WBEZ | healthcare http://www.wbez.org/tags/healthcare Latest from WBEZ Chicago Public Radio en Jeb Bush has a plan to replace Obamacare; here's what's in it http://www.wbez.org/news/jeb-bush-has-plan-replace-obamacare-heres-whats-it-113341 <p><div style="text-align: center;"><img alt="" src="http://www.wbez.org/system/files/styles/original_image/llo/insert-images/Jeb%20Bush%20is%20the%20latest%20Republican%20to%20offer%20an%20alternative%20to%20Obamacare..jpg" style="height: 465px; width: 620px;" title="Jeb Bush is the latest Republican to offer an alternative to Obamacare. (Sean Rayford/Getty Images)" /></div><div><p>Republicans in Congress and on the campaign trail call for an Obamacare repeal all the time. Plans to replace it are rarer, though. Obamacare is a fantastically complicated policy, and overhauling the health care system would likewise be a complicated business, affecting not only government spending and the economy, but people&#39;s very lives on an intensely personal level.</p><p>This week, presidential candidate and former Florida Gov. Jeb Bush released his own detailed proposal for repealing and replacing the Affordable Care Act. In a&nbsp;<a href="http://www.c-span.org/video/?328700-1/former-governor-jeb-bush-rfl-health-care-policy-address">speech</a>&nbsp;and an&nbsp;<a href="http://www.unionleader.com/article/20151013/OPINION02/151019793&amp;source=RSS">op-ed in the New Hampshire Union Leader</a>, Bush announced his plan is aimed at cutting health care costs. Here&#39;s what his plan would do.</p><p><strong>What are the basics of Bush&#39;s plan?</strong></p><p>Bush&#39;s speech and op-ed decry the &quot;skyrocketing premium costs&quot; he says Obamacare created and argue for giving more power to the states. With those as his major guiding principles, here are the highlights of his plan:</p><ul><li><p>Repeal Obamacare, providing its 17 million participants a &quot;transition plan&quot; away from the program.</p></li><li><p>Give people tax credits to buy catastrophic health care plans.</p></li><li><p>Replace the so-called &quot;Cadillac Tax,&quot; albeit with a&nbsp;<a href="http://www.nytimes.com/2015/10/14/upshot/jeb-bush-has-found-a-part-of-obamacare-to-love.html?rref=upshot">policy</a>&nbsp;similarly imposing higher taxes on expensive health plans.</p></li><li><p>Allow some businesses to contribute toward their workers&#39; health insurance, in lieu of providing that coverage themselves.</p></li><li><p>Eliminate the&nbsp;<a href="https://www.cms.gov/cciio/resources/data-resources/ehb.html">benefits</a>&nbsp;the ACA requires health plans to provide.</p></li><li><p>Increase the maximum amount that people can contribute to their health savings accounts from $3,350 to $6,650.</p></li><li><p>Cap federal health spending to states, creating what appears to be a&nbsp;<a href="http://www.vox.com/2014/7/25/5930699/block-grants-explained">block grant-like</a>Medicaid program.</p></li></ul><p><strong>Would it lower health care costs?</strong></p><p>Bush&#39;s plan would make it cheaper to buy your own insurance, says one expert, but there would be trade-offs &mdash; lower costs could mean fewer benefits.</p><p>&quot;I have no doubt that premiums in the individual market would be lower under Bush&#39;s plan, mainly because there would be less regulation of the benefits those plans have to offer,&quot; said Larry Leavitt, co-executive director of the Kaiser Family Foundation&#39;s Program for the Study of Health Reform and Private Insurance.</p><p>Bush&#39;s plan&nbsp;<a href="http://www.nytimes.com/2015/10/14/us/politics/jeb-bush-offers-health-plan-that-would-undo-affordable-care-act.html">gets rid of</a>&nbsp;the requirement that plans cover certain things (Obamacare&#39;s &quot;essential health benefits&quot;), like maternal care and mental health. Rather, it encourages so-called &quot;catastrophic&quot; health insurance plans &mdash; bare-bones plans that protect people in expensive emergency situations. Those plans tend to not only have lower premiums but also higher deductibles.</p><p>&quot;Bush emphasizes high-deductible plans and [health savings accounts] and wants to encourage those plans. High deductibles do discourage people from using services and lead to lower health spending overall,&quot; Leavitt said.</p><p>The plan also would relax Obamacare&#39;s guaranteed coverage for pre-existing conditions. Instead, it would only guarantee it for people with &quot;continuous coverage.&quot; Defenders say this would stop people from getting coverage only when they are sick, but detractors say this makes it too easy to not be covered, as financial hardship or employment changes can easily interrupt coverage. That provision could likewise lower costs by lowering the number of chronically ill people in risk pools.</p><p>Altogether, the plan looks like it could easily lower health care spending.</p><p>&quot;Do I believe that his plan will cost less than the current status quo under the Affordable Care Act? I believe the answer is yes,&quot; said Mark Fendrick, a professor at University of Michigan&#39;s medical school and public health school.</p><p>But there are a lot of &quot;buts&quot; to tack on here. For one, there&#39;s still a lot we don&#39;t know &mdash; for example, how much the plan might cut spending on low-income Americans&#39; health care, as well as how much those new tax credits would cost compared to what&#39;s in place right now.</p><p>Another thing to consider is where that cost-cutting comes from &mdash; is lower-cost health insurance always better, or is it at some point detrimental to customers?