State News

Washington | Aug 18, 2019 | News Story

The Sugary-Drink Tax is Working in Seattle, but Will it Curb Soda Sales?

Seattle’s City Council adopted the Sweetened Beverage Tax in June 2017 to improve the health of the city’s residents, and address persistent health and education inequities, reports The Seattle Times. Evidence to-date shows the tax is funding programs that increase healthy food access, support child health and aid in early learning. However, its impact on reducing sales of sugary beverages is currently unknown. Nevertheless, evaluations of similar taxes imposed in Berkeley and Philadelphia revealed that sales of taxed beverages dropped substantially — by 9.6% and 38%, respectively. 

Missouri | Aug 17, 2019 | News Story

For Many People in Medical Debt, a Trip to the Emergency Room Leads to the Courtroom

Poplar Bluff Regional Medical Center has filed more than 1,100 lawsuits for unpaid bills in a rural corner of Southeast Missouri, where emergency medical care has become a standoff between hospitals and patients, according to The Washington Post. Three nearby hospitals closed for financial reasons in the past few years, leaving Poplar Bluff Regional as the last full-service hospital to care for five rural counties, treating more than 50,000 patients each year. As a result, the hospitals’ uncompensated care costs have risen from about $60 million to $84 million. Community residents are similarly at-risk of financial ruin. Over 35 percent have unpaid medical debt on their credit report, about double the national rate. The resulting lawsuits have become so routine that some people derisively refer to it as the “follow-up appointment.” 

California | Aug 16, 2019 | News Story

Paging More Doctors: California’s Worsening Physician Shortage

California is facing a growing shortage of primary care physicians, according to Cal Matters. By 2030, the state could be short as many as 10,000 primary care professionals, including nurse practitioners and physician assistants. Some areas—the Central Valley, Central Coast and Southern Border region—will be hit especially hard. So too will be remote rural and inner-city residents, communities of color, the elderly, people with mental illness or addiction and those without health coverage. This could result in longer wait times and travel distances for doctor visits, as well as a reduction in preventative care and care for chronic conditions. 

Colorado | Aug 16, 2019 | Report

Colorado Hospital Value Report: Benchmarking Pricing & Quality Reliability for Inpatient Care Across Acute Care Hospitals

Though high prices at specific Colorado hospitals may correlate with higher quality for some services, price does not appear to predict or even reflect quality on balance, according to an analysis by the Colorado Business Group on Health and the Colorado Consumer Health Initiative. The report notes that hospital quality varies nearly as much within hospitals as it does across hospitals. Furthermore, hospital prices for routine healthcare procedures in Denver varied by more than 800 percent in 2017. The hope is that “Hospital Value Reports” such as this one will incentivize value by examining price and quality measures in concert. 

California | Aug 15, 2019 | Report

Influence of Out-of-Network Payment Standards on Insurer–Provider Bargaining: California’s Experience

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. 

Colorado | Aug 15, 2019 | Report

Report Shows Big Swings in Colorado ER Facility Fees

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.

Montana | Aug 14, 2019 | News Story

New Montana legislation enabling Community Integrated Healthcare Pilot Program

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 | Aug 14, 2019 | News Story

Harvard Pilgrim Health Care and Tufts Health Plan, two of Massachusetts’ largest insurers, sign agreement to merge

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. 

Maryland | Aug 14, 2019 | News Story

MD Health Information Exchange Expands Advance Care Planning

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 | Aug 13, 2019 | News Story

Kansas Medicaid Insurer Aetna on Even Thinner Ice with State Officials

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.”