Archive for April, 2012

Medicare To Add Hospital Efficiency, Patient Safety To Payment Formula

Medicare is proposing a significant change in how it decides on hospital reimbursements, adding two measures of patient safety and a financial assessment of whether hospitals are careful stewards of Medicare’s money.

The changes represent a broadening of the way Medicare plans to pay hospitals through its value-based purchasing program, which is set to begin in October. Medicare has already decided that in the initial year of the program, it will pay more to hospitals that follow clinical guidelines for recommended care and do better than average in patient surveys of their experiences.

Hospitals that fall short will get less money, initially losing up to 1 percent of their regular Medicare reimbursements, with even more at stake in 2013 and beyond.

(more…)

Tuesday, April 24th, 2012

An Even Bleaker Prognosis For Medicare?

If readers can bear the first 276 pages of bad news in the annual Medicare trustees report,  released Monday, they will come to several pages in which Medicare Chief Actuary Richard Foster argues the program’s financial future is even bleaker than what the trustees suggest.

Foster acknowledges the trustees did exactly the job they were asked to do, basing their findings on current law, including the 2010 overhaul.

But that future is unrealistic, and Congress won’t be able to avoid changing course, he says. Medicare spending will grow faster than projected, he says, because it is “implausible” that Congress will follow the requirement in current law to cut physician fees by about 30 percent in January. The trustees say as much in another part of the report where they note that eventually, physician payments would be less than half current levels — and far less than what private insurers pay — if those reductions go into effect. See page 216, where the group puts forth “illustrative alternative projections.”

The trustees are required to assume those reductions will occur, even though lawmakers regularly circumvent statutory reimbursement cuts. The health law also is slated to reduce Medicare payments to hospitals and other medical providers, which lowers the trustees’ estimate of program spending. Foster writes that that is unrealistic, noting “the best available evidence indicates that most health care providers cannot improve their productivity to this degree – or even approach such a level – as a result of the labor-intensive nature of these services.”

(more…)

Tuesday, April 24th, 2012

Today’s Headlines – April 24, 2012

Good morning!  Here is your morning news roundup.

The New York Times: Social Security’s Financial Health Worsens
The Obama administration reported a significant deterioration in the financial outlook for Social Security on Monday, while stating that the financial condition of Medicare was stable but still unsustainable. … One of the trustees, Kathleen Sebelius, the secretary of health and human services, said, “Medicare is in a much stronger position than it was a few years ago, thanks to the Affordable Care Act,” signed by President Obama in 2010” (Pear, 4/23).

Los Angeles Times: Trustees Warn Of Looming Insolvency For Social Security, Medicare
Medicare, which is expected to provide health insurance to more than 50 million elderly and disabled Americans this year, is expected to start operating in the red in its largest fund in 2024, according to the annual assessment by the trustees charged with overseeing the programs (Levey, 4/23).

(more…)

Tuesday, April 24th, 2012

Poll: Doctors Fall Short In Helping Many Seniors

Large numbers of seniors aren’t receiving recommended interventions that could help forestall medical problems and improve their health, according to a new survey from the John A. Hartford Foundation.

Notably, one-third of older adults said doctors didn’t review all their medications, even though problems with prescription and over-the-counter drugs are common among the elderly, leading to over 177,000 emergency room visits every year.

Falls cause over 2 million injuries in people age 65 and older annually, but more than two-thirds of the time doctors and nurses didn’t ask older patients whether they’d taken a tumble or provide advice about how to avoid tripping on carpets or slipping on the stairs, the Hartford poll found.

Similarly, depression can cause people to become socially isolated, suicidal, or stop taking care of themselves, but 62 percent of seniors said doctors and nurses hadn’t inquired about whether they were sad, depressed or anxious.

(more…)

Tuesday, April 24th, 2012

Survey: Court Hearings Don’t Move Public Opinion On Health Law


The three days in March that the Supreme Court devoted to debating the health law didn’t change many minds among the public. But the debate, and related media coverage, appear to have increased awareness about the law and made Republicans more supportive of the justices, according to a new survey.

As it has for two years, the public remained divided over the law when they were surveyed a week after the arguments ended, according to the latest survey from the Kaiser Family Foundation. (KHN is an editorially-independent program of the foundation.) According to the poll, 50 percent of American said they were “very or fairly” closely following the court case, up from 37 percent in March.

