Some Boston Marathon Bomb Victims Will Face Insurance Coverage Limits


Boston Marathon

Boston Marathon (Photo credit: Wikipedia)

Payments for prosthetics, rehabilitation and a range of other
treatments may fall outside some insurance limits and could continue
long into the future.

The New York Times: For Wounded, Daunting Cost; For Aid Fund, Tough Decisions

Many of the wounded could face staggering bills not just for the trauma
care
they received in the days after the bombings, but for prosthetic
limbs
, lengthy rehabilitation and the equipment they will need to
negotiate daily life with crippling injuries. Even those with health
insurance may find that their plan places limits on specific services,
like physical therapy or psychological counseling (Goodnough, 4/22).

Politico: Coverage Limits Are Harsh Reality For Amputees

Those who lost limbs in the Boston Marathon bombings now need care to
learn to navigate the world in a new way — and navigate a thorny area of
health care coverage, too. In the case of the Boston bombings, pledges
and offers of support have poured in to help with the health care costs
of the 14 people who reportedly lost all or part of a limb. But for some
amputees, covering the staggering cost for prosthetics care can be a
struggle (Smith, 4/23).

This is part of Kaiser Health News‘ Daily Report – a summary
of health policy coverage from more than 300 news organizations. The
full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

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Layoffs Hit Group Health in Washington and Boston Children’s Hospital


Massachusetts Attorney General Martha Coakley ...

Massachusetts Attorney General Martha Coakley speaking at Faneuil Hall in Boston (Photo credit: Wikipedia)

The Hunnewell Building at Boston Children's Ho...

The Hunnewell Building at Boston Children’s Hospital, Harvard Medical School (Photo credit: Wikipedia)

Topics: Health Costs, Marketplace, States, Hospitals, Insurance

Sep 20, 2012

Group Health Cooperative, a leader in innovations, insures about 600,000 in Washington state.

The Seattle Times: Group Health Announces Layoffs, Cuts
Group Health Cooperative, recognized as a leader in health-care innovations and patient satisfaction, says it must cut $250 million over the next 16 months through layoffs, better cost control and some reorganization at the top. As part of those changes, Richard Magnuson, executive vice president and chief financial and administrative officer, will soon leave the organization. CEO Scott Armstrong says he intends to create a new CFO position focused solely on financial targets. Group Health, which insures about 600,000 people in Washington and has annual revenues of $3.5 billion, is aiming to climb back up to a 3 percent operating margin, Armstrong said in a Friday memo to staff, first reported by the Puget Sound Business Journal (Ostrom, 9/19).

Also, in Boston

WBUR: Boston Children’s Hospital Cuts 255 Jobs, Lays Off 45 Staffers
WBUR’s Martha Bebinger reports that top management at Boston Children’s Hospital sent word to employees today that the hospital was cutting a total of 255 positions, most through attrition but 45 through elimination. Savings total $89.5 million, for a 3% margin (Bebinger, 9/19).

The Boston Globe: 45 Workers To Lose Their Jobs At Boston Children’s Hospital
Children’s has been moving aggressively to reduce expenses over the past two years since it was identified by state Attorney General Martha Coakley as one of the most expensive hospitals in Massachusetts. It has cut fees to private insurers and Medicaid managed care programs by lowering charges for lab tests, doctor appointments, imaging, surgery, and hospital admissions (Weisman, 9/19).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Boston Skyline

Boston Skyline (Photo credit: brentdanley)

Drug Co. Execs Say Cost-Containment Pressures Undermine Medical Innovation


A pano of the Bayer main factories in Leverkus...

A pano of the Bayer main factories in Leverkusen, Germany. (Photo credit: Wikipedia)

English: Pre-war Bayer heroin bottle, original...

English: Pre-war Bayer heroin bottle, originally containing 5 grams of Heroin substance. (Photo credit: Wikipedia)

Topics: Delivery of Care, Health Costs, Marketplace, Public Health

Sep 20, 2012

Executives such as the Bayer CEO said this kind of pressure could hamper efforts to bring new meds to market.

Reuters: Bayer CEO Decries Pressure To Lower Drug Prices
Pressure from governments to lower drug prices risks undermining medical innovation, Bayer AG‘s chief executive said on Wednesday, echoing complaints of other drug company executives. Speaking at the Boston College Chief Executives’ Club, Marijn Dekkers said there was “tremendous pressure” on drugmakers to lower prices (Krasny, 9/19).

