If your cardiologist is away at a conference when you’re having a stabbing feeling in your chest, don’t fret. You may be more likely to live.

A study published Monday in the journal JAMA Internal Medicine found frail patients admitted to teaching hospitals with two common types of heart problems were more likely to survive on days when national cardiology conferences were going on.

The researchers also discovered that heart-attack patients who were at higher risk of dying were less likely to undergo angioplasties when conferences were occurring, yet their mortality rates were the same as similar patients admitted at other times. An angioplasty—in which a doctor unblocks an artery with an inflatable balloon inserted by a small tube—is one of the most common medical procedures for cardiac patients.

The conclusions about teaching hospitals surprised even the authors, who had begun their inquiry anticipating that death would be more common during cardiology meetings because hospital staffs were more short-handed than usual. Finding the opposite, the researchers speculated that for very weak patients, aggressive treatments may exceed the benefits.

“There’s something very specific about cardiology meetings and cardiology outcomes,” said Dr. Anupam Jena, a professor at Harvard Medical School and the lead researcher of the study. “I can tell you with almost certainty that something different is happening in the hospital, but I can’t tell you why this is happening.”

The study looked at Medicare patients admitted to 263 major teaching hospitals between 2002 and 2011, during days that the American Heart Association or the American College of Cardiology held their annual meetings. These conferences draw thousands of doctors, nurses, pharmacists and other medical professionals who come to hear of the latest research, therapies, drugs and technologies, as well as to network and socialize with colleagues.

Dr. Patrick O’Gara, president of the cardiology conference, said he was reassured by the finding that patient mortality did not increase when those doctors were away. “People should take away from this particular paper that they should be confident of going to a teaching hospital at any time of the year,” he said. He cautioned against drawing any conclusions from the paper’s finding that mortality rates dropped for some people, noting that the data is “not granular enough to provide information about what types of patient therapies the patients received.”

For patients with heart failure, heart attacks or cardiac arrest, the researchers examined death rates—either in the hospital or within 30 days of leaving—and compared them with the rates for patients hospitalized on the same days of the week during the three weeks before the conferences started and the three weeks after.

The lower death rates during conferences were limited to high-risk patients in teaching hospitals; researchers did not see a change in mortality for high-risk patients in other hospitals. The study also found that the majority of patients with more robust health had no greater chance of expiring if their hospitalization overlapped with a conference.

The researchers found that 18 percent of high-risk patients with heart failure—where the heart muscle does not pump blood as well as it should—died on conference days, while 25 percent died on the non-meeting days. The difference was even greater for patients with cardiac arrest, when the heart isn’t pumping blood. The study found 59 percent of cardiac arrest patients died when conferences were underway, while 69 percent died on other days.

The researchers suggested several possibilities, but also found reasons to doubt those explanations. It could be that cardiologists who attend conferences are more likely to do aggressive medical treatments such as complex angioplasties than are those doctors who skip conferences. While invasive treatments often save lives, they can also result in infections and other complications, some of which can be deadly.

The researchers also postulated that when a patient’s primary cardiologist is out of town, a substituting doctor may be less likely to perform an aggressive intervention. However, the researchers were unable to find evidence of any procedures that were being performed less frequently for heart failure or cardiac arrest patients during conference dates. Jena said aggressive procedures, such as placing catheters into neck veins to measure the heart, can cause complications but are not always easy to identify in the Medicare billing data used in the study.

The researchers hypothesized that during conferences, there might be fewer patients undergoing elective procedures, therefore giving the remaining doctors more time to focus on the urgent cases. However, they did not find any decrease in the number of heart patient admissions during conference days. They also found no difference in the general health of patients hospitalized on meetings days and those admitted at other times.

One more possibility, Jena said, “is that the doctors who leave are primarily researchers and they don’t take care of as many patients as other doctors, so they are worse doctors.”

Heart attack patients were just as likely to die on conference dates as other dates. But 21 percent received angioplasties or stents when conferences were going on, less than the 28 percent who received these interventions other times. “Patients at the very least are no worst off and in fact they may be better off by having less stenting,” Jena said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

With the deadline looming to re-enroll in California’s insurance exchange, Kuei Lin Liu faced a tough question: Do I want to go through this all over again?

After a year of bureaucratic snags, data glitches and inexplicably dropped coverage, Liu wondered whether Covered California was worth the effort.

“I’m so frustrated right now,” she said. “I spent the last year trying to work out this mess.”

The 37-year-old Richmond resident first enrolled in the exchange last fall, when she left a senior accounting position at a big corporation and the benefits that came with it. With two daughters under 5 and a son due in May, Liu said going uninsured was not an option.

