First Edition: January 27, 2015

Kaiser Health News: HHS Pledges To Quicken Pace Toward Quality-Based Medicare Payments
The Obama administration Monday announced a goal of accelerating changes to Medicare so that within four years, half of the program’s traditional spending will go to doctors, hospitals and other providers that coordinate their patient care, stressing quality and frugality. The announcement by Health and Human Services Secretary Sylvia Burwell is intended to spur efforts to supplant Medicare’s traditional fee-for-service medicine, in which doctors, hospitals and other medical providers are paid for each case or service without regard to how the patient fares. Since the passage of the federal health law in 2010, the administration has been designing new programs and underwriting experiments to come up with alternate payment models. (Rau, 1/26)

Kaiser Health News: ‘Orthopedic Capital Of The World’ Is Still Hiring Despite Health Law Tax
Tom Till eyes the morning’s email to see who’s angling to hire his students: A local employer, which had already hired 23 people in less than a year, says it needs three more to help make the artificial hips, knees and other devices manufactured here in the self-proclaimed 'Orthopedic Capital of the World.' 'Everyone is going gangbusters,' said Till, who oversees an advanced manufacturing program at Ivy Tech Community College in this lake-dotted region two hours north of Indianapolis. Till’s bullish view of the medical device industry – he says he can’t crank out graduates fast enough — contrasts sharply with what industry lobbyists are telling lawmakers in the nation’s capital. They say a 2.3 percent tax on the sale of medical devices put in place two years ago by the Affordable Care Act has already cost more than 30,000 jobs and is stifling innovation. (Appleby, 1/27)

Kaiser Health News: Learning About Hospice Should Begin Long Before You Are Sick
Reporting for Kaiser Health News, Caroline E. Mayer writes: "Introduced to the United States in the 1970s, hospice care is becoming an increasingly common treatment. Last year, 1.65 million people received hospice care, up from just more than 1 million in 2004, according to the National Hospice and Palliative Care Organization. In addition, there were more than 5,500 programs in the U.S. last year, compared to 3,100 in 2000. Although the growth in hospice programs has given patients and their families more choices than ever, a recent Washington Post investigation into the industry found widespread concerns about the quality of care. The Post cited numerous complaints, noting that although hospices are supposed to provide continuous nursing care to patients whose pain or symptoms are out of control — commonly called “crisis care” — one in seven do not." (Mayer, 1/27)

The Wall Street Journal: Medicare To Rework Billions In Payments
The effort faces a long climb ahead amid potential resistance from health-care providers and skepticism from beneficiaries and lawmakers. Medicare, which covers more than 50 million Americans, started to pay some doctors and hospitals on the basis of their performance as part of a provision in the 2010 Affordable Care Act. Currently, around 20 percent of payments are made in this way, and the federal government said Monday it will aim to get that share to 30 percent by the end of 2016 as an interim goal. (Radnofsky and Beck, 1/26)

Los Angeles Times: Medicare To Transform How It Pays Doctors And Hospitals
Most experts believe that this shift is crucial to improving the quality of care that patients receive, while also restraining costs at a time when millions of baby boomers will be entering the nation's primary insurance program for the elderly. Under the goals announced Monday, Medicare will make 30% of its direct payments to doctors, hospitals and other providers through alternative payment models by next year, up from nearly nothing four years ago. (Levey, 1/26)

The Associated Press: Gov't To Overhaul Medicare Payments To Doctors, Hospitals
Medicare will change the way it pays hospitals and doctors to reward quality over volume, the Obama administration said Monday, in a shift that officials hope will be a catalyst for the nation's $3 trillion health care system. "It is in our common interest to build a health care system that delivers better care, spends health care dollars more wisely and results in healthier people," said Health and Human Services Secretary Sylvia M. Burwell. (Alonso-Zaldivar, 1/26)

The Washington Post's Wonkblog: The Obama Administration Wants To Dramatically Change How Doctors Are Paid
Rather than pay more money to Medicare doctors simply for every procedure they perform, the government will also evaluate whether patients are healthier, among other measures. The goal is for half of all Medicare payments to be handled this way by 2018. Monday’s announcement marks the administration’s biggest effort yet to shape how doctors are compensated across the health-care system. As the country's largest payer of health-care services, Medicare influences medical care generally, meaning the changes being initiated by the administration will likely be felt in doctor's offices and hospitals across the country. (Millman, 1/26)

USA Today: Feds Step Up Changes To Hospital Payments
Health care, including for Medicare patients, has traditionally used the "fee for service" model that pays providers for each individual treatment rather than for the overall treatment of a patient or group of patients. That is, they are paid for making people better; not just for trying. For consumers, the end result of HHS' push should be better health care, but it may not seem that way to some. (O'Donnell, !/26)

