Posts Tagged ‘Kathleen Sebelius’

« Older Entries

MLK & Healthcare Reform

Monday, January 30th, 2012

A recent byline article in Forbes magazine by Carolyn McClanahan, M.D., CFP, raises many issues about healthcare in the year 2012.  According to McClanahan “The New England Journal of Medicine’s (NEJM) article on the fate of healthcare reform in 2012 greatly saddens the optimist in me. It discusses four important events, and I’ll share my “simplistic view” of these events:

“State legislatures getting in gear to fill their role assigned by the ACA.  As I’ve discussed previously, we have a complicated healthcare system which is expensive and inefficient.  Instead of simplifying, each state will implement or delay implementing the law based solely on their political interest.  This is not productive.”

“The second event is the Supreme Court’s ruling on the legality of the ACA in May. It is possible that the entire law could be struck down, (albeit unlikely).  If this scenario plays out, we will have wasted billions implementing parts of the law to date.  Another more likely scenario is the law will be upheld but the mandate that everyone purchase health insurance be thrown out.  This would severely weaken the law because people will only buy insurance when they are sick.  There will still be a requirement that insurance companies have to sell insurance to everyone regardless of health status.  This is not financially feasible.  Most likely, the law will stand, but who really knows?”

“The third key event is the deadline for states to apply for federal grants to operate their health insurance exchange.  State who don’t apply will either have to cede control of the exchanges to the federal government or pay for the cost of implementation themselves.  State governors and legislatures against the ACA, like my home state of Florida, risk turning away resources and having more of the federal government running the show.  Talk about the law of unintended consequences.”

“The fourth key date is the election in November.  If President Obama wins re-election, implementation will continue.  If he loses, the winner will have a difficult time repealing the law unless the Republicans can win 60 seats in the Senate.  So what is their plan?  Have everyone drag their feet on implementation or do a half-baked job.  Wouldn’t it be nice if instead they came up with a good plan to fix the parts that are not working?  Simplify and clean up the mess of the insurance part of the law and implement with speed and clarity the good parts like preventive care initiatives, rebuilding our primary care workforce, and improving our ability to handle large disasters.”

A similar viewpoint was expressed by Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, who said that access to healthcare is the next civil rights frontier.  According to Sebelius, “On Martin Luther King Day, it is easy to congratulate ourselves on our progress in moving beyond segregated schools, lunch counters and drinking fountains. The hard question is this: what injustices do we still accept that should, in fact, be intolerable?  Surely Dr. King would find the next civil rights frontier in healthcare, with nearly 50 million uninsured, almost 45,000 deaths annually due to lack of insurance, and more than half of all personal bankruptcies linked to illness and medical bills.”

“While the Affordable Care Act will bring improvements, such as decreasing the ranks of the uninsured, supporting community health centers, and investing in prevention, it leaves many gaps. At least 23 million people will still be uninsured in 2019. Tens of millions will be underinsured, one serious illness away from financial ruin. Most people who suffer medical bankruptcy had private insurance before getting sick. And medical bankruptcy is a cruel double whammy. Already beset with pain, anxiety and fear – due to serious illness – families find themselves financially devastated.  This doesn’t happen in other industrialized countries, which have high-quality health systems that cover everyone.”

As a department, we are committed to ensuring that all Americans achieve health equity by eliminating disparities and doing what we can to improve the health of all groups, including the poor and underserved,” Sebelius said. “One of the most important ways we are doing this is through our new health care law, the Affordable Care Act.”

Tags: , , , , , , , , , , , , , , , ,
Posted in Healthcare, Hospital Systems, Hospitals | No Comments »

ACA Gives 2.5 Million Young Adults Healthcare Coverage

Tuesday, December 27th, 2011

The number of young adults who have no medical coverage has contracted by 2.5 million since the Patient Protection and Affordable Care Act (ACA) took effect, according to a new analysis by the Obama administration.  That decline is 2½ times larger than earlier government and private estimates, which showed about one million Americans ages 19 – 25 had acquired coverage.

Obama administration officials said they now have more comprehensive data and are slicing the numbers more precisely than the government typically does, in an attempt to identify the impact of a popular provision in the law.  Thanks to the ACA, young adults can remain on their parents’ health insurance plans until their 26th birthdays.  Families have flocked to sign up their offspring, making the transition to work in a challenging economic environment a bit easier.

“Thanks to the Affordable Care Act, 2.5 million more young adults don’t have to live with the fear and uncertainty of going without health insurance,” said HHS Secretary Kathleen Sebelius.  “Moms and dads around the country can breathe a little easier knowing their children are covered.”

