State News

WalletHub compared the 50 states and the District of Columbia across 30 key measures of cost, healthare accessibility and baby-friendliness and ranked Mississippi as the worst state to have a baby, according to WDAM7. The state ranked near the bottom on infant mortality rate, low birthweight, midwives and OB-GYNs per capita, pediatricians and family doctors per capita and parental-leave policies. More insurers in the state are working with high risk pregnant women to have access to a progesterone medicine can help prevent preterm births. An area where Mississippi moms struggle is access to care. A March of Dimes study last year revealed a major gap in nearly half the state’s counties.

California’s 2017 law addressing surprise medical billing for out-of-network (OON) non-emergency physician services at in-network hospitals is effectively protecting patients from surprise medical bills, according to a study in The American Journal of Managed Care. However, the law is also exacerbating provider consolidation, as a result of increasing insurers’ bargaining power in their negotiations with physicians. Specifically, an OON payment standard set at payer-specific, local average negotiated rates give insurers leverage to lower or cancel contracts with rates higher than their average as a means of suppressing OON prices. California’s experience demonstrates that OON payment standards can influence the payer–provider bargaining landscape, affecting network breadth and negotiated rates. 

Data from Colorado’s all-payer claims database show wide variation in the facility fees charged by hospitals and freestanding emergency departments, according to Modern Healthcare. For example, the Center for Improving Value in Health Care reports that for the highest severity level, the facility fees commonly ranged from $1,990 (25th percentile) to $4,700 (75th percentile), but can go as high as almost $48,000.

Vermont’s 14 hospitals are requesting to increase patient revenue growth beyond the 3.5% limit set by state regulators, reports the VTDigger. The Green Mountain Care Board, which regulates healthcare spending in Vermont, will review the proposed budgets, which represent a 4.5% growth in revenue compared to budgets approved by the board last year. The hospitals argue that budget increases are necessary to improve solvency. The increased revenue would stem, in part, from rate increases for consumers and insurers.

A recent bill has opened the doors for a new pilot program allowing emergency medical services to provide Community Integrated Healthcare, according to ABC Fox Montana. It's hoped that this pilot will allow paramedics and emergency medical technicians to operate more as primary caregivers when taking care of patients. Great Falls Emergency Services believes this pilot will save the healthcare system money in the long run by managing medical issues with scheduled visits with community paramedics at home rather than waiting for the problem to progress into a 911 emergency. 

Massachusetts second and third largest insurers, Harvard Pilgrim Health Care and Tufts Health Plan, have signed an agreement to merge, according to Mass Live. The two insurers combined would present a formidable challenger to the state's largest insurer, Blue Cross Blue Shield, as the combined company would have revenue excess of $8 billion. However, the merger still requires approval from state regulators, including the Health Care Policy Commission, which oversees healthcare mergers and acquisitions. 

The Chesapeake Regional Health Information System for our Patients (CRISP), a health information exchange covering Maryland and Washington DC, announced plans to expand technical integration of its advance care planning solution, according to EHR Intelligence. CRISP will use advance care planning provider ADVault to try to give providers access to meaningful patient health information during patient encounters. It's hoped the data will help improve clinical efficiency during patient encounters to improve patient health outcomes across the state.  

Kansas has threatened to cancel insurer Aetna’s Medicaid contract if the company fails to resolve a number of long-running problems, reports KCUR. The state’s written complaint to Aetna in July stated that doctors and others struggle to secure provider credentials from the insurer, and that discrepancies in Aetna’s records mean Kansas can’t judge the adequacy of the company’s provider network for the state’s 100,000 Medicaid recipients. Additionally, providers claim they sometimes don’t get paid because Aetna demands advance permission for certain basic procedures and that the company hasn’t put together a complete directory of physicians and specialists. Aetna has reported that it has fixed several issues and that many of the other problems “are well on their way to compliance.”

California hospitals provide significantly less free and discounted care to low-income patients since the Affordable Care Act (ACA) took effect, according to Kaiser Health News. As a proportion of their operating expenses, in 2017 general acute-care hospitals spent less than half as much on charity care as they did in 2013. Experts believe that the ACA is largely responsible for the reduction in charity care spending–with fewer uninsured patients, fewer patients seek financial assistance through the charity care programs. Currently, neither the state nor federal governments impose minimum requirements for charity care spending by hospitals, although the California Attorney General has created standards for a few nonprofit hospitals that have changed ownership in recent years.