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Changing the way it does business, Medicare on Friday unveiled a far-reaching overhaul of how it pays doctors and other clinicians. The goal is to reward quality, penalize poor performance, and avoid paying piecemeal for services. Whether it succeeds or fails, it's one of the biggest changes in Medicare's 50-year history. (10/14)

The Centers for Medicare and Medicaid Services released the highly anticipated rule, which introduces new bonuses and penalties tied to performance for 712,000 doctors and other clinicians starting in 2019. The new bonuses and penalties would be paid or imposed depending on how well doctors do on measures of quality, electronic health records and managing costs. Doctors can also enter Medicare contracts that include quality and cost-control incentives and earn bonuses. (Evans, 10/14)

Nearly a third of physicians could be exempt from Medicare's new Merit-based Incentive Payment System under a final rule the CMS issued Friday for implementing the Medicare Access and CHIP Reauthorization Act. The CMS also signaled it would broaden the opportunities for physicians to participate in alternative models that make them eligible for bigger rate increases and bonuses. (Dickson, Muchmore and Livingston, 10/14)

The Obama administration on Friday rolled out its long-awaited rules for shifting how Medicare pays doctors, implementing changes made by a bipartisan law Congress passed last year. The changes are part of the administration’s larger effort to shift healthcare payments away the traditional system of paying doctors a fee for each test or procedure provided, and toward a system that rewards doctors for improving patient health. In the long run, the goal is to save Medicare money and encourage doctors to provide higher quality care.  (Sullivan, 10/14)

For decades, doctors and hospitals have routinely received a set fee for their services and tests in treating elderly Americans under the Medicare program, regardless of the outcome. This fee-for-service approach provided virtually no incentives for physicians to achieve better outcomes and assure that the patient wasn’t coming back for more treatment or hospitalization anytime soon. The new rule, an outgrowth of bipartisan legislation approved by Congress last year to change the way physicians are paid, is designed to shift the medical system toward rewarding quality over quantity of treatment while saving hundreds of billions of dollars in the coming years, starting in 2019. (Pianin, 10/15)

Reaction was positive to a Centers for Medicare and Medicaid Services rule released Friday finalizing changes to how doctors are paid through Medicare. Health provider groups said they were pleased that the agency has been, and expects to continue to be, responsive to their concerns. The changes implement a new law aimed at saving the Medicare program money by rewarding providers for high quality care. Under the rule, providers will have two paths to choose from to start shifting away from the traditional fee-for-service system. (McIntire, 10/14)

Vice President Biden is expected to tell President Obama on Monday that the administration’s “cancer moonshot” effort infused new urgency in the fight against the disease but that formidable challenges remain, including a lack of coordination among researchers, an “antiquated” funding culture and unacceptably slow dissemination of important information about new treatments. (McGinley, 10/17)

More than 250,000 people in North Carolina are losing the health plans they bought under the Affordable Care Act because two of the three insurers are dropping out — a stark example of the disruption roiling marketplaces in many parts of the country. The defections mean that almost all of the state, from the Blue Ridge to the Outer Banks, will have just one insurer selling ACA policies when the exchanges open again for business in November. The remaining company, Blue Cross Blue Shield of North Carolina, agonized over whether to leave, too. Instead, it is raising its rates by nearly 25 percent. (Goldstein, 10/14)

Doctor and hospital switching has become a recurring scramble as consumers on the individual market find it difficult or impossible to stay on their same plans amid rising premiums and a revolving door of carriers willing to sell policies. The instability, which preceded the health law, is intensifying in the fourth year of the Affordable Care Act’s marketplaces for people buying insurance directly instead of through an employer. “In 2017, just because of all the carrier exits, there are going to be more people making involuntary changes,” said Katherine Hempstead, a senior adviser at the Robert Wood Johnson Foundation, a New Jersey philanthropy. “I would imagine all things being equal, more people are going to be disappointed this year versus last year.” (Rau, 10/17)