The New York Times: Budget Forecast Sees End To Sharp Deficit Declines
The federal budget deficit will continue to inch downward through next year, but even with the economy on an upward trajectory, the government’s red ink will begin to rise in 2017 and expand with an aging population, the Congressional Budget Office said Monday. The new budget projections effectively signal the end of the steep decline in deficits as the economy climbed out of the recession. Lawmakers now face a familiar and politically vexing problem: What to do about increases in Medicare, Medicaid and Social Security spending that reflect the nation’s demographics, not its economic health? (Weisman, 1/26)

The Wall Street Journal: CBO: Deficit To Narrow, Then Widen In ’18
The CBO’s report showed that discretionary spending, after excluding interest costs and major safety-net programs such as Medicare and Social Security, is set to fall by 2019 to its lowest level as a share of the overall economy since comparable data reporting began in 1940. ... Monday’s report also revised down by 7% from its last forecast, released in August, the projected costs to the government from the Affordable Care Act that Mr. Obama signed into law five years ago. Health-insurance spending for the 2015-19 period is now 20% lower than when the CBO issued its first estimates for the law in March 2010. (Timiraos, 1/26)

The Associated Press: CBO: Deficit To Shrink To Lowest Level Of Obama Presidency
For future years however, CBO issued a warning: Beyond 2018, deficits will start rising again as more baby boomers retire and enroll in Social Security and Medicare. By 2025, annual budget deficits could once again top $1 trillion, unless Congress acts. At that point, Social Security benefits would account for one-quarter of all federal spending, said CBO Director Douglas Elmendorf. "The underlying point is that we have a handful of very large federal programs that provide benefits to older Americans," Elmendorf said. "And with the rising number of older Americans and a rising cost of health care, those programs get much more expensive." (1/26)

The Washington Post's Wonkblog: CBO: Interest On Federal Debt Will Triple Over Coming Decade
Meanwhile, the CBO said that the cost of the Affordable Care Act continued to come in substantially below the March 2010 estimates. Because the program gets more expensive over time, the 10-year cost estimates have risen. But costs compared year by year remain lower. In March 2010, the CBO and Joint Committee on Taxation projected that the ACA would cost the federal government $710 billion during fiscal years 2015 through 2019. The newest projects put the cost at just $571 million over those years, about 20 percent lower than the original estimates, the CBO said in its report. The latest projections for the cost in 2019 are $132 billion, or 23 percent less than the original projection. (Mufson, 1/26)

USA Today: Federal Deficit Falling To Lowest In Obama Presidency
CBO also projects the unemployment rate will fall further -- to 5.3% by 2017 -- as more people are encouraged to enter or stay in the workforce. The budget agency estimates that the number of U.S. residents without health insurance will drop from 42 million last year to 36 million this year, largely because the Affordable Care Act. ... While the deficit is projected to hold steady through 2018, CBO projects the gap between spending and revenues will continue to grow due to the retirement of Baby Boomers and healthcare costs associated with an aging population, as well as rising interest rates on the federal debt. (Davis, 1/26)

The New York Times: Budget Office Slashes Estimated Cost Of Health Coverage
The Congressional Budget Office on Monday significantly lowered its estimate of the cost of providing health insurance coverage to millions of Americans under the Affordable Care Act. Douglas W. Elmendorf, the director of the budget office, said the changes resulted from many factors, including a general “slowdown in the growth of health care costs” and lower projections of insurance premiums that are subsidized by the federal government. (Pear, 1/26)

Los Angeles Times: Obamacare Cost To Be 20% Less Than Forecast, Budget Office Says
President Obama's healthcare law will cost about 20% less over the next decade than originally projected, the Congressional Budget Office reported Monday, in part because lower-than-expected healthcare inflation has led to smaller premiums. So far, the number of uninsured Americans has dropped by about 12 million. By the end of 2016, 24 million fewer Americans will lack insurance, the nonpartisan budget office forecast. Excluding immigrants in the country illegally, who are not eligible for coverage under the law, only about 8% of Americans under age 65 will lack insurance by the time Obama leaves office, the budget office's latest report on the law estimates. (Lauter, 1/26)

The New York Times: Supreme Court Rules Against Retirees in Union Health Benefits Case
The Supreme Court on Monday ruled that a chemical company may be able to cut the health benefits of its retired workers, unanimously reversing an appeals court ruling that said the benefits had vested for life. “Courts should not construe ambiguous writings to create lifetime promises,” Justice Clarence Thomas wrote for the court, adding that “retiree health care benefits are not a form of deferred compensation.” (Liptak, 1/26)

