Archive for January, 2013

A Wish List For Medicare

If you could make one change to Medicare, what would it be? Ask three former directors of the program and you’ll get plenty of ideas.

Bruce Vladeck, who was head of what was then known as the Health Care Financing Administration, or HCFA, for former President Bill Clinton, wants more market-based competition and less pricing set by Congress.

“I would like to move all of Medicare drug purchasing, whether through Part D or Part B, all of [durable medical equipment] and related services – almost everything other than hospitals, docs and managed care plans — to a real market-based purchasing model,” he said.  Give the  administrator of the Centers for Medicare & Medicaid Services the authority to negotiate prices “starting with the federal supply schedule for the 20 or 25 percent of Medicare outlays that are creating windfalls for various producers that we don’t talk about so much because it’s only 20 or 25 percent of outlays,” he said.

Gail Wilensky, who ran HCFA for President George H.W. Bush, would urge lawmakers to adopt a competitively bid premium support model that includes the current traditional fee-for-service plan and the payments beneficiaries receive would vary by income and health risk.

Mark McClellan, who ran CMS for George W. Bush, wants to see Medicare make more progress on reducing the growth of costs.  The program, which serves 50 million elderly and disabled Americans, “is nowhere near done with those kinds of steps, nowhere near the private sector” on cost control.   “Reducing overall spending growth while still insuring access to care and improvements in innovation” are key, he said.

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Wednesday, January 30th, 2013

Some Families Will Be Ineligible For Insurance Subsidies Under Final Rule

Some families with costly job-based health coverage may be ineligible for federal subsidies to help them buy less expensive coverage through new online insurance markets, under final rules released Wednesday by the IRS.

The two rules, published by the Treasury Department here and here, uphold earlier proposals outlining what is considered affordable, employer-sponsored coverage.

Under the federal health law, low and moderate-income workers with job-based coverage that is deemed unaffordable can opt out of that and turn to new marketplaces, called exchanges, to buy coverage with government subsidies.

But the rule defines the standard for affordability more narrowly than most consumer groups had hoped — as an amount less than 9.5 percent of household income to cover just that employee’s share of premium costs, not on what he or she must pay to cover their entire family, which is generally more expensive.

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Wednesday, January 30th, 2013

For Medicare Innovations – Think Locally

Reforming Medicare – from changing the way doctors are paid to streamlining patient care – could benefit from a grassroots approach, according to experts and physicians at a policy summit held by National Journal Live in Washington, D.C., Tuesday.

“We need to focus more on responding to and joining local initiatives,” said Len Nichols, director of George Mason University’s Center for Health Policy Research and Ethics. As an example, he pointed to an initiative in Rochester, N.Y., that brought local doctors and hospitals together to successfully reduce hospital readmissions.

The panelists agreed that solutions to address the system’s inefficiencies should begin at the ground level with physicians, community members and patients, who could provide valuable feedback and ideas when designing new approaches to quality care and cost control.

“What the ACA has done is to set up an environment where there is support for new innovation,” said Gail Wilensky, an economist who previously directed the Medicare and Medicaid programs.

With much of the health law going into effect in 2014, the U.S. will likely see increased coverage, insurance marketplaces and an expanded Medicaid program.

But Wilensky said the health law’s limited role in changing payment models and encouraging patient engagement in the health system operations could prove to be a “fatal flaw” in what should be an overhaul of the system. “These are huge constraints in how and how fast Medicare can move,” she said.

Dr.  Edward Murphy, a professor of medicine at the Virginia Tech Carilion School of Medicine, said physicians’ attachment to the status quo was slowing down efforts to move to a system that rewards better health outcomes and lowers consumer costs. He said doctors need to adopt fundamental new practices.

“To get a broadwave movement of change across the country, it seems to me, we need a cultural shift,” he said.

Tuesday, January 29th, 2013

Patient Loads Often At Unsafe Levels, Hospitalist Survey Finds

Nearly forty percent of hospital-based general practitioners who are responsible for overseeing patients’ care say they juggle unsafe patient workloads at least once a week, according to a study published Monday as a research letter in JAMA Internal Medicine.

In the study, researchers at Johns Hopkins University invited nearly 900 attending physicians, known as hospitalists, to complete an online survey that measured various characteristics, including the number of patients they thought they could manage safely during a typical shift.  Hospitalists are the physicians who coordinate a patient’s care and medications among various specialists while they’re in the hospital and oversee their transition home.

Among the 506 doctors who completed the survey, forty percent reported that their patient workloads exceeded levels they deemed safe at least once a month. Thirty-six percent said they exceeded their own notions of safe workloads more than once a week.  And nearly a quarter believe their workloads negatively affected patient outcomes by preventing full discussion of treatments.

“We know that with increased pressures from the health care system, with decreased reimbursement, present restrictions on work hours, and a focus on patient flow, that there is the concern that attending physician workload has increased,” said Dr. Henry Michtalik, an assistant professor of medicine and the study’s first author.

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Monday, January 28th, 2013

Nursing Moms Get Free Breast Pumps From Health Law

This story comes from our partner .

Health insurance plans now have to cover the full cost of breast pumps for nursing mothers. This is the result of a provision in the Affordable Care Act (aka Obamacare), and the new rule took effect for many people at the start of this year.

It’s led to a boom in the sale of the pumps, which can cost hundreds of dollars.

Yummy Mummy, a little boutique on New York’s Upper East Side, has suddenly become a health care provider/online superstore. The company has been hiring like crazy, and just opened an online call center and a warehouse in Illinois. Yummy Mummy even hired somebody to talk to customers’ health insurance companies.

