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High-deductible health plans are billed as a way for small businesses to provide coverage for their employees, mainly by shifting costs to their staffers. While this strategy has had some success, there are big downsides. Employees are often surprised by the high costs, and many employees don't really save any money.
Two serious patient treatment lapses last summer have placed Harbor-UCLA Medical Center, southern Los Angeles County’s cornerstone of emergency care, on the defensive as state inspectors documented the incidents during a surprise visit last fall. One of the cases, a psychiatric patient who refused food and water for as long as 16 days, died after the psychiatric unit failed to monitor his condition, records show. In the second lapse, a patient nearly died because of significant blood loss during elective knee replacement surgery. The death was among a string of problems at Harbor-UCLA detailed in Medicare inspection reports since 2009. Harbor-UCLA officials said last week that they have made an array of changes to improve patient care, and inspectors determined in January that problems found during earlier visits have been resolved.
The call comes in and, for the 10th, 12th, or 20th time, paramedics take a middle-aged man from the streets to the ER. Such frequent users cost the emergency medical system millions, yet don't get the help they need. This five-part series examines the problem of frequent users of emergency services. The frequent 911 users in this series are the most chronic users of the emergency room and can defy institutional, government-based, solutions. They will remain a challenge no matter what becomes of the health reform law currently under U.S. Supreme Court review.
At a time when it’s becoming harder to get a doctor’s appointment, your local school may be the place to turn. School health centers are expanding across California with the help of funding from the federal health care law. And they’re emerging as a model for improving public health in low-income areas for students and community members. An iconic high school near downtown Los Angeles houses one of these clinics that's been open for 10 years. Patients can visit the community clinic on the Abraham Lincoln High School campus and see a nurse, doctor, dentist or counselor for free.
The practice of scheduling an early childbirth may be on the way out in California and the United States. Research shows that newborns have heightened health risks when deliveries occur in the 37th and 38th weeks of pregnancy. That’s led growing numbers of hospitals to prohibit doctors from scheduling deliveries during that time, unless there is a medical reason to deliver. It’s a pendulum swing for a practice of 'elective deliveries' that had gained growing favor, among both doctors and mothers, for the convenience of having a delivery on a date certain. The new trend also is shining a spotlight on labor inductions, which are now quite common but which carry their own risks of complications.
Almost two decades ago, the state made Sacramento County the testing ground for a new model of delivering dental care to poor children. Officials envisioned a managed care system that would control costs and improve children’s ability to see a dentist. Today that model persists – but state data shows that the county has consistently produced one of California’s worst records for care. In 2010, only 30 percent of more than 110,000 Sacramento children with Medi-Cal – the government insurance program for the poor – saw a dentist, according to state data. By comparison, nearly half of their Medi-Cal peers statewide visited a dental office. That year, the county ranked third worst in terms of the percentage of kids who got care - above only rural Alpine and Trinity counties. During the three previous years, it was the state's lowest performing children's dental system, state numbers show.
The day when doctors and mothers-to-be schedule early deliveries may be coming to an end. Hospitals are cracking down on a practice that many practitioners and pregnant women have favored because of the convenience factor. But studies have demonstrated that the practice can be harmful to newborns, and inevitably drives up hospital costs. Some hospitals are telling doctors they'll have to go elsewhere if they want to schedule an early delivery.
For millions of Americans, bagged salads are a miracle food, the perfect mix of health and convenience. They don’t want to think about E. coli O157:H7, which in 2006 tainted spinach in an outbreak that killed five people and sent 100 more to the hospital. And the salad industry doesn’t want them thinking about it either. The safety of bagged greens has emerged as one of the most pressing issues in today’s fresh produce business. It’s why industry and government are investing millions to avoid debacles such as the death of 30 people last year after eating poorly washed, listeria-laced cantaloupe. It’s why food companies are rushing to find the “perfect wash.”
There are so many things Chuck Magner wishes now that he'd known about his father's illness and his doctors' proposed cure. Chief among them is this: that his father, Jerry, who had a history of vascular problems, lived in a part of Northern California where he was much more likely to be recommended for a risky surgical procedure designed to prevent strokes. Jerry Magner's story is a case study of the kinds of information patients and their families need to find out from their doctors and hospitals, but also of the difficulty they encounter trying to get the answers.
Five years after the Salinas Valley became the epicenter of a national food disaster when an E. coli outbreak was linked to spinach grown there, valley farmers have retooled almost every step in their industry to ensure the safety of their produce. One result is that they helped develop state food safety standards that are being held up as a national model.
