popularity of GLP-1 weight loss drugs is affecting demand for bariatric surgeries, which have long been the gold standard treatments for weight loss. Also notable, among the patients with obesity, nearly 95% did not receive either form of treatment, underscoring widespread access challenges, researchers said. (https://www.beckershospitalreview.com/glp-1s/bariatric-surgeries-plunge-in-glp-1-era-new-study.html)
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Sickest Patients Are Fleeing MA Plans - Costing Taxpayers Billions |
A Wall Street Journal analysis of Medicare data found a pattern of Medicare Advantage's sickest patients dropping their privately-run coverage just as their health needs soared. Many made the switch after running into problems getting their care covered. Plans run by the private insurers in the MA system are supposed to offer old and disabled people the same benefits they would get from traditional Medicare. The plans can be a bargain for people because they limit out-of-pocket expenses and often offer extra benefits such as dental care. Yet, as recipients get sicker, they may have more difficulty accessing services than people with traditional Medicare. That's because the insurers actively manage the care, including requiring patients to get approval for certain services and limit which hospitals and doctors patients can use. People in the final year of their lives left MA for traditional Medicare at double the rate of other enrollees from 2016 to 2022, the Journal's analysis found. Those private-plan dropouts - 300,075 during that time span - often had long hospital and nursing-home stays after they left, running up large bills that taxpayers, not their former insurers, had to pay. (https://www.wsj.com/health/healthcare/medicare-private-plans-insurers-389af1a0)
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