“This comparison makes it clear that the increase in coverage among 19 to 25 year-olds can be directly attributed to the Affordable Care Act’s new dependent-coverage provision,” according to an Assistant Secretary for Planning and Evaluation (ASPE) brief.  “Furthermore, the coverage gain for young adults was entirely due to an increase in private coverage (from 49 percent to 58 percent), with no change in Medicaid coverage during this period.”

“The increase in coverage among 19- to 25-year-olds can be directly attributed to the Affordable Care Act’s new dependent coverage provision,” according to the Department of Health and Human Services (HHS).  “Initial gains from this policy have continued to grow as…students graduate from high school and college.”

That age group previously recorded the highest uninsured rate. Now, 26- to 35-year-olds have that dubious distinction by a narrow margin, according to the Centers for Disease Control and Prevention.

According to the HHS survey, nearly 36 percent of Americans ages 19 – 25 — more than 10.5 million people — were uninsured in the third quarter of 2010, before the law’s provision took effect.  The majority of employer-based health plans began carrying the provision January 1, 2011.  By the 2nd quarter of 2011, the proportion of uninsured young adults had fallen to slightly more than 27 percent, or about eight million people.

And just who are these young adults?  Some are transitioning from school to work. Others are trying to start their careers by working at low-wage jobs that don’t usually come with healthcare coverage.  Some – known as the “invincibles” – pass up job-based health insurance because they don’t think they’ll need it and prefer some extra money in their paychecks.

Similarly, the National Center for Health Statistics has documented a broadly similar trend, only not nearly as spectacular.  According to administration officials, those statistics do not focus on the change from calendar quarter to calendar quarter, as the new HHS report does.  Instead, they pool data over longer time periods; that tends to dilute the law’s perceived impact.

Tags: , , , , , , , ,
Posted in Healthcare, Hospital Systems | No Comments »

HHS Awards State Health Insurance Exchange Dollars

Tuesday, December 13th, 2011

The Department of Health and Human Services (HHS) awarded nearly $220 million to 13 states to help them set up insurance exchanges under the Patient Protection and Affordable Care Act (ACA). States were also allowed additional time to apply for future grants while HHS stipulated that states who create their own internet-based exchanges must be operational in all states in 2014.

The recent awards bring to 29 the number of states that have made significant progress in creating Affordable Insurance Exchanges.  States that received funding include Alabama, Arizona, Delaware, Hawaii, Idaho, Iowa, Maine, Michigan, Nebraska, New Mexico, Rhode Island, Tennessee, and Vermont.  “We are committed to giving states the flexibility to implement the Affordable Care Act in the way that works for them,” HHS Secretary Kathleen Sebelius said.  “Exchanges will give consumers more choices and make it easy to compare and shop for insurance plans.”  In the new Exchanges, insurers will provide an easily understandable summary of benefits and costs to consumers.  The level of detail will hone competition between carriers, which is expected to make coverage more affordable.

It’s interesting to note that despite extensive opposition to the ACA, a majority of states have now accepted federal funding to establish health insurance exchanges.  Alaska is the only state that hasn’t applied for federal grants.

Of the 13 states that received this new round of grants, 12 are Level One grants, which provide one year of funding to states that have already made progress using their Exchange planning grant.  The 13th state, Rhode Island, received the initial Level Two grant, which provides multi-year funding to states that have made significant progress in the planning process.  Forty-nine states and Washington, D.C. have already received planning grants; 45 states have consulted with consumer advocates and insurance companies.  Thirteen states have passed legislation to create an Exchange.

The money is intended to provide the states with adequate flexibility and resources to deploy the marketplaces where consumers can shop and compare for a private health insurance plan that fits their needs.  The exchanges are slated to go live just two years from now.

According to Chiquita Brooks-LaSure, HHS director of coverage policy, “We continue to urge all states to establish their own exchanges and move forward with their implementation…while waiting for the Supreme Court to rule.”  The exchanges are a “bipartisan concept,” and states know that if they don’t establish an exchange by 2014, HHS will create one for them. She is “confident the law will be upheld.”  Sebelius said that as a former governor, state insurance commissioner and legislator, she understands “the importance of letting states lead” in creating their own version of a transparent healthcare system in which “insurance companies will have to compete for customers.  That means lower prices and better quality in the same marketplace in which members of Congress will have to shop for their coverage.”

The latest grants come nearly a month after the National Association of Insurance Commissioners asked HHS for greater flexibility in setting up the exchanges, suggesting state insurance commissioners might miss critical deadlines because they lack adequate funding and staff.  Additionally, HHS will delay by six months the deadline for states to apply for more federal funding to help run the exchanges.  HHS also will offer federal aid to states that miss deadlines.

