Archive for June, 2011

U.S. Health Surveys To Ask About Sexual Orientation

The government’s major health surveys would begin asking people to identify their sexual orientation under a proposal released today by the Obama administration.

Under the proposal, the National Health Interview Survey and other major research tools would ask people to identify whether they are straight, lesbian, gay, bisexual or transgender. The idea was recommended by a report the Institute of Medicine issued in March. The IOM declared researchers need more information to understand what health differences exist among people of various sexual orientations.

Today’s proposals would also expand the questions government surveys ask people about their race, ethnicity and disability status. Many of the current questionnaires inquire whether people are black or Hispanic, but don’t dive deeper to find out, for instance, if a Latino is Puerto Rican or Mexican-American. The new questions will. There are big disparities among some of these sub-groups, says Garth Graham, a deputy assistant secretary at the Department of Health and Human Services. “Not all Latinos are all the same, not all Asian Americans are the same,” he says.

The new proposal primarily springs from the Affordable Care Act,  which requires that all national federal data collection efforts seek information on race, ethnicity, sex, primary language and disability status. But parts of the proposal, such as the details on sexual orientation, go beyond what the law mandated.

Most of the new questions can be viewed online. The government is still working on its sexual orientation questions and intends to test different versions with the goal of fully incorporating them into surveys by 2013.

HHS is accepting comments on its proposal through Aug. 1.  HHS has a pretty clear summary of the rationale behind the additional data collection. And here‘s the the press release.

jrau@kff.org

Wednesday, June 29th, 2011

Analyst: Nonprofit Blues Have Huge Reserves

Nonprofit Blue Cross Blue Shield plans are sitting on piles of cash – and consumers might see “premium holidays” or lower-than-expected increases as a result, a Wall Street analyst says in a report Wednesday.

Nationwide, 33 nonprofit plans have almost $29 billion in capital reserves, according to analyst Carl McDonald of Citi Investment Research & Analysis. That’s up from $18 billion at the end of 2008.

While that money is meant as a rainy day cushion – in case the plans face large medical expenses or need to invest in new capital, such as information systems – McDonald says the capital is more than enough to cover those contingencies.

There’s more good news for the industry: Blues plans, just like their for-profit competitors, have been able to set their premium prices above underlying inflation during the past year – and have seen lower-than-expected use of medical services by policyholders.  As a result, net profit margins for the Blues were 4.8 percent in the first quarter, the highest reported since 2005, his report says.

“The peak level of profitability that the industry is enjoying right now … (has) likely resulted in dozens of conversations in Blue Cross boardrooms across the county about how to deal with their unexpected windfall,” writes McDonald.

Earlier this month, Blue Shield of California announced it would cap its profits at 2 percent and issue rebates to policyholders.  While McDonald doesn’t expect many other plans to do the same, he says “premium holidays” and other types of givebacks are possible. That’s particularly true in areas where Blues plans look like they won’t meet the new federal requirement of spending at least 80 percent of premium revenue on medical care and quality improvements.

Blues plans may also come in with more “aggressive premium pricing” – analyst-speak for rates set lower than expected medical cost trends – in several states, including Arizona, North Carolina, Illinois and Texas, he says.

jappleby@kff.org

Wednesday, June 29th, 2011

Today’s Headlines – June 29, 2011

Good morning! Here’s what we’re reading early this Wednesday:

Today’s early morning highlights from the major news organizations include reports about a new plan offered by two senators to cut Medicare spending — but some top Democrats are lined up against it.

The Washington Post: Top Democrats Reject New Plan To Cut Medicare Spending
Leading congressional Democrats immediately recoiled Tuesday from a new proposal to cut $600 billion in Medicare spending over the next decade — in part by raising the eligibility age. Sens. Joseph I. Lieberman (I-Conn.) and Tom Coburn (R-Olka.) unveiled the proposal as part of a bipartisan effort to produce the kind of savings necessary to achieve the $2 trillion in debt reduction both parties say is needed to convince reticent lawmakers to vote to raise the debt ceiling. It would raise Medicare’s eligibility age from 65 to 67 and assess higher premiums on wealthier seniors. The proposal echoes Republican demands that entitlement reform — especially deep cuts in Medicare spending — be a part of any agreement to raise the nation’s debt ceiling. But the swift rejection of the proposal among Democrats reflects the significant obstacles that remain to any agreement to cut the deficit and raise the nation’s legal borrowing limit (Helderman and Kane, 6/28).

The Associated Press: Coburn, Lieberman Seek To Raise Medicare Age To 67
Two Senate rebels jumped into Congress’ cut-the-deficit competition on Tuesday, proposing to raise the age of Medicare eligibility to 67 and increase monthly premiums for millions of current beneficiaries. … Democrats reacted with criticism of the proposal, which Coburn said was designed to rescue the financially imperiled program and help the nation confront a “wall of debt.” Republicans betrayed no sign of support either (Espo, 6/28).