The extensive focus during the court hearings on the individual mandate may have also led to a greater understanding of that provision of the law: 74 percent of Americans were aware it was part of the law, up from 64 percent before the court’s hearing. The mandate, which would require all Americans to obtain health insurance or pay a fine, remains unpopular among the public. Less than one-third of those surveyed feel favorably about it. That barely changed from March. (more…)

Tuesday, April 24th, 2012

Medicare Trustee Has New Personal Stake In Program

As a nationally known expert on federal health policy, Robert Reischauer has for decades had more than a passing interest in Medicare.

But this week his passion for the program – and concern for its future viability — turned more personal.

Robert Reischauer (Photo by Center for American Progress via Flickr)

“I applied for Medicare yesterday,” Reischauer said Monday at a media briefing where he and the other trustees of Medicare and Social Security released their annual report on the financial health of the programs. The report showed Medicare’s Part A Trust Fund, which covers hospital costs, would begin to run out of money in 2024 — the same projection as last year. “I have great interest in sustaining Medicare for current and future generations,” he said.

Reischauer, 70, retired from the non-partisan Urban Institute at the end of Februrary. There is no financial penalty for signing up late for Medicare Part B  (physician coverage)  for people who have employer coverage. Most people are enrolled automatically for Medicare Part A when they turn 65. There is no premium for Part A.

Reischauer is one of two public trustees for Social Security and Medicare. The other trustees are members of the Obama administration.

Reischauer was director of the Congressional Budget Office from 1989 to 1995. He also was a researcher at the Brooking Institution and co-chair of the Medicare Payment Advisory Commission.

Reischauer is not the only Washington health policy insider to gain a more personal interest in Medicare. Don Berwick, former head of the Centers for Medicare and Medicaid Services until last December, became eligible when he turned 65 last September. Mitt Romney did not sign up when he turned 65.

Reischauer joined the other trustees in urging Congress to act quickly to extend the solvency of Medicare and Social Security. “Both of these vitally important programs are on unsustainable paths,” he said.

Monday, April 23rd, 2012

Today’s Headlines – April 23, 2012

Good Monday morning! Here are your headlines to get you back in the swing of things:

The Associated Press/Washington Post: Social Security, Medicare Strained By Slow Economic Recovery, Aging Workforce
An aging population and an economy that has been slow to rebound are straining the long-term finances of Social Security and Medicare, the government’s two largest benefit programs. Those problems are getting new attention Monday as the trustees who oversee the massive programs release their annual financial reports (4/23).

USA Today: Government Says Medicare Will Save $200 Billion Through 2016
The government plans to announce today that the 2010 health care law will save Medicare beneficiaries $208 billion through 2020, and save Medicare itself $200 billion through 2016, based on a Centers for Medicare & Medicaid Services actuary report (Kennedy, 4/23).

For more headlines …

Los Angeles Times: Romney’s Healthcare Plan May Be More Revolutionary Than Obama’s
As he pushes to “repeal and replace” President Obama’s healthcare law, former Massachusetts Gov. Mitt Romney has turned to proposals that could alter the way hundreds of millions of Americans get their medical insurance. In public, Romney has only sketched the outlines of a plan. … But his public statements and interviews with advisors make clear that Romney has embraced a strategy that in crucial ways is more revolutionary — and potentially more disruptive — than the law Obama signed two years ago (Levey, 4/23).

Politico: Health Reform Law Poses Quandary For States
If the Supreme Court upholds the health reform law this summer, states could be forced to a moment-of-truth situation: Do they set up a health insurance exchange, or do they let the feds come in and run theirs? (Millman, 4/22).

Reuters/Chicago Tribune: Republicans Eye Health Plan Should Court Overturn Reform
House Republicans are working to create a legislative blueprint they can sell to voters after the Supreme Court rules on Obama’s Patient Protection and Affordable Care Act, the nation’s most sweeping healthcare legislation since Medicare and Medicaid in the 1960s (Morgan, 4/22).

The New York Times: GAO Calls Test Project By Medicare Costly Waste
Medicare is wasting more than $8 billion on an experimental program that rewards providers of mediocre health care and is unlikely to produce useful results, federal investigators say in a new report (Pear, 4/22).

The Associated Press/Washington Post: Auditors Call On Obama Administration To Cancel Medicare Bonuses GOP Sees As Political
In a rebuke to the Obama administration, government auditors are calling for the cancellation of an $8 billion Medicare program that congressional Republicans have criticized as a political ploy. The nonpartisan Government Accountability Office says in a report to be released Monday that the $8.3 billion the administration has earmarked for quality bonuses to Medicare Advantage insurance plans would postpone the pain of cuts to the plans under the new health care law. Most of the money would go to plans rated merely average (4/23).

