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House Passes Bill To Fix Medicare's Doctor Payments. What's In It?

House Speaker John Boehner speaks to members of the media during his weekly news conference on Capitol Hill Thursday. (Andrew Harnik/AP)

House Speaker John Boehner speaks to members of the media during his weekly news conference on Capitol Hill Thursday. (Andrew Harnik/AP)

The troubled payment formula for Medicare physicians is one step closer to repeal.

The House Thursday overwhelmingly passed legislation to scrap Medicare’s troubled physician payment formula, just days before a March 31 deadline when doctors who treat Medicare patients will see a 21 percent payment cut. Senate action could come this week as well, but probably not until the chamber completes a lengthy series of votes on the GOP’s fiscal 2016 budget package.

According to a summary of the bill, unveiled by Republican and Democratic committee leaders earlier this week, the current system would be scrapped and replaced with payment increases for doctors for the next five years as Medicare transitions to a new system focused “on quality, value and accountability.”

Hundreds of state and national physician groups are urging Senate passage.

“It will relieve many years of frustration and uncertainty for all physicians by eliminating that sword of Damocles, that’s been hanging over our heads with regards to cuts and replacing it with a predictable albeit small increase in fees over the next four to five years,” said the Massachusetts Medical Society’s president-elect, Dr. Dennis Dimitri.

There’s enough in the wide-ranging deal for both sides to love or hate.

Senate Democrats have pressed to add to the proposal four years of funding for an unrelated program, the Children’s Health Insurance Program, or CHIP. The House package extends CHIP for two years. In a statement Saturday, Senate Finance Democrats said they were “united by the necessity of extending CHIP funding for another four years” but others have suggested they may support the package.

Some Democratic allies said the CHIP disagreement should not undermine the proposal. After the House approved the package by a vote of 392-37, Ron Pollack, executive director of the consumers group Families USA, urged the Senate to “adopt a CHIP funding bill as soon as possible. Families USA believes that a four-year extension is preferable to two years. We also know that time is of the essence, and it is crucial that the Senate act quickly.”

Some senators have also raised concerns about asking Medicare beneficiaries to pay for more of their medical care, the impact of the package on women’s health services and cuts to Medicare providers.

In a letter to House members before Thursday’s vote, the seniors group AARP said the legislation places “unfair burdens on beneficiaries. AARP and other consumer and aging organizations remain concerned that beneficiaries account for the largest portion of budget offsets (roughly $35 billion) through greater out-of-pocket expenses” on top of higher Part B premiums that beneficiaries will pay to prevent the scheduled cut in Medicare physician payments.

Hospitals, nursing homes and rehabilitation centers would see lower rates of increase, but are largely backing the legislation.

“Although nothing’s perfect, at a time when it’s so difficult to reach accord on really complicated issues, broad support for this solution is really impressive,” said Tim Gens, executive vice president at the Massachusetts Hospital Association. “And if it fails, we go back to these temporary patches that only solve the problem in a very expensive way for months at a time.”

Some GOP conservatives and Democrats are unhappy that the package isn’t fully paid for, with policy changes governing Medicare beneficiaries and providers paying for only about $70 billion of the approximately $200 billion package. The Congressional Budget Office Wednesday said the bill would add $141 billion to the federal deficit.

For doctors, the package offers an end to a familiar but frustrating rite. Lawmakers have invariably deferred the cuts prescribed by a 1997 reimbursement formula, which everyone agrees is broken beyond repair. But the deferrals have always been temporary because Congress has not agreed to offsetting cuts to pay for a permanent fix. In 2010, Congress delayed scheduled cuts five times. In a statement Sunday, the American Medical Association urged Congress “to seize the moment” to enact the changes.

Here are some answers to frequently asked questions about the proposal and the congressional ritual known as the doc fix. Continue reading

Suicide Prevention Campaign Approaches Men ‘On Their Own Terms’

Franklin Cook, project manager of the MassMen campaign, and Candice Porter, executive director of Screening for Mental Health, using the MassMen website. (Lynn Jolicoeur/WBUR)

Franklin Cook, project manager of the MassMen campaign, and Candice Porter, executive director of Screening for Mental Health, using the MassMen website. (Lynn Jolicoeur/WBUR)

Franklin Cook of Watertown knows the issue of suicide among men all too well. In 1978, when Cook was 24, his father killed himself.

After that Cook struggled with addiction and found recovery, suffered from depression but got treatment, and built a career in suicide prevention and suicide grief support.

He knows many men struggle to seek help for mental illness.

More men than women die by suicide, and across the country middle-aged white men have the highest suicide rate of any age group.

“But the care-giving world also doesn’t market or doesn’t design programs specifically around our species, if you will,” Cook says. “[Some men] might not want to sit down face-to-face and talk to somebody for 55 minutes about their feelings. I’ve done that hundreds of times with a counselor, and it works for me, but it doesn’t work for all men.”

Now Cook is helping lead a Massachusetts suicide prevention campaign centered around a new website called MassMen.org. It was created by the Wellesley-based organization Screening for Mental Health, with funding from the state Department of Public Health.

