3 Lessons Learned: Counseling

The Counselor Who Brings Back Joy Certain conditions that may face an individual may call for psychological assistance. These are low moments when everything seems not to work. One may also feel discouraged in life due to the occurrence of a certain event. It is also possible that an individual is undergoing frustrations due to consistent failure in an issue.… More →

Court Decision Leaves Undocumented Immigrants’ Health Care Options In Limbo

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Erica Torres is one of the estimated 1.4 million Californians who live without health insurance largely because they are undocumented.
She was hopeful when President Barack Obama expanded deportation-relief programs for undocumented immigrants — a controversial move that would have put government-subsidized health care within her reach.
But last month’s Supreme Court decision suspending Obama’s order has derailed that aspiration, leaving Torres’ future — and her health insurance options — in limbo.
“I haven’t had insurance since my son [now 7] was born,” said the 44-year-old Torres, who lives in the Southern California suburb of Canoga Park. “I thought this was one possibility, that maybe I would qualify for Medi-Cal.”

For undocumented immigrants, finding affordable health care has been an ongoing battle. They’ve claimed some victories — undocumented children in California, for example, can now enroll in Medi-Cal, the state’s Medicaid program.
But there are few low-cost health care options for adults who are in the country illegally.
The U.S. Supreme Court’s split decision last month, which temporarily blocked Obama’s deportation-relief programs, leaves millions of undocumented immigrants in California and across the nation facing deep uncertainty.
Miranda Dietz, a researcher at the University of California, Berkeley Center for Labor Research and Education who has studied immigrants and health care, said the Supreme Court’s ruling means that fewer undocumented people in California will have access to health insurance, either from Medi-Cal, college enrollment or employer coverage.

Torres, who came to the United States illegally 17 years ago, had set her hopes on one of the deportation-relief programs affected by the Supreme Court decision, known as Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA). The program would grant adults who have lived in the country continuously since 2010 and have a U.S.-born child protection from deportation.
Eligibility for the program would allow this group of undocumented adults to apply for work permits. And in California, they also could apply for Medi-Cal, as long as they met the income criteria.
Because her son was born in the United States, Torres would be eligible to apply for DAPA. She already had gathered the paperwork she thought she’d need.
But last month’s Supreme Court decision let stand a lower court ruling that blocked the program, which had not yet taken effect because of the legal challenges. The ruling means that, at least for now, Torres still can’t apply for Medi-Cal.
“It was disappointing and frustrating,” Torres said. She had been feeling confident that she’d soon have a sense of security, and with it, access to basic preventive care.
The Supreme Court decision also blocked, at least temporarily, Obama’s planned expansion of another program, known as Deferred Action for Childhood Arrivals (DACA), the controversial deportation-relief program for undocumented youth. The expansion would have raised the age limit for inclusion in the program, making it available to a larger group of people, who would have been eligible for Medicaid health coverage
California health advocates note that the Supreme Court’s ruling is temporary and will most likely be retried. Last week, the U.S. Department of Justice filed a petition with the Supreme Court, requesting a rehearing of the case. But if and when that rehearing will take place will likely depend on the result of presidential election.
The original DACA program, which has allowed 700,000 undocumented young people to stay in the U.S. since 2012, is not affected by the Supreme Court ruling. Current participants in that program retain their rights, including access to Medi-Cal for those living in California.
Researchers at UCLA’s Center for Health Policy Research and UC Berkeley’s Labor Center estimate that in California, between 310,000 and 440,000 undocumented adults could be eligible for Medi-Cal if the expansion of the two programs ultimately is allowed.
But how many immigrants actually would sign up is hard to determine, the researchers say. As of mid-2014, 154,000 people in California were granted protection under DACA, of which 125,000 were eligible for Medi-Cal. Yet fewer than 11,000 of them actually signed up for it, the UCLA and UC Berkeley research showed.

