By Liz Kowalczyk, Globe Staff

Massachusetts House leaders released a major proposal to control health care costs Friday, calling for creation of a new agency to monitor health spending and order reductions in hospital and doctor fees it finds excessive. The lawmakers project their plan would save families thousands of dollars over the next five years.

The long-awaited bill would require the medical industry to cut the rate of growth of health spending about in half, to roughly 3.6 percent a year, mirroring the overall growth in the Massachusetts economy.

A quasi-independent agency would oversee compliance with this goal, in part by investigating providers and insurers whose prices exceed the limit and in some cases requiring them to renegotiate fee increases.

Another key provision would charge hospitals and insurers a one-time tax totaling about $200 million to help struggling hospitals that treat lots of poor patients. They would have to pay it by July 2013.

The legislation also takes aim at the extreme variation in prices that hospitals charge insurers and government payers for similar services. Investigations by the Globe Spotlight Team and Attorney General Martha Coakleys office have documented that hospitals with market power --because of their reputation, location or specialized services -- often charge much more than other hospitals for services of similar quality.

Under the legislation being filed Friday, hospitals that charge 20 percent or more above the median -- and cannot link their hefty prices to above-average quality -- must pay a 10 percent tax, similar to the luxury tax in baseball, which also will support struggling hospitals.

The House released its plan during a 2:30 p.m. press conference at the State House and is sure to find both people who feel it doesnt come down hard enough on the health care industry -- a proposal by Governor Deval Patrick would allow his administration to more directly scrutinize contracts between insurers and providers -- and those who believe it intervenes too heavily into an important private industry.

Lynn Nicholas, president of the Massachusetts Hospital Association, said the bills spending goals are unreasonable and will impinge on our ability to deliver care at the level people expect. By 2016, the legislation calls for health care spending to shrink to the rate of growth of the gross state product -- a measure of economic activity -- minus a half-percent. The hospitals want more time to reach spending targets, and think its unfair to require health care to grow by less than the economy overall.

During an interview with the Globe, House Speaker Robert A. DeLeo said he tried to strike a balance because he did not want to stifle the research and innovation done by an industry that employs one of seven people in Massachusetts. He called his approach a carrot more than a stick.

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House releases plan to cut growth of Massachusetts health spending in half

The president of the Health Sciences Association of Saskatchewan (HSAS) is warning of a crisis if the provincial government doesn't deal with the staffing shortage of respiratory therapists.

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Alberta wages hurting Sask. health care

JUNCTION CITY, Kan. (WIBW) - Community health care centers in Kansas received more than $21 million in grants from the Department of Health and Human Services.

One center in Junction City, the Konza Prairie Community Health Center and Dental Clinic, is one of five recipients in Kansas, receiving a $4.5 million grant.

Jay Angoff, Regional Director of HHS, on Friday visited the center on 361 Grant Avenue, to share the good news with Konza Prairie's board and staff.

"This past week we announced nationwide grants of $730 millionto community health centers throughout the country [and] as I said, five in Kansas," Angoff said. "The most you can get is $5 million and you all were awarded $4.5 million. So that's pretty good," he said to cheers from board members.

The money comes from the new health care law, the Affordable Care Act.

Health and Human Services Secretary Kathleen Sebelius announced $21,689,730 in grants towards construction and renovation of community health centers on Tuesday. Grantees estimate these awards will help them serve approximately 39,496 new patients.

The grant couldn't have come at a better time, Konza Prairie executives said. The center serves patients who are uninsured, underinsured, on Medicaid or Medicare, as well as patients with insurance. 50 percent are uninsured, and its clientele include many active-duty soldiers and their families from Fort Riley.

Christina Carrigan of Junction City and a mother of two, said Konza Prairie is a well-kept secret that has helped her through some tough times.

"At the time I had my daughter, I wasn't working and i didn't have insurance," she said. She became a patient two years ago. "They offered the sliding scale and I was really pleased to have that," she said, referring to a program that permits patients to pay depending on their income level.

Angoff cited that policy as one of Konza Prairie's qualities. "You don't turn people away. That's one example of what's best about our health care system," he said.

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Konza Prairie Health Center Receives $4.5 Million Grant

Many of your health care needs may soon be handled by a "doctor" who has actually been trained as a nurse.

Advanced registered nurse practitioners are increasingly performing duties once reserved for physicians, including diagnosing illnesses and prescribing medicine. It's a trend that's likely to continue as the state grapples with escalating health care costs and a shortage of primary care physicians.

