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Daily Archives: January 20, 2015

Hatch Vows To Dismantle Health Law But Predicts Bipartisan Success On Other Issues

While Republicans cannot expect a full repeal of the health law while President Barack Obama remains in office, the GOP intends to “strike away at it, piece by piece,” Senate Finance Committee Chairman Orrin Hatch, R-Utah, said Tuesday.

But in a speech at the U.S. Chamber of Commerce, Hatch also said he expected that Republican and Democratic lawmakers would work together on several other key pieces of health legislation.

Hatch said there may be more bipartisanship in some “must pass items,” including continued funding for the Children’s Health Insurance Program and overhauling the way Medicare pays physicians, known as the “sustainable growth rate.”  On CHIP, Hatch said the Finance Committee has “heard from a number of governors from red states and blue stakes alike that they want to see this program extended. It has been a marvelous program. It has worked very, very well. I’m optimistic that we can work on a bipartisan, bicameral basis to extend CHIP in a responsible way.”

Sen. Orrin Hatch (R-UT) talks with reporters in April 2014 in Washington, DC. (Photo by T.J. Kirkpatrick/Getty Images)

Sen. Orrin Hatch (R-UT) talks with reporters in April 2014 in Washington, DC. (Photo by T.J. Kirkpatrick/Getty Images)

Hatch also said he wants the Finance panel “to address the SGR challenge once and for all.” Last year he co-sponsored legislation that would move physicians from the traditional system in which they are paid for volume and instead use financial incentives to encourage them to move to alternative payment models emphasizing quality care.  Finance must also act “sooner rather than later” to strengthen Medicare, Medicaid and Social Security, he said, noting that in the last Congress he supported several significant changes to Medicare, including raising the eligibility age and simplifying cost-sharing in the program.

In his remarks, Hatch said his committee would work on several measures to repeal elements of the health law — including its medical device tax and employer mandate — even though Obama would be likely to veto the measures.

“We can send them all to the president’s desk and have him try to explain to the American people why he’s right and they’re wrong,” Hatch said.

While House Republicans have passed dozens of measures to repeal or weaken the health law, the Senate has not voted on many of those bills because until this month, Democrats controlled the chamber. With Republicans now in charge with 54 seats, odds are better that some of the repeal measures will see floor consideration. But the GOP will still need some Democratic support to reach಼ votes to avoid a filibuster, and they are unlikely to garner enough Democratic support for the 67 votes needed to override a presidential veto.

This KHN story can be republished for free (details).

In a wide-ranging speech that also touched on tax reform, trade and pensions, Hatch said the first health-related bill the Finance Committee will consider is legislation the House passed earlier this month. It allows employers to exempt workers who received health coverage through the Defense or Veterans Affairs departments from the tally used to determine whether the employer is meeting the health law’s requirements for providing coverage.

Hatch said Republicans need to be ready with an alternative to the health law if the Supreme Court later this year strikes down the provision that provides premium subsidies for low- and middle-income people buying coverage on the federal exchanges. If that happens, “we’ll need to act to mitigate the additional damage Obamacare will inflict on the health care system,” he said, but he offered no specific remedies. Along with Sen. Richard Burr, R-N.C., and former Sen. Tom Coburn, R-Okla., Hatch last year co-sponsored a health law alternative that, among its provisions, would repeal the health law’s individual and employer mandates.

Hatch said while he prefers to find bipartisan solutions on health care and other topics, he did not rule out a procedure known as budget reconciliation that allows legislation to pass with 51 votes in the Senate rather than the 60 needed to stop a filibuster. A number of Republicans have suggested that reconciliation could be used to repeal major portions of the health law.

“Should we decide to go that route, I’ll work with my colleagues on the Budget Committee to make sure whatever we do under the Finance Committee’s jurisdiction is effective,” he said.

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Mass. Malpractice Reforms Offer Faster, More Open Process For Injured Patients

When a woman had gall bladder surgery at a Massachusetts hospital in 2013, doctors noticed something suspicious on a CT scan that they thought could be ovarian cancer. But the recommendation that the patient get a pelvic ultrasound fell through the cracks. Months later, she was diagnosed with stage 3 ovarian cancer.

Normally, this type of medical mistake could mark the start of a protracted malpractice lawsuit. But in Massachusetts, where medical, legal and consumer groups have worked together in support of a recently enacted law that tries to preempt litigation by establishing a process and timeframe for discussing mistakes, that’s not what happened, according to her attorney who recounted the case in an interview.

