Health Law

The New York Times (12/19, A19, Nossiter) reports, "Six months ago, it was springtime in Louisiana, dollars were raining in from high oil prices, and the tax cuts and highway spending couldn't come fast enough in the euphoric Legislature." Now, "oil has plummeted and the joy is gone in a poor state that for a time seemed insulated by natural resources from the national downturn." The state could cut some "$160 million in healthcare," much of it "from Medicaid -- unfavorable circumstances for the rollout of [Governor Bobby] Jindal's (R) ambitious new plan to partly privatize Medicaid in the state."

        The AP (12/18, Deslatte) explained that "Gov. Bobby Jindal wants to provide healthcare services in the state's $7 billion Medicaid program for the poor through managed care networks, run by private and competing companies, rather than the state's current system of paying doctors and hospitals directly for care." But, "senators questioned the financing plans, the administrative costs of the proposal, and the timing."

The AP (12/19, Kusmer) reports that on Dec. 18, Indiana Family and Social Services (FSSA) Secretary Mitch Roob said that planned cuts in Medicaid next year "could hold back five percent of payments to doctors and other providers, and cut the rates paid to the lowest-performing nursing homes." Indiana also "will change the way it buys prescription drugs for Hoosier Healthwise enrollees to take advantage of higher rebates from" pharmaceutical companies, he added. The changes, if fully implemented, "would save Indiana about $155 million during the state fiscal year that begins next July 1," Roob explained. But, the holdback in reimbursements -- which Roob "described as 'draconian' -- is a last resort that FSSA will seek to avoid, he said."

The AP (12/19, Smith) reports that, according to a performance audit released Dec. 18 by Ohio Auditor Mary Taylor, the state's "Medicaid program is inefficient and in need of a long term vision, and lawmakers and the governor have failed to make recommended changes that could have saved the state $300 million in the past two years." The audit, which examined Ohio's "progress in implementing 109 recommendations made in 2006 to improve Medicaid," found that "only 15 of those recommendations have been fully implemented. Another 40 recommendations are partially implemented, while 54 recommendations have not been implemented at all." But, Ohio Medicaid Director John Corlett "disagreed" with the "findings, and with Taylor's premise that cost savings had been lost as a result of failing to meet the recommendations." He added that "Taylor is taking the recommendations too literally and not giving Medicaid officials credit for meeting their intent in other ways."

The CBS Evening News (12/18, story 6, 1:50, Couric) reported that "many Americans have been frustrated over the lack of a system for comparing the nation's nursing homes." On Dec. 18, the Centers for Medicare and Medicaid Services (CMS) "came up with one online. Twelve percent of the nation's nursing homes scored the highest rating, but 22 percent scored the lowest." Correspondent Wyatt Andrews explained that "to achieve a five-star rating, a nursing home has to score well on a number of measures, including its state health inspection and the number of staff." CMS officials "believe the rankings will help Americans shop for nursing homes and pressure the lower-ranked homes to improve."

        In its Opinion blog, USA Today (12/19) examines "the federal government's first ratings" of performance of over 16,000 nursing homes. Its own "analysis of the ratings" finds that "non-profit nursing homes as a whole score better than for-profit homes, which tend to have fewer staff members per patient." Specifically, "19 percent of non-profit facilities received the top, five-star ranking, compared with nine percent of the for-profits." USA Today (12/18) also provided a guide explaining how to interpret the rankings data.

        But, in an opposing viewpoint posted in the USA Today (12/19) Opinion blog, Bruce Yarwood, president and CEO of the American Health Care Association, "a Washington-based trade group whose members include for-profit and not-for-profit nursing homes," writes that "through an attempted oversimplification of the multifaceted long-term care profession, facilities that have been long recognized for outstanding quality care and patient outcomes have received inappropriately low ratings." Therefore, the American Health Care Association disagrees "with the fact that the five-star system places the most importance on health inspections when determining a facility's overall quality rating, and that the staffing component fails to reflect all caregivers within a facility."

        In the Wall Street Journal (12/18) Health Blog, Sarah Rubenstein observed that some "nursing-home groups claim the government grades miss the mark." And, "after hearing doctors complain aplenty about a lack of nuance in healthcare quality ratings, it didn't surprise us that nursing homes are squawking too," calling the ratings system "premature and problematic."

        According to Modern Healthcare (12/18, Zigmond), CMS officials pointed out that they "developed the system -- with help from a panel of academics, patient advocates, and nursing-home provider groups -- based on each nursing home's performance in three areas: health inspection surveys, quality measures, and staffing information."

        WebMD (12/18, Boyles) noted that "rankings will be updated monthly, and can be found at the Center for Medicare & Medicaid Services (CMS) website under the search tool Compare Nursing Homes in Your Area." HealthDay (12/18, Gardner) and the Dallas Morning News (12/18, Moos) also covered the story.

