Denton Record-Chronicle (Denton, Tex.), Vol. 113, No. 154, Ed. 1 Tuesday, January 3, 2017 Page: 3 of 16
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LOCAL/NATIONAL
3A
Denton Record-Chronicle
Tuesday, January 3, 2017
Medicare launches treatment pay experiment
surgeon-tumed-congressman
Tom Price, has expressed gener-
al concern that the doctor-pa-
tient relationship could be
harmed by Medicare payment
changes seeking to contain
costs. And the Medicare division
that designed the experiments
— the Center for Medicare &
Medicaid Innovation — is itself
under threat of being abolished
because it was created by Presi-
dent Barack Obama’s 2010
health care law.
Some outside groups, includ-
ing AARP, worry that Medicare
may be moving too fast and that
focusing on cost containment
could lead to beneficiaries being
shortchanged on rehab care.
Innovation center director
Patrick Conway, who also serves
as Medicare’s chief medical offi-
cer, is plowing ahead nonethe-
less. “Delivery system reform
and paying for better care are bi-
partisan issues,” Conway said.
And quality ranks ahead of cost
savings in evaluating any results,
he added.
The cardiac and hip fracture
experiments focus on traditional
Medicare, which remains the
choice of nearly 7 in 10 out of
Medicare’s 57 million beneficia-
ries. The cardiac experiment in-
volves both heart bypass and
heart attack patients. The trials
join similar ongoing tests involv-
ing surgery for hip and knee re-
placement, as well as care for
Around the country, hospi-
tals in 98 metro areas will be in-
volved in the cardiac experi-
ment. The hip surgery experi-
ment involves 67 areas that are
also part of Medicare’s ongoing
test with hip and knee replace-
ments.
Areas in the cardiac test in-
clude Boston, as well as Akron,
Ohio; Charleston, South Caroli-
na; Fort Collins, Colorado; Uti-
ca, New York; and Yuma, Arizo-
na. A smaller group of commu-
nities will be involved in a relat-
ed experiment that pays
hospitals for coordinating rehab
care for heart patients. Although
the benefits of cardiac rehab are
widely recognized, only a small
share of patients receives it.
The hip fracture test includes
the Miami, New York, and Los
Angeles metro areas, as well as
Austin; Bismarck, North Dako-
ta; Flint, Michigan, and New
Orleans.
Hospitals are not happy with
the changes, though doctors
have generally been supportive.
A big concern for hospitals is
that Medicare requires manda-
tory participation by all the facil-
ities in areas selected for these
tests. But Conway says that’s
likely to lead to even better re-
sults. The idea is that hospitals
will watch each other’s perfor-
mance closely, and the ones that
have room to improve will try to
catch the high achievers.
By Ricardo Alonso-Zaldivar
Associated Press
WASHINGTON
Heart
attacks and broken hips cause
much suffering and worry as
people grow older. This year,
Medicare wants to start chang-
ing how it pays for treatment of
these life-threatening condi-
tions, to promote quality and
contain costs. Beneficiaries and
family members may notice a
new approach.
Hospitals and doctors in doz-
ens of communities selected for
large-scale experiments on this
front are already gearing up. The
goal is to test the notion that bet-
ter coordination among clini-
cians, hospitals, and rehab cen-
ters can head off complications,
prevent avoidable hospital re-
admissions and help patients
achieve more stable and endur-
ing recoveries. If results back
that up, Medicare can adopt the
changes nationwide.
The cardiac and hip fracture
experiments are the latest devel-
opment in a big push under the
Obama administration to rein-
vent Medicare, steering the pro-
gram away from paying piece-
meal for services, regardless of
quality and cost. It’s unclear
whether Donald Trump as pres-
ident will continue the pace of
change, slow down or even hit
I
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Patrick Semansky/AP file photo
Patrick Conway, director of the Center for Medicare & Medicaid Innovation, poses for a photo-
graph in the center’s offices in Baltimore County, Md., in this April 12 photo.
providers. If the hospital falls
short, it may have to pay the gov-
ernment money.
“Now your doctor and hospi-
tal are working together to make
sure they are well coordinated,”
said Conway.
Under the old system, if a pa-
tient was discharged from the
hospital after a heart attack,
“they might hand you a piece of
paper that said please follow up
cancer patients undergoing che-
motherapy.
In the experiments, doctors,
hospitals, and rehab centers get
paid the regular Medicare rates.
But hospitals are given responsi-
bility for overall quality and cost,
measured against benchmarks
set by Medicare. If the hospital
meets or exceeds the goals, it
earns a financial bonus, which
can be shared with other service
with your primary care doctor,”
Conway continued. “In this
model, the hospital is going to
have a strong incentive to make
sure you follow up.”
Overall, about 168,000
Medicare beneficiaries are treat-
ed for heart attacks in a given
year, while 48,000 undergo
heart bypass surgery for clogged
arteries and 109,000 have sur-
gery for broken hips.
pause.