States where insurers underpriced individual plans in the early years of the federal healthcare exchanges are posting sharply higher premiums for next year, although subsidies will moderate the increases for many low- and moderate-income consumers. Illinoisans learned Friday that people buying insurance on the state's exchange will face steep price increases for next year. The Illinois Department of Insurance published an analysis of 2017 health plans Friday based on final price increases approved by state and federal regulators. Statewide, the average rate increase for the lowest cost "silver" plan is 45%. (Silver is a label of a middle-tier plan that's been a popular choice.) (10/15)

The individual health insurance marketplace is not a small capillary for Blue Cross and Blue Shield of Arkansas, the dominant insurer in the fourth-poorest state in the country. It's a main artery. And the good news for the Arkansas Blues is that the individual market—a “disaster” according to presidential hopeful Donald Trump—is pumping black ink, not the blood-red ink reported by some insurers selling individual plans on the Affordable Care Act exchanges across the country. ... Next door, in Tennessee, a much different story unfolded. Blue Cross and Blue Shield of Tennessee posted an underwriting loss of $195.7 million on $866.4 million of revenue in 2015 just from its individual plans—a negative margin of almost 23% that gets worse when administrative expenses are tacked on. (Herman, 10/15)

House Republicans are wading into the heated legal battle between the White House and several insurers that claim they are owed money under ObamaCare. The House GOP announced Friday it has filed a brief in a major ObamaCare lawsuit that involves a multibillion-dollar shortfall in a fund intended to cushion health insurers from financial losses under the law. The $5 billion class-action lawsuit was filed by the now-shuttered insurance company called Health Republic of Oregon. It is one of about a dozen companies that have sued over the still-delayed payments, which they say crippled their businesses. (Ferris, 10/14)

Health insurers do not want congressional Republicans to block potential settlements of their lawsuits against the administration involving Obamacare, according to Marilyn Tavenner, president and CEO of America’s Health Insurance Plans. Within the Republican conference, options are being discussed about how to stop any lawsuit-related payments to the industry. Conservative groups are loudly urging against such settlements. (Owens, 10/14)

While the Affordable Care Act cut the number of uninsured by about 32%, millions of immigrants don't qualify for the law's coverage expansions. They still have few options for primary care. People living in the U.S. without authorization can't buy health insurance from the ACA's exchanges and aren't eligible for Medicare, Medicaid or the Children's Health Insurance Program. Even lawful residents who have lived in the U.S. for less than five years can't get Medicaid or CHIP. Local governments in areas with large numbers of new immigrants have stepped up to become their health safety net. (Johnson, 10/15)

A diagnosis of breast cancer at age 27 is shattering for anyone. But for Eli Oberman, it came with extra layers of anxiety. He is a transgender man, who was born female but began taking male hormones when he was 19 to change gender. Like many transgender people, Mr. Oberman switched gender without having surgery to change his body. The cancer was a stark reminder that he was still vulnerable to illnesses from his original anatomy — and that the medical world has blind spots in its understanding of how to take care of trans men and women. (Grady, 10/16)

Planned Parenthood's 100th anniversary celebrations this weekend come with a sense of relief for the group that traces its roots to a time when women could not vote and contraception was illegal. The organization, whose services include birth control, sex education and abortions, has survived largely intact in the face of violence, vilification and fierce efforts in Congress and many states to cut its funding. (Crary, 10/15)

A federal appeals court Friday unanimously upheld the constitutionality of a new California law that requires religiously affiliated pregnancy clinics to inform women about abortion options. The law, which took effect in January, says licensed clinics must disseminate information to women about government programs that provide free or low-cost services for family planning, abortions and prenatal care. (Dolan, 10/14)