And they'll be better trained, due to higher standards for nursing school accreditation that could go into effect as soon as 2015. In Florida and around the country, schools have been adding "doctor of nursing practice" programs, which they expect will soon become the standard degree for practitioners.They won't be physicians, but you can call them doctor.

Nurse practitioners, who are registered nurses with a specialized master's degree, used to be found mostly in rural areas where physicians were scarce or in public health settings where most patients were poor. But in recent years, private physicians have increasingly been hiring them to help manage their patient load.

Patient care isn't suffering, according to several national studies, which have credited nurse practitioners for spending more time with patients and properly treating most routine medical conditions.

"Nurses often tend to have a holistic approach. They try to get to know all aspects of the patient, not just the medical condition," said Susan Folden, a retired nursing professor of nursing at Florida Atlantic University.

There are nearly 18,000 nurse practitioners in the state, twice as many as a decade ago. They can handle more than 90 percent of a patient's primary health care needs at a lower cost, so it makes sense they're becoming more prevalent, said Sheldon Fields, an assistant dean at Florida International University's College of Nursing.

"If you have a common cold, you don't need to see a physician for that," Fields said. "If you need a routine check for high blood pressure or diabetes or if a child needs a physical for camp, a nurse practitioner is well trained."

They often perform a similar role as physician assistants, although the training and approach are different. Physician assistants receive specific medical training to diagnose conditions and serve the needs of a physician, while nurse practitioners are trained foremost as nurses and tend to focus more on preventative and maintanence care, experts say.

Nursing educators say patient care will further improve as nurse practitioners receive doctoral level training. They say practitioners will learn more about clinical research, health policy initiatives and technology, giving them new tools to solve problems.

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Nurse practitioners tackling more 'doctor' tasks

Gov. John Kitzhaber has convinced the Obama administration that he can deliver better health care at a lower cost by investing in preventive care that reduces avoidable hospitalizations.

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With federal money, Oregon kicks health care reform into high gear

KEY POINTS:

* Blacks and lower income Hispanics are more likely than Whites or Asians to live in areas with few or no primary care physicians. * Majority Asian zip codes were associated with a greater likelihood of having a primary care physician.

By Randy Dotinga, Contributing Writer Research Source: Health Services Research Health Behavior News Service

Newswise New research into "health care deserts" finds that primary-care physicians are especially hard to find in predominantly Black and/or low-income Hispanic metropolitan neighborhoods.

"What this says to us is that we really need to encourage physicians to locate in these areas," said study lead author Darrell J. Gaskin, Ph.D., deputy director of the Hopkins Center for Health Disparities Solutions at Johns Hopkins Bloomberg School of Public Health.

Research suggests that minorities, the poor, people in inner cities and rural areas, and the uninsured are more likely to not have a regular source of medical care. Primary-care physicians are crucial because they're "our first line of defense in the health-care system," Gaskin said. "They deliver most of our preventive and routine services in terms of checkups and initial acute-care services and do the initial diagnosis to let patients know if they need a higher level of care."

In the new study, published in the latest issue of Health Services Research, Gaskin and colleagues examined U.S. Census and American Medical Association data from 2000 and 2006 to determine which zip codes in U.S. metropolitan areas - which can include rural neighborhoods - had a shortage of primary-care physicians, defined as one physician for 3500 or more people, or no physician at all.

After controlling for other demographic and economic factors, 25.6 percent of Blacks and 24.3 of Hispanics lived in zip codes with few or no primary-care physicians, compared to 9.6 percent of Asian and 13.2 percent of Whites. Zip codes that were identified with mostly Black or Hispanic residents were more likely to have a shortage of primary care physicians, however the disparity disappeared for Hispanics after controlling for socioeconomic factors.

Interestingly, segregation of Asians, and to a lesser extent, certain groups of Hispanics, was positively associated with the availability of a primary care physician. Gaskin speculated that shortages in Asian and some Hispanic neighborhoods may be averted by the immigration of foreign-trained doctors. They might be looking for places where patients speak their languages, he said.

As for black neighborhoods, he said racism and bigotry may not be a major factor for physicians as they make decisions about where to locate their practices. It may be difficult to financially sustain a practice in black neighborhoods because higher proportions of black patients are uninsured or covered by Medicaid.