</p><p>&nbsp;</p><blockquote class="twitter-tweet" lang="en"><p dir="ltr" lang="en">Today in NH, I announced my plan to repeal &amp; replace Obamacare. Read about it here: <a href="http://t.co/E3JsN4Aqas">http://t.co/E3JsN4Aqas</a> <a href="http://t.co/6ymKRXI1Vs">pic.twitter.com/6ymKRXI1Vs</a></p>&mdash; Jeb Bush (@JebBush) <a href="https://twitter.com/JebBush/status/653959139153063936">October 13, 2015</a></blockquote><script async src="//platform.twitter.com/widgets.js" charset="utf-8"></script><p>&nbsp;</p><p>Bush&#39;s policies would curb cost growth to an extent, said Sabrina Corlette, senior research fellow at Georgetown&#39;s Health Policy Institute, but she added a caveat: &quot;I would note that they do so on the backs of consumers, rather than tackling some of the more thorny issues such as how we pay providers and suppliers.&quot;</p><p>Moreover, Fendrick said, focusing too intently on costs might be wrongheaded.</p><p>&quot;I did not go to medical school to learn how to save people money,&quot; he said. &quot;So when the first question always is whether we should save money on health care or not, that is largely irrelevant to the bigger question of whether this would make people healthier or not. ... My answer is probably not.&quot;</p><p><strong>OK, so would it make people healthier?</strong></p><p>The unsatisfying answer is that it&#39;s impossible to know. But here&#39;s what we do know: One thing is that the plan would remove Obamacare&#39;s mandate that people get coverage. Removing that, as well as requirements that businesses provide coverage, could easily leave many fewer people insured.</p><p>But does less coverage mean worse health? There&#39;s some evidence of this, but it&#39;s not entirely clear-cut.</p><p>One&nbsp;<a href="http://www.ncbi.nlm.nih.gov/pubmed/18815523">2008 meta-analysis</a>, for example, found that health care access increased self-reported health, the use of preventive services, and lowered mortality.</p><p>But a recent,&nbsp;<a href="http://www.nejm.org/doi/full/10.1056/NEJMsa1212321#t=articleResults">well-known study</a>&nbsp;of Medicaid in Oregon was more mixed &mdash; going on Medicaid was associated with lower rates of depression and better self-reported health (as well as increased financial stability) but no statistical difference in blood pressure or cholesterol. People sought out more diabetes treatment, but improvements in their health also weren&#39;t significant.</p><p>Meanwhile, higher-deductible plans seem to reduce health care usage, as a&nbsp;<a href="http://www.nber.org/papers/w21632?utm_campaign=ntw&amp;utm_medium=email&amp;utm_source=ntw">recent study</a>&nbsp;found. That might be good, in the sense that it might reduce unnecessary doctor visits, but it might reduce necessary ones as well.</p><p>That&#39;s a lot of information, so here&#39;s the upshot: Reasonable people could disagree on this. Leavitt, for his part, stressed that the link between insurance and outcomes is murky. Fendrick, meanwhile, thinks health outcomes would likely be worse under Bush&#39;s plan.</p><p>But here&#39;s one more important point: This question wouldn&#39;t even affect many Americans whose employers would simply continue providing coverage. Rather, Bush&#39;s plan would disproportionately affect lower-income people, according to several nonpartisan experts who spoke to NPR.</p><p>Aside from potentially cutting Medicaid benefits, the size of Bush&#39;s tax credits is adjusted based on age, not income, according to the New York Times.</p><p>&quot;This is not a wise path if one&#39;s priority is to protect Americans facing the greatest economic and health risks,&quot; said Harold Pollack, professor at the University of Chicago&#39;s School of Social Service Administration, in an email.</p><p><strong>What don&#39;t we know?</strong></p><p>Bush&#39;s plan does lay out a lot of information, but a few important parts aren&#39;t specifically explained. For example, it says there would be a &quot;transition plan&quot; for the 17 million people currently covered by Obamacare, but it doesn&#39;t explain what that plan looks like.</p><p>&quot;It would be a huge transition from Obamacare to a plan like this, which would be a huge disruption,&quot; Leavitt said. &quot;If this were to become a reality, there would be a lot more details required about how that transition would work.&quot;</p><p>There&#39;s also the cost. The Bush campaign says it believes the plan would reduce the deficit. But there aren&#39;t enough specifics here to really know what that might look like.</p><p>We do know that repealing Obamacare could be expensive. The Congressional Budget Office&nbsp;<a href="http://www.politico.com/story/2015/06/obamacare-repeal-congressional-budget-office-deficit-119228">estimated earlier this year</a>&nbsp;that repealing the Affordable Care Act would add $353 billion to the deficit. Bush&#39;s plan would mitigate some of these effects, like with his replacement for the Cadillac Tax, but it&#39;s unclear to what degree, as well as how the rest of his plan&#39;s costs and cost-cutting would balance out.</p><p><strong>What is Jeb Bush saying with this plan?</strong></p><p>Wanting to repeal Obamacare doesn&#39;t itself set Bush apart from other Republicans &mdash; calls for Obamacare repeal have been constant since the law passed in 2010.</p><blockquote class="twitter-tweet" lang="en"><p dir="ltr" lang="en">.<a href="https://twitter.com/HillaryClinton">@HillaryClinton</a>&nbsp;and&nbsp;<a href="https://twitter.com/BernieSanders">@BernieSanders</a>&nbsp;would double-down on Obamacare &amp; its failures. My plan:&nbsp;<a href="http://t.co/BZgQcM6YXE">http://t.co/BZgQcM6YXE</a>&nbsp;<a href="http://t.co/HVio8lkrQD">pic.twitter.com/HVio8lkrQD</a></p>&mdash; Jeb Bush (@JebBush)&nbsp;<a href="https://twitter.com/JebBush/status/654028797214371841">October 13, 2015</a></blockquote><p>But the plan does send a couple of political messages about Bush. One is in setting his priorities. Opponents may attack Bush for the plan&#39;s potential effects on lower-income Americans, but it does accomplish other, decidedly conservative economic goals.