On the site, people can complete an anonymous mental health screening in about two minutes to find out whether their feelings and behaviors are consistent with depression or another mental health disorder. They get results immediately and after the screening a “video doctor” does an interactive assessment.

“I’m concerned about your symptoms. I want to be sure you’re aware of the impact this can have on your health and well-being,” the video doctor, portrayed by an actor, says in one portion of the segment. “To help me understand how you feel about taking steps to feel less depressed, I have a question for you. On a scale of one to nine, how ready would you say you are to take steps to feel better?”

Candice Porter is executive director of Screening for Mental Health and a clinical social worker. She points out that while middle-aged men have the highest suicide rate, many of them may not be “moping around,” appearing overtly sad or depressed.

“They might mask their symptoms in a lot of ways that we’re not recognizing, and they’re not seeking the help,” Porter says. But she adds that even though the men might not seek counseling or treatment, many people who die by suicide visit their doctor for some physical ailment in the months leading up to their death.

“We do know that the primary care physicians are not asking the question, ‘How are you feeling? Are you depressed? Have you had thoughts of wanting to end your life?'” Porter explains. “So part of what we’re also trying to do is just increase awareness that these questions should be asked.”

The MassMen site also directs users to resources including mental health services in their communities.

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Not Male Or Female: Molding Bodies To Fit A Genderfluid Identity

From left to right, Devon Jones, Dale Jackson and Taan Shapiro. (Courtesy)

From left to right, Devon Jones, Dale Jackson and Taan Shapiro. (Courtesy)

For more than three years, Devon Jones gave himself weekly shots of testosterone to align his body with the feeling that he was male. The shots worked. Jones’ voice dropped, body fat shifted from his thighs and breasts into his neck and stomach, and he sprouted facial hair.

But then last year, Jones, a 27-year-old author who lives in Dorchester, stopped taking the hormone.

“I realized that wasn’t the look I was ultimately going for,” Jones said. “I wanted to still have breasts that had substance to them, they’d really shrunk and I wanted that back.”

And Jones wants the option of getting pregnant and having a child, something he could not do while testosterone overpowered estrogen in his body. It’s not clear if he will be able to get pregnant now.

“I’ll only know that when I try,” he said.

Jones still use male pronouns. The changes to his voice are permanent. But as estrogen again becomes the dominant hormone in Jones’ body, the hair on his face doesn’t grow as quickly and his body fat has shifted back.

“I have a more curvy feminine shape. I’m more comfortable now with people being confused. So it’s an evolving process. It’s weird to be in the middle of it right now actually, and talking about it,” Jones said, his voice trailing off.

Jones is part of a growing group of young adults who are genderfluid and are using hormone therapy and surgery to create bodies that matches this identity.

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The Science Of Suicide: Researchers Work To Determine Who’s Most At Risk

Harvard psychology professor Matt Nock and research assistant Nicole Murman demonstrate the Implicit Association Test related to suicide risk. (Robin Lubbock/WBUR)

Harvard psychology professor Matt Nock and research assistant Nicole Murman demonstrate the Implicit Association Test related to suicide risk. (Robin Lubbock/WBUR)

Part of an occasional series we’re calling “Suicide: A Crisis In The Shadows

BOSTON — Up on the 12th floor of a nondescript concrete building in Cambridge, about a dozen Harvard University researchers spend their days trying to crack the code on something that’s eluded scientists for decades.

“We’re really lacking in our ability to accurately predict suicidal behavior and to prevent it,” says psychology professor Matt Nock, who runs the so-called Nock Lab, which is focused entirely on suicide and self-harm. “We are really struggling with identifying which people who think about suicide go on to act on their suicidal thoughts and which ones don’t.”

Nock demonstrates a computer-based exercise he’s using in his research, known as the Implicit Association Test, or IAT. The test asks patients to quickly classify words related to life or death — such as “thriving” or “suicide” — as being like them or like other people.

“For suicidal people, they’re faster responding when ‘death’ and ‘me’ are paired on the same side of the screen. People who are non-suicidal are faster responding when ‘death’ and ‘not me’ are paired on the same side of the screen,” Nock explains.

He and his team are evaluating the test by trying it out with patients in the psychiatric emergency room at Massachusetts General Hospital. The study participants do one other word classification exercise called Stroop and answer questions about addiction, mental illness and suicidal thoughts or behavior. Continue reading

Wishing They Asked Tough Questions: Reflecting On A Father’s Suicide

Valerie Alfeo files through a table full of old family photos at her home in Waltham. Her father, Ted Washburn, took his own life in 2011. He was 54. (Jesse Costa/WBUR)

Valerie Alfeo files through a table full of old family photos at her home in Waltham. Her father, Ted Washburn, took his own life in 2011. He was 54. (Jesse Costa/WBUR)

Part of an occasional series, “Suicide: A Crisis In The Shadows

WALTHAM, Mass. — TJ Washburn first learned his father, Ted Washburn, was battling depression in 2009. That’s when the then-52-year-old starved himself for three days.