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'Health Care Deserts' More Common in Black Neighborhoods

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BOSTON Stepping in front of a planned announcement from state senators, House leaders late Thursday said theyll unveil a long-awaited health care payment reform and cost control bill on Friday.

According to House Speaker Robert DeLeos office, the bill will be unveiled during a 2:30 p.m. press conference in Nurses Hall with Health Care Financing Committee Co-chairman Rep. Steven Walsh, D-Lynn, and other members of the committee.

Senate President Therese Murray said last week the Senate planned to debate its version of Gov. Deval Patricks payment reform bill, filed in February 2011, in mid-May, after the bill emerged from the Senate Ways and Means Committee. This week, Murray said the Senate bill would be released next week.

Rumors began circulating on Beacon Hill Wednesday that a House health care bill might emerge on Friday, before the Senate bill. Until Thursday afternoon, House aides either declined to respond or declined comment when asked to confirm those plans or whether committee members were voting on a bill.

After 14 months of review, the Health Care Financing Committee last week released Patricks bill to the Senate, with Walsh saying the panel released the governors bill at the Senates request. Murray on Wednesday expressed surprise at Walshs assertion. On Thursday, committee co-chair Sen. Richard Moore, D-Uxbridge, said he was not aware of any plans by the House to release its own bill.

The Legislature and Gov. Patrick have passed a pair of major health care bills since Gov. Mitt Romney in 2006 signed the landmark law requiring Massachusetts residents to have health insurance or pay tax penalties. While both of those laws included components aimed at addressing rising health care costs, the payment reform bill is viewed as possibly the most aggressive effort to control costs while also striving towards the goal of improving and better coordinating patient care and reducing unnecessary testing.

Many health care industry executives are voluntarily moving toward systems reflecting goals of payment reform financial savings, more integrated and better quality care and a movement away from the fee-for-service payment model and lawmakers must decide whether and how heavily to regulate rates and how much of cost control they should leave to the private sector.

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Walsh-led health bill to be unveiled

OTTAWA Ontario's health system is confusing and hard to navigate for the sickest seniors, and a majority have run into problems that lead to poor care, according to a new survey that asks older Ontarians about their health-care experiences.

The report by The Change Foundation, a Toronto think-tank, finds that older voices are often the faintest with many of the seniors surveyed saying they feel ignored or let down by health-care providers, who work in a patchwork of fragmented and badly organized services.

And because of poor information sharing among family doctors, hospitals, nursing homes and home-care agencies, seniors often run into problems, or fall through the cracks entirely, as they are transferred from one provider to another.

The picture that emerges points to shortcomings in a system that remains well suited for patients needing acute, short-term care, but is not equipped to deal with a growing number of seniors suffering from chronic illnesses, who are among the heaviest users of health services.

Instead of reflecting the concerns of health-care insiders, the report gives voice to patients and their families, who are often the best placed to spot problems, said Cathy Fooks, chief executive of The Change Foundation.

"They're really the only people who see the entire trip through the system. Providers interact at various stages in time, but they don't really see the whole process of patients trying to navigate the system."

Of 138 seniors interviewed more than half said they had experienced a disruption in health services because of a communication breakdown among providers, or between providers, themselves and their caregivers.

Only 20 per cent of seniors surveyed said they had never had a problem.

"Seniors and caregivers don't want the moon; they don't necessarily even want more. Their most frequent calls for change revolve around co-ordination and communication," the report said.

The communications gap often starts with family physicians as they refer patients to specialists.

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Ontario health system confusing for ailing seniors, study finds

There's still work to be done when it comes to creating an environment in which Hmong residents are comfortable with Western medicine, including easing cultural and language barriers.

Candice Adam-Medefind, executive director for Healthy House Within a MATCH Coalition in Merced, said "We still have a lot of providers who don't recognize how critical language access is."

To examine what has been done to try to remove those barriers over the last couple of years, the local group will bring in an author who has explored the issue in Merced.

Anne Fadiman wrote "The Spirit Catches You and You Fall Down," which is set in Merced. She will be the keynote speaker at Healthy House's annual multicultural dinner on Saturday at the Merced Elks Club. Four Mercedians featured in the book will participate in a panel discussion with the author.

They will talk about the improvements in the gap between Hmong beliefs and Western medical practices that have been made since the book was published in 1998.

Adam-Medefind said several actions have been taken. "The writing of that book was one of the main events that prompted the setting up of the Healthy House in the community to address the cultural clash between Hmong shamans and the Western medicine establishment," she said.

