KHN: Kaiser Health News

Labor unions, under pressure by states and employers to shoulder more of their health care costs, have fared relatively well at protecting workers’ health benefits during the recession, according to a study released today.

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The study by the nonpartisan Employee Benefit Research Institute in Washington found that from 2007 to 2009 union workers were less likely to lose employer-based health coverage than nonunion workers.

Union workers covered by health insurance through their own job fell from 82 percent to 80.4 percent between 2007 and 2009, a 2 percent drop, EBRI found. For nonunion workers with coverage through their own job, coverage fell from 55.9 percent to 52.2 percent over the period, a 6.5 percent decline.

Additionally, the overall percentage of union workers with any employment-based coverage fell from 93.4 percent to 91 percent –a 2.6 percent decline, while among nonunion workers it fell from 74.3 percent to 70.6 percent –a 5 percent decline

“The analysis shows that unionization is a key to many workers having health benefits, and that during tough economic times, union worker health benefits suffer less,” said Paul Fronstin, director of EBRI’s Health Research and Education Program and author of the study.

But Fronstin warned that as unionization in the private sector continues to decline, so will the overall percentage of workers with employer-based coverage.

Last September, the Census Bureau released a study that showed that the bad economy caused a sharp increase in the number of the uninsured in 2009, to 50.7 million people.

Joan Sivley believes that health information technology could have helped her son Dan from unnecessary suffering as he struggled for eight years to get an accurate diagnosis of schizo-affective disorder. During that time, he shuffled through various psychiatric hospitals and residential centers, paying as much as $30,000 a month out of pocket, only to receive conflicting diagnoses and a myriad of medications.

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The Nashville, Tenn., mother joined other advocates at a briefing for congressional staff on Capitol Hill Wednesday to push to have mental and behavioral health providers receive the same incentives to move to electronic health records that the federal government is offering to other doctors and hospitals dealing with physical ailments. She noted the importance of having providers take an in-depth family medical history and talk to each other about past treatment plans, adding, “Each provider acted as though it was an island.”

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The Silicon Valley investors who thought the nascent tech start-up Google was a good idea back in 1999 are now putting their money behind another zany scheme: accountable care organizations, the networks of doctors and hospitals that experts hope will save the health system millions of dollars.

Kleiner Perkins Caufield & Byers, the venture capital firm that also provided early funding for Genentech, Amazon.com and AOL, and other investment companies are pouring $61 million into Essence Group Holdings Corp., a St. Louis-based company that helps doctors build the networks.

The money will help Essence’s technology arm, Lumeris, market software that enables collaboration among doctors, hospitals and insurers in accountable care groups. Essence believes the market for related products and services could reach $80 billion, and that as much as $1 trillion in revenue could pass through the accountable care organizations that use them within 10 years.

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Dying patients in nursing homes are an increasingly lucrative market for hospice companies, which have expanded rapidly into these facilities, according to a new federal audit.

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The Department of Health and Human Services Office of the Inspector General found that Medicare spending on hospice care for patients in nursing facilities grew by 69 percent over just four years, from $2.6 billion in 2005 to $4.3 billion in 2009. More than a third of total Medicare hospice spending in 2009 was for the care of 337,000 patients in nursing homes.

About 58 percent of the higher Medicare spending was due to increased enrollment. But much of the spending also was caused by nursing home patients’ length of hospice stay, which is three weeks longer than that of patients overall, such as those who receive services at home. The report found hospices with more than two-thirds of their patients in nursing homes earned on average $21,306 per patient, which was $3,182 more than the overall average cost per hospice patient.

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Hospitals and other health care providers have complained that federal regulations for accountable care organizations (ACOs) – a proposed model of care in which doctors and hospitals work together to cut unnecessary treatment of patients and share in the savings – don’t offer enough financial rewards and are too burdensome. But the results from a recent poll of hospital executives tell a different story.

According to a US News & World Report survey of 1,852 hospital executives, more than 33 percent of executives said it is “extremely likely” that their facility will, in fact, become part of an ACO. Another third said it was fairly likely. But when asked if they thought “over time ACOs will significantly improve the quality and efficient delivery of health care,” most responses fell in the middle of “extremely likely” and “not at all likely.”

The survey results come as some hospitals and physicians have expressed disappointment in how the government is handling ACOs. The American Hospital Association criticized Medicare’s ACO regulations. In a June memo to Dr. Donald Berwick, who heads the agency that oversees Medicare, the organization says that while many hospitals are already engaged in “ACO-like” efforts, the “excitement about Medicare ACOs has dwindled dramatically,” and, “substantial changes are needed to make the program operationally viable and attractive to potential participants.” The letter goes on to say that “the proposed rule places too much risk and burden on providers with little opportunity for reward in the form of shared savings, especially in light of the significant start-up and operating costs that providers must bear with little or no assistance.”

With officials from both parties considering cuts to entitlement programs as part of a deal to raise the federal debt ceiling, advocates for seniors are taking their message to Capitol Hill Wednesday to press Congress about the impact of potential cuts to Medicaid and Medicare.

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About 250 members of the National Association of Agencies on Aging, also known as n4a, are expected on the Hill as the group’s annual conference in Washington comes to an end.

“In the midst of this debate, we already know that we’ve been compromised in our ability to reach out and serve everybody who needs our services,” Sandy Markwood, CEO of the association, said to members Tuesday.

A survey conducted by the association in 2010 found that Area Aging Agencies suffered substantial losses in local funding as a result of the economic downturn.  Forty-eight percent reported that they had cut services, and almost a fifth eliminated some programs altogether. At the same time, about half had increased caseloads and instituted waitlists for some of their services, while most were reducing staff, according to Markwood.

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