Trump’s Health and Human
Services nominee, orthopedic-
Dems frustrated with national committee
BRIEFLY
ACROSS THE NATION
Billings, Mont.
New dam challenged
over sturgeon worries
Wildlife advocates plan to
challenge the approval of a new
Yellowstone River dam aimed at
benefiting Montana and North
Dakota farmers that critics say
could kill off a dwindling popu-
lation of a fish species dating to
the time of dinosaurs.
A bypass channel would be
built alongside the concrete irri-
gation dam near the Montana-
North Dakota border to let en-
dangered pallid sturgeon reach
upstream spawning grounds.
But scientists don’t know if
the fish would use the channel.
Advocates for the few remaining
wild sturgeon say betting they
would is an unacceptable risk
because they could die off alto-
gether if the channel plan does
not work.
Pallid sturgeon are one of the
rarest native fish in the Missouri
and Mississippi River basins.
— The Associated Press
it was under former chairman
Howard Dean.
Party chairs say that’s result-
ed in fewer staff members and
training programs, a change felt
particularly in Republican-lean-
ing states. State leaders also say
Obama’s grassroots group Orga-
nizing for Action has functioned
more like competition than a
partner.
Beginning in 2017, Republi-
cans will hold 33 governorships
and fully control legislatures in
25 states, as well as the Congress
and presidency. During Oba-
ma’s two terms in office, the par-
ty lost more than 1,000 seats at
the state and national level.
“I love President Obama, but
he and his administration al-
lowed for the deterioration, the
terrible deterioration, of the
state parties over the last eight
years,” said Mark Brewer, who
led the Michigan Democratic
Party for 18 years.
Obama has announced
plans, though, to improve Dem-
ocrats’ down-ballot fortunes
once he leaves office. He is
launching an initiative with for-
mer Attorney General Eric
Holder aimed at making Demo-
cratic gains when states redraw
legislative district lines following
the 2020 census. Democrats
have blamed Republican gerry-
mandering for some of their
losses in Congress and state leg-
islatures.
State officials say it’s been
hard to plan long term and re-
cruit and train candidates in off-
election years due to inconsis-
tent funding from the DNC. Un-
der Dean, the national party in-
stalled and paid several staff
members in each state. But that
program ended after Obama’s
election.
State parties began to receive
monthly payments of anywhere
from $5,000 to $10,000, an
amount that varies depending
on the year. At some point, the
parties have received no money
at all. The DNC does provide
some money to state parties for
elections based on the state’s
By Kathleen Ronayne
Associated Press
CONCORD, N.H. - Demo-
crats around the country are de-
manding change from a nation-
al committee they say has fo-
cused too heavily on the White
House at the expense of gover-
norships, legislatures and state
party operations.
“It’s got to be helping us orga-
nize in our states to be able to
build that power at the state leg-
islative level,” Michigan Demo-
cratic Party Chairman Brandon
Dillon said of the Democratic
National Committee, currently
searching for a new leader.
‘We’ve lost governorships and
state legislatures at a rate that is
pretty astounding.”
DNC members gather in
February to elect a new chair-
man, with five candidates run-
ning so far, each pledging to re-
build from the ground up. Mon-
ey from the DNC to state parties
has been inconsistent during
President Barack Obama’s ten-
ure and, in most states, less than
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Pablo Martinez Monsivais/AP file photo
In this 2013 photo, President Barack Obama sits with Attorney
General Eric Holder during the 32nd annual National Peace
Officers Memorial Service on Capitol Hill in Washington. Oba-
ma has announced plans to improve Democrats’ down-ballot
fortunes once he leaves office.
competitive races and other fac-
tors.
Dean’s tenure. But when Dean’s
“50-state strategy” ended, it was
hard to keep one and pay the
rent, said Maureen Monahan, a
vice president of the Association
for State Democratic Chairs
from Nebraska.
The change has left some
states scrambling.
The Nebraska Democratic
Party, for example, paid five full-
time staff members during
From Page 1A
Resolutions
Bradley said if she stumbles
upon a book list — for example,
an online list of a dozen “binge-
worthy” books for the summer
— she’ll read those, too.
“I tried to challenge myself by
getting out of my comfort zone,”
she said. “A few of the books, like
The Last Templar [Raymond
Khoury] and Devil in the White
City [Erik Larson], covered a
historical genre I don’t normally
read, and Finny [Justin Kra-
mon] was a book I literally pull-
ed off the bookshelf because it
had a feather on the spine.”
To make her goal, Bradley
sacrificed some television
watching, “and some sleep, if the
book was a real page-turner,” she
said.
for the fall 2017 semester.
Cunningham plans a dual
major in physics and math, with
a minor in computer science. If
all goes well, he will pursue a
master’s degree and even his
doctorate.
“Maybe in physics, maybe in
aerospace engineering,” he said.
His new-found success fol-
lowed two important lessons he
learned in the past year, Cun-
ningham said.
First, to meet a goal, a person
has to put in the hours on the ba-
sic stuff, just like professional
athletes who still practice their
foot drills, he said.
