“A research network funded with millions by the Affordable Care Act will begin conducting vast studies next year to compare standard medical treatments. But what about the 100 million patients in the network — do they have a choice in the matter?
Will researchers get permission from each of those patients? And if patients are told about the studies, what, exactly, will they be told? These questions have bioethicists, scientists and health care officials debating how to bring the question of patient informed consent into the 21st century.
Obamacare is best known for extending health coverage to more Americans. But the health care law has many provisions aimed at improving health care outcomes and safety while lowering costs.

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“Dive Brief:
•In an effort to reduce the backlog of contested Medicare claims, the Centers for Medicare and Medicaid Services has offered to pay hospitals 68% of what they say they are owed for short-term inpatient stays.
•The system of hearings on challenged claims has been on hold since December, when the HHS Office of Medicare Hearings and Appeals temporarily suspended most new requests for administrative law judge hearings on payment denials by recovery audit contractors.
•Hospitals will have 60 days to decide whether to accept CMS’ offer, which does not apply to any short-term hospital admission that occurred after October 1, 2013.”

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“Josiah Citrin’s Melisse and Suzanne Goin’s Lucques, The Larder restaurants, Tavern and the new AOC are just the latest in a group of Los Angeles restaurants implementing a 3% employee benefit surcharge to all guest checks..
Goin, along with Citrin and Rustic Canyon’s Josh Loeb and Zoe Nathan all made the announcement to add the surcharge in recent newsletters to customers. The surcharge started showing up on guest checks Monday.
“To us, when we rolled it out, we thought people would want to support places that are supporting their staff,” Loeb told The Times. “I would do that. If I knew a place was supporting their staff, I’d want to go there.”
According to Loeb, the decision to add a surcharge rather than increase menu prices was twofold.
“We wanted to have our menu prices be an accurate reflection of ingredient costs, and we also wanted give customers a little bit of control and power,” said Loeb.

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“Over the past few weeks, the American Medical Association has complained publicly and privately to the Centers for Medicare and Medicaid Services over its so-called Open Payments database, which will display what drug and device makers pay physicians. The system was created in response to concerns that medical practice and research may be unduly influenced by industry. But the database has been plagued by delays and technical glitches. The AMA is concerned that physicians lack the needed time to ensure correct data is displayed and that the public will understood what they see. The database is expected to go live on Sept. 30, but the AMA wants a six-month postponement to compensate for the problems. So far, CMS says no. We spoke with AMA president Robert Wah about the frustrations. This is an edited version.”

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“Enrolling in Missouri’s Medicaid program has not been easy.
Many applicants have experienced a barrage of problems when trying to sign up for the program, including long delays until coverage kicks in, lost paperwork and a lack of one-on-one interaction with caseworkers. State officials have blamed a new computer system used to process Medicaid applications.
But there is another reason why some Missourians struggle to get help.
When Deborah Weaver, 28, had issues enrolling in the state’s Medicaid coverage for pregnant women, a switch from her Medicaid disability coverage, she was directed to use a toll-free number, 1-855-373-4636.

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“NORTHPORT, Maine – By the time Laura Tasheiko discovered the lump in her left breast, it was larger than a grape. Tasheiko, 61, an artist who makes a living selling oil paintings of Maine’s snowy woods, lighthouses and rocky coastline, was terrified: She had no health insurance and little cash to spare.
Laura Tasheiko, 61, sits in her home in Northport, Maine (Photo by Joel Page for USA TODAY).
But that was nearly six years ago, and the state Medicaid program was generous then. Tasheiko was eligible because of her modest income, and MaineCare, as it is called, paid for all of her treatment, including the surgery, an $18,000 drug to treat nerve damage that made it impossible to hold a paintbrush, physical therapy and continuing checkups.
But while much of America saw an expansion of coverage this year, low-income Maine residents like Tasheiko lost benefits. On Jan.

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“It’s not a news flash that health insurance can be complex and confusing. But the health insurance maze can be a problem, especially if you have never had health insurance before or have not had it for a long time. That’s the case for about half of the uninsured and for many people enrolling in the new insurance marketplaces set up under the Affordable Care Act.
Consider:
37% of enrollees don’t know the amount of their deductible. The deductibles in the plans sold on the exchanges are large; on average $2,300 for single coverage in the most popular plan, a Silver plan. For many people their deductible will be as important to their family budgets and their ability to get health care as the premium they pay, especially if they get a premium subsidy as most do in the exchanges. If people don’t understand their deductibles and copays they may pick a plan based solely on the premium and be in for a nasty surprise when they begin to use care and their deductible hits.

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“The District of Columbia U.S. Circuit Court of Appeals in Washington on Thursday said the full 11-member court will rehear (PDF) the controversial case that ruled Americans could not receive subsidies to help pay for plans on federally run health insurance exchanges. Oral arguments will begin Dec. 17.
The court’s decision to rehear the case en banc, which experts said is rare for the D.C. appellate court, vacates the judgment issued earlier this summer. On July 22, a three-judge panel ruled 2-1 in Halbig v. Burwell that the Patient Protection and Affordable Care Act forbade people with lower incomes from receiving tax subsidies from insurance marketplaces run by the federal government, effectively making those subsidies illegal in 36 states.
Opponents of the Affordable Care Act greeted the D.C. court’s initial ruling with praise, saying the judges upheld the text of the law.

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“Unlike the financial services industry, health care companies lack measures to adequately prevent identity theft, even as they continue to digitize medical records and other sensitive information.
Twelve years ago, when Nikki Burton was 17, she tried to donate blood for the first time. She was denied without explanation. Perplexed, the Portland, Ore. resident called Red Cross headquarters to inquire, only to learn that her Social Security number had been used to receive treatment at a free AIDS clinic in California, rendering her ineligible to donate blood.
Years later, she wondered if, when asked whether she had any preexisting conditions, that instance of fraud might show up. So she called the Red Cross again. The organization told her that it no longer asked for Social Security numbers and she could donate blood without it. “I said, that’s fine for you guys to receive the donation, but that doesn’t solve the problem of that information existing in your system,” Burton says.

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“Federal officials are floating the idea of expanding Medicare’s Pioneer model for accountable care organizations, but they might struggle to recruit any new participants.
Some prominent ACO leaders shared their skepticism in letters to the CMS that the agency released this month. The program, designed and administered by the CMS Innovation Center, is the government’s earliest and most aggressive test under the Patient Protection and Affordable Care Act of new financial incentives for hospitals and doctors to hold down medical costs and meet quality targets.
The Pioneer initiative’s rules put doctors and hospitals at too much risk of losing money with too little control, officials with Universal American, CHE Trinity Health, St. Vincent’s Health Partners, the Franciscan Alliance and others said in the comment letters to federal officials.
Pioneers must agree to accept potential losses with the promise of bonuses after the first year.

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