And new moms now seem more likely to splurge on fancy new breast pumps. Caroline Shany, a Yummy Mummy customer, spent her own money to buy a breast pump for her first baby. She may buy another one now because insurance will pick up the tab.

“Why not?” she says.

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Monday, January 28th, 2013

Americans Want Deficit Addressed Without Medicare Cuts, Poll Finds

Most Americans want quick action to reduce the deficit, but almost six in 10 oppose cutting Medicare spending to achieve that goal, according to a new poll released today.

Lawmakers should examine other alternatives, including requiring drug makers to give the government “a better deal” on medications for low-income seniors (85 percent) and making higher-income seniors pay more for coverage (59 percent), according to the survey conducted by the Kaiser Family Foundation, the Robert Wood Johnson Foundation and the Harvard School of Public Health. (KHN is an editorially independent program of the Kaiser Family Foundation.)

More than seven in 10 Democrats, independents and Republicans say that if the President Barack Obama and Congress made the “right changes,” they could reduce the deficit without making major cuts to Medicare.  Just over half (51 percent) oppose raising the Medicare eligibility age from 65 to 67, an idea discussed by both parties on Capitol Hill, and 85 percent oppose requiring all seniors to pay higher Medicare premiums.

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Thursday, January 24th, 2013

Report: States Making It Easier To Apply For Medicaid

Despite the reluctance of some Republican governors to expand Medicaid next year under the 2010 health law, most governors are making it easier for people to apply for coverage in the state-federal program for the poor, according to a study released today.

Residents of 37 states — four more than the year before — can now apply online for Medicaid or the Children’s Health Insurance Program. And 28 states allow families to renew online, including eight states that added this capability in 2012.

These were among the findings of the annual survey of Medicaid programs by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured. (KHN is an editorially independent program of the foundation).

“Our survey shows that states already are making significant advances to modernize the Medicaid enrollment process in 2014 to lower barriers to coverage and reduce administrative burdens for both families and states,”  Diane Rowland, executive vice president of the foundation and the commission’s executive director, said in a statement.

When major provisions of the health law go into effect next January, all states will have to offer online enrollment in Medicaid. The law also requires all states to hire  “navigators”  later this year to help people sign up for coverage in new online health insurance marketpaces that will open in October. The KFF report found that 23 states currently pay community-based workers to help people sign up for Medicaid.

As many as 17 million people are expected to qualify for Medicaid if all states  expand the program to cover everyone with incomes below 138 percent of the federal poverty level, or $32,000 for a family of four. Even though the federal government is paying the full cost for newly eligible enrollees for the first three years and no less than 90 percent thereafter, Republican governors from states such as Florida and Texas say they may not go along with the expansion because of concerns about states’ share of the costs.

Wednesday, January 23rd, 2013

Report: CMS Community Initiatives Could Reduce Health Costs

A pilot program introduced by the U.S. Centers for Medicare and Medicaid Services to boost quality of care for seniors by developing community approaches to health problems could play a key role in bringing down costs, according to a new report in the Journal of the American Medical Association.

Quality Improvement Organizations, or QIOs, are private groups in each state and U.S. territory that contract with the government for three years to improve health services for Medicare patients. They are comprised of health care providers and other medical professionals, social services workers and other community members.

In Tuesday’s report, researchers found a 5.7 percent average reduction in 30-day hospital readmissions across 14 economically and demographically diverse communities over a two-year period. The number of patients admitted to the hospital within 30 days of a prior admission is one possible measure of efficiency, since the cost and burden of readmission can be preventable.

One in five Medicare patients returns to the hospital within 30 days of being discharged. The problem is an expensive one: in 2004, these readmissions cost Medicare $17.4 billion dollars.

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Tuesday, January 22nd, 2013

AMA Offers $10 Million To Fund Med School Innovations

Memo to medical schools: If you have new ideas on how to train doctors, the American Medical Association may have some cash for you.

The AMA says it will provide $10 million over the next five years to fund eight to 12 “bold, innovative projects.”

“Rapid changes in health care require a transformation in the way we train future physicians,” AMA President Jeremy A. Lazarus said in a statement. “The AMA is deeply committed to redesigning undergraduate medical education to prepare the medical students of today for the health care of tomorrow.”

Among its criteria, the AMA says it is looking for proposals that create “more flexible, individualized learning plans,” or that promote “exemplary methods to achieve patient safety, performance improvement and patient-centered team based care.”

Applicants have until Feb. 15 to submit their ideas. Finalists will submit their full proposals by May 15 and winners will be announced at the AMA’s annual meeting in June.

Monday, January 21st, 2013

Mental Health Gun Laws Unlikely To Reduce Shootings

This story comes from our partner ‘s Shots blog.

States aren’t likely to prevent many shootings by requiring mental health professionals to report potentially violent patients, psychiatrists and psychologists say.

The approach is part of a gun control law passed in New York yesterday in response to the Newtown, Conn., shooting a month ago. But it’s unlikely to work because assessing the risk of violent behavior is difficult, error-prone and not something most mental health professionals are trained to do it, say specialists who deal with violence among the mentally ill.

“We’re not likely to catch very many potentially violent people” with laws like the one in New York, says Barry Rosenfeld, a professor of psychology at Fordham University in The Bronx.

The New York law says mental health professionals must report people they consider likely to do harm. It also gives law enforcement officials the power to take guns from these people.

Such laws “cast a very large net that will probably restrict a lot of people’s behavior unnecessarily,” Rosenfeld says. “Maybe we’ll prevent an incident or two,” he says. “But there are other ways that would be more productive.”

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Thursday, January 17th, 2013

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