But those are just estimates, UC Berkeley’s Dietz explained. There is no box that DACA participants can check allowing the California Department of Health Care Services, which runs Medi-Cal, to identify applicants who are part of the deportation-relief program.
“The best estimate we have is from early to mid 2014, and it looks pretty low,” Dietz said.” Some of that is due to people not knowing [about Medi-Cal]. In early 2014, there were a lot of changes going on in the health care system and there was some confusion about eligibility.”
Dietz said it is important to get the word out that the original DACA program still exists. The Supreme Court’s decision is a missed opportunity, said Denisse Rojas, Dietz’ colleague and a beneficiary of the DACA program. Rojas is a medical student and cofounder of Pre-Health Dreamers, an information-sharing network for undocumented students pursuing careers in health care.
“There are great programs and assistance for [undocumented] youth,” she said, “but there is not much for adults, and there is an urgency for adults who are aging, especially those with chronic conditions.”
Rojas added: “Undocumented youth have been labeled as deserving and high achieving, and therefore have different points of access [to health care]. Meanwhile adults — our parents — have been blamed.”
Back in Canoga Park, Torres worries about her health, especially with her family history of diabetes. She only visits a doctor when she’s feeling very ill, she said. Preventive checkups are not a common practice for her.
Her husband, who works at a nursery, has coverage through his job. But they can’t afford the cost of adding her to his health plan. Their son is covered through Medi-Cal.
When she was pregnant, Torres bought health insurance. She had a high-risk pregnancy and figured that she’d receive better prenatal care by paying for her coverage, rather than receiving the free coverage offered through a limited-benefit version of Medi-Cal, which pregnant women may qualify for regardless of their immigration status.
“We were paying $400 a month,” Torres said. “We can’t always afford that.”
Torres volunteers with the Coalition for Humane Immigrant Rights of Los Angeles, an advocacy group, where she learned about access to health care through county-run programs. Some coverage is available to her in Los Angeles by a county-based health care program, but it’s not offered everywhere in the state. It is not available to someone living in nearby Kern County, for example.
She has also considered purchasing a health plan through Covered California, the state insurance exchange. Although the Affordable Care Act bars people living in the country illegally from buying policies on the exchanges, that might change in California.
California officials are asking the federal government for an exemption from that rule. If granted, California would become the first state to allow undocumented immigrants to buy health coverage on the exchange, which has caused controversy with opponents who argue California must address costs and other issues with its current health care system before growing the pool.
While access to the exchange could potentially help some, others like Torres wouldn’t be able to afford it without subsidies, she said.
Torres hopes the Supreme Court will ultimately overturn its decision, allowing her to get Medi-Cal through the DAPA program.
“We won’t give up,” Torres said. “And we can’t lose hope.”
This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Study: 30 Percent Of Children’s Readmissions To Hospitals May Be Preventable

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One of the key indicators of the quality of a hospital’s care is how frequently its patients are readmitted within a month after being discharged. A study this month examined readmission rates for pediatric patients and found that nearly 30 percent of them may have been preventable.
The study, published online by the journal Pediatrics, reviewed the medical records and conducted interviews with clinicians and parents of 305 children who were readmitted within 30 days to Boston Children’s Hospital between December 2012 and February 2013. It excluded planned readmissions such as those for chemotherapy.
Overall, 6.5 percent of patients were readmitted during the study period.

The study found that 29.5 percent of the pediatric readmissions were potentially preventable. In more than three-quarters of those cases, researchers determined that hospital-related factors played a role. A significantly smaller proportion were related to the patient (39.2 percent), often because of issues that arose after discharge, or the primary care physician (14.5 percent). (Multiple factors played a role in some patients’ readmissions, so the total exceeds 100 percent.)
The most common hospital-related reasons had to do with how patients are assessed, postoperative complications or hospital-acquired conditions.
“One of the things we need to improve upon is engaging families at the time of discharge around how we’re feeling and how they’re feeling about the status of the child at that point in time,” said Dr. Sara Toomey, the study’s lead author, who is the medical director of patient experience at Boston Children’s Hospital and an assistant professor at Harvard Medical School.
Sometimes clinicians and family members may be overly optimistic about a child’s readiness to go home, Toomey said.
When policymakers discuss the importance of reducing hospital readmissions, they typically focus on older patients, who make up a much larger proportion of hospital patients than do pediatric patients. The Medicare program, which provides health benefits for Americans age 65 and older, imposes financial penalties on hospitals whose readmission rates are too high.
The federal Centers for Medicare & Medicaid Services doesn’t penalize hospitals for pediatric readmissions, but a growing number of states are doing so, the study found.
Readmissions will never be completely avoidable, Toomey said. Still, “when you have a child coming home from the hospital, there are things you need to know, and the more active people are in creating a plan and making sure they understand it, the better that will help their children.”
Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