In addition, the nationally recognized program, Partners in Healing, has made strong contributions to the advancements in the disparities between Hmong beliefs and Western medicine.

The program allows Hmong spiritual healers, known as shamans, to conduct healing ceremonies when requested by Hmong patients or family members to meet their spiritual needs, provide support and promote optimal healing.

The program is made possible by a partnership between the Healthy House and Mercy Medical Center.

In a community as diverse as Merced, culturally competent health care services and language access continue to be an issue, Adam-Medefind said.

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Hmong health care gap focus of Healthy House dinner

RICHMOND, Va. --

With the theme from "Mission Impossible" playing in the background, a gubernatorial advisory panel inched closer to deciding what essential health benefits would have to be offered in a Virginia-operated insurance exchange.

The panel, appointed by Gov. Bob McDonnell to help carry out federal health care reform, came just short on Thursday of endorsing a small-group insurance plan offered by Anthem, Virginia's biggest insurer, as the benchmark for competitors in the exchange.

Instead, the Virginia Health Reform Initiative Advisory Council decided to wait for a detailed comparison of benefits currently provided under insurance plans in the state, as well as a better understanding of what services would be covered for mental health, substance abuse and therapies for developmentally delayed children.

"We're almost making it too complicated," said state Sen. John Watkins, R-Powhatan, who has pushed the state to make decisions sooner rather than later on how to establish a health benefits exchange. "It's pretty straight up."

The council debated the benefits issue in its first meeting since making recommendations last September that neither the governor nor the legislature acted upon. McDonnell has not taken a public position on the recommendations, choosing instead to wait until after a U.S. Supreme Court ruling on the Patient Protection and Affordable Care Act.

"Our instructions remain: 'prepare,' " said Health and Human Resources Secretary Bill Hazel, a former orthopedic surgeon who chairs the advisory panel.

Previous recommendations focused on the governing structure for an exchange, including whether to house it at the State Corporation Commission or create an independent, quasigovernmental entity.

The debate on Thursday at the Greater Richmond Convention Center dealt solely with the package of essential benefits that all insurers competing in an exchange would have to offer individuals and small businesses.

Federal regulators have left the decision to the states, while providing a list of 10 essential services that insurers would have to cover, either through a benchmark benefit plan or additional riders that would be eligible for federal subsidies.

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Health-care reform panel considers exchange options for Va.

Illustration by Ryan Cox

By Jonathan Cohn and David A. Strauss Thu May 03 23:00:36 GMT 2012

As they await the Supreme Court ruling on the Affordable Care Act, legal critics of the law say their case is about liberty. If the government can instruct people to obtain health insurance, they keep asking, whats to stop it from requiring them to buy broccoli?

But the real threat to liberty in this case isnt a hypothetical broccoli law. Its the problem that the mandate remedies -- the failure of the health-insurance market -- and the long-standing national crisis of rising health-care costs that Congress finally found a way to address.

Its not a coincidence that in every advanced country in the world, including the U.S., the government is heavily involved in the health-care market and has been for generations. Everybody needs medical attention, at some point, and virtually everybody needs health insurance to pay for it. Nobody can predict when he or she will need care and virtually nobody can pay for it out of pocket. Even the laws challengers acknowledge these facts.

But in the U.S., not everybody can actually get health insurance -- partly because, as economists have long understood, the health-insurance market is almost uniquely prone to dysfunction.

Insurers need premiums from healthy people, so that, at any one time, they have money to pay the bills of the sick and injured. Private insurers can build these broad risk pools when they sell coverage through large employers, since such companies typically have big and diverse workforces. But when insurers sell health-care policies directly to individuals, they run into trouble: They disproportionately attract people who already have medical conditions.

During the 20th century, this problem of adverse selection pushed many insurers into financial distress.

To preserve themselves, carriers today charge higher premiums, reduce benefits or deny coverage altogether to applicants who have pre-existing medical conditions. Although this keeps insurers solvent, it excludes people who need insurance the most -- in ways that limit their ability to participate fully as members of society and, for that matter, to engage in interstate commerce. Frequently these people cant switch jobs or start a business. In the worst cases, they cant pay their medical bills or obtain the care they need.