California can require hundreds of antiabortion clinics known as “crisis pregnancy centers” to notify their patients that the state makes abortion and other reproductive health care available at little or no cost, a federal appeals court ruled Friday. The law, which took effect in January, does not violate freedom of speech or religion because it merely requires the clinics to provide accurate information about health care that the patients have a right to receive, said the Ninth U.S. Circuit Court of Appeals in San Francisco. While the ruling only denied an injunction that would have halted further enforcement, the court made it clear that it saw no constitutional grounds for overturning the law. (Egelko, 10/14)

Traditional sperm tests don’t reveal much.They can assess how many sperm a man produces, whether sperm are misshapen, and how well they swim. But that’s about it. Determined to extract more data, several startups are developing next generation tests that they hope will help men better understand their fertility. The goal: To explain why some men who have normal sperm counts still cannot conceive. (McFarling, 10/17)

The 24/7 coverage of the acrimonious U.S. presidential election has caused stress for more than half of American adults, regardless of party affiliation, according to a survey conducted by the American Psychological Association (APA)... Overall, 52 percent of Americans age 18 and older said the election is a somewhat or very significant source of stress. That included 55 percent who align with Democrats and 59 percent with Republicans.The survey also found that 38 percent of respondents said political and cultural discussions on social media cause them stress. (10/14)

Yana Shapiro is a partner at a Philadelphia law firm, has an exhausting travel schedule and two boys, ages 9 and 4. When she feels run-down from juggling everything and feels a cold coming on, she books an appointment for an intravenous infusion of water, vitamins and minerals. "Anything to avoid antibiotics or being out of commission," the 37-year-old says. (English, 10/17)

Digital gizmos can monitor your heart, whether it's a wrist-worn fitness tracker or a smartphone app to help cardiologists analyze diagnostic tests. The question is whether they're going to do your heart any good. The short answer: it depends. New research finds that wrist-worn fitness trackers become less accurate with more vigorous exercise, which presumably is when you'd most want to know your heart rate. The study, published Wednesday in JAMA Cardiology, tested the Apple Watch, FitBit Charge HR, Basis Peak and Mio Alpha wristbands. (Ross, 10/15)

Ebola no longer dominates the headlines but for an estimated 17,000 survivors of the largest Ebola outbreak in history, the struggle is not over. Many who survived the West African outbreak that sickened nearly 30,000 people between 2014 and 2016 are living with a constellation of long-term symptoms known as post-Ebola syndrome. Some of those Ebola survivors are right here in Texas. A Fort Worth doctor fell sick with Ebola while working in Liberia and two nurses became infected in Dallas while caring for the first person to be diagnosed with Ebola in the U.S. (Yasmin, 10/15)

Women's hearts are more susceptible to certain kinds of diseases, and they produce symptoms that can lead to different care in emergency situations than men would get. Rather than feeling the classic complaint of extreme pressure in the chest during a heart attack, some women feel shortness of breath or upper-abdominal pain that they or their doctors may chalk up to acid reflux or anxiety. Even though coronary heart disease is the No. 1 killer of women, clinical trials for medical devices to treat cardiovascular disease still enroll two men for every female participant. That long-standing imbalance — and the efforts to address it — will be a topic for discussion this week at AdvaMed 2016, the national med-tech industry conference at the Minneapolis Convention Center that runs through Wednesday. (Carlson, 10/16)

California this year became the second state after Hawaii to raise its minimum smoking age to 21. When the law took effect in June, state public health officials declared it would “literally be a life-saving measure. ”But experts say it’s too soon to know whether the law will live up to such claims, and there are few studies from elsewhere pointing the way. (Karlamangla, 10/17)

Do tobacco taxes reduce smoking? It’s an important question as four states, including California, prepare to vote on whether to raise their tobacco tax in November.Research and anecdotal evidence suggest it can.  For every 10 percent increase in the price of cigarettes, smoking goes down 4 percent, according to a 2014 report on smoking by the U.S. surgeon general. (Dembosky, 10/17)