</p><p>&quot;It&#39;s important to see these replacements not as doing everything the ACA did but as fulfilling other policy aims: less regulation, cutting taxes and reducing federal spending,&quot; Leavitt said.</p><p>Moreover, Bush seems to be staking out a position as the substantive, policy-wonk GOP contender. His detailed repeal-and-replace plan, on top of his other recent tax and energy proposals, for example, could help cement that identity.</p></div><p>&mdash;<a href="http://www.npr.org/sections/itsallpolitics/2015/10/14/448570670/jeb-bush-has-a-plan-to-replace-obamacare-heres-whats-in-it"><em> via NPR</em></a></p></p> Wed, 14 Oct 2015 12:25:00 -0500 http://www.wbez.org/news/jeb-bush-has-plan-replace-obamacare-heres-whats-it-113341 Seniors tend to quit Medicare Advantage when health declines http://www.wbez.org/news/seniors-tend-quit-medicare-advantage-when-health-declines-113204 <p><p>Senior citizens are switching from privately run insurance plans for traditional Medicare when they face serious, long-term health conditions, a study shows.</p><p>Researchers at Brown University found that 17 percent of Medicare Advantage patients who entered nursing homes for long-term care chose to switch to traditional Medicare the following year. Only 3 percent of similar patients in Medicare made the decision to go to a private Medicare Advantage plan.<br /><br />The story is the same for patients who required short-term nursing care or home health care. A larger number switched out of Medicare Advantage plans than chose to move into them from traditional Medicare.</p><p>The results suggest that the private Medicare Advantage health plans are managing to get rid of patients once their care becomes too costly, says economist&nbsp;<a href="https://vivo.brown.edu/display/mrahman">Momotazur Rahman</a>, the study&#39;s lead author. &quot;When the plan finds out this patient is very costly, there are incentives for the plan to get rid of the patient,&quot; he says.</p><p><img alt="" class="image-original_image" src="http://www.wbez.org/system/files/styles/original_image/llo/insert-images/insurance-switches-after-nursing-home-care_chartbuilder_enl-f04caa0a4fe0e4c938aaae0f8fa3fb6eac4c485f-s1400.png" style="height: 320px; width: 200px; margin-left: 10px; margin-right: 10px; float: right;" title="Bars show the proportion of people who left one type of Medicare coverage for the other after receiving either long-term or short-term nursing home care.(NPR/Source: High-Cost Patients Had Substantial Rates of Leaving Medicare Advantage And Joining Traditional Medicare, October 2015)" />The&nbsp;<a href="http://content.healthaffairs.org/content/34/10/1675.abstract?sid=225f9167-0749-445a-a660-80241597bc7d">findings were published</a>&nbsp;in the October issue of&nbsp;Health Affairs.</p><p>The shift of patients who were insured by private companies back to traditional Medicare rolls can cost taxpayers more.</p><p>The government pays&nbsp;<a href="http://www.npr.org/sections/health-shots/2015/09/03/436964368/white-house-takes-aim-at-medicare-and-medicaid-billing-errors">a set monthly fee&nbsp;</a>for each patient in Medicare Advantage plans. The amount varies according to a&nbsp;<a href="http://www.publicintegrity.org/2014/06/04/14865/how-risk-scores-work">risk score</a>&nbsp;for each person. But since the ultimate cost for patient care is borne by the private plans, insurers&#39; profits can suffer if patients are more expensive to care for than expected.</p><p>The private plans don&#39;t kick people out. But they can provide reasons to leave, Rahman said. Those measures include imposing steep cost-sharing as patients need more expensive care, which is common for nursing or home care patients. They can also limit care for expensive treatments, such as cutting benefits for rehab after a hip replacement. And they can restrict their networks in some areas so physicians who care for particularly ill patients are hard to find or get to.</p><p>The Center for Medicare and Medicaid Services has been looking to minimize this so-called adverse selection &ndash; when sicker patients move back onto the government&#39;s health care rolls. The steps include paying more to private plans for sicker patients, and giving them incentives to manage costs.</p><p>These incentives aren&#39;t enough, according to Rahman. The agency should consider imposing penalties on the plans, he says, when patients &quot;disenroll.&quot;</p><p>Medicare Advantage plans &quot;definitely should not be telling people to leave in any kind of way,&quot; says Jack Hoadley, an analyst at Georgetown University&#39;s Health Policy Research Institute. &quot;There&#39;s no evidence in this study that they are.&quot;<br /><br />But limits on care in Medicare Advantage plans that are designed to cut costs can make those plans less appealing to sicker patients, Hoadley says. The Brown study, he says, suggests the incentives in the program aren&#39;t working properly.</p><p>&mdash;<a href="http://www.npr.org/sections/health-shots/2015/10/06/446112458/seniors-tend-to-quit-medicare-advantage-when-health-declines?ft=nprml&amp;f=446112458" target="_blank"><em> via NPR</em></a></p></p> Tue, 06 Oct 2015 13:26:00 -0500 http://www.wbez.org/news/seniors-tend-quit-medicare-advantage-when-health-declines-113204 Emanuel pitches privatization of HIV/AIDS primary care clinics, cuts to training http://www.wbez.org/news/emanuel-pitches-privatization-hivaids-primary-care-clinics-cuts-training-113133 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/AP_471755110302_1.jpg" alt="" /><p><p dir="ltr" id="docs-internal-guid-074d446a-2090-467c-a274-feda1848bdc1">Chicago Mayor Rahm Emanuel is strongly considering privatizing primary care services for HIV/AIDS patients on the South and North sides. He is also ending an <a href="http://www.cityofchicago.org/city/en/depts/cdph/provdrs/sti_hiv_aids.html">HIV/AIDS training program</a> for city agencies. Local advocates and community health groups say the Chicago Department of Public Health has already informed them of their intentions.