Tags: , , , , ,
Posted in Hospital Systems, Hospitals | No Comments »

Obama to Sign Executive Order Releasing $1 Billion to Cut Medical Fraud

Wednesday, November 23rd, 2011

President Barack Obama will once again sidestep a fractious Congress and sign an executive order designed to cut fraud from Medicare and Medicaid.  The Department of Health and Human Services (HHS) will administer the changes, such as testing changes to obsolete hospital billing systems to prevent overbilling, administration officials said.

The billion-dollar initiative will reward the “most compelling new ideas” for cutting costs and improving care of Medicare and Medicaid patients with rewarding federal grants.  Called the Health Care Innovation Challenge, the initiative will provide between $1 million and $30 million over three years to individual organizations or coalitions that develop sustainable, new approaches to improving healthcare quality and efficiency.  “We’ve taken incredible steps to reduce healthcare costs and improve care, but we can’t wait to do more,” said HHS Secretary Kathleen Sebelius.  “Both public and private community organizations around the country are finding innovative solutions to improve our healthcare system, and the Health Care Innovation Challenge will help jump-start these efforts.”

Centers for Medicare and Medicaid Services (CMS) administrator Dr. Donald M. Berwick, M.D. said, “When I visit communities across the country, I continually see innovative solutions at the very ground.  By putting more programs like this in place and more ‘boots on the ground,’ these types of programs can truly transform our healthcare system.”

This program is part of the Obama Administration’s “We Can’t Wait” initiative, which is a series of legal Executive Branch steps designed to move America forward while Congressional Republicans block critical and necessary legislation.

To demonstrate that its campaign to cut government waste is working, the White House said the administration cut improper payments by nearly $18 billion in 2011, largely in such programs as Medicare, Medicaid, Pell Grants and food stamps.  Budget chief Jack Lew ordered federal agencies to tighten their oversight of contractors and grant recipients to reduce the potential for taxpayer waste.

Not surprisingly, there was some immediate opposition to the initiative, with Republican critics calling it a “$1 billion experiment.”  “On the day the Supreme Court decided to review the constitutionality of ‘Obamacare,’ the president is asking for another $1 billion in taxpayer dollars to pay for another healthcare experiment that will continue taking us in the wrong direction,” said RNC spokeswoman Kirsten Kukowski.  “We already spent $2.6 trillion on his job-killing health care bill.  Another $1 billion Executive Order is just more words for a president more interested in campaign talking points than creating jobs.”

With the Supreme Court preparing to hear arguments for and against the Patient Protection and Affordable Care Act (ACA) next March, it is important to note that even the 26 states suing to have the law overturned are hedging their bets.  Only four states have refused all federal money to plan for the changes that are scheduled to take place.

Several healthcare industry leaders expressed their support for the ACA. “The system is transforming itself,” said Charles N. Kahn III, president of the Federation of American Hospitals.  “But the success of these changes depends a lot on whether there is sufficient funding.”  Nationally, hospital systems are anticipating an influx of federal funds and patients as the law goes into full effect.  “If the law is struck down, healthcare reform will have to continue one way or another,” said Patricia Brown, president of Johns Hopkins HealthCare.

Tags: , , , , , , , , , , , , , , , , , , ,
Posted in Healthcare, Hospital Systems | No Comments »

Medicare Part B Premiums To Rise Slightly in 2012

Monday, November 7th, 2011

Despite rumors to the contrary, the basic monthly premium for Medicare will be less than anticipated in 2012.  The new Part B premium, which covers outpatient care, will be $99.90 a month for 2012, approximately $7 less than projected as recently as May.  In other words, the majority of senior citizens will pay $3.50 more a month next year, instead of $10.20, as forecast earlier.  Some younger retirees who enrolled recently will actually see their rates go down.  They have been paying as much as $115.40 a month.  Instead, they’ll also pay $99.90 next year.  The primary reason for the lower-than-expected premiums is a result of the interaction between Social Security cost-of-living adjustments (COLA) and Medicare.

“Thanks to the Affordable Care Act (ACA), Medicare is providing better benefits at lower cost,” said Health and Human Services Secretary Kathleen Sebelius.  She reassured seniors that they have nothing to fear from the healthcare law, and described keeping premiums in check as “pretty remarkable.”

Some Republicans do not see the connection between Medicare premiums and the ACA.  “Lower Medicare premiums are being driven by lower-than-average Medicare spending due to the slow economy” – not the healthcare law, said Antonia Ferrier, spokeswoman Senator Orrin Hatch (R-UT), the ranking Republican on the panel that oversees Medicare.