The morning after Christine Grounds gave birth to her son Nicholas, she awoke to find a neurologist examining her baby. It was summer 2006, and Nicholas was her first child. There had been no indication that anything was wrong during her pregnancy, but it was soon clear that there was a problem. “Did you know he has microcephaly?” she remembers the doctor asking matter-of-factly. (Santora, 10/17)

Federal health officials are pushing back against Florida Gov. Rick Scott’s criticism about the slow flow of money to fight the Zika virus into his state. Florida has spent only about $3.5 million out of the $27 million that’s been given to the state by the Centers for Disease Control and Prevention (CDC) this year, according to a federal health official. The state has also been given $8 million in Zika-specific funding that it has not used, according to the source. (Ferris, 10/14)

Federal prosecutors in Texas said Friday that a dozen people have been charged in a $100 million health care scheme targeting military veterans and their families. The defendants, including doctors, pharmacists and marketers, were charged in a 35-count overruling indictment returned last week in Dallas, according to U.S. Attorney John Parker. Prosecutors contend the men sought to defraud Tricare, the health insurance program for veterans and their families. (10/14)

Federal authorities have indicted 10 more people, including two doctors, as part of a massive illegal kickback scheme in Dallas involving pharmacies that allegedly scammed the military’s health-insurance program out of $100 million. Nine of the defendants were arrested this week and the 10th turned himself in, the U.S. attorney's office said. Two others were charged in February. The defendants include doctors, pharmacy owners and marketers. ... They are accused of conspiring to sell to soldiers expensive compounded products like pain and scar creams that were not needed. (Krause, 10/15)

More than $80 million has been spent at Baltimore hospitals caring for patients shot in gun crimes in the past five years. During that time, the number of cases doubled and the annual price tag soared nearly 30 percent. Most of the medical costs are now covered by Medicaid, the federal-state health insurance program for the poor...Outside the hospital, first responders are trying to keep up with the merciless uptick in gun violence. Baltimore police officers have begun carrying tourniquets, which constrict blood flowing from wounds, and a national push is underway to make the devices as widespread as defibrillators and as commonly understood as CPR. (George, 10/14)

Supporters of Proposition 52 took to the airwaves in mid-August and have run a heavy rotation of ads meant to build support for the hospital industry-sponsored measure that would place in the California Constitution an existing state charge on hospitals. Some of the ads feature a theme common in a state in which lawmakers are usually held in low esteem: The measure will keep the Legislature from diverting the money. (Miller, 10/14)

Former doctors and nurses at New Hampshire Hospital have argued for months that the fix was in for Dartmouth-Hitchcock to take over a lucrative staffing contract. Now the ousted employees and other Dartmouth-Hitchcock critics have a paper trail at which to point. Documents released Friday by the state Republican Party suggest cooperation, if not collusion, between Dartmouth College executives and state officials in drafting a request for proposals that some say was designed so that only Dartmouth-Hitchcock could apply. (Solomon, 10/16)

Backing the Florida Department of Health, hospitals in Clay and Palm Beach counties are seeking to intervene in a legal battle about proposed changes to the state's rules for approving new trauma centers. Orange Park Medical Center and JFK Medical Center — both of which are part of the HCA health-care chain — filed requests Thursday to intervene in the dispute at the state Division of Administrative Hearings. The Department of Health last month began moving forward with a controversial proposal that would change criteria for determining where additional trauma centers can open. (10/16)

A Cuyahoga County jury awarded a Sheffield Lake family $1.9 million Thursday after deciding that an emergency room misdiagnosis cost a 31-year-old woman her life. [Lisa] Born had a blood clot, called a deep vein thrombosis or DVT, that was blocking circulation in her right leg. But physicians at the University Hospitals facility never tested her for DVT, the jury found, even after a triage nurse noted that Born's birth control medication increased her risk for DVT as much as 10 times. (Harper, 10/14)