</p><p dir="ltr">Currently, the city&rsquo;s public health department runs <a href="http://www.cityofchicago.org/city/en/depts/cdph/provdrs/sti_hiv_aids/svcs/hiv_aids_early_interventionservices.html">two primary care clinics</a> - one in Englewood and the other in Uptown - that provide medical care, mental health assistance and other support to any Chicago resident living with HIV/AIDS.</p><p dir="ltr">Officials with American Federation of State, County and Municipal Employees, the union that represents the at least 17 employees who would be affected by the changes, said they&rsquo;re concerned about job losses and access to quality care.</p><p dir="ltr">&ldquo;We&rsquo;re especially concerned about the services provided in Englewood, because there aren&rsquo;t as many other options for folks to go to and we&rsquo;ve already made it pretty clear from research that having services in close proximity makes a difference in terms of people being able to get the care they need and follow the regime they need to do,&rdquo; said Jo Patton, Director of Special Projects for AFSCME.</p><p dir="ltr">The mayor&rsquo;s office is selling the outsourcing proposal as a way to &ldquo;expand community-based primary care services.&rdquo; In the 2016 budget book, the city pledges to serve 2,000 low-income HIV positive residents through &nbsp;a $1.5 million investment, granting access to a &ldquo;wide array of services through the City&rsquo;s delegates, including primary medical care, mental health, substance abuse treatment, case management and other supportive services.&rdquo;</p><p dir="ltr">A budget office spokeswoman said right now, the city provides care to less than 500 HIV-positive residents, and outsourcing would allow them to reach an additional 1,500. The city is planning on including a requirement in the request for proposal, which isn&rsquo;t available yet, that the new care provider works within the current Englewood facility.</p><p dir="ltr">The city also confirmed it would be ending the HIV prevention training program, and union officials estimate that at least six jobs will be lost. A city spokeswoman said the health department is in talks with the Illinois Department of Public Health and other agencies to make sure that the training is covered.</p><p dir="ltr">David Ernesto Munar, President and CEO of the Howard Brown Health Center, said he agrees with the plan, as the city currently can&rsquo;t provide the different levels of care (like behavioral health or mental health) that some HIV-positive patients need, but he&rsquo;ll be watching the city&rsquo;s execution. &nbsp;</p><p dir="ltr">&ldquo;It&rsquo;s really all about how it&rsquo;s done, and making sure that the transition is handled carefully, and particularly that the transfer of care for patients is done in a way that nobody is lost,&rdquo; Munar said. &ldquo;That&rsquo;s been the concern of HIV activists around the city that in this system redesign we don&rsquo;t lose sight of making sure the patients are stewarded to the new model of care or that nobody&rsquo;s care is interrupted.&rdquo; &nbsp;</p><p dir="ltr">Munar said Howard Brown recently hired Dr. Cori Blum, the physician who used to staff these city clinics, which he hoped would alleviate some of the pressure on patients who might want to leave the Uptown clinic. He also added that Howard Brown might compete in the future bidding process to take over the city&rsquo;s private clinics. &nbsp;</p><p dir="ltr">Roman Buenrostro, Director of Special Projects for the AIDS Foundation of Chicago, says the idea to privatize is not a new one. Buenrostro also serves as community co-chair for <a href="http://www.cahisc.org/">CAHISC</a>, where the idea has come up a number of times in the past as a way to maximize resources. Buenrostro said his number one concern is also to make sure no patient is left behind in the transition, but that outsourcing could be a &ldquo;creative&rdquo; way to continue care in an era of budget crises on both the city and state crises.</p><p dir="ltr">&ldquo;What the city is saying is, if we turn this money over to community-based organizations to provide these services, we can serve a lot more people with the same amount of money,&rdquo; Buenrostro said. &ldquo;And why wouldn&#39;t we want to do that? So that&rsquo;s where I don&rsquo;t think that the word privatization is necessarily a bad word.&rdquo;</p><p>Privatization has been a popular word lately around city hall, as the mayor is also considering outsourcing the city&rsquo;s 3-1-1 services, which would cut 72 jobs. Officials have said the non-emergency phone system requires costly upgrades, potentially $25-30 million dollars over four years, and private vendors could suggest better or cheaper options.</p><p>The Chicago Department of Public Health is scheduled to appear in front of aldermen Thursday for a budget hearing. On Wednesday, both aldermen who represent the clinics said they hadn&rsquo;t heard definite details about the potential privatization.</p><p dir="ltr" id="docs-internal-guid-074d446a-2084-9829-7a15-c92ab0befffa"><em>Lauren Chooljian covers Chicago politics for WBEZ. Follow her<a href="http://twitter.com/triciabobeda"> </a><a href="https://twitter.com/laurenchooljian?