Part B premiums have been frozen at the 2008 level of $96.40 a month for about 75 percent of Medicare beneficiaries because of a lack of a Social Security COLA during the recession.  Social Security recently announced a raise of an average of $39 a month for 2012.  The Part B premium is of great interest to the 48 million people covered by Medicare.  Average premiums for prescription coverage and for popular Medicare Advantage plans will stay flat or dip slightly for 2012, but fewer beneficiaries opt for those benefits.  In May, government experts forecast that Medicare premiums would rise to $106.60 for 2012.  At that time, they were also estimated a Social Security COLA of just 0.7 percent – but it turned out to be a larger 3.6 percent increase.  As a result, rising Medicare costs could be spread among many more people, resulting in smaller individual increases.

“Thanks in part to the Affordable Care Act, people with Medicare are going to have more money in their pockets next year,” added Donald Berwick, MD, administrator of the Centers for Medicare & Medicaid Services (CMS).  “With new tools provided by the Affordable Care Act, we are improving how we pay providers, helping patients get the care they need and spending our healthcare dollars more wisely.”

Advocates for senior citizens also were pleased with the smaller rise in Medicare Part B premiums.  “The payment reforms enacted over the past few years, including those in the Affordable Care Act, in addition to crackdowns on fraud, waste and abuse, are partially responsible for the increased optimism about Medicare’s financial health, the lower-than-predicted Part B premium and an almost unheard-of drop in the Part B deductible,” said Joe Baker, president of New York-based Center for Medicare Rights.  “These developments help show the promise of the ACA’s delivery system reforms, and why we must let them do their job in the coming years.”

AARP echoes that sentiment.  “Millions of America’s seniors are struggling with higher expenses – particularly higher healthcare costs, lower incomes, depleted savings and reduced home equity or homes lost to foreclosure, and this small increase is welcome news,” noted David Certner, AARP’s legislative policy director.

Writing in Family Practice News, Alicia Ault takes issue with the way HHS is tying the low increase to healthcare reform.  According to Ault, “Part B premiums are calculated to cover one-fourth the cost of physician services, plus a contingency margin that is essentially equivalent to an insurer’s reserve.  This has nothing to do with health reform; it’s been a statutory requirement since, well, for a long time. And the contingency margin is always dependent on what happens with the Sustainable Growth Rate (SGR) formula.  CMS assumes every year that the SGR will be overturned, so that calculation also has nothing to do with health reform.  For an administration that prides itself on transparency, it seems to have done little today to pull back the curtain on Medicare spending — even as Dr. Berwick said that transparency itself had led to lower costs.”

Tags: , , , , , , , , , , , , , , , ,
Posted in Healthcare, Hospital Systems | No Comments »

National Health Service Corps Caring for More Medically Underserved Americans

Wednesday, October 19th, 2011

In the last three years, membership in the National Health Service Corps (NHSC) has tripled, according to Kathleen Sebelius, Secretary of Health and Human Services (HHS).  The NHSC is a national network of 10,000 primary-care providers and 17,000 sites in underserved communities with limited access to healthcare.

“When you don’t have access to primary care, small health problems grow into big ones,” Sebelius said.  “Way too many Americans have gone without check-ups, preventive screenings, vaccines, routine dental work and other care simply because there was no one to see,” Sebelius said.  The agency estimates that its providers care for approximately 10.5 million patients, compared with just 3,600 providers who cared for roughly 3.7 million patients three years ago.

The program, which is almost 40 years old — is administered by HHS’ Health Resources and Services Administration (HRSA) — and provides financial, educational and professional resources to medical, dental and behavioral healthcare providers.  According to HRSA the NHSC has awarded approximately $900 million in scholarships and loan repayment to healthcare professionals since 2008 to expand the agency’s primary-care workforce. That funding has come from the Patient Protection and Affordable Care Act (ACA), the American Recovery and Reinvestment Act (ARRA) and base appropriations.  “Eighty-two percent of NHSC clinicians continue to serve in high-need areas after they fulfill their service commitment,” HRSA Administrator Mary Wakefield said.  “These awards help ensure that underserved communities across the country have access to quality healthcare both today and in the future.”

“When you don’t have access to primary care, small health problems grow into big ones,” Sebelius said. “Most of these providers graduate with tens or even hundreds of thousands of dollars in loans, and it is very difficult to pay off while doing this important work.”

The Association of American Medical Colleges estimates that the nation will have a shortage of 91,500 physicians across all specialties just nine years from now. 

Despite the program’s recent significant growth, Wakefield said there are underserved areas of the country that qualify for National Health Service Corps members, but there is not enough money to fund providers there.  “It is a significant challenge,” Wakefield said.  “We have more sites that are designated or eligible than we have clinicians.  We also have, on the flip side, more students applying to National Health Service Corps than we have availability” to fund.