30 Percent Of Children’s Readmissions To Hospitals May Be Preventable: Study

andrewsthumb

One of the key indicators of the quality of a hospital’s care is how frequently its patients are readmitted within a month after being discharged. A study this month examined readmission rates for pediatric patients and found that nearly 30 percent of them may have been preventable.
The study, published online by the journal Pediatrics, reviewed the medical records and conducted interviews with clinicians and parents of 305 children who were readmitted within 30 days to Boston Children’s Hospital between December 2012 and February 2013. It excluded planned readmissions such as those for chemotherapy.
Overall, 6.5 percent of patients were readmitted during the study period.

The study found that 29.5 percent of the pediatric readmissions were potentially preventable. In more than three-quarters of those cases, researchers determined that hospital-related factors played a role. A significantly smaller proportion were related to the patient (39.2 percent), often because of issues that arose after discharge, or the primary care physician (14.5 percent). (Multiple factors played a role in some patients’ readmissions, so the total exceeds 100 percent.)
The most common hospital-related reasons had to do with how patients are assessed, postoperative complications or hospital-acquired conditions.
“One of the things we need to improve upon is engaging families at the time of discharge around how we’re feeling and how they’re feeling about the status of the child at that point in time,” said Dr. Sara Toomey, the study’s lead author, who is the medical director of patient experience at Boston Children’s Hospital and an assistant professor at Harvard Medical School.
Sometimes clinicians and family members may be overly optimistic about a child’s readiness to go home, Toomey said.
When policymakers discuss the importance of reducing hospital readmissions, they typically focus on older patients, who make up a much larger proportion of hospital patients than do pediatric patients. The Medicare program, which provides health benefits for Americans age 65 and older, imposes financial penalties on hospitals whose readmission rates are too high.
The federal Centers for Medicare & Medicaid Services doesn’t penalize hospitals for pediatric readmissions, but a growing number of states are doing so, the study found.
Readmissions will never be completely avoidable, Toomey said. Still, “when you have a child coming home from the hospital, there are things you need to know, and the more active people are in creating a plan and making sure they understand it, the better that will help their children.”
Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Seniors Who Live Alone Likeliest To Rate Their Health Highly, Study Says

People over 65 who live alone were more likely to describe their health as excellent or very good than were seniors who live with others, according to a study exploring connections between older Americans’ health status and their living arrangements.
Conversely, older people living with others — whether related or unrelated to them — were significantly less likely to call their health as excellent or very good, researchers reported recently in the Journal of Applied Gerontology.
That may be because when seniors encounter serious health problems and mounting physical difficulties, they often stop living by themselves and choose to live with others for support, they speculated.

But the researchers said they drew no conclusions about whether keeping a solitary household in old age leads to a longer life.
In fact, living alone wasn’t superior in every way for people over 65, according to the study. Those who share a home with a spouse or partner were less likely to report serious psychological distress than were older people without companions, a finding that meshes with prior research.
“Their physical health was better living alone rather than with a spouse or partner, but the mental health from living alone was worse,” said Judith D. Weissman, the study’s lead author. She is an epidemiologist and research manager in the Department of Medicine at the New York University School of Medicine.
Mental health affects physical health and that’s why older adults’ psychological wellbeing deserves more attention, she said.
“From a policy standpoint, it indicates we may have to provide either emotional or mental support for seniors living alone,” Weissman said.
The study was based on data for 41,603 adults 65 and older collected in six years of federal surveys. Researchers studied people living alone, with a spouse or partner, with others related or unrelated, or living only with children.
Researchers also discovered the relationship between living arrangements and health differed for men and women.
For instance, older men living alone were less likely to report having two or more chronic health conditions — such as cancer or diabetes — than counterparts in households with spouses or partners. They were also less likely to report their health as fair or poor.
The opposite was true for women on both counts: Those on their own were more likely to report multiple health conditions than the ones with spouses or partners. Yet, they were also more likely to describe their health as excellent or very good.
“This apparent paradox may be difficult to untangle due to the varied life experiences that lead women to live alone,” researchers said.
For example, they said, older women are more likely to be widowed and after becoming widows, they tend to live alone.
KHN’s coverage of aging and long term care issues is supported in part by a grant from The SCAN Foundation.Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Seniors Who Live Alone Likeliest To Rate Their Health Highly: Study