“He said basically that he was planning on not eating or drinking anything until he passed away,” TJ recalls. “And obviously shock kind of sets in at first.”

Ted, who lived in Waltham, spent a few weeks in two psychiatric units. And during that time his son was stunned to learn he had attempted suicide at the age of 21 — two years before he started having children.

“To think that he could have taken his life before I was born was something that was just… surreal is the best word that I keep using — that I can’t really imagine,” TJ says.

But in 2009, when their father got out of the hospital and right back into his routine as a truck driver, TJ and his sister, Valerie Alfeo, say he didn’t talk about his depression. And they didn’t ask much.

“I was scared. I mean, for me it’s half of the people who created me. You still have them on a pedestal to some degree, even at late 20s, early 30s,” TJ reflects. “I mean, I still would go to him, ask him for his advice. I guess I wasn’t prepared to be kind of on the other end, and be the one giving any advice.”

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AG Healey Seeks Ban On Sale Of E-Cigarettes To Minors

Attorney General Maura Healey on Tuesday filed proposed regulations that would ban the sale of electronic cigarettes to minors, prohibit free product giveaways or sampling, and require the devices be kept out of the reach of customers at stores.

Currently there is no state law prohibiting the sale of e-cigarettes to minors in Massachusetts. Several cities and towns have approved their own local age restrictions.

The regulations would treat e-cigarettes like other tobacco products including cigarettes, cigars and chewing tobacco – including banning most sales of e-cigarettes except through face-to-face purchases and not through vending machines except in adults-only establishments.

Attorney General Maura Healey (AP)

Attorney General Maura Healey (AP)

The regulations would also define as an unfair or deceptive practice the sale of nicotine liquid or gel without the use of child-resistant packaging that meets federal standards.

“The regulations make it clear that in Massachusetts an e-cigarette is a cigarette when it comes to protecting our kids,” Healey said.

The regulations don’t extend all current smoking prohibitions to e-cigarettes, including the state’s workplace smoking ban. Healey said she supports legislation that would require users of e-cigarettes to abide by additional smoking regulations.

The metal or plastic battery-powered devices resemble cigarettes but heat a liquid nicotine solution, creating vapor that users inhale.

While e-cigarettes contain fewer toxic substances than burning traditional cigarettes, health officials warn they shouldn’t be considered harmless and say much more needs to be known about long-term effects of e-cigarette use.

Continue reading

Connector Gains New COO, Corner Office Adviser

The Baker administration continues to put its stamp on the state’s Health Connector Authority with the hiring of two top officials.

Vicki Coates, a former vice president of dental management at DentaQuest, starts on Monday as chief operating officer, according to Louis Gutierrez, the authority’s executive director.

Coates has also worked at Harvard Pilgrim Healthcare, Blue Cross Blue Shield of Massachusetts, and Metro West Medical Center.

Gutierrez also announced Patricia Wada, who has worked on state information technology projects, will take the job of special assistant to the governor for project delivery. Continue reading

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Gov. Baker Fills 2 Connector Board Seats

After sweeping out four Connector Board members, Gov. Charlie Baker on Thursday morning named insurance executive Mark Gaunya and business consultant Rina Vertes to serve on the Massachusetts Connector Authority Board.

Vertes and Gaunya were appointed minutes before a scheduled board meeting and the governor’s office reported they plan to participate in that gathering in Boston.

Gaunya is co-owner and chief information officer at Borislow Insurance. Vertes is president of Marjos Business Consulting.

Baker during the 2014 campaign for governor complained that there had been no major personnel changes at the Connector Authority despite major problems with the rollout of an expensive website intended to help people comply with requirements of the new federal insurance law.

“Our administration believes these health care professionals with decades of experience will continue the turnaround effort of the Connector, and provide the people of Massachusetts with an efficient, well run exchange,” Lt. Gov. Karyn Polito said in a statement.

Gaunya is filling a seat reserved for a member of the broker community on the 11-member board, with Vertes taking a seat set aside for a health insurance actuary. Continue reading

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Baker Deputies Outline Plan To Tame MassHealth Costs

Leaning heavily on the extraction of savings from MassHealth to balance their state budget proposal, top Baker administration health officials on Thursday said that changes to benefits for patients were mostly taken off the table, but the administration may look at co-payments or other commercial market solutions to control cost growth in the future.

According to the Baker administration, MassHealth will cost the state $14.5 billion this fiscal year. The program covers low- and moderate-income adults and children, and is projected to service 1.7 million enrollees in fiscal 2016. Under Baker’s $38.1 billion state budget, the program’s cost will grow to $15.3 billion next fiscal year. Continue reading

Blue Cross To Expand Results-Based Doctor Payments System

The state’s largest health insurer, Blue Cross Blue Shield of Massachusetts, is moving to expand its system of paying doctors for the quality of their service. It replaces the traditional system of paying doctors for the number of services provided.

To talk about what’s driving this, Andrew Dreyfus, the company’s CEO, joins Morning Edition.

To hear the full interview, click on the audio player above.