Modern Healthcare (12/18, Carlson) reported, "Five years after Congress passed a law forcing states to disclose precisely how much uncompensated-care costs decrease through Medicaid disproportionate-share funding," the Centers for Medicare and Medicaid Services "has issued its final rule telling states and providers how to comply with the 2003 law." According to Sen. Chuck Grassley (R-Iowa), Medicare's "long-awaited rule on disproportionate-share hospital (DSH) payment reporting comes" as "hospitals anticipate a rise in uncompensated-care costs in 2009." The new rule will go into effect Jan. 19 2009.

The Los Angeles Times (12/19, Williams) reports, "The California Supreme Court ruled Thursday that a young woman who pulled a co-worker from a crashed vehicle isn't immune from civil liability because the care she rendered wasn't medical." The woman "allegedly worsened the injuries suffered by" her "fellow department store cosmetician," when she "yanked her [co-worker] 'like a rag doll' from the wrecked car." Now, the woman "faces possible liability for injuries suffered by" the co-worker, "who was rendered a paraplegic in the accident." The court decided that "the Health and Safety Code, which provides that 'no person who in good faith, and not for compensation, renders emergency care at the scene of an emergency shall be liable for any civil damages resulting from any act or omission,'" does not protect the defendant.

        The justices ruled that the law "only protects people from liability if they are administering emergency medical care," the AP (12/19, Elias) adds. Writing for the majority, Justice Carlos Moreno claimed that "a person is not obligated to come to someone's aid," but if "a person elects to come to someone's aid, he or she has a duty to exercise due care."

        Justice Moreno added that "if the 'scene of an emergency'...means a scene where 'an individual has a need for immediate medical attention'...it logically follows that the Legislature intended for the phrase 'emergency care'...to refer to the medical attention given to the individual who needs it," The Recorder (12/19, McKee) notes.

        But, in a "concurring and dissenting opinion, Justice Marvin Baxter called the majority's reasoning an 'arbitrary and unreasonable limitation' on" the Health and Safety Code. He contended that "nothing in the statute 'limits or qualifies the kind of emergency aid -- medical or non-medical -- that an uncompensated lay volunteer may provide without fear of legal reprisal from the person he or she tried to help.'" The court's ruling "affirmed an appeal court," and "the case goes back to the trial court for further proceedings." The San Francisco Chronicle (12/19, Egelko) also covers the story.

The AP (12/19, Johnson) reports, "Illinois pharmacists who object to dispensing emergency contraception won another day in court to fight a rule they claim forces them to choose between their livelihood and conscience." On Thursday, the Illinois Supreme Court ruled that the circuit court, which previously "refused to hear the case," must "consider a lawsuit brought by two pharmacists who claim they should not be required to dispense emergency contraception because it violates their religious beliefs." The disputed rule, issued in 2005 by Gov. Rod Blagojevich (D), prohibits "pharmacies from turning away women seeking emergency contraception." The plaintiffs contend that "they are protected by state laws that prohibit forcing healthcare decisions over moral objections." The justices' opinion said that Gov. "Blagojevich's public statements that pharmacists with moral objections 'should find another profession' could be seen as a signal the state would allow no exceptions to the rule," which "left the plaintiffs with no recourse but the courts."

The AP (12/19, Witte) reports that "two Maryland state senators said Thursday they will propose legislation to change how Maryland's medevac system is managed, after a fatal helicopter crash and an ensuing audit...raised safety issues." Under Sen. John C. Astle (D) and Sen. E.J. Pipkin's (R) proposal, laid out in two "separate bills," the "current helicopter program" would be split "into two fleets -- one focusing on emergency medical services and the other on law enforcement, homeland security, and search and rescue." The plan would also "require the state's program to be certified by the nationally recognized Commission on Accreditation of Medical Transport Systems." In addition, the State Police, "which runs the program," would be required "to join private certified helicopter providers in submitting a bid to get a clear picture of expenses associated with the operation." The pair "also wants to enable the state to apply for reimbursement from private insurance carriers," and "create a Cabinet-level Department of Emergency Services to focus on the state's emergency services personnel."

The AP (12/18, Johnson) reported, "Wyeth has acquired a private British biotech company developing medicines in the potentially lucrative field of obesity, in a deal that could be worth up to $150 million." The company "initially will pay $30 million in cash for Thiakis." Thiakis's "current shareholders...would get future payments totaling as much as $120 million if milestones are reached in development of its lead drug candidate, TKS1225." Researchers with the biotech "have been studying that compound and related ones for the treatment of severe obesity and related conditions, including heart disease and type 2 diabetes." In March, the drug developer said "it had begun an early-stage study in people after animal testing showed TKS1225 is long-acting and caused significant weight loss. It said at the time that the data show the compound has the potential to help people use the insulin they produce more efficiently."