People over 65 who live alone were more likely to describe their health as excellent or very good than were seniors who live with others, according to a study exploring connections between older Americans’ health status and their living arrangements.
Conversely, older people living with others — whether related or unrelated to them — were significantly less likely to call their health as excellent or very good, researchers reported recently in the Journal of Applied Gerontology.
That may be because when seniors encounter serious health problems and mounting physical difficulties, they often stop living by themselves and choose to live with others for support, they speculated.

But the researchers said they drew no conclusions about whether keeping a solitary household in old age leads to a longer life.
In fact, living alone wasn’t superior in every way for people over 65, according to the study. Those who share a home with a spouse or partner were less likely to report serious psychological distress than were older people without companions, a finding that meshes with prior research.
“Their physical health was better living alone rather than with a spouse or partner, but the mental health from living alone was worse,” said Judith D. Weissman, the study’s lead author. She is an epidemiologist and research manager in the Department of Medicine at the New York University School of Medicine.
Mental health affects physical health and that’s why older adults’ psychological wellbeing deserves more attention, she said.
“From a policy standpoint, it indicates we may have to provide either emotional or mental support for seniors living alone,” Weissman said.
The study was based on data for 41,603 adults 65 and older collected in six years of federal surveys. Researchers studied people living alone, with a spouse or partner, with others related or unrelated, or living only with children.
Researchers also discovered the relationship between living arrangements and health differed for men and women.
For instance, older men living alone were less likely to report having two or more chronic health conditions — such as cancer or diabetes — than counterparts in households with spouses or partners. They were also less likely to report their health as fair or poor.
The opposite was true for women on both counts: Those on their own were more likely to report multiple health conditions than the ones with spouses or partners. Yet, they were also more likely to describe their health as excellent or very good.
“This apparent paradox may be difficult to untangle due to the varied life experiences that lead women to live alone,” researchers said.
For example, they said, older women are more likely to be widowed and after becoming widows, they tend to live alone.
KHN’s coverage of aging and long term care issues is supported in part by a grant from The SCAN Foundation.Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Children Exposed To Hepatitis C May Be Missing Out On Treatment

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Several times a month, Jessica Wen, a pediatrician specializing in liver diseases, has a teenager show up at her clinic at the Children’s Hospital of Philadelphia with an unexpected diagnosis: hepatitis C.
Hepatitis C virus, or HCV, is the most common bloodborne infection in the U.S. and a leading cause of liver failure and cancer. Injection drug use is a common risk factor, as is receiving a blood transfusion before 1992. But some of the teens Wen sees picked up the illness another way: at birth, from their mothers.
“I have diagnosed moms after diagnosing the kids,” Wen said, referring to mothers who have hepatitis C, didn’t know it and then passed it to their babies during childbirth. Wen estimates that about 1 or 2 of every 1,000 young children have chronic hepatitis C.
A study by the Philadelphia Department of Health points to what Wen and others in the medical profession see as a worrisome trend: Children with hepatitis C may be unaware of their diagnosis and the potential need for treatments down the road in order to prevent long-term liver damage.