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor">@laurenchooljian</a></em></p></p> Wed, 30 Sep 2015 18:07:00 -0500 http://www.wbez.org/news/emanuel-pitches-privatization-hivaids-primary-care-clinics-cuts-training-113133 'Right to Try' measure passes Illinois House http://www.wbez.org/news/right-try-measure-passes-illinois-house-111878 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/medicine_flickr_epSos .de_.jpg" alt="" /><p><p>SPRINGFIELD, Ill. &mdash; The Illinois House has approved a measure that would grant greater access to experimental drugs for terminally-ill patients.</p><p>Rep. Greg Harris is the chief sponsor of the legislation. The Chicago Democrat and other backers of establishing a &quot;Right to Try&quot; Act in Illinois say it gives those who have exhausted conventional treatments a chance at drugs that have only passed the first phase of federal testing and increases patient choice.</p><p>The measure passed with a vote of 114-1. It now moves to the Illinois Senate.</p><p>The lone &quot;no&quot; vote was Rep. Al Riley. The Democrat from suburban Olympia Fields says that he agrees with the concept of allowing more options for the terminally-ill but had concerns about safety.</p></p> Wed, 15 Apr 2015 15:48:00 -0500 http://www.wbez.org/news/right-try-measure-passes-illinois-house-111878 Teaching hospitals hit hardest by medicare fines for patient safety http://www.wbez.org/news/teaching-hospitals-hit-hardest-medicare-fines-patient-safety-111272 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/er.jpg" alt="" /><p><p>Medicare has begun punishing 721 hospitals with high rates of infections and other medical errors, cutting payments to half the nation&#39;s major teaching hospitals and many institutions that are marquee names.</p><p>Intermountain Medical Center in Utah, Ronald Reagan UCLA Medical Center in Los Angeles, the Cleveland Clinic, Geisinger Medical Center in Pennsylvania,&nbsp;Brigham and Women&#39;s Hospital in Boston, NYU Langone Medical Center and Northwestern Memorial Hospital in Chicago are all being docked 1 percent of their Medicare payments through next September,&nbsp;<a href="http://cdn.kaiserhealthnews.org/attachments/HACPenaltyChart.pdf">federal records show</a>.</p><p>In total, hospitals will forfeit $373 million, Medicare estimates.</p><p>The federal health law required Medicare to lower payments for the quarter of hospitals with the highest rates of hospital-acquired conditions, or HACs.</p><p>These&nbsp;<a href="https://www.qualitynet.org/dcs/ContentServer?c=Page&amp;pagename=QnetPublic%2FPage%2FQnetTier3&amp;cid=1228774294977">avoidable complications</a>&nbsp;include infections from central line catheters, blood clots and bed sores.</p><p>The penalties come as hospitals are showing some success in&nbsp;<a href="http://www.ahrq.gov/professionals/quality-patient-safety/pfp/interimhacrate2013.html">reducing harmful errors</a>. A recent federal report found the frequency of mistakes dropped by 17 percent between 2010 and 2013, an improvement Health and Human Services Secretary Sylvia Burwell called &quot;a big deal, but it&#39;s only a start.&quot; Even with the reduction, one in eight hospital admissions in 2013 included a patient injury.</p><p>Dr. Eric Schneider, a Boston health researcher, said studies have shown that medical errors can be reduced through a number of techniques, such as entering physician orders into computers rather than scrawling them on paper, better hand washing and checklists on procedures to follow during surgeries. &quot;Too many clinicians fail to use those techniques consistently,&quot; he said.</p><p>The quality penalties have &quot;put attention to the issue of complications and that attention wasn&#39;t everywhere,&quot; said Dr. John Bulger, chief quality officer at Geisinger Health System, based in Danville, Pa. However, he said hospitals like Geisinger&#39;s now must spend more time reviewing their Medicare billing records as the government uses those to evaluate patient safety. The penalty program, he said, &quot;has the potential to take the time that could be spent on improvement and [spend it instead] making sure the coding is accurate.&quot;</p><p>Hospitals complain there may be almost no difference between hospitals that are penalized and those that narrowly escape fines. &quot;Hospitals may be penalized on things they are getting safer on, and that sends a fairly mixed message,&quot; said Nancy Foster, a quality expert at the American Hospital Association.</p><p>The penalties come on top of other fines Medicare&nbsp;<a href="http://kaiserhealthnews.org/news/medicare-readmissions-penalties-2015/">has been levying</a>. With the HAC penalties now in place, the worst-performing hospitals this year risk losing more than 5 percent of their regular Medicare reimbursements.</p><p>About 1,400 hospitals are exempt from penalties because they provide specialized treatments such as psychiatry and rehabilitation or because they cater to a particular type of patient such as children and veterans. Small &quot;critical access hospitals&quot; that are mostly located in rural areas are also exempt, as are hospitals in Maryland, which have a special payment arrangement with the federal government.</p><p>In evaluating hospitals for the HAC penalties, the government adjusted infection rates by the type of hospital. When judging complications, it took into account the differing levels of sickness of each hospital&#39;s patients, their ages and other factors that might make the patients more fragile. Still, academic medical centers have been complaining that those&nbsp;<a href="http://www.npr.org/templates/transcript/transcript.php?storyId=323998618">adjustments are insufficient</a>&nbsp;given the especially complicated cases they handle, such as organ transplants.