“To learn, you have to em-
brace the boring aspects of any
good skill,” Cunningham said.
“The routine stuff is way too im-
portant to overlook — it’s not go-
ing away. You have to front-load
that pain.”
The second lesson was more
cerebral, but just as important,
he said.
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Photos by Jeff Woo/DRC
Danielle Bradley made a resolution to read 50 books this year,
almost a book per week. She ended up reading 56.
Brady Cunningham resolved in 2016 to get accepted into col-
lege. He re-taught himself physics, algebra and calculus so he
could take the ACT and apply for school.
ed from high school in 2011 as
one of 24 in his graduating class
in the tiny Perrin-Whitt school
district.
The district is about 55 miles
west of Denton in Jack County.
The son of a teacher, Cun-
ningham felt he got a good edu-
cation in the small district and
he did well enough. But his plan
was to enlist in the U.S. Marine
Corps and serve his country first.
Then, unexpectedly, the Ma-
rine Corps discharged him for
medical reasons.
“I was not really prepared,”
Cunningham said.
Without a backup plan, he
drifted. He moved to Midland
and got into oilfield work for a
while, but living there was too
expensive, he said.
He was hanging around the
wrong people, too, which even-
tually led to real trouble. To set-
tle his legal problems, he went
on probation, but that made it
“I felt bad for both him and
the students, who could not care
less about being there,” Cun-
ningham said. “But the sheer
passion he had makes you excit-
ed to learn.”
That teacher’s enthusiasm
made him think it was possible
to pursue a degree, Cunning-
ham said. He took on the job of
re-teaching himself math and
science step by step.
“I went to the library and
checked out a pre-algebra text
and then algebra I,” Cunning-
ham said. He worked through
all the problems and took prep
courses online, too.
He especially liked Kahn
Academy for its test preparation
help. He took the ACT, a college
readiness test, and scored 35 out
of a possible 36 points. (The
average score is 20.)
He applied for college and
was recently admitted to the
University of Texas at Arlington
For others who want to read
more, Bradley recommends
starting with a list of books you
want to read and map out a
schedule, checking in on your
goal each week or month to ad-
just your pace. Talk with others
who like to read, too, and share
your enthusiasm.
“Once you’ve read a few, and
you’re starting to feel confident,
take the plunge and try some-
thing new,” Bradley said. “You
may discover a new favorite
genre, or author. I had that hap-
pen to me, with The Shadow of
the Windby Carlos Ruiz Zafron.
He’s from Spain originally, and
the text was translated into Eng-
lish.”
wards books that will take me
somewhere else,” she said.
She plans to re-read a favor-
ite, the 1949 environmental clas-
sic, A Sand County Almanac,
and to fix an embarrassing hole
on her list, by finally reading
Richard Louv’s Last Child in
the Woods.
The 2005 book about a “na-
ture deficit disorder” for the cur-
rent generation of children —
which Louv says haven’t played
enough outside for a host of rea-
sons — has become influential
over the last decade.
Bradley said meeting her
goal has been infectious for her
family and friends.
“It also inspired my boy-
friend to read more, and that
was really important to me,” she
said.
hard to get a job.
“No matter how hard you
work, that follows you,” Cun-
ningham said.
His family, however, did
what they could to help him get
back on his feet. His sister of-
fered to let him move into her
place, so last summer, he moved
to Denton.
However, he was embar-
rassed and ashamed, he said.
“I was sleeping on her couch,”
Cunningham said. “I told myself
I can’t live like this anymore.”
He decided he needed to go
to school. He snared a job that
paid enough for him to rent a
small place of his own. And he
hit the books — hard.
He’d always liked science and
math. He remembered how in-
spired he was by his high school
physics teacher, who enjoyed the
topic so much that even the apa-
thetic teenagers in his classroom
didn’t discourage his teaching.
“Several times, I thought I’d
messed up my chances, but
that’s way too self-destructive,”
Cunningham said. “I started to
realize that I was trying to avoid
a feeling of failure, but by not
starting, I was already feeling
that failure. By not trying, that
feeling was not going to go
away.
People shouldn’t let them-
selves think that they’ve been
out of school too long.
Anybody can learn anything,
he said.
She plans on upping her goal
in 2017 to 75 books. She wants to
read more nature-based books,
which she did read a lot more of
in college.
“Since I spend so much time
outside, I do tend to lean to-
It’s not too late.
PEGGY HEINKEL-WOLFE
can be reached at 940-566-
6881 and via Twitter at
@phwolfeDRC.
Brady Cunningham,
ace of the ACT
Brady Cunningham graduat-
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Parks, Scott K. Denton Record-Chronicle (Denton, Tex.), Vol. 113, No. 154, Ed. 1 Tuesday, January 3, 2017, newspaper, January 3, 2017; Denton, Texas. (https://texashistory.unt.edu/ark:/67531/metapth1131582/m1/3/?q=%22~1%22~1: accessed August 15, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; .