Using city surveillance data, the study found that as many as 8 in 10 children at high risk for hepatitis C exposure in Philadelphia were never screened for the condition. More specifically, of the approximately 500 moms-to-be who were registered as having hepatitis C between 2011 and 2013, only 84 of their newborns, or about 16 percent, were tested for the virus by 20 months of age.
“Sixteen percent is really low,” said Danica Kuncio, lead author of the study. “When you think about children, you hope that the number would be 100 percent, that it should be in the interest of every provider to be doing the best they can to get information to the next provider.”
Kuncio, an epidemiologist with the city, worries that people who don’t know they contracted hepatitis C as babies won’t get the health care they need or realize they could spread the virus to others through blood-to-blood contact. It’s a concern intensified by a rise in both injection drug use and hepatitis C among women of childbearing age, she said.
“It’s a call to arms to figure out how we can do this better,” said Dr. Michael Narkewicz, who specializes in pediatric liver diseases and hepatitis C at the University of Colorado School of Medicine.
Not so long ago, the lack of drugs to cure hepatitis C made screening less of a priority. But in 2013, the Food and Drug Administration approved the first of several drugs that effectively eliminate the virus. Now, with access to these expensive medicines, the condition has gone from chronic and debilitating to curable.
Narkewicz and others say the next frontier is to prove these treatments are safe and effective in children. Clinical trials are underway, and he thinks the drugs could become available for children in the next year or two.
But unlike HIV, which has safe and effective treatments that can dramatically reduce transmission of the virus from mother to child, “for hepatitis C, there are no treatments to prevent transmission in a mom or in a newborn,” said Narkewicz.
Hepatitis C in children may be lacking attention for another reason: Perinatal transmission rates are a lot lower for hepatitis C compared to hepatitis B and HIV. For every 100 babies born to women with HCV, five to seven will contract the virus. Of those who do get it, 30 to 40 percent will clear it on their own before the age of two, said Narkewicz. That’s why the current protocols for children exposed to HCV call for monitoring and then screening them at 18 months with an antibody test.

But up to 15 percent of those born with HCV will develop a more aggressive form of the disease during adolescence, said Narkewicz, which can result in advanced fibrosis or liver scarring that can progress over time. “It’s a small percentage, but it’s still a real number,” he said.
The medical community really hasn’t done a good job of projecting the costs and benefits of early identification and treatment in children, according to Dr. Ravi Jhaveri, a pediatrician at UNC Children’s Hospital in Chapel Hill, N.C.
“A lot of these other issues related to mom-to-infant transmission, it really all fallen by the wayside,” Javeri said. “[The conversation] still falls on, we don’t have resources to treat patients that are the priority right now.”
Having new drugs to treat hepatitis C in children will be a game-changer, according to Dr. Regino Gonzalez-Peralta, a pediatrician at the University of Florida Health System in Gainesville.
“The old dogma was, why screen mothers if there’s nothing to be done?” said Gonzalez-Peralta, who has also been studying gaps in identifying children infected with HCV.
He said that while drugs to prevent transmission are not yet available, there are promising developments. “Now we’ve got drugs that potentially might be useful in preventing maternal-fetal transmission. This is going to become a hotter area,” he said.
Another issue under debate is universal screening for the virus. Dr. Damien Croft, an obstetrician at Hahnemann University Hospital in Philadelphia, doesn’t advocate it for everyone in the country. But he thinks it might be a good idea for his pool of patients. “There [are] enough women who are high risk for hepatitis C in Philadelphia that maybe we should consider doing that.”
Croft also thinks it’s important to improve communication between obstetricians and pediatricians so the pediatrician will know which children are at higher risk for having hepatitis C and can recommend screening.
In the meantime, Philadelphia’s health department has begun working with health care providers and at-risk mothers in the city to improve the testing of infants born to women with hepatitis C, and when necessary, linking mother or child to specialists.
This story is part of a reporting partnership with NPR, WHYY’s health show The Pulse and Kaiser Health News.Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Single Mom’s Search For Therapist Foiled By Insurance Companies

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A 12-year-old boy named Strazh hangs from the monkey bars, staring at the ground. The other kids in the park aren’t interested in him. And he’s not interested in them.
“I just like to play by myself,” he says.
Strazh has autism. Today is a good day. But on most others, Strazh has meltdowns. Something frustrates him and he can’t control his emotions.
“I sometimes end up screaming,” he says. “And I end up yelling and screaming.”
And hitting and banging things, throwing things, adds Strazh’s mom, Natalie Dunnege. As a single parent, she says she bears the brunt of it.
“He told me that I disgusted him,” she says softly. “He tells me he hates me.”

