Issue link: https://www.epageflip.net/i/622651
ByRicardo Alonso-Zaldivar TheAssociatedPress WASHINGTON Whether it's coverage for end-of-life counseling or an experi- mental payment scheme for common surgeries, Medi- care in 2016 is undergoing some of the biggest changes in its 50 years. Grandma's Medicare usually just paid the bills as they came in. Today, the na- tion's flagship health-care program is seeking better ways to balance cost, qual- ity and access. The effort could rede- fine the doctor-patient re- lationship, or it could end up a muddle of well-inten- tioned but unworkable gov- ernment regulations. The changes have been build- ing slowly, veiled in a fog of acronyms and bureaucratic jargon. So far, the 2016 change getting the most attention is that Medicare will pay cli- nicians to counsel patients about options for care at the end of life. The volun- tary counseling would have been authorized earlier by President Barack Obama's health care law but for the outcry fanned by former Republican vice presiden- tial candidate Sarah Palin, who charged it would lead to "death panels." Hast- ily dropped from the law, the personalized counsel- ing has been rehabilitated through Medicare rules. But experts who watch Medicare as the standards- setter for the health system are looking elsewhere in the program. They're paying attention to Medicare's at- tempts to remake the way medical care is delivered to patients, by fostering team- work among clinicians, em- phasizing timely preven- tive services and paying close attention to patients' transitions between hospi- tal and home. Primary care doctors, the gatekeepers of health care, are the focus of much of Medicare's effort. Patrick Conway, Medi- care's chief medical offi- cer, says that nearly 8 mil- lion beneficiaries — about 20 percent of those in tra- ditional Medicare — are now in "Accountable Care Organizations." ACOs are recently introduced net- works of doctors and hos- pitals that strive to deliver better quality care at lower cost. "Five years ago there was minimal incentive to coor- dinate care," said Conway. "Physicians wanted to do well for their patients, but the financial incentives were completely aligned with volume." Under the ACO model, clinical net- works get part of their re- imbursement for meeting quality or cost targets. The jury's still out on their long- term impact. Still, a major expansion is planned for 2016, and ben- eficiaries for the first time will be able to pick an ACO. Currently they can opt out if they don't like it. "We're all trying to un- derstand where is that threshold when things will flip," said Kavita Pa- tel, a Brookings Institution health policy expert who also practices as a primary care doctor. It could be like the switch from snail mail and interoffice memos to communicating via email, she says, but "I'm not sure we have reached critical mass." Glendon Bassett, a re- tired chemical engineer, says he can vouch for the teamwork approach that Medicare is promoting. Earlier this year, a pri- mary care team at SAMA Healthcare in El Dorado, Arkansas, prevented what Bassett feared would turn into an extended hospital- ization. It started with a swollen leg. SAMA is part of Medi- care's Comprehensive Pri- mary Care Initiative, an ex- periment in seven regions of the country that involves nearly 400,000 beneficia- ries and a much larger number of patients with other types of insurance. The insurers pay primary care practices a monthly fee for care coordination, and the practices also have the opportunity to share in any savings to Medicare. The primary-care teams at SAMA consist of a doc- tor, a nurse practitioner, three nurses, and a care co- ordinator. The coordinator shepherds patients to avoid gaps in care. The nurses can be an early warning system for the doctor. Bassett said he had a history of circulatory problems in his legs, but this was different. "It was scary," he said. "Within a week's time it turned from red to dark." He thought about the emergency room, but he got in right away to see the nurse practitioner working with Dr. Gary Bevill, his longtime physician. The nurse fetched other clini- cians to look at Bassett's swollen right leg. He was immediately given antibi- otics. And the doctor re- ferred him to a cardiologist for an outpatient procedure that has since improved his circulation. While the medical treat- ment may have followed fairly standard protocols, Bassett believes the team approach prevented seri- ous consequences. "If I hadn't seen the nurse practitioner when I did, I feel like I would have been in the hospital," he said. Bassett has since moved to Hot Springs, in another part of the state, but stays in touch. Medicare is weighing whether to expand the pri- mary care model. Conway said more data is needed. Other notable changes coming in 2016: — Hip and Knee Surgery Joint replacements are the most common surgi- cal procedure for Medi- care beneficiaries. Start- ing in April, hospitals in 67 metro areas and com- munities will be respon- sible for managing the to- tal cost of hip and knee replacements. The experi- ment covers a 90-day win- dow from the initial doc- tor's visit, through surgery and rehabilitation. At stake for the hospitals are poten- tial financial rewards and penalties. Medicare's goal is to im- prove quality while low- ering cost. But hospitals worry about financial con- sequences and advocates for patients say there's a potential to skimp on care. "What we are discover- ing with all this change is that trying to get to value over volume is very diffi- cult to do," said Herb Kuhn, who heads the Missouri Hospital Association. — Hospice Flexibility Patients choosing Medi- care's hospice benefit at the end of their lives have tra- ditionally had to give up most curative care. Under Medicare's new Care Choices model, pa- tients with a terminal ill- ness will be able to receive hospice services without giving up treatment. A can- cer patient could continue to get chemo, for example. Seventy hospices will start the experiment Jan. 1, and another 70 will join in two years. HEALTH Me di ca re i s cha ng in g: W ha t' s ne w fo r be ne fic ia ri es EVANLEWIS—THEASSOCIATEDPRESS Glendon Bassett does a cardio workout at the Family YMCA in Hot Springs, Ark. By Mary Clare Jalonick The Associated Press WASHINGTON It's now hardertofindoutwhereyour beeforporkwasborn,raised and slaughtered. After