In Minnesota, for example, a state with vast wilderness areas, the federal government is providing $6.6 million in incentive dollars to doctors and nurses to increase the state’s number of primary-care providers.  According to Minnesota Public Radio, “Minnesota’s rural healthcare system is feeling new pressure.  National healthcare reform is forcing expensive record-keeping changes.  Greater reliance on Medicare and Medicaid reimbursement makes rural providers vulnerable.  Rural people tend to be older and poorer, are less likely to have insurance and suffer more chronic illness.  And the doctor shortage has gotten harder to deal with.  In response, care is changing.  Services like mental health counseling are delivered via teleconference.  Clinics and hospitals are consolidating.  ‘Mid-level’ practitioners like paramedics and dental therapists are starting to play new roles.”

Tags: , , , , , , , , , , , , , , ,
Posted in Healthcare, Hospital Systems | No Comments »

HHS Website Monitors Health Insurance Premium Increases

Monday, October 17th, 2011

Consumers can now select their state on a federal web page to see if any health insurers have raised rates, as well as the company’s reasoning behind the action. This information was previously unavailable, according to Steve Larsen, the Department of Health and Human Services (HHS) deputy director for oversight (only a few states include rate increases on their own websites).  Now, all insurance companies must file this information with HHS as one directive of the Patient Protection and Affordable Care Act (ACA).  “We are taking a good, hard look at why insurance companies are seeking to raise your rates, why your premiums might be going up, and making sure these decisions are public and justified,” HHS Secretary Kathleen Sebelius said.  “This is just a start, and over time we will be reporting more of these requests.”

The announcement follows a recent survey by the Kaiser Family Foundation that showed premiums for an employer-sponsored plan for a family of four climbing nine percent in 2011.  A report by Barclays Capital Equity Research showed that in the first three months of 2011, 13 of the leading 14 health insurers exceeded their earnings per share estimates; average earnings were 46 percent over estimates.  Insurers who wanted to raise rates 10 percent or more for individual or small group plans are required to provide justification.

At the same time, an advisory group urged officials to create a list of essential health benefits under President Barack Obama’s healthcare overhaul that aligns with the cost of typical small-employer plans.  The Institute of Medicine (IOM) report recommended that HHS be specific in deciding what health benefits should be required in individual and small group plans as the ACA goes into full effect in 2014.  The IOM, one of the National Academies of Science that advises U.S. policymakers, did not address any specific benefits types, in keeping with its assigned task.  “We’re in a marathon.  What we’ve just gotten today is the first leg,” said Paul Keckley, executive director of the Deloitte Center for Health Solutions.

The IOM recommendation favors business groups and insurers who have sought a narrow package of required benefits because of concerns that the plans will cost too much, said Neil Trautwein, vice president for the National Retail Federation.  Government should limit premiums to levels no higher than what small businesses pay on average and choose benefits “within the context of financial constraints,” according to the report.  The recommendation “is the appropriate tack to take since the objective is to cover everyone with at least basic benefits,” Trautwein said.

The issue has seen businesses and patient advocacy groups — such as the American Cancer Society, which argues for robust coverage — at odds with each other.  The ACA requires insurance plans to cover 10 broad categories of care, including hospitalization, mental health and pediatrics starting in 2014 and left details to Obama’s HHS secretary, who has  asked the IOM to recommend the optimal way to select the benefits that should be included in the plans.  Employer lobby groups argue that a generous package of benefits would cause workers to desert company plans, which could have the effect of compelling employers to pay fines and raise premiums as the number of people covered by their health plans decreases.

According to the IOM, Sebelius should start with a package of benefits that mirrors what small businesses offer their employees.  She should set a “premium target” for the benefits that is approximately the same as what small businesses will pay, on average, in 2014.  Next, she should select benefits that meet the target, a process the IOM compared to shopping for groceries under a budget.  “If the package of essential health benefits gets too comprehensive, it quickly becomes unaffordable,” said John Ball, chairman of the institute committee that wrote the report.

Beginning in 2014, every health plan in the new marketplaces known as “exchanges” will have to provide a minimum package of “essential health benefits.”  The IOM report provides federal officials with a framework for devising that package, but doesn’t provide specifics.  “I’m sure a lot of people were expecting to get a list,” said Elizabeth McGlynn, a member of the IOM committee and head of the Kaiser Permanente Center for Effectiveness and Safety Research.  “That was outside of our charge.”

“With this thoughtful report, the IOM is urging policymakers to strike a balance between the affordability of coverage and the comprehensiveness of coverage,” said Karen Ignagni, president and CEO of the health insurance trade group America’s Health Insurance Plans.  “We agree that this balance is critical to ensuring that individuals, working families and small employers can afford health insurance.”  Amanda Austin of the National Federation of Independent Business termed the report “encouraging,” and “pretty thoughtful,” although she believes that HHS still has to do the heavy lifting to write the plans.