The Boston Globe: Executives Say Global Push To Contain Health Costs Threatens Innovation
The push to contain spiraling health costs around the world could hamper the ability of drug makers to bring new medicines to market, two biopharmaceutical executives warned Wednesday. Marijn Dekkers, chairman of German drug giant Bayer AG, sounded the alarm at a luncheon hosted by the Boston College Chief Executives’ Club of Boston, saying the global economic downturn has intensified pressure to restrict reimbursements for therapeutics (Weisman, 9/19).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Bayer

Bayer (Photo credit: Pelota Amarela)

Massachusetts committee releases health care bill


By

July 31, 2012 • Reprints

BOSTON (AP)Massachusetts House and Senate negotiators have filed the final version of a bill they say will save up to $200 billion in health care costs over the next 15 years and help guarantee the future of the state’s landmark 2006 health care law.

The bill rejects a proposed “luxury tax” for hospitals that charge more than 20 percent above the state median price for a service, but includes $135 million in grants to help community hospitals make the transition to new electronic medical records systems.

Another goal of the bill is to allow residents better access to their own medical records and cut down on unnecessary and expensive repeat medical testing.

Sen. Richard Moore, an Uxbridge Democrat and one of those working on the final bill, said another top aim of the bill is to set a cost growth goal close to the state’s rate of inflation, far less than current year-to-year increases in insurance and medical costs.

“I think it’s a very good bill,” Moore said.

The bill would also encourage the creation of so-called “accountable care organizations” — health care networks that take a more coordinated approach to medicine. There are already five accountable care organizations in Massachusetts.

Such organizations are considered key to the transition away from more piecemeal medical care that rewards doctors for each test or procedure to care that looks at the entire patient and the best way to maintain overall health.

Rep. Steven Walsh, D-Lynn, also worked on the final version of the sweeping bill and said he’s confident it will benefit patients, health care providers and business — which could see a reduction on the cost of health premiums.

He said the bill should also win the approval of Gov. Deval Patrick, who has made health care cost control a top priority.

“I’m very confident that the governor will sign this,” Walsh said, noting that every member of the conference committee working on the compromise legislation — both Democratic and Republican members — signed off on the final bill.

Patrick told reporters mid-afternoon on Monday, that he hadn’t seen the final language of the bill but that the administration was working closely with the conference committee charged with drafting the final bill.

The 342-page bill, which was filed late Monday, is expected to be voted on Tuesday, the final day of the Legislature’s formal session.

That decision to wait until the absolute last minute before releasing the final version of such a complicated piece of legislation irked some lawmakers, even some on those on the conference committee.

“I have a lot of concerns,” Senate Minority Leader Bruce Tarr, a Gloucester Republican who also sat on the committee, said just hours before the final bill was filed. “I have concerns about being able to understand what’s being put before us, not from an intellectual standpoint, but just from a substantive standpoint.”

One of the most contentious proposals was the “luxury tax” aimed at addressing the wide price differences that hospitals charge for the same operation or procedure in Massachusetts.

The House version of the bill included the tax which essentially targeted bigger name Boston hospitals that can charge more than 20 percent above the state median price for a service.

Under the proposal, those hospitals would be levied a 10 percent surcharge that would go into a fund to help support hospitals serving the poor and most vulnerable. The proposal, which did not appear in the Senate version of the bill and came under fire by those hospitals, was dropped from the final bill.

But Walsh was quick to point out that the final bill included help for community hospitals.

The bill takes other steps to control costs.

It expands the role of physician assistants and nurse practitioners to act as primary care providers to guarantee access to more affordable care and creates a new “wellness tax credit” for businesses that adopt programs to combat preventable chronic diseases like obesity, diabetes, and asthma.

The bill also seeks to control medical malpractice costs by creating a 182-day “cooling off” period to give both sides a chance to negotiate a settlement, and bans the use of mandatory overtime for nurses in hospitals except in emergency situations.

By trying to bring spiraling insurance and other health costs under control, the bill seeks to help ensure the success of the Massachusetts health care law signed in 2006 by then-Gov. Mitt Romney.

That law — which became the blueprint for the federal health care law signed by President Barack Obama in 2010 — expanded access to health coverage in Massachusetts, but did little to rein in premiums and other health care costs that have threatened to undermine its long-term fiscal stability.

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Associated Press Writer Shannon Young contributed to this report.