For many years California has had the notable distinction of having the lowest reimbursement rates in the country for Medi-Cal, its program to subsidize health costs for the poor. But because of the state’s budget crisis, Medi-Cal is getting even skimpier, with a new 10 percent cut taking effect. Toby Douglas, who oversees the Medi-Cal program, argues that recipients will continue to have access to critical health services. But in a question-and-answer session with senior writer Emily Bazar, he acknowledges that they may have to see a different doctor, at a different time, at a different location.
Insurers, hospitals and government agencies say it's possible to cut health costs and improve patient care at the same time. They're using sophisticated data to identify doctors and other health providers who are using outmoded or unnecessary procedures, and pressuring them to come into line. In some cases it's choosing a non-invasive procedure over an older, invasive type. In other cases it's using new research data to discard a practice that's been found to be ineffective. But doctors are concerned that they're losing the ability to respond effectively to individual cases. The president of the Amerian Medical Association, Peter Carmel notes that, "if there are two treatments ou there in play for a given condition, most commercial interests will choose the cheaper."
State budget cuts may force thousands of poor elderly and disabled Californians to lose access to the day centers where they receive meals, therapy and medical care, as well as companionship and a sense of community. The state’s elimination of the Medi-Cal Adult Day Health Care (ADHC) benefit – slated for Dec. 1 – could endanger some of California’s frailest individuals, people who suffer from multiple disabilities including dementia, incontinence, paralysis and traumatic brain injury. As the centers are forced to close, advocates say, many will be left home alone and at high risk of landing in emergency rooms and nursing homes. Los Angeles County – especially its many ethnic minority communities –will be hit hardest by the closures. According to state data, the county is home to more than 60 percent of the program’s 38,000 enrollees statewide.
California hospitals have repeatedly bought themselves extra time to make their structures capable of withstanding a major earthquake. But even when this shoring up work is completed, it will be years and even decades before many hospitals will really be able to operate after an earthquake. That’s because California law allows them, in many cases, up to 2030 to make nonstructural upgrades. And recent quakes have shown that it’s these internal issues that mean hospitals are dead in the water after the shaking stops.
Doctors are increasingly are dealing with longtime patients who suddenly have lost their insurance or are now underinsured. The problem is particularly thorny because many practices themselves are hurting financially as patients save money by avoiding care. But some doctors are responding the old-fashioned country doctor way -- reducing or delaying fees for their services, jawboning pharmaceutical representatives to provide more drug samples, or leaning on specialists to give their patients a break. Said Dr. Eric Ramos of Modesto, "What I try to tell (longtime patients) is that until our relationship is severed by either you or me, I'm your physician."
Medical debt is at an all-time high in the United States, affecting about one in four adults under 65. Americans are being hit by a combination of higher health costs, unemployment and cutbacks in employer-provided insurance. To cope, financially strapped patients are turning to payday loans and credit cards to pay off their medical bills. Hospitals, meanwhile, are also squeezed trying to collect millions of dollars in bad debt. Some turn to collection agencies or, in a few cases, sell off patients’ debt on the markets, Wall Street-style. But hospitals’ collection rates aren’t what you might expect. So far, the government isn’t doing much to help. California has regulations in place to help protect some patients from medical debt, but many consider them weak on enforcement. And while the federal health care law could bring some relief, implementation is still a few years away – if the measure survives at all.
Residents in the Northern California town of Clearlake have been having two common heart procedures at five and six times the state average. Rates are also high across a wide swath of the Central Valley. These elevated numbers are partly a result of widespread health problems that show up in the population. But a new study suggests that the high rates go well beyond that, and researchers say the biggest cause may be clinical practice decisions made by doctors. The findings could have enormous implications for health costs and the quality of care. Insurers and government agencies are taking up the cause, increasingly using these so-called variation studies to pressure doctors to change their practices.
Thousands of California parents are choosing not to vaccinate their children, despite last year's record-setting whooping cough outbreak. And the number is growing, much to the alarm of pediatricians and state health officials. Over the past decade, "personal belief exemptions" (PBEs) have tripled. Signed by parents, the exemptions allow children to enter school missing some or all vaccines. Statewide, more than two percent of kindergarteners have such exemptions. With a 9.5 percent PBE rate -- more than four times the state average -- Santa Cruz County is close to ground zero in this often heated and emotional debate. State experts say that as long as 95 percent of a population is immunized, "herd immunity" keeps contagious diseases from spreading. But vaccine refusal tends to concentrate in geographical areas like northern Santa Cruz County, where close to 17 percent of incoming kindergarteners had PBEs on file last fall – one of California’s highest rates. "If they were scattered fairly evenly around the state, the implications would be much less concerning," said Dr. Rob Schechter, medical officer with the Immunization branch of the state Department of Public Health, which collects the statistics on student immunizations. "The fact that they are concentrated in communities, social networks and schools with much higher rates -- that allows disease to spread much more rapidly."