Sebelius issued her own statement on the report, saying she will hold “listening sessions” to help people choose what benefits they want included in the mandatory package.  “These conversations will help us ensure that every American can access quality, affordable health coverage they can rely on,” she said.  This seems to suggests to some that a proposal from the department won’t be coming anytime soon.

Tags: , , , , , , , , , , , , , , , , ,
Posted in Healthcare, Hospital Systems | No Comments »

Medicare Advantage Premiums to Fall Four Percent in 2012

Tuesday, October 4th, 2011

The Obama administration’s announcement that Medicare Advantage insurance plans premiums will decline in 2012, at a time when enrollment is expected to rise, is good news for the leading health insurers in that segment.  Wall Street analyst Ana Gupte said that the announcement suggests strengthening support in the administration for the privately-run versions of the government’s Medicare program, which covers the elderly and disabled.  Medicare Advantage plans offer basic Medicare coverage with extras like vision or dental coverage oratremiums lower than standard Medicare rates.  Health and Human Services Secretary Kathleen Sebelius said that Medicare Advantage premiums will average four percent less in 2012, and insurers running the plans believe that enrollment will rise by 10 percent.  “Overall, we were very encouraged by the announcement and see this as reinforcing our bullish thesis on the Medicare Advantage and (prescription drug coverage) segments,” according to Gupte.

It’s highly unusual to see healthcare insurance premiums falling. Reduced premiums and growing enrollment are the opposite of what insurers and Republicans predicted would happen to Medicare Advantage after the passage of the Patient Protection and Affordable Care Act (ACA).  The ACA cut payments to fee-for-service Medicare Advantage plans by about $136 billion over the next 10 tears.  Right before the law passed, American’s Health Insurance Plans predicted that “millions of seniors in Medicare Advantage will lose their coverage, and millions more will face higher premiums and reduced benefits.”  So what accounts for the drop?  The decrease in premiums doesn’t have a lot to do with policy decisions made in the ACA.  It’s three outside factors that are putting downward pressure on Medicare.  One is that Medicare costs are growing more slowly.  Both in Medicare and in private insurance, the recession has seen patients using fewer medical services.  This looks to be especially true in Medicare, where seniors might have more limited resources because they tend to live on a fixed income.  The latest S&P Healthcare Economic Indices data indicates that Medicare spending appears to be rising at a slower rate than just a few years ago.

Jonathan Blum, director of the Centers for Medicare and Medicaid Services (CMS) Center for Medicare, said the more affordable costs and growth forecasts demonstrate that companies are still interested in offering such plans despite new consumer protections under the healthcare law and payment caps to insurers.  According to Blum, “We can say with complete accuracy that despite projections in 2010 that the program will decline, the program has grown and will continue to grow.  The plans have made a very strong statement that they intend to commit to the program.  Plans that do a better job serving the needs of their Medicare members should be rewarded and all plans should be encouraged to improve their performance.” 

Healthcare insurers warned that seniors can expect more costs and receive fewer benefits from their Medicare Advantage plans after payment cuts take effect.  They point to projections from the Congressional Budget Office, which predicted Medicare Advantage enrollment would fall to just 7.8 million participants in 2019.  “Medicare Advantage plans remain committed to the program and are doing everything they can to preserve benefits and keep coverage as affordable and possible for beneficiaries,” said Robert Zirkelbach of America’s Health Insurance Plans (AHIP).  “However, as these cuts take effect in the coming years, Medicare Advantage beneficiaries will face higher out-of-pocket costs, reduced benefits, and fewer health care choices.”  The group and its insurer members, who opposed many of the healthcare reforms before they passed, are now committed to implementing the law.

“Many people raised fears that under the Affordable Care Act, beneficiaries would see their Medicare Advantage options shrink and their premiums rise,” Sebelius said.  “Instead, we have seen just the opposite.”

Some in the industry are looking at other ways to bring Medicare costs down.  According to the Fierce Pharma website, “Healthcare industry leaders are poised to make their own deficit-reduction suggestions — including some that might not win them points in a popularity contest.  Uncertain what budget cuts the deficit-reduction committee might propose, the Healthcare Leadership Council has come up with its own proposal that would ask Medicare beneficiaries to endure more belt-tightening themselves.  The group is aiming to put forward an alternative more palatable than across-the-board Medicare cuts mandated by the deficit-reduction bill if the “supercommittee” doesn’t agree on its own plan.  And it’s betting that its proposal will be easier to bear than budget-cutting ideas floated in the past, such as drug re-importation.  The council, which includes Big Pharma executives, hospital companies and insurers, crafted a plan that would raise the Medicare-eligibility age little by little to 67 from 65, beginning in 2014. It would hike co-pays and deductibles.  It would require well-off seniors to pay higher premiums.  And it would add private-sector competition to traditional Medicare coverage, pitting government-subsidized private insurance plans against regular Medicare.  Requiring seniors to pay more might be considered a non-starter; after all, consumer groups, particularly AARP, have vociferously fought against such moves in the past.  But the council figures that provider-based Medicare cuts will end up costing beneficiaries when all is said and done.  ‘This thinking that we’re protecting beneficiaries because we’re only cutting providers — that’s mythical,’ said Mary Grealy, the council’s president.”