The New York Times: In Presidential Race’s Give-And-Take, Hope For A Fiscal Compromise
The optimists include leading stakeholders in Washington’s oft-spurned centrist boutique, which may be especially vulnerable to wishful analysis. But two looming events — an automatic $1.2 trillion budget “sequester” hitting defense and domestic spending, and the expiration of all of President George W. Bush’s tax cuts — will create pressure for the two parties to strike a compromise (Harwood, 4/22).

The Associated Press/Washington Post: Romney On Spending: Guns Triumph Over Butter As Pentagon Boost Ensures Domestic Cuts
Reducing government deficits Mitt Romney’s way would mean less money for health care for the poor and disabled and big cuts to nuts-and-bolts functions such as food inspection, border security and education. Romney also promises budget increases for the Pentagon, above those sought by some GOP defense hawks, meaning that the rest of the government would have to shrink even more (4/23).

The Wall Street Journal: Budget Promise Proves Tough Test
During his long primary campaign, Mitt Romney vowed to balance the federal budget by 2020 and sharply shrink spending by 2016. He pledged to do so without cutting Social Security or Medicare benefits, two of the main drivers of federal spending, either for current beneficiaries or those poised to become one. These twin promises are causing some headaches for his economic-policy team (Paletta and Murray, 4/20).

Politico: Ob-Gyns Aim To Deliver On The Hill
They rush to meetings, deal with crying babies, talk about contraception and fall behind on their schedules. It’s the daily schedule for a typical obstetrician and gynecologist, but also for the lawmakers who were  ob-gyns before they ditched their white coats for pinstriped suits and became some of the most conservative and outspoken members of Congress (Nocera, 4/22).

The New York Times: Conservative Nonprofit Acts as a Stealth Business Lobbyist
ALEC also sends talking points to its lawmakers to use when speaking publicly about issues like President Obama’s health care law. Last month, on the day that Supreme Court arguments on the law began, ALEC sent an e-mail to legislators with a bullet-point list of criticisms of it, to be used “in your next radio interview, town hall meeting, op-ed or letter to the editor” (McIntire, 4/21).

Politico: HHS Hires Former Planned Parenthood Spokesman
If the Obama administration was already on bad terms with abortion opponents, it’s not going to improve relations by hiring Planned Parenthood’s former spokesman for a job at the Department of Health and Human Services. Tait Sye, Planned Parenthood’s former media director, has joined HHS as deputy assistant secretary for public affairs, HHS made public Friday. He’ll have the public health portfolio — an area where you can be pretty sure abortion and contraception issues will come up (Feder, 4/20).

Chicago Tribune: Health Records Lost, Stolen Or Revealed Online
Almost a decade after a new law went into effect to strengthen health privacy protections, the number of breaches of patient records and databases across the U.S. suggests that personal health information is not as private or secure as many consumers might want or expect (Shelton, 4/23).

The Wall Street Journal: Lab Mistakes Hobble Cancer Studies But Scientists Slow to Take Remedies
Cancer experts seeking to solve the problem have found that a fifth to a third or more of cancer cell lines tested were mistakenly identified—with researchers unwittingly studying the wrong cancers, slowing progress toward new treatments and wasting precious time and money. … It is a problem hiding in plain sight. Warnings to properly test cancer cell lines have sounded since the 1960s (Marcus, 4/20).

USA Today: Some Physicians Offer Service Based On Monthly Retainers
Family physician Steven Butdorf of Eugene, Ore., was tired of rushing patients through appointments, tired of insurers denying procedures, and tired of paperwork (Loew, 4/22).

USA Today: Genetic Testing And Disease: Would You Want To Know
Gone would be the days of waiting to develop a disease. People would know about diseases they are at risk for and could change their living habits or consider treatments. Opponents warn about the potential for invasion of privacy — threatening employment and insurance — and the possibility that people equipped with the knowledge of their genetic makeup might make risky and unhealthy decisions (Lloyd, 4/22).

Los Angeles Times: Proposed Limits On Health Self-Insurance Plans Debated
Business and insurance groups are attacking a proposal by state regulators to impose new limits on a controversial form of health coverage that insurers are selling to small employers. The California Department of Insurance is pushing legislation that calls for new rules on a type of company self-insurance that’s growing more popular as small businesses seek alternatives to ever-rising premiums for conventional health coverage (Terhune, 4/21).