Dunnege puts all her spare money into therapy for Strazh. She says it helps a lot. But Dunnege herself is struggling, feeling depressed and overwhelmed. She decided to look for her own therapist.
“One of the things that I’ve really had to wrap my head around is that I can’t change him. I can only change how I handle the situation,” she explains. “And not that I would want to change who he is. He’s a really good kid, but it’s a lot to handle, especially as a single parent.”
But when she logged onto her insurance website to find a therapist, she realized her copay for a mental health visit was going to be upwards of $75 — more than double her copay for other doctors’ appointments. Under a 2008 federal mental health law, those copays are supposed to be the same.
“There’s no way,” Dunnege says. “It’s out of my budget right now.”
Dunnege lives in a one-bedroom apartment with her son and her father in San Francisco’s Haight district. Grandfather and grandson sleep in twin beds side by side. It’s an awkward walk past those beds to the only bathroom. Dunnege says $75 a week for therapy is impossible.
“My income, I just made lower middle income. Just by the skin of my teeth,” she says. “So I just have to hold off until I’m actually middle class.”

More than 43 million Americans suffer from depression, anxiety and other mental health conditions, according to the most recent federal data. But more than half the people who felt like they needed help last year, never got it. Even people who had insurance complained of barriers to care. Some said they still couldn’t afford it; some were embarrassed to ask for help. Others just couldn’t get through the red tape.
Recent health laws, the 2008 Mental Health Parity Act and the Affordable Care Act, were supposed to fix this. They require health plans to provide benefits for mental health conditions on par with physical health conditions. Under the law, insurance companies can’t charge higher copays or set up separate deductibles for mental health care compared to other medical or surgical care. They can’t limit hospital stays or require preauthorization for mental health treatment if the same limits are not applied to treatment for physical health conditions.
But advocates say insurance companies are still finding ways to keep people who need care from getting it. Some are still not complying with the law. And some have found subtle, technically legally, ways to limit treatment.
Problems With Mental Health Provider Directories
Natalie Dunnege encountered some of these barriers when she tried again to find a therapist. In the last year, she got a promotion at work and moved into a larger apartment. Her employer switched to a better health plan, too. Now she has Blue Shield coverage, and her copay for mental health appointments is only $20.
“Which I was really excited about,” Dunnege says.
But when she looked for a therapist who took her insurance, she struck out.
“I contacted six or seven,” she says.
Only three called her back.
“One of them, they were completely booked,” she says. “And then the other two just didn’t accept the insurance anymore.”
Zero hits out of seven. Had to be a bad draw, right?
To find out, we decided to conduct our own survey and called all the psychologists — 100 in total — that were listed on the Blue Shield website for Natalie’s plan in San Francisco.
Here’s what happened:

The end result: 28 psychologists actually had appointments. And only eight of them had slots available outside regular work hours. Eight out of 100.
“Sorry, I wish you the best of luck,” was a common refrain in therapists’ voicemail messages.
For Natalie Dunnege, after seven rejections, she gave up looking.
“It’s hard when you’re feeling sad and you feel like you can barely keep things together,” she says. “It just seemed like way too much at the time.”
Mental health advocates say this is exactly what insurance companies are hoping.
“It’s a way to control cost,” says Keith Humphreys, a Stanford psychiatry professor who served as an advisor to Congress when it was developing the 2008 Mental Health Parity Act. He says while insurers are now required to keep an adequate number of clinicians listed in their directories, they still find ways to sidestep the rules.
“You know the law doesn’t say you can’t put people on there who are dead, or you can’t put people on there who are not taking new patients,” he says. “What that translates into, then, is people have to wait longer for care, which then cuts expenditures for the insurer and reduces access.”
California passed a law last year, SB 137, raising the standards for physician directories. Insurers will have to police their lists for providers who are booked or retired. But a lot of questions remain about how the law will be enforced, especially when it comes to mental health providers, who are largely self-employed, solo practitioners.
The insurance industry says it will be a challenge.
“When you have networks as large as ours and you have as many enrollees as we have here in California, you’re not going to be able to just have everything accurate every single second of every single day,” says Charles Bacchi, CEO of the California Association of Health Plans.
He said the industry is working to make it better.
“But we also need to be realistic,” he says. “We don’t run a mental health provider’s office. They do. And how they handle people calling their offices is their job.”
In a statement, Blue Shield said it tries to make it easy for providers to update changes in their contact information and schedule.
“We understand that there are a number of issues that impact a provider’s availability to take new patients, such as administrative limitations and fluctuating numbers of patients based on their individual needs. When those instances arise, the provider is required to notify us so that patients have access to the most up-to-date information about who is available in their area.”
The industry also says it’s facing another challenge: a nationwide shortage of mental health providers, further exacerbated by the millions of people who signed up for insurance under the Affordable Care Act.
In California, there are “around 4 to 5 million more people with coverage, just in the last two years,” Bacchi says. “And that’s creating a strain for everybody, plans and mental health providers.”
This story is part of a partnership that includes KQED, NPR and Kaiser Health News.Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Many Well-Known Hospitals Fail To Score 5 Stars In Medicare’s New Ratings