Tags: , , , , , , , , , , , , , , , , , , ,
Posted in Healthcare, Hospital Systems | No Comments »

Medicare Bundling Payments to Save Money

Wednesday, September 21st, 2011

The Centers for Medicare and Medicaid Services (CMS) has a new program that would bundle insurance payments for multiple procedures with the goal of improving patient care while saving money.  CMS invited providers to help develop four models to bundle payments.  The program encourages hospitals, doctors and other specialists to coordinate in treating a patient’s specific condition during a single hospital stay and recovery.  “Today Medicare pays for care in the wrong way,” Health and Human Services Secretary Kathleen Sebelius said.  “Payments are based on the quantity of care, and not on the quality of that care.  There is little financial incentive for the kind of care coordination that can help patients from returning to the hospital.” 

The models give providers flexibility regarding how they get paid and for which services, and provides financial incentives to avoid needless or duplicate procedures.  “Hospitals and other providers recognize that they have to accommodate the current (fiscal) environment,” said Nancy Foster, vice president for quality at the American Hospital Association. 

“From a patient perspective…you want your doctors to collaborate more closely with your physical therapist, your pharmacist and your family caregivers,” CMS Administrator Donald Berwick said.  “But that sort of common sense practice is hard to achieve without a payment system that supports coordination over fragmentation.  We’re taking steps that will save Medicare, seniors and taxpayers $28 billion over 10 years. Medicare is paying much more than the private sector for equipment like wheelchairs and walkers.  By expanding our successful competitive bidding program, we can ensure that Medicare pays a fair rate for these goods.”

According to CMS, the initial round of competitive bidding has added up to savings of 35 percent compared to the fee schedule.  Questions in the 1st quarter of 2011 totaled less than 0.9 percent of calls to Medicare’s call center; Medicare received just 45 complaints during that time.  CMS will conduct the second phase of the program for a similar set of products in 91 major cities.  Competition begins this fall; the new prices go into effect on July 1, 2013.  “The success we’ve had in the first phase tells us that we can achieve these savings with no disruption for patients’ access and no negative effect on patients’ health,” said Jonathan Blum, deputy CMS administrator and director of the Center for Medicare. “We remain confident in our bidding methodologies that will produce tangible savings while ensuring adequate choice of qualified suppliers.”

The CMS Innovation Center, created under President Barack Obama’s Patient Protection and Affordable Care Act (ACA), has been investigating bundling payments as part of a larger effort to both improve patient care and reduce costs.

There is some disagreement over whether the CMS bidding program is successful.  Economists, consumer groups and some in Congress are on record opposing the program.  They cite reduced access to care, flaws in the program design and impact on local jobs.  “There’s a reason why more than 30 patient advocacy groups, 244 economists and auction experts and 145 members of Congress oppose this program: it undermines quality of care and it increases costs,” said Tyler J. Wilson, president of the American Association for Homecare.  “Because of this bidding program, beneficiaries will spend more time in expensive institutions, rather than in the far more cost-effective setting for care – their own homes.” 

Tim Size, executive director of the Rural Wisconsin Health Cooperative, is concerned about the impact on rural hospitals.  “Washington has created a new ‘super committee’ to find more cuts.  Some call it a super Congress to remind us this is a small group given powers usually kept by Congress.  Most economists say Washington needs a coherent policy for both additional cuts and additional revenue.  But politics seems to have taken new revenue off the table.  Most people believe the super committee will deadlock.  If Congress fails to act, cuts will be implemented across the board.  Most federal programs will be cut.  Across-the-board cuts harm efficient programs along with the inefficient.  Across-the-board cuts harm necessary along with the less necessary. The country deserves better than bulldozers driven by blindfolded drivers.  Most rural hospitals are financially just holding their heads above water.  Under-payment by government programs has left them vulnerable.  A sluggish economy and an increasingly competitive healthcare marketplace are taking their toll.  Medicare and Medicaid are rural hospitals’ largest payers. Additional cuts are likely to tip many rural hospitals into the red and eventual closure.”

