Mary K. Caffrey

Health officials from CDC and the state of Texas are reeling in the wake of today's report that a second nurse at the Texas hospital that treated Ebola patient Thomas Eric Duncan has tested positive for the virus. The news came while health leaders were still trying to determine how 26-year-old nurse Nina Pham contracted Ebola while caring for the first patient diagnosed with the disease on US soil. Meanwhile, the largest nurses' union says its members report that most hospitals are not ready for an Ebola patient.

A survey by Kaiser Family Foundation projects 13.2% overall growth in Medicaid through fiscal year 2015, but the difference between states that expanded the program and those that did not will be stark. The survey of state Medicaid directors also finds 23 states plan expansion of managed care in the next year.

Ohio is the latest state to experience a rough transition to managed care in its Medicaid program, according to weekend reports. Delayed payments and service disruptions to fragile patients are among the complaints. Kentucky had a similar bumpy start when it changed to Medicaid managed care in 2011, and Kansas has had many problems recently.

A study conducted at NYU Langone Medical Center finds that unnecessary radiation in cardiac stress tests costs $500 million a year and causes nearly 500 cases of cancer. Greater use of ultrasound or treadmill tests could save money and improve patient safety; however, earlier studies by The American Journal of Managed Care point out possible barriers to these options.

Even though roughly 9 million Americans have gained healthcare coverage, other forces related to the "anemic recovery" will keep healthcare spending under control, at least in the short term, writes Charles Roehrig, PhD, in a commentary published online yesterday in the New England Journal of Medicine.

Amid yesterday's good news from the CDC that Americans are living longer than ever was a sobering fact. Rates for the top 10 causes of death all fell from 2011 to 2012, save one: suicide. The death rate increased from 12.3 to 12.6 deaths per 100,000 people.

Payroll audits to ensure proper staffing and better tracking of the use of antipsychotic medications are just 2 new items that the Centers for Medicare and Medicaid (CMS) will add to its list of quality measures for nursing homes starting in January, the agency that oversees all Medicare spending announced Monday. The changes are due to passage of the Improving Medicare Post-Acute Care Transformation Act (IMPACT) which President Obama signed Monday. Some of the changes will bring managed care concepts to the home health sector, where regulations have not been updated in 25 years

Peter B. Bach, MD, MAPP, Memorial Sloan Kettering Cancer Center, writes in the Journal of the American Medical Association that cancer drugs could be charged different prices by indication, since the value for patients varies. His article appeared days before an appearance on 60 Minutes to discuss the high price of cancer drugs.

The next phase of New Hampshire's plan to bring managed care to the state's Medicaid program will not go into effect on January 1, 2015, as planned, due in part to concerns about the ability to ensure smooth transitions for those with complex medical cases to receive uninterrupted care.

Deaths from overdoses on heroin rose in 28 states with just over half the nation's population from 2010 to 2012, but deaths from overdoses on prescription opioid pain relievers fell slightly during that period.

As Texas health officials monitor 80 people for symptoms of the Ebola virus, the question arises: could this public health threat have avoided if the ER at Texas Presbyterian admitted the patient with the disease when it first had the chance? Was the patient's insurance status an issue, as some have suggested?

No state-run exchange, no subsidy for health coverage. That's what a federal judge in Oklahoma ruled yesterday, marking the second such ruling against a key component of the Affordable Care Act and setting up a potential return trip to the US Supreme Court to decide the fate of a key piece of the law.

A ballot question to limit narrow networks in South Dakota evokes the outcry that occurred when managed care first sought to rein in costs in the 1990s. Critics of the measure say its passage will push up premiums 20 percent.

The accountable care organization, or ACO, can be a mechanism for employers to achieve healthcare savings, according to a just-published article in The American Journal of Accountable Care, the publication of The American Journal of Managed Care dedicated to healthcare reform.

Life for accountable care organizations (ACOs) in Medicare's Pioneer program appears to be as tough as that on the prairie itself: only the strongest are surviving. Yesterday, 3 more ACOs exited the program, according to numerous news reports. This morning the web site for the Centers for Medicare and Medicaid Services' Pioneer program listed only 19 ACOs from the original 32 that were part of the initiative when it launched in 2012.

Managed care has an answer to what happens when previously uninsured patients suddenly gain coverage: the cost of uncompensated care falls substantially, and so do the numbers of patients showing up at hospitals and emergency rooms without insurance.

The ACO and Emerging Healthcare Delivery Coalition, a project of The American Journal of Managed Care, hosts meetings via WebEx, an online tool that combines elements of the conference call and PowerPoint. The sessions offer opportunities to hear case studies and ask "on the ground" questions, as new reimbursement models take shape.

So far, the recent failure of a high-profile bundled payment pilot in California has not slowed enthusiasm for the concept from CMS.

Since it appeared last week, the editorial in the September issue of The American Journal of Managed Care, "Is All ‘Skin the Game' Fair Game? The Problem With ‘Non-Preferred' Generics," has received comment in The New York Times, ProPublica, US News and World Report, and Mother Jones, among others. Commentators note that what Gerry Oster, PhD, and Co-Editor-in-Chief, A. Mark Fendrick, MD, uncovered in their brief survey of health plans is not just disturbing but possibly violates the Affordable Care Act's prohibition against discrimination based on pre-existing conditions.

Measuring quality in psychiatric care and using mindfulness-based stress reduction techniques for better pain management were some of the ideas of interest to managed care professionals at the 27th US Psychiatric and Mental Health Congress, which opened Saturday in Orlando, Florida.

One of the most vexing problems in managed care is the lack of pricing transparency: patients can't act like consumers when they don't have information on what they are buying. This week, the need for healthcare pricing transparency took center stage in several places.

Sweeping changes to the way America delivers care at the end of life would better serve patients and their families while bringing the healthcare savings that managed care has long sought, according to the Institute of Medicine report, "Dying in America," which was released yesterday.

A study published today found that 16 major U.S. food companies that pledged to cut calories from foods sold consumers cut 6.4 million calories, or 10.6 percent, over a five-year period ending in 2012. Authors of the study say the results show that selling Americans healthier food need not be at odds with a healthy bottom line, and that "the results should encourage other manufacturers and retailers to follow suit."

Deaths from overdoses of prescription painkillers are not rising as quickly, but the reasons for that trend are unclear and could be linked to the legalization of marijuana, according to reports released today.

Open enrollment season is almost upon us. That will bring a test of whether the website for the federal exchange, HealthCare.gov can perform better in its second year than in its disastrous debut.