The federal government released its first overall hospital quality rating on Wednesday, slapping average or below average scores on many of the nation’s best-known hospitals while awarding top scores to many unheralded ones.
The Centers for Medicare & Medicaid Services rated 3,617 hospitals on a one- to five-star scale, angering the hospital industry, which has been pressing the Obama administration and Congress to block the ratings. Hospitals argue the ratings will make places that treat the toughest cases look bad, but Medicare has held firm, saying that consumers need a simple way to objectively gauge quality.
Just 102 hospitals received the top rating of five stars, and few are those considered as the nation’s best by private ratings sources such as U.S. News & World Report or viewed as the most elite within the medical profession.
Medicare awarded five stars to relatively obscure hospitals and a notable number of hospitals that specialized in just a few types of surgery, such as knee replacements. There were more five-star hospitals in Lincoln, Neb., and La Jolla, Calif., than in New York City or Boston. Memorial Hermann Hospital System in Houston and Mayo Clinic in Rochester, Minn., were two of the only nationally known hospitals getting five stars.

Medicare awarded the lowest rating of one star to 129 hospitals. Five hospitals in Washington, D.C., received just one star, including George Washington University Hospital and Georgetown University Hospital, both of which teach medical residents. Nine hospitals in Brooklyn, four hospitals in Las Vegas and three hospitals in Miami received only one star.
Some premiere medical centers received the second highest rating of four stars, including Stanford Health Care in California, Massachusetts General Hospital in Boston, Duke University Hospital in Durham, N.C., New York-Presbyterian Hospital and NYU Langone Medical Center in Manhattan, the Cleveland Clinic in Ohio, and Penn Presbyterian Medical Center in Philadelphia. In total, 927 hospitals received four stars.
Medicare gave its below average score of two-star ratings to 707 hospitals. They included the University of Virginia Medical Center in Charlottesville, Beth Israel Medical Center in Manhattan, North Shore University Hospital (now known as Northwell Health) in Manhasset, N.Y., Barnes-Jewish Hospital in St. Louis, Tufts Medical Center in Boston and Washington Hospital Center in D.C. Geisinger Medical Center in Danville, which is a favorite example for national health policy experts of a quality hospital, also received two stars.
Nearly half the hospitals — 1,752 — received an average rating of three stars. Another 1,042 hospitals were not rated, including all hospitals in Maryland.
Medicare based the star ratings on 64 individual measures that are published on its Hospital Compare website, including death and infection rates and patient reviews. Medicare noted that specialized and “cutting-edge care,” such as the latest techniques to battle cancer, are not reflected in the ratings.
The government said in a statement that it has been using the same type of rating system for other medical facilities, such as nursing homes and dialysis centers, and found them useful to consumers and patients. Those ratings have shown, Medicare said, “that publicly available data drives improvement, better reporting, and more open access to quality information for our Medicare beneficiaries.”
In a statement, Rick Pollack, president of the American Hospital Association, called the new ratings confusing for patients and families. “Health care consumers making critical decisions about their care cannot be expected to rely on a rating system that raises far more questions than answers,” he said. “We are especially troubled that the current ratings scheme unfairly penalizes teaching hospitals and those serving higher numbers of the poor.”
A preliminary analysis Medicare released last week found hospitals that treated large numbers of low-income patients tended to do worse, as did teaching hospitals.Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.