The Massachusetts State House

The Massachusetts State House

The law mandates that people give health care providers six months notice if they intend to sue. The woman’s lawyer notified the hospital of the mistake and the harm it had caused her: A delay in diagnosis that may have led to more extensive cancer treatment and, arguably, a higher risk that the cancer will recur.

Hospital officials, who had 150 days to respond, determined that their actions hadn’t met the standard of care. The hospital arranged a meeting between the woman and one of their physicians to talk about why the error occurred and the measures being taken to make sure it won’t happen again. The physician apologized, and soon after the woman accepted a financial settlement from the hospital.

The whole process took about a year, far less time than a drawn-out legal battle would have involved, says Jeffrey Catalano, the Boston attorney who represented the woman but declined to provide identifying details in the case.

“The hospital did the right thing,” he says. “My client felt really good about it. She felt like she was heard.”

More from this series

Traditionally, medical liability reform has focused on laws that set caps on the dollar amount that plaintiffs can receive in damages. But interest in non-traditional types of medical liability reform has been growing, spurred on by dissatisfaction with so-called “deny and defend” adversarial systems that often result in lengthy and expensive legal proceedings when a medical error occurs.

In the national health care debate, the issue has been a key dividing line between Democrats and Republicans. The GOP generally supports capping damage awards as a way to rein in frivolous medical malpractice lawsuits and keep health care costs down. Democrats, supported by the trial lawyers lobby, argue that the Republican strategy is ineffective and leaves patients who have been injured with inadequate recourse. After the health law passed, President Barack Obama offered to work with Republicans on the issue. In 2010, his administration awarded $23 million in planning and demonstration grants around the country as part of a patient safety and medical liability reform initiative.

Boston’s Beth Israel Deaconess Medical Center and the Massachusetts Medical Society received a planning grant for $274ꯠ to develop a roadmap for a statewide communication, apology and resolution (CARe) system modeled after a successful program at the University of Michigan.

“Our effort was to take a model that had been very successful in a closed [health care] system and see if we could create an environment to implement it in a much broader way,” says Dr. Alan Woodward, a retired emergency physician who chairs the Massachusetts Medical Society’s Committee on Professional Liability.

Communication and resolution programs are gaining in popularity. Advocates emphasize moving quickly when a medical error is made to discuss it with the patient and the patient’s family, apologize and, if the standard of care has not been met, offer compensation.

In Massachusetts, six hospitals joined a pilot project to implement the model. Medical, legal and consumer groups that had participated in developing the roadmap formed a health care alliance to exchange information and develop best practices, and provide support for the hospital pilot projects.

In turn, that state law bolsters the alliance’s efforts to change how medical injuries are addressed. In addition to the six-month “cooling off” period before a suit can be filed, the law requires that patients be told when medical mistakes are made that result in unexpected complications and allows providers to apologize for unanticipated outcomes without fear their words will be used against them in court.

While many health systems and states are experimenting with non-traditional forms of medical liability reform, Massachusetts’ efforts are among the more comprehensive.

The broad-based Massachusetts’ effort is modeled after the University of Michigan’s communication and resolution program. Since the program began in 2001, it had reduced the rates of average monthly new claims and average monthly lawsuits, while cutting the time to resolve disputes and legal costs, a 20Ǫ study published in the Annals of Internal Medicine found.

Saving money shouldn’t be the primary motivation for adopting a program, says Richard Boothman, the chief risk officer for University of Michigan health system and the man who pioneered their program. Patient safety is the goal.

“The very best risk management is to not hurt anybody in avoidable ways, and the second best [strategy] if we do hurt someone is not to do it again,” he says.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

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Viewpoints: Assaults On Abortion Rights; Shifting From Employer-Provided Health Care

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State Highlights: Calif. Health Providers’ Dispute Threatens Coverage; Mass. Focuses On Cost Control

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Minn. Study Compares Patient Health Status By National Origin, Native Language

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California Nurses Association Calls Off Strike Against Kaiser Permanente

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Health Law Co-Ops Go Toe-To-Toe With Insurance Giants

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Consumers Find Wide Disparities In Health Marketplace Premiums

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GOP Lawmakers Continue To Contemplate Best Strategy To Undo Health Law

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Tavenner’s Departure Comes As Health Law Faces Another High Court Challenge

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