For more headlines …

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Wednesday, June 29th, 2011

Next Gray Generation (Slightly) Better Off

As a group, the next generation of seniors will still have trouble paying for health care, but they’ll fare better than current retirees, according to a report released Tuesday by the Kaiser Family Foundation. Future retirees, the report said, will have slightly higher incomes, greater savings and more equity in their homes. But that doesn’t mean everyone. The biggest improvements will be for people who are white and better educated.

Kaiser Health News is a program of the Kaiser Family Foundation.

mserafini@kff.org

Tuesday, June 28th, 2011

For-Profit Hospices Get New Scrutiny As Costs Grow

Are for-profit companies driving up the cost of Medicare’s hospice benefit?

After a decade in which most new hospices were started by corporations, half of Medicare-certified hospices are now for-profits. Concurrently, Medicare’s hospice costs have increased from $2.9 billion in 2000 to $12 billion in 2009, making it one of the fastest growing segments of the government health care program for the elderly.

The increase isn’t only because more people are using hospice.  It’s also because patients are staying in hospice longer before dying. And those long-stay patients are more likely to be cared for by for-profit companies than nonprofits, studies show.

As Kaiser Health News and the New York Times explain Tuesday, there’s a financial incentive for longer stays. Medicare’s method of paying hospices a flat fee for each day in hospice encourages them to seek out patients early on — and try to keep them as long as possible. That’s because the big costs for hospice care are at the beginning—when a patient is evaluated and a plan of care established—and the end, when they need the most intensive attention.

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Tuesday, June 28th, 2011

70 for Medicare? Unexpected Agreement

UPDATE 4:40 p.m.:  Sens. Joe Lieberman, I-Conn., and Tom Coburn, R-Okla., released a proposal Tuesday to overhaul Medicare that included an increase in the eligibility age to 67.

ORIGINAL POST:  Gail Wilensky and Bruce Vladeck rarely agree on anything, yet the two former Medicare administrators managed to find some common ground Tuesday in an idea that is proving wildly unpopular with seniors. The notion is raising the eligibility age from 65 to around 70, and Wilensky, who ran Medicare under President George H.W. Bush, and Vladeck, who did the same for President Bill Clinton, agreed that keeping Americans in the workforce longer is a good thing.

The two spoke at a Kaiser Family Foundation discussion on Medicare, where, as expected, they clashed about recent proposals in Washington to fundamentally change Medicare to slow spending. Front and center was the Republican “premium support” proposal in the House-passed budget resolution, which would limit federal spending on Medicare beneficiaries. Vladeck even interrupted Wilensky’s remarks when she compared premium support to the insurance system for federal workers. An adamant Vladeck didn’t think so.

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Tuesday, June 28th, 2011

Patients Can Help Thwart Errors In Doctors’ Offices

Serious medical errors that result in malpractice payments are almost as common in outpatient settings like physicians’ offices and urgent care clinics as they are in hospitals, according to a recent study published in the Journal of the American Medical Association. Of 10,739 malpractice claims paid on behalf of doctors in 2009, 48 percent were for problems that occurred in hospitals, while 43 percent were for outpatient errors (another 9 percent occurred in both settings).

Unlike hospitals, however, where surgical errors were the number one reason for adverse events that led to malpractice payouts, in outpatient settings, the study found, there was a very different culprit: diagnostic errors.

Of course, this makes a lot of sense in some ways, since much of what happens in doctors’ offices and clinics is related to trying to figure out what’s wrong with patients.

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Tuesday, June 28th, 2011

Google Health Signing Off, Medicaid Funding And Planned Parenthood

With the launch of our new blog, Capsules, we’ve also resurrected Blogwatch, where we’ll track a variety of health policy blogs and give you the highlights in easy-to-swallow bites. I’m your new host, Andrew Villegas. Read your favorites or add to the conversation below:

This week, bloggers are sounding off about the demise of Google Health, the Internet behemoth’s version of the personal health record. They’re also talking about shifting state liabilities in Medicaid and the movement among some states to cut off funding for Planned Parenthood because of the abortions that group provides at its clinics.

In The Health Care Blog, Matthew Holt laments the loss of Google Health and says that an independent system like it is needed in health care to help consumers track their health records. He says players in the health care system, the government itself or a non-profit foundation could take over the idea to keep it alive: “Rather than Google closing down Google Health could they give it (code & data) to an unimpeachable non-profit with enough money to keep it going for while? Other Foundations and the government could step in to fund it. I believe there’s already a strong group of potential developers and more out there who could run it.”

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Tuesday, June 28th, 2011

Welcome To Capsules

Today Kaiser Health News launches a blog that  will complement our coverage of health care policy and politics. Capsules will provide a new venue for staff-written news and observations, outside voices and commentary and other timely and interactive features.

We look forward to your feedback and hope you will make Capsules an important part of your daily dose of health news.

Tuesday, June 28th, 2011

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