</p><p>&quot;To lump in all of those things that are very complex procedures with simple things like pneumonia or hip replacements may not be giving an accurate result,&quot; said Dr. Atul Grover, the chief public policy officer of the Association of American Medical Colleges.</p><p>Medicare levied penalties against a third or more of the hospitals it assessed in Colorado, Connecticut, Delaware, Nevada, New Jersey, New Mexico, Rhode Island, Utah, Washington and the District of Columbia, a Kaiser Health News analysis found.</p><p>A separate analysis of the penalties that Dr. Ashish Jha, a professor at the Harvard School of Public Health, conducted for Kaiser Health News found that penalties were assessed against 32 percent of the hospitals with the sickest patients. Only 12 percent of hospitals with the least complex cases were punished.</p><p>Hospitals with the poorest patients were also more likely to be penalized, Jha found. A fourth of the nation&#39;s publicly owned hospitals, which often are the safety net for poor, sick people, are being punished.</p><p>&quot;I&#39;ve worked in community hospitals. I&#39;ve worked in teaching hospitals. My personal experience is teaching hospitals are at least as safe if not safer,&quot; Jha said. &quot;But they take care of sicker populations and more complex cases that are going to have more complications. The HAC penalty program is really a teaching hospital penalty program.&quot;</p><p>You can download the full list of hospital penalties&nbsp;<a href="http://cdn.kaiserhealthnews.org/attachments/HACPenaltyChart.pdf">here</a>.</p><p>&mdash; <a href="http://www.npr.org/blogs/health/2014/12/19/371862146/teaching-hospitals-hit-hardest-by-medicare-fines-for-patient-safety"><em>via NPR</em></a></p></p> Fri, 19 Dec 2014 12:22:00 -0600 http://www.wbez.org/news/teaching-hospitals-hit-hardest-medicare-fines-patient-safety-111272 The health problems facing rural and urban poor in Illinois http://www.wbez.org/news/health-problems-facing-rural-and-urban-poor-illinois-110959 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/chinese.JPG" alt="" /><p><p>Each year, researchers at the University of Wisconsin&rsquo;s Population Health Institute put out the County Health Rankings. The rankings show how counties across the country match up on things like life expectancy and residents&rsquo; health.</p><p>Julie Willems Van Dijk is one of the directors.</p><p>&ldquo;The reason we do it is to raise awareness about how healthy our communities are, and how healthy they&rsquo;re not. To do so in a way that piques people&rsquo;s interest by comparing them to other counties in their community. And ultimately in a way that helps everybody see &hellip; that health in your community is not just about what the doctors and nurses do. But it really is about decisions that are made by businesses, by government,&rdquo; Willems Van Dijk says.</p><p>Most of the counties around Chicago do really well,&nbsp; but Cook County is way down near the bottom - 75 out of 102 Illinois counties in health outcomes.</p><p>Twenty spots down the list from Cook is Edwards County. Edwards County ranks 96th of all Illinois counties for health outcomes. It&rsquo;s worth looking at because unlike most of the sickest counties, it isn&rsquo;t particularly poor. Edwards County&rsquo;s poverty level is better than the state average.</p><p>&ldquo;Income, and especially poverty are definitely drivers of health,&rdquo; Willems Van Dijk says.</p><p>But that&rsquo;s not what&rsquo;s happening in Edwards County.</p><p>Edwards is due south from Chicago, down near where Illinois, Kentucky and Indiana meet. It&rsquo;s incredibly sparse with just 30 people per square mile. The Illinois average is almost eight times as much.</p><p>Misty Pearson is the administrator of the Edwards County Health Office.</p><p>Edwards is one of only two counties in Illinois without an official health department. That&rsquo;s why it&rsquo;s called a health office, instead of a department of health like in almost every other county.</p><p>&ldquo;We are not certified by the state of Illinois, by choice, I guess. Not my choice, I would change that if I could,&rdquo; Pearson says.</p><p>The health office isn&rsquo;t certified because Edwards County leaders are so against the state being involved in their county they refuse to take health funding from Illinois because it comes with strings attached - like state oversight.</p><p>&ldquo;Food sanitation, we don&rsquo;t have that. None of our restaurants are inspected. It does [make me nervous]. There are certain restaurants I won&rsquo;t eat at,&rdquo; Pearson says. &ldquo;The only thing we can do that a health department does is vaccines for children.&rdquo;</p><p>So Edwards County - despite its low health ranking and relative economic strength - isn&rsquo;t the best indicator of the state&rsquo;s health needs overall.</p><p>The state government can&rsquo;t force people to vaccinate their kids or make counties take its money.</p><p>Still, experts say Illinois needs to come up with policies that work for Edwards County with 30-people per square mile, and Cook County with 5,500-people per square mile.</p><p>They say it can be done. Because despite their differences in population and demographics the two counties face similar health challenges.</p><p>At the top of the list is access to doctors.</p><p>The Illinois Department of Public Health has a map of areas with a dearth of primary care providers.</p><p>There are a lot of downstate counties shaded in - but there&rsquo;s also a bunch of Chicago neighborhoods -- from Rogers Park up north to Austin on the West Side and Chicago Heights down south.