The New York Times (12/19, A19, Pear) reports, "The Congressional Budget Office (CBO) said Thursday that many of the healthcare proposals championed by President-elect Barack Obama and other Democrats would carry a high price tag and would generate only modest savings." For its analysis, the budget office examined "115 options, including proposals to expand coverage and slow the growth of health spending." In addition, "some of the options, including proposals to increase taxes on cigarettes and nondiet soft drinks, are sure to meet stiff political opposition." Still, the CBO estimated that the "potential savings from a requirement for doctors and hospitals to use health information technology, including electronic medical records, as a condition of participating in Medicare," might "save the federal government $7 billion in the first five years and a total of $34 billion over 10 years." The requirement would reduce "medical errors and" avoid "unnecessary tests and procedures," as well as "lower health insurance premiums in the private sector," the budget office said.

        The report also indicated that "federal spending on Medicare and Medicaid will rise from about four percent of gross domestic product in 2009 to nearly six percent in 2019 and 12 percent by 2050," with most of the increase stemming "from rising per capita costs, rather than from the aging of the population," Modern Healthcare (12/18, Lubell) added.

The Hill (12/19, Young) reports that "Incoming House Energy and Commerce Committee Chairman Henry Waxman (D-CA) and the old bull he ousted from the post, Rep. John Dingell (D-MI) have reached an unusual power-sharing arrangement." On Dec. 18, the two legislators announced that Rep. Waxman "will cede to" Rep. Dingell "the lead role in drafting health-reform legislation." Rep. Dingell will continue to "retain a sizable staff, remain an ex officio member of each of the panel's subcommittees, and become 'chairman emeritus' of the full committee." According to the Hill, "the deal appears to be meant as a signal to the party that the two strong-willed lawmakers are moving on from their high-profile battle. That could ease tensions as Democrats prepare for a very full legislative schedule in 2009." And, "by giving Dingell the reins of the panel's health-reform efforts, Waxman may also be giving himself more room to pursue energy and environmental legislation with less resistance from his predecessor."

The AP (12/19, Murphy) reports, "A federal judge on Thursday gave preliminary approval to a $900 million-plus settlement that resolves a lawsuit pitting UnitedHealth Group shareholders against the insurer over its stock options." At issue was whether "investors were hurt because UnitedHealth and" Former Chairman and Chief Executive William McGuire "didn't really grant stock options when they said they did in the late 1990s and early 2000s." Under the settlement, "UnitedHealth has agreed to pay $895 million." In addition, McGuire "agreed to pay $30 million...and to return stock options representing more than three million shares." Retired UnitedHealth General Counsel David J. Lubben, "who also was named a defendant in the case," will pay $500,000 as part of the agreement. A spokesman for the company said that "UnitedHealth officials consider the settlement 'fair, adequate, and reasonable.'" Minnesota's Star Tribune (12/19, Yee) also covers the story.

The Detroit Free Press (12/18, Anstett) reported, "Michigan's Attorney General's office has warned Blue Cross Blue Shield of Michigan to immediately stop what it believes are deceptive business practices that make it difficult for seniors to buy supplemental Medicare policies." Carol Issacs, deputy attorney general, sent a letter Wednesday to Blue Cross general counsel Lisa DeMoss indicating that "the office has received more than a half dozen complaints that Blue Cross...does not promote the policies." Rather, the insurer "'and its agents have been fervently marketing' its costlier Medicare Advantage products," Isaacs contended. The office said that it "wants Blue Cross to find better ways to promote the policies." Currently, Blue Cross "charges $107 a month in premiums for its basic Medigap policy and as much as $297 a month" for the Medicare Advantage plans. According to a company spokeswoman, however, "the insurer 'fully responded to state and federal regulators on these complaints earlier this year and believes that the matters were resolved to their satisfaction.'"

The Los Angeles Times (12/19, Chawkins) reports, "Grappling with ethical questions about organ transplants, a San Luis Obispo jury on Thursday acquitted a surgeon accused of trying to speed a potential donor's death." This "case against Dr. Hootan Roozrokh, believed to be the first of its kind in the United States, was watched intensely by doctors and other professionals involved in transplant surgeries. Experts had feared that a conviction would turn away potential donors, their families, and even some of the doctors who harvest organs."

        The AP (12/19, Deutsch) adds that Dr. Roozrokh "was found not guilty in San Luis Obispo County Superior Court by a jury that deliberated for more than two days. He would have faced up to four years in prison had he been convicted." Dr. Roozrokh "was accused of prescribing too much medication to Ruben Navarro, 26, when he died in February 2006 at a San Luis Obispo hospital." Testifying in his own defense, Dr. Roozrokh said that "he did not try to hasten Navarro's death, but did order painkillers to ensure the patient would not suffer when being withdrawn from life support." Modern Healthcare (12/19, Blesch) and the USA Today (12/18, Winter) On Deadline blog also covered the story.