In a move that could end up serving as a model for both private and public health care systems across the country, New York City’s public hospitals are poised to begin linking doctors’ paychecks to the quality of the care they provide patients, the New York Times reports.

Obamacare already attempts to shift the nation’s health care model towards one that rewards better care quality — rather than the volume of services provided — by tying safety net hospitals’ reimbursement rates to procedural benchmarks and patient satisfaction questionnaires. But elements of the yet-to-be-finalized NYC proposal would go even further than that, potentially tying physician groups’ salaries and bonuses to a variety of performance indicators in an effort to improve care quality and lower health care costs:

“I would expect that we’re going to see this become more and more prevalent in compensation arrangements,” said Alan Aviles, president of the city’s Health and Hospitals Corporation, which runs the city’s 11 public hospitals and is the country’s largest public health system, handling more than 1 million emergency room visits a year.

The corporation’s plan would make doctors’ raises dependent on their performance on quality measures. The details are being negotiated with the doctors’ union, but both sides expect to reach an agreement that incorporates the idea. [...]

The public hospital system has come up with 13 performance indicators. Among them are how well patients say their doctors communicate with them, how many patients with heart failure and pneumonia are readmitted within 30 days, how quickly emergency room patients go from triage to beds, whether doctors get to the operating room on time and how quickly patients are discharged.

Union officials said they were still fighting for wage increases, in addition to performance bonuses. The union has also proposed expanding the indicators to 20, including measures that would give doctors bonuses for going to community meetings, giving lectures, getting training during work hours, screening patients for obesity and counseling them to stop smoking. It has also proposed excluding some patients — like developmentally disabled patients, homeless people and those who have no place to go — from incentives aimed at reducing the time patients spend in the hospital.

The strategy is not without risks. Just as doctors take advantage of the current scheme — in which a caretaker is reimbursed by public insurance programs for the bulk and length of the services provided — through shoddy practices such as “self-referring” and “upcoding” their safety net patients, they might also learn how to game this new system. Other countries with pay-for-performance models have had mixed results as to the efficacy of such programs.

But with quality indicators that are structured soundly and an effective oversight and enforcement mechanism, the pay-for-performance plan presents the opportunity to improve care while curbing costs. Most importantly, it encourages a proactive health care system that is actually centered on Americans’ general well-being, rather than the reactionary “sick care” paradigm that currently dominates the American medical landscape.

Gov. Jan Brewer (R-AZ) is the third Republican governor to accept Obamacare’s optional expansion of the Medicaid program. The governor’s decision to expand Medicaid will extend health coverage to an additional 30,000 previously uninsured Arizonans.

In a speech on Monday, Brewer explained that expanding Medicaid is the right financial decision for Arizona because the federal government will reimburse states for the cost of expansion:

The governor said it makes no sense not to take the federal dollars. She said it’s not like opting out of what’s been called “Obama-care” will save federal dollars or go toward debt reduction.

On the other side of the equation, Brewer said not taking the money will continue to mean a high number of uninsured in Arizona, people who show up in emergency rooms to get care but are unable to pay. The governor said those costs amount to a “hidden tax’” of $2,000 per family.

Brewer could have a fight on her hands: While a few Democrat lawmakers stood to cheer, most Republicans not only stayed seated but refused to applaud.

Brewer joins New Mexico Gov. Sususan Martinez (R) and Nevada Gov. Brian Sandoval (R), who were the first GOP leaders to agree to expand Medicaid in their states. Seventeen Democratic governors have also accepted the expansion, but Republican politicians have been especially reluctant to cooperate with health reform.

About 19 percent of Arizona’s population doesn’t currently have health insurance, a statistic that spurred Brewer to expand the Medicaid program’s eligibility level. Nonetheless, GOP governors in some of the states with the highest rates of uninsurance are still resisting participating in any aspect of the health reform law, including its Medicaid expansion.

CNN's Steven Jiang stands in front of the Beijing skyline

Beijing has tolerated abysmal air pollution for years as the price for China’s rapid economic development. But on January 12, the city’s air pollution reached unprecedented levels, even beyond the upper limits of the Air Quality Index, which reports daily air quality around the world.

The worst pollution on record is taking a serious toll on Beijing’s residents. According to one hospital official, the number of emergency room patients with heart attacks roughly doubled over the weekend. Hospitals are struggling to handle an influx of people suffering from respiratory and cardiac trouble.

As dictated by emergency procedure, the city banned government vehicles from the roads, and asked industrial companies to reduce their emissions. Hyundai also suspended production for a day. While these measures may help ease the immediate problem, this public health crisis has been a long time coming. In the past year, air pollution was responsible for 8,572 premature deaths in China. Studies show that air pollution is now more deadly than high cholesterol.

The main cause of the out-of-control pollution is burning coal, exacerbated by weather conditions trapping the smog. As Beijing-based engineer Vance Wagner notes, the bulk of the pollution originates in factories and power plants spawned by the breakneck speed of China’s unchecked industrialization.