</p><p>Harold Pollack with the University of Chicago says the state could help poor people in urban and rural areas by raising Medicaid rates, or just paying its bills on time.</p><p>&ldquo;I can tell you that as someone who takes care of an adult on Medicaid that there are services that we can&rsquo;t use because the providers that we&rsquo;d like to use don&rsquo;t accept Medicaid,&rdquo; Pollack says.</p><p>So physician shortages might not be the happiest point of unity, but Misty Pearson in Edwards County and Harold Pollack in Chicago say they - and others - will be thinking of it when they go into the voting booth.</p><p>In a little more than a week there will be millions of people at the polls. They&rsquo;ll each have different experiences and different expectations, but they&rsquo;ll all be voting on the future of one state.</p><p>&ldquo;How are we going to make these budget numbers work &hellip; and also pay for the services that people in the state actually want and will continue to demand,&rdquo; says Pollack..</p><p><em>Patrick Smith is a WBEZ Reporter/Producer. Follow him on twitter <a href="http://twitter.com/pksmid" target="_blank">@pksmid</a>.</em></p></p> Fri, 17 Oct 2014 12:32:00 -0500 http://www.wbez.org/news/health-problems-facing-rural-and-urban-poor-illinois-110959 Morning Shift: Exploring options for caring for the elderly http://www.wbez.org/programs/morning-shift-tony-sarabia/2014-04-16/morning-shift-exploring-options-caring-elderly-110031 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/old Flickr VinothChandar.jpg" alt="" /><p><p>We unpack some of the questions surrounding elder care. Also, a conversation with comedian Bob Saget, whose new book swings back and forth between funny and poignant.</p><div class="storify"><iframe src="//storify.com/WBEZ/morning-shift-exploring-options-for-caring-for-the/embed?header=false&border=false" width="100%" height=750 frameborder=no allowtransparency=true></iframe><script src="//storify.com/WBEZ/morning-shift-exploring-options-for-caring-for-the.js?header=false&border=false"></script><noscript>[<a href="//storify.com/WBEZ/morning-shift-exploring-options-for-caring-for-the" target="_blank">View the story "Morning Shift: Exploring options for caring for the elderly" on Storify</a>]</noscript></div></p> Wed, 16 Apr 2014 08:44:00 -0500 http://www.wbez.org/programs/morning-shift-tony-sarabia/2014-04-16/morning-shift-exploring-options-caring-elderly-110031 First day glitches as Affordable Care Act launches http://www.wbez.org/news/first-day-glitches-affordable-care-act-launches-108822 <img typeof="foaf:Image" src="http://llnw.wbez.org//main-images/getcoveredillinois.jpg" alt="" /><p><p dir="ltr">The government may have shut down today, but the Affordable Care Act is marching forward. The state website, <a href="http://getcoveredillinois.gov/">Get Covered Illinois,</a> was up by early this morning. And the <a href="https://www.healthcare.gov/">federal website,</a> where Illinois residents will shop on the marketplace for coverage, was also live. But many people encountered glitches, delays, and error messages.</p><p dir="ltr">Jose Galarza is the billing manager at the Infant Welfare Society on the Northwest side of Chicago. They don&rsquo;t have health navigators in their offices, but staff did receive training to sign people up on the marketplace and the organization is listed on the government&rsquo;s website<a href="http://getcoveredillinois.gov/get-help/"> as an official resource. </a></p><p dir="ltr">Galarza says his organization has been preparing for today for a long time. This morning he says he was full of nervous energy. &ldquo;I was up at 4:30 a.m. this morning, thinking about this the whole process and what to expect,&rdquo; he said.</p><p dir="ltr">When he got to the office the first thing Galarza did was to go to the website and try to fill out an application. &nbsp;He received error messages and never completed the process. Later, he couldn&rsquo;t get to the application at all and instead received a message that the site was overburned by traffic.</p><p dir="ltr">Galarza&rsquo;s experiences were not unique. Organizations and individuals across the city reported similar problems. Before today&rsquo;s launch officials said that some aspects of the site, such as the Spanish language version and small business site, wouldn&rsquo;t be entirely complete.</p><p dir="ltr">By 9:30 a.m. Galarza says three people called to say they would come in for help that day. &nbsp;&ldquo;I put myself in the client&#39;s shoes. If I am excited and I get myself &nbsp;prepared, and then come into a place like this... and [can&rsquo;t fill out an application], it would be very frustrating,&rdquo; he said.</p><p dir="ltr">Illinois Governor Pat Quinn cautioned against judging the Affordable Care Act based on first day problems. &nbsp;&ldquo;We understand with any new program there will be glitches and bumps along the way. When Apple unveils a new device, they may have some minor problems and glitches&hellip; but they go forward. They don&rsquo;t stop and say they will take a year off. They understand how important it is to complete the mission,&rdquo; said Quinn.</p><p dir="ltr">Despite his frustrations, Galarza had a positive message for his clients, one that wasn&rsquo;t that different from the Governor&#39;s. &ldquo;I would say just take a deep breath. We have until December 15th, which is the deadline for your coverage to start on January 1st,&rdquo; said Galarza.</p><p dir="ltr">According to the state, as of 6:00 p.m. more than 76,653 visitors &nbsp;had come to the online marketplace.</p><p>If you run into a problem or need help navigating the website, you can contact the state hotline at 1-866-311-1119.