Tags: , , , , , , , , , , , , , , ,
Posted in Healthcare, Hospital Systems | No Comments »

HHS Provides Funding to Improve Rural Healthcare IT

Thursday, September 8th, 2011

Department of Health and Human Services (HHS) Secretary Kathleen Sebelius awarded as much as $137 million, to the states funded in part by the Affordable Care Act (ACA), with the goal of strengthening the public health infrastructure and provide jobs in core areas of public health.  Awarded in almost all 50 states, the grants enhance state, tribal, local and territorial efforts to provide tobacco cessation services, reinforce public health laboratory and immunization services, prevent healthcare-associated infections, and provide comprehensive substance abuse prevention and treatment programs.  “More than ever, it is important to help states fight disease and protect public health,” Sebelius said.  “These awards are an important investment and will enable states and communities to help Americans quit smoking, get immunized and prevent disease and illness before they start.”

The grants will fund vital state and local public health programs supported through the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA).  The majority of grant dollars come from the Prevention and Public Health Fund section of the Patient Protection and Affordable Care Act (ACA).  SAMHSA dollars add to this investment.  “CDC supports state and local public health departments which are key to keeping America safe from threats to health, safety, and security from this country or anywhere in the world,” said CDC director Dr. Thomas Frieden.  “With these funds, CDC is strengthening our ability to prevent and combat diseases and keep Americans safe against expensive and dangerous health threats.”

“These funds will allow us to bolster public health services to communities and build on successful programs that have helped people lead healthier lives.  Today’s investments will help us prevent future healthcare costs from problems such as tobacco-related illness and substance abuse,” said Pamela Hyde, SAMHSA administrator.

According to Rene Letourneau, Managing Editor of Healthcare Finance News, “The grants include $1 million to further enhance the nations’ public health laboratories by hiring and preparing scientists for careers in public health laboratories, providing training for scientists and supporting public health initiatives related to infectious disease research; nearly $5 million to help states and territories enhance and expand the national network of tobacco cessation toll-free quit lines to increase the number of tobacco users who quit; More than $42 million to support improvements to the Immunization Information Systems (registries) and other immunization information technologies; development of systems to improve billing for immunization services; planning and implementation of adult immunization programs; enhancement of vaccination capacity located in schools; and evaluations of the impact on disease of recent vaccine recommendations for children and adolescents; and $2.6 million to the Emerging Infections Programs around the country to continue improvement in disease monitoring, professional development and training, information technology development and laboratory capacity,” to name a few.

In a related initiative, President Obama recently announced that new healthcare IT jobs are part of his Jobs Initiatives for Rural America at the recent White House Rural Economic Forum held in Peosta, IA.  The plan includes making HHS loans available to assist more than 1,300 Critical Access Hospitals recruit supplementary staff, and help rural hospitals purchase software and hardware to implement healthcare IT.

“These are tough times for a lot of Americans – including those who live in our rural communities,” Obama said.  “That’s why my administration has put a special focus on helping rural families find jobs, grow their businesses, and regain a sense of economic security.”

“Creating jobs and economic opportunity in rural America is a priority for the Obama Administration, and the White House Rural Council has used an ‘all hands on deck’ approach to leverage resources across the federal government to achieve that goal,” said Agriculture Secretary Tom Vilsack. “By bringing new capital, job training, and additional investments to our rural communities, we are working to ensure the people who live in these towns have a better, brighter future.”

“The Small Business Administration (SBA) is pleased to announce that we will be doubling the capital going to rural businesses through the Small Business Investment Company program, with no cost to taxpayers,” said Administrator Karen Mills.  “Small businesses of all kinds are thriving in rural areas where they are creating jobs of the future and helping ensure the economic stability of the middle class.  Half the people who work in America either own or work for a small business, and two out of three new private sector jobs are created by small businesses.  The Obama Administration and SBA have been committed to supporting rural businesses, which drive economic growth across the country and will continue to do so through these programs.”

“Creating jobs and economic opportunity in rural America is a priority for the Obama Administration, and the White House Rural Council has used an ‘all hands on deck’ approach to leverage resources across the federal government to achieve that goal,” said Agriculture Secretary Tom Vilsack. “By bringing new capital, job training, and additional investments to our rural communities, we are working to ensure the people who live in these towns have a better, brighter future.”

“The Small Business Administration (SBA) is pleased to announce that we will be doubling the capital going to rural businesses through the Small Business Investment Company program, with no cost to taxpayers,” said Administrator Karen Mills. “Small businesses of all kinds are thriving in rural areas where they are creating jobs of the future and helping ensure the economic stability of the middle class.  Half the people who work in America either own or work for a small business, and two out of three new private sector jobs are created by small businesses. The Obama Administration and SBA have been committed to supporting rural businesses, which drive economic growth across the country and will continue to do so through these programs.”

Tags: , , , , , , , , , , , , , , , , , , , , , ,
Posted in Healthcare, Hospital Systems | No Comments »

« Older Entries