Late last week, after deliberating for 2½ hours, a jury returned a $2 million verdict against Indiana University Health Methodist Hospital for Smith’s death in December 2006. The decision, which took 10 years, in part because the first judge assigned to the case retired, came as long-awaited relief to Monica Smith, who lost her car and house after her husband died at age 45. Under Indiana law, the verdict will be capped at $1.25 million, but that doesn’t bother Smith. (Rudavsky, 10/14)

The latest front in the battle over doctor-assisted suicide is unfolding in Colorado, where voters will consider a ballot measure next month that would permit physicians to aid terminally ill patients in dying. Proposition 106 would allow adults who have six months or less to live, and are mentally competent, to take medication prescribed by a doctor to end their lives. (Frosch, 10/16)

While Connecticut has made inroads in developing a system to address trauma in school-aged children, experts say there are still significant gaps in services for younger children who have been exposed to domestic violence, abuse, parental drug use, homelessness or other potentially traumatic experiences – things that can have lasting consequences for a person’s mental and physical health. Now, there’s an effort underway to address that gap. The Child Health and Development Institute of Connecticut, a Farmington-based nonprofit, is leading an initiative to train child care providers and others who work with young children to recognize signs of trauma – and to expand the availability of services to help. (Levin Becker, 10/17)

The task force created to draft recommendations for regulating the relationship between doctors and nurse practitioners brainstormed a few suggestions Thursday in a meeting that made more progress than previous ones. Much of the meeting focused on credentialing and whether advanced practice nurses are engaged in the practice of medicine as defined by state law, and if that is allowable under their training. The tenor of the four-and-a-half-hour meeting was at times confrontational and divided down professional lines — but less so than the two previous meetings. (Fletcher, 10/14)

Addressing the HIV increase among young people, the National Institutes of Health has awarded up to $24 million for a research network, including Emory University and other universities, to target new services for adolescents and young adults (individuals ranging in age from 13 to 24). Emory, along with the University of North Carolina at Chapel Hill, will provide one of three research hubs. A primary focus of researchers will be developing technologies – including mobile apps – that better serve young people with HIV or at risk of the virus, says Dr. Patrick Sullivan, an HIV expert at Emory. (Miller, 10/16)

MetroHealth is one of 14 centers nationwide receiving the funding from the National Institute on Disability, Independent Living and Rehabilitation Research. Ohio State University Wexner Medical Center received a National Institute grant of $2.2 million. The grant designates MetroHealth and the other centers a "Spinal Cord Injury Model System" and brings support to their projects, research, vocation and other means of making progress toward the needs and treatment of individuals with spinal cord injuries. (Washington, 10/14)

There’s no question that hospice has helped millions of terminally ill people be as comfortable as possible so they can focus on living their last days with family. But as the number of patients and providers and the amount of taxpayer money spent on hospice care has grown steadily in recent years, government agencies and advocates have been sounding the alarm about the potential for fraud. Several reports by the Office of Inspector General, including one released last month, found that some hospice providers, doctors and staff members have aggressively recruited patients, including some who don’t quality for services. (Pyle, 10/17)

With medical marijuana already a reality in Florida, voters will decide in November whether to vastly expand the types of patients who are eligible for the treatment. It's the second time Floridians will weigh in on a medical-marijuana constitutional amendment, with the first proposal narrowly failing in 2014 to capture the 60 percent approval required for passage. But the evolving politics of pot, an already-established marijuana industry and increased voter turnout for the presidential election improve the odds of passage in 2016. (10/14)

The August primary already is having a positive impact: The Legislature is expected to hold hearings and vote next session on Medicaid expansion – and it could pass. It remains to be seen whether Gov. Sam Brownback will loosen his opposition to expansion – or whether the loss of more of his allies in the Nov. 8 general election is needed to help change his priorities. (10/16)