Indeed, as air quality worsens, the country’s economic growth has also exploded. China’s coal production has tripled in the past decade to keep pace with skyrocketing energy consumption rates. The government has tried to dismiss the environmental consequences of modernization, even whitewashing this most recent episode as “heavy fog.”

China’s pollution disaster should serve as a warning for American lawmakers who claim environmental regulation hurts business. While US pollution levels are nowhere near China’s, cities like Los Angeles and Birmingham struggle to meet basic federal air quality standards.

Despite Republican opposition, the Environmental Protection Agency recently issued more stringent soot standards projected to save roughly 15,000 lives a year. Still, Congressional Republicans have not given up on their long campaign to defund the EPA. As part of the impending “fiscal cliff,” the agency’s clean air program stands to lose more than $100 million in funding.

Four public colleges and universities — Florida’s Palm Beach State College, Pennsylvania’s Community College of Allegheny County, Ohio’s Youngstown State University, and New Jersey’s Kean University — are planning to move adjunct and “contingent” faculty members to part-time status in order to avoid an Obamacare provision requiring businesses with 50 or more full-time employees to provide health coverage for at least 95 percent of their workers.

Advocates such as Gwen Bradley, a representative of the American Association of University Professors, warn that the colleges’ intent to cut hours to avoid extending benefits presents a concerning trend that will harm workers who do not enjoy broad benefits or salaries to begin with:

“Adjuncts are very precarious anyway,” said Bradley. “They usually have very low wages, and are often already below the thresholds for health care. But for those people who have it, being cut down to lose it is very devastating.”

Only contingent faculty—as opposed to full-time, tenure-track faculty—would be affected by the change in policy. Since the Affordable Care Act requires that employers provide health care to any employee who works 30 hours per week or more, universities like Palm Beach State College have opted to cap the time that contingent faculty are allowed to work at just below the 30-hour benchmark.

“It’s about having their course load reduced so they’re teaching less and having less paid for their salaries,” said Craig Smith, the director of the American Federation of Teacher’s higher education division. For many contingent faculty members, “it’s not like they were receiving health care in the first place.”

The IRS released new regulations last week to make it harder for employers to circumvent Obamacare and deny their employees heath insurance. One rule stipulates that “employers could still fall under the mandate if they employ enough part-time workers to equal 50 full-time workers,” which would force employers to make draconian, self-defeating cuts to workers’ hours in order to game the system. As the AFT’s Smith puts it, employers who pursue such extreme hour cuts are “just using the Affordable Care Act as an excuse.”

The planned move by the four colleges comes on the heels of similar actions by several restaurant chains, including Olive Garden, Red Lobster, Papa John’s, and isolated Wendy’s and Taco Bell franchises. Olive Garden and Red Lobster chains faced particularly harsh public backlash and falling profits in the wake of their decisions.

Coca-Cola is pursuing a new PR strategy with the company’s first advertising foray into the national obesity debate. The ads, launched on Monday, come as the soda industry faces increasing scrutiny over the role that soft drinks play in the obesity epidemic, while it faces a declining share of the U.S. beverage market.

The Associated Press describes the new ads:

The Atlanta-based company on Monday will begin airing a two-minute spot during the highest-rated shows on CNN, Fox News and MSNBC in hopes of becoming a more influential voice in the intensifying debate over sodas and their impact on public health. The ad lays out Coca-Cola’s record of providing drinks with fewer calories over the years and notes that weight gain is the result of consuming too many calories of any kind — not just soda.

In the ad, a narrator notes that obesity is an issue that “concerns all of us” but that people can make a difference when they “come together.”

A second ad “features a montage of activities that add up to burning off the ’140 happy calories’ in a can of Coke.”

But soda’s impact on health is a little more complicated than that. One-third of the sugar in Americans’ diets come from soda and sweetened beverages, and ample research links soft drinks to obesity, diabetes, and heart disease. One study found children’s odds of becoming obese increased 60 percent for each additional 12-ounce soda. American children consume an estimated 7 trillion calories each year from soda.

In fact, research suggests that even when Coca-Cola touts diet soda as a healthy option, the company is still advertising a product that is linked to weight gain, heart attack, and stroke risks.

While Coca-Cola runs these ads, it will likely continue to wage well-funded battles against efforts to implement a soda tax, through the trade group American Beverage Association.

New York Gov. Andrew Cuomo (D) has declared a state of emergency in response to the recent flu outbreak, which the Centers for Disease Control reports has reached “epidemic” levels. Cuomo’s announcement ensures that children will have expanded access to the flu vaccination, since the governor’s order temporarily allows pharmacists to administer flu shots to patients between 6 months and 18 years old.

“We are experiencing the worst flu season since at least 2009, and influenza activity in New York State is widespread, with cases reported in all 57 counties and all five boroughs of New York City,” Cuomo said in a statement over the weekend. In addition to New York, 46 other states are also reporting high levels of flu cases this year, and Boston’s mayor also declared a state of public health emergency last week.