California’s foster care system often does a poor job of meeting foster children’s health needs, thanks to the often haphazard way their medical records are kept. By law, each time a foster youth in California is relocated, a comprehensive paper file of their medical records called a “health passport” is to be promptly forwarded with them to their new caregiver. But this doesn’t always happen, according to many foster care experts -- sometimes with potentially serious consequences. A growing number of child-welfare advocates are calling for the creation of a statewide electronic health passport system that would allow authorized health care providers to access a foster youth’s medical history online. Advocates say that such a computerized system could greatly improve medical care for already-traumatized children who have suffered more than their share of hardship and deprivation.
A flawed Medicare policy has contributed to the suffering of American kidney patients for decades. While the federal entitlement program covers a lifetime of costly dialysis treatments, it provides only 36 months of anti-rejection medications that kidney transplant recipients need the rest of their lives. Without the drugs, the kidney fails and recipients return to the dialysis regimen, sometimes waiting years for the next kidney transplant. The counter-intuitive policy keeps patients in a U.S. dialysis system with some of the worst mortality rates in the world, and wastes the precious resource of donated kidneys. It can cost taxpayers millions more in the long run. Yet, attempts by lawmakers to remedy the problem have been defeated by lobbying from a multi-billion dollar dialysis industry that wants to ensure that monies for the transplant drugs do not come from the government's dialysis budget. Among the key lobbyists is dialysis drug maker Amgen of Thousand Oaks.
California legislators are moving to delay implementation of a new vaccine requirement aimed at stopping the spread of whooping cough. School officials said it would have been impossible to meet a fall deadline for administering a vaccine to 3 million middle school and high school students.
The term "obesity epidemic" is often in the news these days. For residents of Fresno County, in the heart of the health-challenged San Joaquin Valley, that issue hits particularly close to home. About 36 percent of adolescents, ages 12 - 17, are overweight or obese. Their parents fare even worse -- fifty-seven percent of the county's adults are overweight or obese. This project includes two radio stories produced for Valley Public Radio. The first focuses on an obese teenager who says his diabetes diagnosis saved his life. The second radio piece looks at obesity prevention in Fresno. Among the voices is a nutrition educator, who is overweight herself. She is struggling to get healthier alongside her students. The project includes a Center-organized expert panel on obesity education, prevention and policy, featured on Valley Public Radio's Quality of Life program.
Every year, an estimated 200,000 Californians fall victim to an infection acquired in a hospital. For a surprisingly large number, the infection is life-ending. About 12,000 people die every year from hospital infections in California, more than three times the number of people who die from auto accidents in the state. Even so, these deaths often occur in the shadows, with little or no public accounting. Are hospitals and government regulators doing all they can to stop or limit the spread of hospital infections? Some critics say the answer is no. In California, the state's Department of Public Health comes in for particular criticism, in part because it has been slow to implement legislation passed in 2006 and 2008 addressing the problem.
One of the most important principles of federal health reform is that more health services must be delivered outside of hospitals and nursing homes. The federal government is providing billions of dollars to encourage state and local governments to achieve that aim. Simultaneously, though, cash-strapped state and local governments are slashing programs like Adult Day Health Care that are critical pieces of this initiative. The result? In some cases, people are being forced back into institutional care.
Health reform is on its way to low-income residents of rural California, including Humboldt and Del Norte counties along the northern coast. A consortium of 34 rural counties has applied to participate in the “Bridge to Health Reform,” a $10-billion federally financed expansion of statewide public health coverage. While backers are convinced it will save health care services in these sparsely populated, budget-challenged counties, skepticism abounds among Redwood Country health professionals that the new health order is not tailored to their needs.
The smallest and most isolated counties in California have banded together to implement the expanded health coverage mandated by the Patient Protection and Affordable Care Act, better known as health reform. Under the bureaucratic umbrella of the relatively obscure County Medical Services Program, they will seek to provide the state’s poorest, most isolated patients with a “medical home,” something like a publicly funded HMO. But even as they forge ahead, they ask fundamental questions: Where will we find the primary care doctors needed? The specialists? The enrollment staff? And will the state and federal officials in charge of distributing the matching funds in support of the effort do so quickly enough to keep the program alive?