So Liu and her husband Qing Lin, a 45-year-old stay-at-home dad, signed up for a benefits-rich platinum plan from Blue Shield of California. With a projected income of about $90,000 from her tax prep business,  they were eligible for a subsidy that covered a third of their nearly $1,600-a-month premium.

The plan wasn’t as generous as the coverage at her accounting job, but having most of the year virtually free to spend with her family was, to her, a fair trade.

Then the hassles began, said Liu, a CPA and native of Taiwan who immigrated to the United States in 1997 to attend college.

After applying in November 2013 for the Blue Shield plan, she didn’t hear back. With no response from the exchange or the insurer by Dec. 28, she panicked. She had her insurance broker submit another application.

The New Year came and went with neither a confirmation nor a bill from Covered California or Blue Shield. She had to pay for an ultrasound out-of-pocket — about $600, said Liu, who goes by Cecily in English. Fearful of giving birth without insurance, she shelled out about $1,200 for an off-exchange policy with Blue Shield that started on Feb. 1.

Shortly afterward, Liu received confirmation that her Covered California plan was in effect. Blue Shield agreed to apply the payment she had already made on the off-exchange plan to the exchange plan — but that took another month. The reason: Blue Shield had separate payment systems for off- and on-exchange plans.

“I actually visited Blue Shield in El Dorado Hills, their corporate office, to try and make them move the payments,” said Liu’s broker, Kevin Knauss.

Liu thought her problems were behind her after the company applied the payment correctly. Then, in May, her son Nolan was born.

Knauss contacted Covered California the day after his birth to add him to the family policy. When the enrollment data was submitted to Blue Shield, however, the rest of the family’s coverage disappeared from the computer record. It was reinstated –except for Liu’s older daughter Larissa.

That problem eventually was corrected but the policy started on the wrong date.

Although Blue Shield covered the baby’s birth, Liu and Knauss had to hector the insurer and Covered California for two months to ensure Nolan and his siblings remained properly enrolled, they said. Liu even filed a complaint with the state Department of Managed Health Care.

“No one was willing to take responsibility. I told them… ‘You took my money and ran.’”

In late September, Knauss was checking online and noticed the family’s coverage seemed to have disappeared again.

After another round of calls they were back in the system. But all the stress resurfaced in November when the pediatrician’s biller called to say coverage couldn’t be verified for her younger daughter Fiona’s visit in July.

“It’s like history is repeating,” said an exasperated Liu, who fielded several similar calls in the summer, when she was trying to sign up her son. “It’s ridiculous.”

‘We can do better’

Neither Covered California nor Blue Shield would comment specifically on Liu’s case. But they and consumer advocates both underscored the need to improve “the customer experience.”

Covered California is “going to have to not just promise but provide a better experience for people in renewing and signing up for coverage,” said Anthony Wright, executive director of Health Access California, an advocacy group.

Despite glitches, Covered California’s first enrollment period, which started in October 2013, was a success compared to the rollout of its federal counterpart operating in 36 states, healthcare.gov. Enrollment this year began on Nov. 15 and runs until Feb. 15, and California’s exchange appears to be going more smoothly. In the first month, 144,178 people selected a health plan, nearly a third more than signed up in the first month in 2013, according to Covered California.

Exchange officials say they spent the summer making improvements, bolstering technological infrastructure and adding staff.

“I’m sure there are people who have had a negative experience that won’t come back,” said Roy Kennedy, a spokesman. “We ask that they come back and let us try to make it up to them. We know that we can do better.”

A Blue Shield spokesman said in an email that during the early implementation of the health reform law, “some customers did not experience the level of service they deserve.”

“We have and will continue to work closely with Covered California and our vendors to address these issues and streamline the process in 2015 and beyond,” said the spokesman, Sean Barry.

A Cautious Decision

For months, Liu went back and forth about whether to re-enroll.

She found herself thinking, “It’s just too much work. I don’t have time for that.”

If she took no action, she and her family would be automatically re-enrolled in their Blue Shield platinum policy. The pre-subsidy premium would be $1,699 a month, a $116 hike.

Days before the Dec. 21 deadline for coverage beginning in the New Year, Liu cautiously decided to give Covered California another try. Instead of a platinum plan, she picked a slightly less rich gold one because she doesn’t expect to need as much care as this year when she had the baby. She will pay $1,482—or $949 with the tax credit.

Liu’s hoping the switch proceeds without difficulties but if the service isn’t substantially better, she’s buying private insurance off exchange next time.