Los Angeles Times: Supreme Court Knocks Down Promised Health Benefits For Union Retirees
The Supreme Court cast doubt Monday on the future of old union contracts that had promised lifetime health benefits for retired workers and their families. In a case seen as a victory for corporate America, the justices ruled these promises should not be treated as “vested rights” unless they are spelled out in the contract. (Savage, 1/26)

The Wall Street Journal: Supreme Court Rules Against Union Retirees In Benefits Case
The Supreme Court on Monday ruled ambiguous provisions in union contracts shouldn’t automatically be interpreted in favor of workers, giving a chemical manufacturer another chance to terminate lifetime health-care benefits for retirees. ... The retirees and their dependents filed suit, and the Sixth U.S. Circuit Court of Appeals in Cincinnati found the company had reneged on the contract, saying it was “unlikely that [the union] would agree” to such a deal “if the company could unilaterally change the level of contribution.” (Bravin, 1/26)

USA Today: Supreme Court Says Retiree Health Benefits Can Expire
The Supreme Court ruled unanimously Monday that companies can terminate retiree health benefits when labor agreements are renewed if the original contract language was ambiguous. (Wolf, 1/26)

Los Angeles Times: Californians Received $3.2 Billion In Obamacare Premium Subsidies
Californians received $3.2 billion in Obamacare premium subsidies during the rollout of the federal health law last year. That federal aid went to about 800,000 California households, state officials said Monday. Those individuals and families paid $1.1 billion in premiums themselves, meaning for every dollar they spent the federal government paid an additional $3 to their health insurer. Nearly 90% of enrollees in the Covered California exchange qualified for financial help based on their income. The average monthly subsidy was $436 per household, according to the state. (Terhune, 1/26)

The Associated Press: VA To Create Unified Framework With 5 Service Regions
The Veterans Affairs Department said Monday it is creating a single regional framework that divides the sprawling agency into five clearly marked regions. The new framework is part of a larger reorganization that VA leaders say will bring a singular focus on customer service to an agency that serves 22 million veterans, including more than 6 million who receive health care each year from the VA's 970 hospitals or clinics. (1/26)

The Washington Post: Democrat Bill Would Give Federal Workers Paid Parental Leave
Federal employees would be eligible for six weeks of paid leave for purposes related to the birth or adoption of a child, under legislation introduced Monday by a group of House Democrats. President Obama two weeks ago called on Congress to enact that benefit–which would be paid “administrative” leave that would not be charged against either sick leave or annual leave time–while separately ordering agencies to advance up to six weeks of paid sick leave for those purposes under existing authority. (Yoder, 1/26)

The Wall Street Journal's Total Return: A Way to Fix Long-Term Care Insurance?
The best way to make long-term-care insurance accessible—and affordable—for more people might be to change what has become gospel in the business: the use of short “elimination periods.” That’s the thinking in a new article in Financial Planning: “How to Fix LTC Insurance,” by Michael Kitces, director of research at Pinnacle Advisory Group in Columbia, Md. Mr. Kitces notes that long-term-care insurance originally was created to guard against the “high-impact but lower-probability risk of needing long-term care assistance at an advanced age.” In other words, relatively small numbers of people would need long-term care—or so statistics indicated—but those who did would face steep bills. (Ruffenach, 1/26)

The Washington Post: Extra Funding Sought To Fight Antibiotic-Resistant Bacteria
The Obama administration wants to double the amount of federal funding dedicated to combating antibiotic-resistant bacteria, a mounting problem that causes an estimated 2 million illnesses and 23,000 deaths annually in the United States. (Dennis, 1/27)

The New York Times: Treatment Of Overdose Will Cost Cities Less
The Clinton Foundation on Monday announced that it had negotiated a lower price for an emergency treatment that can prevent overdoses with a company that makes it. The soaring cost of the treatment has constrained its widespread use by municipalities across the country. Naloxone is a medication that reverses the effects of prescription painkiller or heroin overdoses. Doctors and paramedics give it to people who have stopped breathing or lost consciousness. In the past it was used mostly in medical settings like hospitals, but in recent years its use has spread to homes or on the streets, where overdoses commonly occur, a trend experts say can improve the chances of saving a person’s life. (Tavernise, 1/26)

The New York Times: Joan Rivers’s Daughter Files Malpractice Suit Against Manhattan Clinic
Ms. Rivers went into cardiac and respiratory arrest during the procedure on Aug. 28 and died several days later. There has been no official determination of exactly what it was that killed her, though federal health investigators found a number of errors, including a failure by those treating Ms. Rivers to notice that her vital signs were dropping, which the lawsuit said contributed to the death. The lawsuit also said the closing of Ms. Rivers’s vocal cords was a cause. The defendants include Dr. Korovin; the clinic; Renuka Bankulla, the anesthesiologist; and Dr. Cohen, who stepped down as the clinic’s medical director. (Hartocollis, 1/26)