By establishing the mandate, which is really just a financial incentive for people to get insurance, the Affordable Care Act will build large, stable risk pools for health insurance. It will also enable the government to set rules about standard benefits and pricing that allow people buying insurance on their own to comparison-shop. In the long run, according to the Congressional Budget Office, it will help government control the cost of medical care, which increasingly strains public and private resources alike -- and today accounts for one-sixth of the American economy.

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Yes, the Health-Care Mandate Is About Liberty

The Southwest Louisiana Primary Health Care Center of Opelousas will receive more than $1 million from the federal government to increase its building capacity and serve more patients, U.S. Sen. Mary Landrieu, D-La., announced this week.

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Health center gets $1M federal grant

THURSDAY, May 3 (HealthDay News) -- Despite the fact that Americans spend more on their health care than citizens of 12 other developed nations, a new report finds that more does not necessarily equal better when it comes to quality of care.

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U.S. Health Care Spending High, But Quality Lags: Report

The Obama administration is buying into an ambitious health care initiative in Oregon, announcing Thursday it has tentatively agreed to chip in $1.9 billion over five years to help get the program off the ground.

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Feds to put up $1.9B for Oregon health overhaul

WASHINGTON -- Medicare's payment system, the unseen but vital network that handles 100 million monthly claims, could freeze if President Barack Obama's health care law is summarily overturned, the administration quietly informed the courts.

Although Obama's overhaul made significant cuts to providers and improved prescription and preventive benefits, Medicare was overlooked in Supreme Court arguments that focused on the law's controversial requirement that all individuals carry health insurance.

Havoc for Medicare could have repercussions as both parties avidly court seniors in this election year and as hospitals and doctors increasingly complain the program doesn't pay enough.

In papers filed with the Supreme Court, administration lawyers warned of "extraordinary disruption" if Medicare is forced to unwind countless transactions that are based on payment changes required by more than 20 separate sections of the Affordable Care Act.

Opponents say the whole law must go. The administration counters that even if the court strikes down the insurance mandate, it should preserve most of the rest of the legislation. That would leave in place the changes to Medicare and a major expansion of Medicaid coverage.

Last year, in a lower court filing, Justice Department lawyers said reversing Medicare payment changes "would impose staggering administrative burdens" on the government and "could cause major delays and errors" in claims payment.

Former program administrators disagree on the potential for disruptions, while some private industry executives predict an avalanche of litigation unless Congress intervenes.

The AARP says it's concerned. If doctors became embroiled in a legal battle over payments, then "a general concern would be that physicians would cease to take on new Medicare patients, as well as potentially have issues seeing their current patients," said Ariel Gonzalez, an AARP lobbyist.

Medicare payment policies are set through a time-consuming process that begins with legislation passed by Congress. Even if the law were completely overturned, the government would have authority under previous legislation to pay hospitals, doctors, nursing homes and other providers.

But reversing the new law's payment changes from one day to the next would be a huge legal and logistical challenge and raise many questions. How would Medicare treat payments made over the last two years, when the overhaul was the law of the land? Would providers who received cuts subsequently have a right to refunds?

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Scuttling health care act will freeze Medicare, White House warns

28-03-2012 08:48 Preview of day 3 of arguments before the Supreme Court regarding the affordable health care law. Wednesday's arguments will be split into two parts: Justices will hear 90 minutes of debate in the morning over whether the rest of the law can take effect even if the health insurance mandate is unconstitutional and another hour Wednesday afternoon over whether the law goes too far in coercing states to expand the federal-state Medicaid program for low-income people by threatening to cut off federal aid to states that don't comply.

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Final Day of Health Care Law Arguments Before Supreme Court - Video

28-03-2012 08:49 Health care takes center stage at the US Supreme Court. CNN's Kate Bolduan reports.

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Health care on trial - Video

28-03-2012 13:30 Several Supreme Court justices seemed receptive Wednesday to the idea that portions of President Barack Obama's health care law can survive even if the court declares the centerpiece unconstitutional. (March 28) Subscribe to the Associated Press: Download AP Mobile: Associated Press on Facebook: Associated Press on Twitter: Associated Press on Google+:

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Raw Audio: High Court Dissects Health Care Act - Video

02-04-2012 13:36 President Obama attacks Supreme Court on health care

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President Obama attacks Supreme Court on health care - Video

02-04-2012 13:41 Obama answers a question about the possible supreme court decision to repeal the healthcare law's individual mandate. Read the HuffPost article here:

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Obama Healthcare Individual Mandate - Video