Doctors in Stanislaus County say mounting numbers of out-of-work professionals and laid-off blue collar workers have joined the chronically poor and undocumented in clinic waiting rooms throughout the region, threatening to overwhelm its fragile safety net. The deep recession has pushed the ranks of Central Valley uninsured to unprecedented levels, while a dire state budget deficit has forced lawmakers to cut key health care programs for the state’s poorest residents. These two trends reveal a troubling new reality: Across class lines, people are struggling to access care -- or simply are going without.
California's new insurance commissioner promises to use every available power to scrutinize health insurers' rates, which he says are too high. But Dave Jones cautions consumers not to expect too much from his office. Most of the rate increases will take place, he says, because he lacks fundamental authority to roll them back. He renews calls for the legislature to give him new powers.
California's Latinos have by far the biggest stake in the future of health reform, accounting for more than half of the uninsured population that will be newly eligible for its publicly funded medical coverage. Even after deducting undocumented immigrants, who are excluded, approximately 2.1 million of the 3.9 million uninsured people eligible statewide are Latino, according to a recent study. If the new law clears the political and legal hurdles it faces to become a functional medical system by its 2014 full- implementation date, experts believe it could transform the long-suffering health profile of California’s Latino community. If repealed, advocates say, the state’s Latinos could be relegated to a perpetual state of limited medical access.
California consumers were urged not to read too much into its first-ever report on hospital-acquired infections. In fact, though, the report suggests some wide differences in performance, and interviews with hospital officials show that many medical centers are working intensely to reduce their infection numbers. In some places, these efforts appear to be paying off.
Why do women often pay higher insurance premiums than men? According to insurance companies, it’s all based on claims experience. And partly because of the costs of child-bearing, women on average pay higher rates. But starting Jan. 1, 2011, insurers in California can no longer take differences between men and women into account. Because of a new California law, gender-based premiums join other banned categories such as race, ethnicity and religion. The upshot is that, on the private insurance market, rates will go down for many women. But for a few, especially older beneficiaries, the tables get turned and men get the lower rates.
California has the nation's oldest doctor population, and in few places is it more evident than in scenic, rural Mendocino County, where more than half the physicians are 56 or older. Hospital administrators, experts and the physicians themselves worry about who is going to care for the sick and elderly -- baby boom doctors are retiring just as members of their generation are themselves heading into old age -- and the answers are not satisfying.
With the start of 2011, the first of the nation’s 75 million baby boomers will reach age 65, setting the stage for a huge retirement rush that could swamp the health care system. Nowhere is the challenge bigger than in California, with the nation’s largest boomer population and a safety net already under enormous financial pressure. Boomers may expect to face doctor shortages, changing family dynamics that determine how they’re cared for as they age, and a health care system less centered on hospitals and nursing homes, and more focused on cost savings. With government resources tapped out, they can expect to shoulder more of their own health costs.
In January 2011, California becomes the last of the big states to disclose the incidence of hospital-caused infections. Hospital infections kill an estimated 13,500 Californians a year, but critics say the state’s hospitals and health department remain far behind other states in waging war against this largely preventable scourge. The new law doesn’t require identification of where deaths occurred and doesn’t include surgery centers, which account for a growing number of surgeries.
No county in California has a worse record than Riverside County for processing Medi-Cal applications. In a recent audit, the county failed to meet deadlines for processing new applications 30.8 percent of the time, or three times the maximum allowed by federal and state law. Riverside is the only California county that has failed to meet Medi-Cal enrollment deadlines every year since the current monitoring system began in 2004. The county has been swamped with a state-high 30 percent increase in beneficiaries for Medi-Cal, the government's health program for the poor and disabled. Its struggle to handle the influx does not bode well for the state’s ability to handle a wave of new Medi-Cal applicants that will come via health reform in 2014.
The Inland Empire is a new testing ground for whether the federal government and health consumers can finally do something about rising health costs. Medicare is rolling out a new competitive bidding program that it says will reduce the costs of certain medical equipment by 30 percent or more. Yet what would seem to be a classic, all-American way to deal with pricing – through competition – and with happy winners – taxpayers and Medicare recipients -- turns out not to be that simple. We dive into the debate over the program.
Health reform offers up a big benefit for young adults who haven’t been able to get their own health insurance. Many of them will be able to return to their parents’ insurance policies, up to age 26. This provision is expected to give hundreds of thousands of young adults a bit of breathing room in their hunt for decent medical coverage. (Also published in the LA Daily News, the San Gabriel Valley Tribune, the Whittier News, the Torrance Daily Breeze, and Neon Tommy).