“I don’t want to deal with that headache again,” she said.

Blue Shield of California Foundation helps support KHN coverage of California.

The California Endowment helps support KHN coverage of California.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Ballots for the AaNA Joint Board of Directors & Labor Council election were counted on December 19, 2014 at 3:00 PM at the Association office. Congratulations to our leaders who were elected by AaNA members. Newly elected members will begin their terms on January 1, 2015. Elected to the AaNA Board of Directors and Labor Council:


Board of Directors Vice President / Labor Council Director
Jane Erickson

Board of Directors Labor Council Designee / Labor Council Director
Donna Phillips

Board of Directors Director-at-Large / Labor Council Director
Lila Elliott
Kimberly Kluckman
Shelley Burlison

Ballots for the Providence Registered Nurses election were counted on December 19, 2014 at 3:00 PM at the Association office. Congratulations to our leaders who were elected by PRN members. Elected to PRN:


Vice President
Jane Erickson

PRN Representative to the AaNA Labor Council
Jennifer Hazen

Grievance Officer
Jennifer Hazen

Health & Safety Officer
Donna Phillips

Starting next year, the government will offer some seniors enrolled in private Medicare Advantage insurance an opportunity to leave those plans if they lose their doctors or other health care providers.

Last year, thousands of seniors in at least 10 states were left stranded or assigned new doctors when insurers discontinued contracts with the physicians.

The Medicare Advantage policies cover 16 million seniors and are an alternative to the government-run Medicare program. Medicare Advantage members can only get care from a network of providers under contract to participate in their plan. They must remain in their plans for the calendar year, with some rare exceptions, but losing their doctor has not been among the permitted reasons.

But if certain conditions are met, officials at the Centers for Medicare & Medicaid Services will create a special three-month enrollment period following network changes “considered significant based on the [effect] or potential to affect, current plan enrollees,”  according to an update to Medicare’s Managed Care Manual. During that time, they could join traditional Medicare or another Medicare Advantage plan whose provider network includes their doctors.

“If CMS does not prohibit midyear network terminations then a special enrollment period is the next best thing for beneficiaries,” said David Lipschutz, senior policy attorney at the Center for Medicare Advocacy, a nonprofit law firm that works on behalf of Medicare patients.

Clare Krusing, a spokeswoman for the trade group America’s Health Insurance Plans, said banning network changes would hamper provider contract negotiations, which occur throughout the year, and could ultimately reduce the variety of available plans.

She said “CMS has taken a balanced approach” in dealing with seniors’ needs while assuring flexibility for health plans.

But Lipschutz said no one seems to know what the “significant” network changes are that will trigger the special enrollment opportunity.

Medicare spokesman Raymond Thorn said the agency will make that “case-by-case” determination based on the number of beneficiaries affected and whether they received adequate and timely advance notice, the size of the plan’s service area, when during the year the provider terminations occur and other factors. He declined to provide details on the minimum number of beneficiaries, providers or service area size that would be necessary.   Once Medicare decides that plan members should be allowed to leave their plan, the agency will require the plan to notify its members about their new options.

Only CMS will make a determination of the need for this provision. Individual beneficiaries who are concerned after their doctor is dropped from a plan cannot request the special enrollment period, Thorn said. That is different from how Medicare handles some other mid-year changes in these policies. Beneficiaries can request a special enrollment if they move into an area where their plan is not available, become eligible for Medicaid, or move into a nursing home, among other reasons.

Last year, UnitedHealthcare cut thousands of physicians from its Medicare Advantage plans across the country, including 2,200 physicians in Connecticut.  At town hall meetings held by the Fairfield County, Conn., Medical Association, executive director Mark Thompson said angry and fearful patients told “heart-wrenching” stories about their experience.

“They were being forced to leave their doctors and there wasn’t anything they could do about it,” he said.  “They couldn’t go to another plan and they couldn’t go back to traditional Medicare.”

The only option at the time, he said, “was to go to another doctor who they had no history with.”

UnitedHealthcare spokesman Terence O’Hara said next year its enrollees “nationally will continue to enjoy a broad selection of doctors that can provide the right care where and when it is needed.”

The special enrollment option comes after officials established stricter notification rules for network changes that also take effect Jan. 1, 2015. Insurers must tell CMS at least 90 days before instituting network “significant” changes.  The rules also recommend that insurers provide more than the required 30 days’ advance notice to beneficiaries. It should include the name of the provider being terminated and how members can request continuation of ongoing medical treatment from that provider.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.