Less than half of Americans decided to get a flu shot by the end of December, even though vaccination is the best method to protect against influenza. Expanding access to vaccinations in pharmacies, as New York state is now attempting to do, could help start to address that discrepancy. But some enduring myths about vaccinations, a lack of widespread understanding about the potential dangers of influenza, and the fact that flu shots — unlike vaccinations against mumps and measles — aren’t tied to the ability to attend work or school could also contribute to Americans’ reticence to get the shot.

New York City’s health commissioner points out that it’s still not too late to get a shot. Americans who get vaccinated are about 60 percent less likely to come down with the flu, and public health officials say that some protection is better than nothing at all. However, as public awareness about the flu outbreak has spread and increasing numbers of Americans may be convinced to get a shot, pharmacies are worried about not being able to meet the rising demand.

Fortunately, the CDC reports the worst could be over since the current flu season may have already peaked. That’s especially good news for the 29 states that slashed their public health budgets from 2010 to 2012 and may not be prepared to combat a public health emergency.

Obamacare seeks to extend health coverage to millions of previously uninsured Americans, but that doesn’t include the nation’s estimated 12 million undocumented immigrants. And as Kaiser Health News reports, that oversight — along with the historical difficulty that undocumented immigrants face when trying to obtain coverage — has led to the proliferation of underground, cash-only “bodega clinicas” in Los Angeles migrant communities.

The clinicas aim to serve Latino immigrants who do not have public or private health insurance. Strictly speaking, they are closer to private primary care doctors’ offices than public clinics that are subject to much tighter regulations. But while the community clinics provide immigrants with a much needed service, their off-the-grid nature has some health officials worried about the quality of care that they provide.

Still, care providers also see in the clinicas the potential to ease the burden of America’s primary care doctor shortage:

Health officials see in the clinicas the tantalizing opportunity to fill persistent and profound gaps in the county’s strained safety net, including a chronic shortage of primary care physicians. By January 2014, up to 2 million currently uninsured Angelenos will need to enroll in Medicaid or buy insurance and find primary care. And the clinicas, public health officials note, are already well established in the county’s poorest neighborhoods where they are meeting the needs of Spanish-speaking residents. The clinicas also could continue to serve a market that the Affordable Care Act does not touch: undocumented immigrants who are prohibited from getting health insurance under the law.

Dr. Mark Ghaly, deputy director for Community Health at the Los Angeles County Department of Health Services, said bodega clinicas, a term he seems to have coined, that agree to some scrutiny could be a good way of addressing the physician shortage in these neighborhoods.

“Where are we going to find those providers?” he said. “One logical place to consider looking is these clinics.”

The clinicas are obviously not a perfect solution. While the clinicas could make for an effective source of cost-effective primary care, their cash-only model does pose some risks for the people who may need more specialized and expensive care — after all, paying $120 in cash for antibiotics is one thing, but $5,000 for a surgery is another story entirely. For more extensive care, these immigrants will require some sort of public or private insurance coverage.

But barring comprehensive immigration reform or additional measures to extend health benefits to America’s undocumented immigrants, Los Angeles’ clinicas are many people’s realities.

State lawmakers across the country are gearing up for their new legislative sessions — and, just two weeks into the new year, Republicans are already planning their next attacks on women’s reproductive rights. Since voters largely rejected extreme anti-abortion ideology in the November elections, some Republican lawmakers are now treading somewhat cautiously to avoid risking more public outrage over their positions on women’s health.

But at least one anti-choice lawmaker in Wyoming isn’t as worried about disguising his radical agenda. Despite the fact that a similar measure was unable to gain traction in Ohio because the state’s Republicans admitted it was too controversial even among abortion opponents, Wyoming Rep. Kendall Kroeker (R) has introduced an extreme “fetal heartbeat” bill to redefine the medical concept of viability for the women in his state:

Rep. Kendell Kroeker, R-Evansville, a sponsor of HB97, said that detecting heartbeats is a unique way to look at life.

“It became clear that if a baby had a heartbeat, that seemed simple to me that it’s wrong to kill it,” he said.

The bill substitutes two words in current state law with four words. Current law says abortions are prohibited after the embryo or fetus has “reached viability.” The proposed law removes “reached viability” and adds “a detectable fetal heartbeat.” [...]

Kroeker said that the idea for the bill just came to him, but it’s possible that he heard about it in the news.

Restrictions on late term abortion procedures were one of the most popular methods that Republicans employed to limit reproductive freedom in 2012. However, those extreme laws can come under the scrutiny of the courts for banning abortion before the point of viability, which medical professionals agree occurs at about 22 or 23 weeks of pregnancy. Several laws seeking to ban abortions at 20 weeks of pregnancy have been blocked in court because they go too far to threaten women’s constitutional right to an abortion under Roe v. Wade.

But so-called “fetal heartbeat” bills move the goal posts even further, banning abortion procedures as soon as a fetal heartbeat can be detected — which can occur as early as six weeks, before some women even realize they’re pregnant. According to Kroeker, limiting abortion procedures by an additional 17 weeks is “a unique way to look at life,” but it’s actually a dangerous step toward rolling back women’s constitutional rights.