more than a decade of wrangling, Congress re- pealed a labeling law last month that required retail- ers to include the animal's country of origin on pack- ages of red meat. It's a ma- jor victory for the meat in- dustry, which had fought the law in Congress and the courts since the early 2000s. Lawmakers said they had no choice but to get rid of the labels after the World Trade Organization repeat- edly ruled against them. The WTO recently authorized Canada and Mexico, which had challenged the law, to begin more than $1 bil- lion in economic retaliation against the United States. "U.S. exporters can now breathe a sigh of relief," said Republican Sen. Pat Roberts of Kansas, chairman of the Senate Agriculture, Nutri- tion and Forestry Commit- tee. The longtime opponent of the labels helped add the repeal to a massive year-end spending bill. After the law waspassed,AgricultureSec- retary Tom Vilsack said the government immediately would stop requiring the la- bels. Consumer groups say the repeal is a disappointment just as consumers are ask- ing for more information on their food packages. Ad- vocates say the labels help people make more informed buying decisions and en- courage purchases of Amer- ican meat. Before repeal, the labels told shoppers that a particu- lar cut of meat was "born in Canada, raised and slaugh- tered in the United States" or "born, raised and slaugh- tered in the United States." Congress first required the labels in 2002 amid fears of mad cow disease from imported cattle. The labels weren't on most packages until 2009, though, due to delays pushed by the meat industry. Repeal became inevitable once the United States lost all its WTO appeals and the retaliationbecameapossibil- ity. But the consumer groups criticized Congress for re- pealing the law for ground meat and pork in addition to the fresh cuts of meat that werethesubjectofWTOcon- cerns. Thebillwas"aholidaygift to the meatpacking industry from Congress," complained the advocacy group Food andWaterWatch.Meatpack- ers who buy Mexican cattle were some of the law's most aggressive opponents. The repeal also was a big defeat for lawmakers from northernborderstateswhere U.S. ranchers directly com- petewithCanadianranchers. Thoselawmakersinsistedon including the labeling in the 2002and2008farmbillsand this year fought to replace it with a voluntary program once the WTO rulings came down. But after years of suc- cess, this time they were not able to find enough support. Roger Johnson of the Na- tionalFarmersUnion,which has heavy membership in those states, said the group was "furious" about the re- peal. "Packers will be able to once again deliberately de- ceive consumers," Johnson said. Still, there was some good news for food labeling advo- cates in the spending bill. Despite an aggressive push by the food industry, law- makers decided not to add language that would have blocked mandatory labeling of genetically modified in- gredients. Also, a provision by Sen. Lisa Murkowski, R- Alaska, would require label- ing of genetically modified salmon recentlyapprovedby the Food and Drug Admin- istration. The issue is expected to come up again in 2016, with Vermont set to require label- ing on genetically modified food this summer. The day the spending bill passed, Vilsack said he would try to help Congress come up with a middle ground on labeling of engi- neered foods "in a way that doesn't create significant market disruption, while at the same time recognizing consumers' need to know and right to know basic in- formation." FOOD US r ep ea ls m ea t la be li ng l aw a er trade rulings against it ANDREW HARNIK — THE ASSOCIATED PRESS Meat labels are seen at a grocery store in Washington. By Brian Bakst The Associated Press ST. PAUL, MINN. A can- nabis producer left out of Minnesota's medical mari- juana program is suing the state over the planned pub- lic release of information submitted as part of an unsuccessful bid. Abatin Minnesota was established as a limited liability company in Sep- tember 2014 for the sole purpose of bidding to be a medical marijuana manu- facturer in the state. Aba- tin dissolved less than a year later after it wasn't selected for the job. Cali- fornia-based BHC Group, a company closely aligned with Abatin in its Minne- sota pursuit, filed the law- suit late last month. The company is seek- ing an injunction to stop posting of application in- formation on the Health Department's website on Jan. 22, as the agency has said will happen. The lawsuit, filed in Ramsey County District Court, also seeks unspecified damages and attorney fees. When the Health De- partment sought manu- facturers following pas- sage of a 2014 medical marijuana law, the agency asked for extensive infor- mation from companies bidding for state certifica- tion. They were required to provide details about cultivation, extraction methods, pricing, build- ing blueprints and se- curity plans, ownership structure and compensa- tion agreements with ex- ecutives and investors. The lawsuit contends that disclosure of appli- cation details — even af- ter promised redactions are made — could neg- atively impact the repu- tation of investors and provide "an unjust in- formational windfall to competitors that wish to tarnish such principals'/ investors' market and thought leadership." Bill Pentelovitch, an attorney for BHC, had no comment Monday beyond the court filings. The De- partment of Health didn't provide immediate com- ment. In planning for the information release, the Health Department has relied on an advi- sory opinion provided in April by the Department of Administration, which is also a defendant in the case. The nonbinding opin- ion determined that ap- plications submitted by manufacturers were "pre- sumptively public" once any manufacturers were registered with the state. Trade secret and security information were deemed the sole exceptions. COURTS Bypassed medical marijuana producer sues Minnesota Newpatientsalwayswelcome! Dr.AuroraBarriga,Optometrist 715 Jackson St., Suite A, Red Bluff (530) 527-9242 Red Bluff Vision Center An Optometric Practice YourFullServiceEyeCareProfessionals Don't forget to use your HSA before the end of the year Quality Eye Care, Quality Eyewear Come see us for your vision exams and treatment of medical eye problems such as dry eye, allergies, blurred vision and eye injuries. 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