Joblessness is a scourge that hits hard at workers trying to make a life for their families. But it also hits hard at the families themselves, including the children. In San Luis Obispo, children are acting up in school and at home, self-medicating with drugs and alcohol, and suffering from mental health problems such as depression and anxiety. Meanwhile, the institutions that normally serve families – schools, county agencies, churches and nonprofits – are grappling with budget cuts and are slashing services.
Since the town’s clinic closed last year, residents of tiny Doyle, California, now have to travel more than 40 miles one-way to see a doctor. We look at health access in California’s far north, where the lagging economy has forced six rural clinics to close their doors and left the poor and elderly increasingly shut out from health care.
Kern County, with some of the state’s highest rates for diabetes, heart disease and obesity, is home to a test case for the federal government’s new Health Care Coverage Initiative. We examine the successes and challenges of an innovative health care demonstration program for the county’s lower-income population that provides them with a publicly funded “medical home.”
Health reform will offer special incentives to small businesses who continue coverage for their employees – tax cuts covering up to 35 percent of their costs. But that’s of little consolation to many business owners, many of whom are getting rate increases that exceed the tax credits. Some think it’s fishy. (Also published in the Ventura County Star).
There is hope at last for tens of thousands of Californians unable to get health coverage because of pre-existing conditions. The state is establishing a new high-risk pool with more than $750 million in federal money to widen coverage. The new program is a bridge to 2014, when denials of coverage based on pre-existing conditions will be banned.
In the winter, Butte County suffers from a number of bad air quality days that have serious health consequences for the elderly and those with respiratory conditions. We examine the politics and science behind the debate over whether wood stove-generated smoke pollution constitutes a threat to residents’ health. In a county with a long history of heavy dependence on stoves as a source of heat and a bountiful supply of inexpensive wood, this is a heated question.
The nation’s 75 million baby boomers, it turns out, are not immune from the crisis in health care. Economic problems are hitting many Ventura County middle-class baby boomers with loss of jobs and health insurance, and the safety net they paid into during better times was not designed to help them. Uninsured patients ages 45-64 nearly doubled at county hospitals and clinics between 2005 and 2009.
Health reform will have its largest impact in California four years from now. But in the wake of historic passage by Congress, the health overhaul will have multiple immediate effects. Here’s a look. (Also published in the Merced Sun-Star, the Modesto Bee, the Sacramento Bee and the San Luis Obispo Tribune).
The foreclosure of a home is more than a financial transaction. It also is a hidden human drama. Merced County ranked first in California for foreclosure filings in 2009, and sixth among counties nationwide. With one in seven county homes foreclosed on since September 2006, we examine the psychological problems, including anxiety, sleeplessness and depression, wreaked by the local foreclosure crisis, which shows no sign of abating.
Santa Cruz’s Healthy Kids program was wildly successful until 2009, when the battered economy threatened its funding. Like 28 other programs in California, the county’s Healthy Kids program was lauded for providing health coverage for virtually every poor child who was not otherwise insured, regardless of immigration status. By early 2010, however, the program had reached a crossroads: it was forced to freeze enrollment and faced financial struggle.
What impact does the quality of a board of directors, selected by voters, have on the quality of care at public hospitals? It turns out it matters a lot. An analysis of hospitals in North San Diego County shows how decisions made at the ballot box can have a huge effect on a hospital’s success or distress.
The smoke inhalation from long-burning forest fires in northern California extracts a huge, frightening toll on residents’ respiratory health. We measure the ill effects and suggest potential remedies.
In the past two years, many of Santa Cruz County’s elderly and disabled patients have been shut out from a primary care system that has no room for them. Fed up with the low reimbursement rates paid by the federal insurance program for the elderly and disabled, many Santa Cruz County-based doctors have refused to accept new Medicare patients. The series investigates the breakdown in care and the prospects for fixing it.
Nowhere in California are people more likely to die of diabetes than in the eight counties that make up the state’s Central Valley. The disease has reached epidemic proportions in the valley, where it touches one of every ten residents. An analysis by the Center paints a disturbing, detailed picture of the toll diabetes reaps among the valley’s 3 million residents.
What are prospects for bringing a medical school to the University of California’s newest and smallest campus, and to a valley population of 3 million burdened by poverty and lack of access to care? We survey politicians, university officials, representatives of the valley business community, health care workers and farm workers to look at the implications such a school would have on valley health, as well as the impediments the proposal faces.
The call comes in and, for the 10th, 12th, or 20th time, paramedics take a middle-aged man from the streets to the ER. Such frequent users cost the emergency medical system millions, yet don't get the help they need.
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Part 1: The problem
Part 2: The streets
Part 3: The emergency room
Part 4: A new model
Part 5: Frequent Users - Joan Kloh
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