Immigration Bill Has Healthcare Workforce Implications

A bipartisan Senate immigration bill could boost the nation's healthcare workforce, in addition to expanding coverage to millions of newly legal residents. If passed, the law is expected to increase both visas and green card access for a broad range of healthcare workers. Specifically, it would make it easier for foreign physicians who come to the U.S. for their medical residencies to stay on after their training (if they’ll serve three years in medically underserved areas).

According to American Medical Association President Jeremy Lazarus, MD, “The AMA strongly supports the permanent reauthorization of the J-1 visa waiver program outlined in the Senate immigration bill that will allow International Medical Graduates to continue providing much needed healthcare to people in communities across the country. “IMGs play an integral part in American medicine, often joining physicians in practices serving patients in rural and low-income urban areas.”

Read more about the immigration bill and the two kinds of visas that foreign doctors can get: an H-1B visa for specialty workers or a J-1, which is an educational or cultural visa in Modern HealthCare (free subscription required) or Politico.

ACA Meeting in Denver on April 27th

Affordable Care Act (ACA) meeting scheduled for April 27th. Come learn the myths from the facts about the ACA and get answers to your questions on Saturday, April 27th from 1:00 – 5:00 at Manual Auditorium in Denver. Get more details in the flyer or read the agenda here.

Mediator Coming to Help with Exchange Set Up

Sparring between Colorado Department of Health Care Policy and Financing (HCPF) and the Colorado Health Benefit Exchange Board (COHBE) prompted an outside analyst to recommend a third party to triage and manage the project.

Federal grants that Colorado received to launch its exchange require outside analysts to conduct independent reviews. According to a new report from outside analysts at First Data, squabbling between state and exchange managers over IT projects and other policy decisions has been slowing down progress on the exchange.Therefore, a mediator from the Robert Wood Johnson Foundation now will come to Colorado to help managers get the giant multi-million dollar project off the ground on time by October 1st when it’s slated to open to consumers.

Yen Pham, an analyst from First Data stated, “A number of policy decisions need to be resolved by both COHBE and HCPF; they include the approach to accommodate referrals, eligibility mixed households and life change events.” Read more in the Colorado blog, Health Policy Solutions. 

Response to Study Finding CAHs Had a Slightly Worse Mortality Rate Than Major Medical Centers

A recent research report in the Journal of American Medicine stated that Critical Access Hospitals (CAHs) had a slightly worse mortality rate than major medical centers. Dr. Wayne Myers, a retired pediatrician and rural medical educator, responds in The Daily Yonder stating that the report gave the wrong reasons for the small difference in survival between the rural CAHs and larger regional hospitals. Read Dr. Myers's insightful response here.

Report Says Experience of CHIP Hints at Impact of Medicaid Expansion on Providers

Enrollment in public health insurance coverage will expand significantly beginning in 2014. At this time there is only a limited understanding of what happens when an influx of newly insured patients encounters a relatively fixed supply of providers. Will they choose to work longer hours to accommodate the increase in demand? The experience of the Children’s Health Insurance Program (CHIP) offers a preview of how providers might respond to the expansion.

According to a report in the Medicare & Medicaid Research Review, researchers from the Government Accountability Office and the Washington-based Center for Studying Health System Change found that the creation of the Children's Health Insurance Program in 1997 did not create a deluge of patients that the nation's pediatricians couldn't handle. Read more here.

Policy Options to Cut Emergency Department Costs

For nearly 50 years, emergency rooms have been fingered as a major source of excessive healthcare costs. And while some newer research has challenged the idea that a large proportion of patients visit the emergency room for routine problems, many payers and policy makers continue to focus on these patients as a major source of wasteful spending.

For a new study published in The Journal of the American Medical Association, researchers reviewed the records from almost 35,000 patient visits to emergency departments across the country. In just 6 percent of cases, the patient was discharged and could have been treated in a healthcare provider’s office. 

History has shown that limiting payments based on discharge diagnoses has been largely unsuccessful. However, other policy options are being tested around the country. Beginning last summer, emergency departments in Washington state established programs to educate patients on how to access care, as well as other measures designed to improve care, including statewide guidelines on prescribing narcotics, shared electronic health and prescription information, and regularly updated reports on how emergency department resources are utilized. The policy has already resulted in significant changes and a projected savings of over $31 million by the end of the fiscal year. Read more here.

Interim Report Says There is Little Support for Medicare Payments That Vary

An interim report recently issued by the Institute of Medicine concluded Medicare should not adjust payments on a broad regional basis to reward hospitals and doctors that spend less to achieve high-quality care. 

The study was conducted at the request of the secretary of Health and Human Services, Kathleen Sebelius, in response to a push by some members of Congress to revisit how Medicare pays hospitals and doctors. The report’s authors were responding to the argument that Medicare should pay higher levels of reimbursement to areas of the country that deliver measurably good care at low cost and less to regions where costs are high and outcomes are poor. Read more about the study in the New York Times.

Colorado Health Report Card Released

Each spring, the Colorado Health Foundation releases a health report card for the state, measuring things like teen pregnancy, smoking, obesity and mental health. This year, Colorado received three Bs, a C and a D.

The analysis divides Coloradans into five age groups, prenatal to old age. Overall, the report said adolescents, adults and the elderly are doing pretty well; they earned Bs and B pluses. However, the score for Colorado’s children, was a D plus. According to Anne Warhover, president and CEO of the Colorado Health Foundation, “[W]e’re not growing our own healthy children. Our child obesity rate remains in the middle of the pack. That’s where the foundation is really going to emphasize more and more of our work in trying to prevent childhood obesity. It leads to so much cost in our system.”

Read more about the report card in Katie Kerwin McCrimmon's post in the Colorado blog, Health Policy Solutions.