The Wall Street Journal: Cuomo Keeps Grip On Funds In Settlement
In the waning days of New York Gov. Andrew Cuomo’s tenure as attorney general, his office shifted tens of millions of dollars in settlement funds from a high-profile insurance probe to an account controlled by the state Department of Health. … The transfer was approved on Dec. 22, 2010. The attorney general’s office has since sought an analysis of Fair Health’s expenditures from the Health Department but hasn’t yet received the information, said an attorney general official (Gershman, 4/22).

Monday, April 23rd, 2012

Rushed Medicine; Exercising Your Way To A Smarter Brain

Every week, Kaiser Health News reporter Jessica Marcy selects interesting reading from around the Web.

Newsweek: The Doctor Will See You–If You’re Quick
Something in the world of medicine is seriously amiss. Unhappy patients gripe about their doctors’ brusque manner and give them bad marks on surveys and consumer websites like HealthGrades and Angie’s List. They tell tales of being rushed out of the office by harried doctors who miss crucial diagnoses, never look up from their computers during an exam, make errors in prescriptions, and just plain don’t listen to their patients. … And things don’t seem much better from the other side of the stethoscope. In a recent survey by Consumer Reports, 70 percent of doctors reported that since they began practicing medicine, the bond with their patients has eroded (Shannon Brownlee, 4/16).

(more…)

Friday, April 20th, 2012

Maryland’s First Green House Project Nursing Home Aids Low-Income Seniors

What was once a novel idea for  longterm care for the elderly — small, homey facilities of 10 to 12 residents each — is now a model cropping up around the country.

On Thursday The Green House Project– an alternative to senior institutional care created by Dr. William H. Thomas, a geriatrician and self-described ‘nursing home abolitionist’ — opened their 133th nursing home nationally and their first in Baltimore. According to Thomas, the homes are designed to emphasize quality living for seniors by creating a comfortable and independent space where residents sleep in private bedrooms, share family-style meals and have more freedom of movement  than in traditional nursing homes.

The four-unit facility on the site of the former Memorial Stadium is the first “green house” in the state of Maryland, and the first in the country to take advantage of special funding for low-income seniors thanks to a collaboration between the Robert Wood Johnson Foundation and NCB Capital Impact.

Sixty percent of the beds in the Baltimore facility, which will be run by Associated Catholic Charities, are reserved for low-income seniors on Medicaid.

Shortage of nursing homes in urban areas is a long-standing problem, according to Robert Jenkens, director of The Green House Project. According to a 2011 study in the Archives of Internal Medicine, “The relative risk of [nursing home] closure was significantly higher in zip code areas with higher proportion of blacks and Hispanics or a higher poverty rate.”

Photo by The Green House Project

In 2005 the first “green home” was built in Tupelo, Miss. and operated by Mississippi Methodist Senior Services. Jenkens says rather than the hospital-like facilities of yesteryears’ nursing homes, Green House units are small, private residences with personalized touches such as locked medicine cabinets in each room. Staffing is minimal, with the aim of building personal relationships with residents.

Jane Lowe, the team director of the Vulnerable Populations Portfolio at the Robert Wood Johnson Foundation says the facilities involve an entirely different philosophy of care. “You want people to age with dignity. You want people to have their individual needs met and you don’t want them to be institutionalized to die.”

Lowe says the foundation is gathering data to evaluate The Green House Project model. A small sample from a randomized trial at the Tupelo facility showed “significant” improvements in resident’s eating habits, social behaviors and overall quality of life.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

Friday, April 20th, 2012

Today’s Headlines – April 20, 2012

Happy Friday! Here are your morning headlines:

Los Angeles Times: House Passes 20% Tax Cut For Businesses
Despite a veto threat from President Obama, the Republican-led House approved a 20% election-year tax cut for most companies intended to entice them to pick up the pace of hiring and, thus, boost the economy. Democrats, though, said the 20% tax-cut measure comes as Republicans work to revamp Medicare and slash domestic programs, including the Meals on Wheels program for seniors (Mascaro and Lee, 4/19).

Reuters/Chicago Tribune: Analysis: A Romney Pick For Top U.S. Court? Frontrunners Emerge
As a candidate, Romney has pledged to nominate judges in the mold of the Supreme Court’s four most conservative justices, and he has said the court should overrule Roe v. Wade, the 1973 opinion that said women have a right to an abortion. … Paul Clement, who served as U.S. solicitor general under President George W. Bush and is now a lawyer in private practice, is the favorite of many conservatives. Clement argued last month for the Supreme Court to strike down Obama’s 2010 healthcare law (Ingram, 4/19).

For more headlines … (more…)

Friday, April 20th, 2012

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