</p><p><em>Shannon Heffernan is a WBEZ reporter. Follow her <a href="https://twitter.com/shannon_h">@shannon_h</a></em></p></p> Wed, 02 Oct 2013 09:35:00 -0500 http://www.wbez.org/news/first-day-glitches-affordable-care-act-launches-108822 Illinois businesses work to sort out the Affordable Care Act http://www.wbez.org/news/illinois-businesses-work-sort-out-affordable-care-act-107194 <p><p>&nbsp;</p><p dir="ltr">Illinois businesses are preparing for the Affordable Care Act to go into full effect in 2014, and a leader from the Illinois Chamber of Commerce says some are considering limiting work hours to avoid future healthcare costs. But costs and logistics vary widely across different types of firms.</p><p dir="ltr">&ldquo;It&rsquo;s one giant puzzle within a puzzle within a puzzle,&rdquo; said Laura Minzer, the Executive Director of the Health Care Council for the for the Illinois Chamber of Commerce.</p><p dir="ltr">She says employers, small and large, are scrambling to figure out which provisions of the federal law will apply to them and their employees. Businesses with under 25 employees may become eligible for tax credits for providing health care, while businesses with over 50 workers could face fines if they don&rsquo;t provide affordable insurance for all employees working 30 hours or more.</p><p dir="ltr">The number of workers receiving employer-sponsored health care has declined steadily in recent years. Now, Minzer says limiting employee hours to under 30 is on the table for some bigger businesses worried about new health care costs.</p><p dir="ltr">&ldquo;The cost of their benefits is not going down and it will not go down with this law,&rdquo; said Minzer. Indeed, insurance premiums have been steadily rising, and experts expect to see a continued rise nationwide. But cuts to hours may be nothing new: the proportion of workers in part-time jobs has been on the rise since 2007.</p><p dir="ltr">One in five adults in Illinois is currently uninsured, and if they can&rsquo;t get employer insurance, some will become eligible for government subsidies through the &ldquo;marketplace&rdquo; (formerly known as the exchange), which is a state and/or federally-run service intended to centralize and streamline shopping for private health insurance. Sliding scale subsidies in the form of tax credits will be available to those making up to four times the federal poverty level. Currently, Illinois has agreed to an insurance marketplace run jointly by Illinois and the federal government, but Minzer says the Chamber of Commerce supports opening a state-run marketplace by 2015.</p><p dir="ltr">&ldquo;Even with all the concerns that we have about affordability, we see value in...the fact that you have a one-stop-shop for health insurance,&rdquo; said Minzer. &ldquo;The state is in a better position to administer that.&rdquo;</p><p dir="ltr">States also have the option to expand Medicaid eligibility to adults making up to 138 percent of the federal poverty level, an option that&rsquo;s <a href="http://www.wbez.org/news/cook-county-begins-enrolling-250000-new-medicaid-recipients-103902">already being piloted in Cook County</a>. However, because of a controversial Supreme Court decision, states can opt out of the Medicaid expansion, and Illinois has yet to pass a bill that would expand Medicaid statewide in 2014.</p><p dir="ltr">Perhaps surprisingly, the Illinois Chamber of Commerce also supports the Medicaid expansion.</p><p dir="ltr">That&rsquo;s because there&rsquo;s a benefit for business: employees who receive Medicaid would do so without triggering penalties for their big employers (as opposed to seeking out insurance through the marketplace, which would trigger penalties). Recent reports have found that larger businesses have a financial incentive to support Medicaid expansion and avoid fees for not providing health insurance to low-income employees.</p><p dir="ltr">Bills to expand Medicaid and to establish a state-run insurance marketplace are creeping through the Illinois General Assembly, and the federal/state insurance marketplace is slated to open October 1, 2014.</p><p>Lewis Wallace is a Pritzker Journalism Fellow at WBEZ. Follow him <a href="http://twitter.com/lewispants">@lewispants</a>.</p></p> Thu, 16 May 2013 05:00:00 -0500 http://www.wbez.org/news/illinois-businesses-work-sort-out-affordable-care-act-107194 10 Years since Iraq: The Changing Face of War http://www.wbez.org/series/chicago-amplified/10-years-iraq-changing-face-war-107190 <p><p>This program to mark the tenth anniversary of the beginning of the Iraq War in 2003, includes a panel of speakers addressing the changing face of war. Abroad, the US&#39; increased use of drones for &quot;targeted killings&quot; in Afghanistan, Pakistan, Yemen, and Somalia, has resulted in the deaths of thousands of civilians. Here in the US, deadly cuts continue to be imposed on domestic programs in order to fund the Pentagon&#39;s excessive spending and line the pockets of wealthy corporations, such as Boeing. The fights for public education, housing, and healthcare are intricately tied to the fights against war and imperialism.</p><p><strong>Peter Lems</strong> is a leader in the American Friends Service Committee anti-drone effort. <strong>Kait McIntyre</strong> of the Anti-War Committee speaks about the local campaign targeting Boeing. <strong>Vince Emanuele</strong>, of the Iraq Veterans Against the War, served two tours in Iraq.</p><div class="image-insert-image "><img alt="" class="image-original_image" src="http://www.wbez.org/system/files/styles/original_image/llo/insert-images/AFSC-webstory_7.jpg" style="float: left;" title="" /></div><p>&nbsp;</p><p>&nbsp;</p><p><br />Recorded live Wednesday, March 20, 2013 at Grace Place.&nbsp;</p></p> Wed, 20 Mar 2013 15:37:00 -0500 http://www.wbez.org/series/chicago-amplified/10-years-iraq-changing-face-war-107190