One of the biggest ongoing scandals in North Carolina is that several hundred thousand people live every day without health insurance because Gov. Pat McCrory and legislative leaders have refused to follow the lead of 31 other states and expand Medicaid under the Affordable Care Act. ... Studies from the N.C. Institute of Medicine and other foundations and think tanks have found that expanding Medicaid would not just provide health care to people who need it, but create jobs too, 25,000 of them in the first few years of expansion and 18,000 sustained jobs after that. (Chris Fitzsimon, 10/16)

What you don't measure, you can't improve. But if you measure everything, you are at risk of sending false signals about what's important and what's not. This is especially true when measuring healthcare quality, a movement that began in earnest in the late 1990s and now has exploded into a mini-industry. Quality measurement helps determine physician and hospital reimbursement, Medicare star ratings, insurer networks and more. (Merrill Goozner, 10/15)

The Department of Veterans Affairs admits a suicide hotline it runs is failing to answer the phone. How can that be, when about 20 veterans commit suicide every day? Fix it. Now. The former director of the Veterans Crisis Line told The Associated Press that an average of 35 to 40 percent of the calls in May went unanswered by the crisis-trained health science specialists at its Canandaigua, New York location. The calls rolled to backup centers run by a contractor and staffed by workers, sometimes volunteers, who lack specialized training. (10/14)

This fall, as Americans make their choices in a host of local, state and national elections, including presidential, gubernatorial and congressional races, seniors and those eligible for Medicare in San Antonio must pay special attention to the decisions they face during another important election — the Medicare annual election period, or AEP. During this year’s AEP, which is underway until Dec. 7, it’s important for people with Medicare to understand that the choice they make can affect their health throughout 2017. As with any major decision, thoughtful research will go a long way toward the best care-coverage choice, one that maximizes value based on your individual health needs. (Dan Tufto, 10/16)

Prescription drug misuse has become a public health crisis. Though misusing any prescription medications can be dangerous, misusing opioids like oxycodone, hydrocodone, or methadone, can be fatal. One of the simplest and most effective things all of us can do to fight this epidemic is to properly dispose of unused or expired medications. (Betsy Walker, 10/16)

Although companies like Fitbit claim that their fitness trackers have positive outcomes for their customers, the scientific research on the effectiveness of the most wearable devices remains quite divided. A recent study by researchers at the University of Pittsburgh published in JAMA showed that patients, who tracked their activities levels using fitness trackers lost less weight than others who were not monitoring their activities using such devices.  On the other hand, a study published in AJPM showed that older women exercise more when they can track their activity using a Fitbit. (Vibhanshu Abhishek, 10/14)

The scientific community widely accepts that babies born prematurely — or at full term but small — are at a significantly increased risk for heart disease, high blood pressure and Type 2 diabetes later in life. On the surface, the association seems unlikely. But research has shown they are linked because conditions of fetal undernutrition permanently reprogram the body’s energy metabolic pathways. (John Barnard, 10/16)

The effectiveness of surgical procedures for back pain, especially spinal fusion, has come under fire in the media. A systematic review of spinal fusion, published in 2007, was interpreted by New York Times reporter Gina Kolata as concluding that the procedure is “no better than alternative treatments.” There has been a quiet campaign among medical experts over the past few years to rein in the use of the procedure. But let’s take a close look at that evidence. The 2007 review included just four trials of spinal fusion. In one trial, fusion was superior to conservative options like exercise or talk therapy. Two of the other trials weren’t large enough to detect a difference in pain between the fusion and non-fusion groups. The fourth was plagued with poor follow-up, making it difficult to interpret the results. That’s not exactly a resounding dismissal of spinal fusion. (Ahilan Sivaganesan, Matthew McGirt, Andrew Sumich and Clinton Devin, 10/14)

Recently, a study published in The New England Journal of Medicine suggested that outcomes of prostate cancer patients who underwent aggressive treatment were no different than those who chose the so-called “watchful waiting” approach for this typically slow-growing cancer. While those results may be true for patients in general, African-American men might choose the more aggressive approach. (Crystal Moore, 10/17)