VA Care: Still the Best Care Anywhere?
By Phillip Longman
Washington Monthly, June 3, 2014
Last week, when I accepted an invitation to go on Hugh Hewitt’s nationally syndicated talk show, his first question to me was, “So how does it feel to be the author of a book about the VA that has been thoroughly discredited?”
Well, yes, as the author of the title "Best Care Anywhere, Why VA Health Care would be Better for Everyone," it’s been dispiriting to have it confirmed by a preliminary inspector general’s report that some frontline VA employees in Phoenix and elsewhere have been gaming a key performance metric regarding wait times. But what’s really has me enervated is how the dominate media narrative of the VA “scandal” has become so essentially misleading and damaging to the cause of the health care delivery system reform.
I don’t mean just the fulminations of the right-wing press. It’s nothing new when Fox rolls out Ollie North to proclaim that any real or reported failure of the VA is proof of the case against socialized medicine.
I’m also talking about the work of hard-working and earnest reporters, who due to a combination insufficient background knowledge and the conventions of Washington scandal coverage, wind up giving the public a fundamentally false idea of how well the VA is performing as an institution. Over the next several days, I plan to make a series of posts here at Political Animal that I hope will be helpful to those covering the story, or for those who are just trying to get the full context for forming an opinion.
Today, let’s just start by scrutinizing the now almost universal assumption that there is a “systemic” problem at VA hospitals with excessive wait times. Even progressives, including the likes of Jon Stewart and Bill Maher, seem predisposed to believe this for their different reasons. Some voices, like my former colleague Brian Beutler of The New Republic, even speculate that the scandal may ultimately bounce in a way that harms the Republicans more than it does the Democrats.
But before we go there, can we get clear on just what the underlying reality is? There is, to be sure, a systemic backlog of vets of all ages trying to establish eligibility for VA health care. This is due to absurd laws passed by Congress, which reflect on all us, that make veterans essentially prove that they are “worthy” of VA treatment (about which more later). But this backlog often gets confused with the entirely separate issue of whether those who get into system face wait times that are longer than what Americans enrolled in non-VA health care plans generally must endure.
Just what do we know about how crowded VA hospitals are generally? Here’s a key relevant fact that is just the opposite of what most people think. For all the wars we’ve been fighting, the veterans population has been falling sharply (pdf). Nationwide, their number fell by 17 percent between 2000 and 2014, primarily due to the passing of the huge cohorts of World War II- and Korea War-era vets. The decline has been particularly steep in California and throughout much of New England, the Mid-Atlantic and industrial Midwest, where the fall off has ranged between 21 percent and 36.7 percent.
Reflecting this decline, as well a general trend toward more outpatient services, many VA hospitals in these areas, including flagship facilities, want for nothing except sufficient numbers of patients to maintain their long-term viability. I have visited VA hospitals around the county and often been unnerved by how empty they are. When I visited two of the VA’s four state-of-the-art, breathtakingly advanced polytrauma units, in Palo Alto and Minneapolis, there was hardly a patient to be found.
But at the same time there is a comparatively small countertrend that results from large migrations of aging veterans from the Rust Belt and California to lower-cost retirement centers in the Sun Belt. And this flow, combined with more liberal eligibility standards that allow more Vietnam vets to receive VA treatment for such chronic conditions as ischemic heart disease and Parkinson’s, means that in some of these areas, such as Phoenix, VA capacity is indeed under significant strain.
http://www.pnhp.org/print/news/2014/june/va-care-still-the-best-care-anywhere
Washington Monthly, June 3, 2014
Last week, when I accepted an invitation to go on Hugh Hewitt’s nationally syndicated talk show, his first question to me was, “So how does it feel to be the author of a book about the VA that has been thoroughly discredited?”
Well, yes, as the author of the title "Best Care Anywhere, Why VA Health Care would be Better for Everyone," it’s been dispiriting to have it confirmed by a preliminary inspector general’s report that some frontline VA employees in Phoenix and elsewhere have been gaming a key performance metric regarding wait times. But what’s really has me enervated is how the dominate media narrative of the VA “scandal” has become so essentially misleading and damaging to the cause of the health care delivery system reform.
I don’t mean just the fulminations of the right-wing press. It’s nothing new when Fox rolls out Ollie North to proclaim that any real or reported failure of the VA is proof of the case against socialized medicine.
I’m also talking about the work of hard-working and earnest reporters, who due to a combination insufficient background knowledge and the conventions of Washington scandal coverage, wind up giving the public a fundamentally false idea of how well the VA is performing as an institution. Over the next several days, I plan to make a series of posts here at Political Animal that I hope will be helpful to those covering the story, or for those who are just trying to get the full context for forming an opinion.
Today, let’s just start by scrutinizing the now almost universal assumption that there is a “systemic” problem at VA hospitals with excessive wait times. Even progressives, including the likes of Jon Stewart and Bill Maher, seem predisposed to believe this for their different reasons. Some voices, like my former colleague Brian Beutler of The New Republic, even speculate that the scandal may ultimately bounce in a way that harms the Republicans more than it does the Democrats.
But before we go there, can we get clear on just what the underlying reality is? There is, to be sure, a systemic backlog of vets of all ages trying to establish eligibility for VA health care. This is due to absurd laws passed by Congress, which reflect on all us, that make veterans essentially prove that they are “worthy” of VA treatment (about which more later). But this backlog often gets confused with the entirely separate issue of whether those who get into system face wait times that are longer than what Americans enrolled in non-VA health care plans generally must endure.
Just what do we know about how crowded VA hospitals are generally? Here’s a key relevant fact that is just the opposite of what most people think. For all the wars we’ve been fighting, the veterans population has been falling sharply (pdf). Nationwide, their number fell by 17 percent between 2000 and 2014, primarily due to the passing of the huge cohorts of World War II- and Korea War-era vets. The decline has been particularly steep in California and throughout much of New England, the Mid-Atlantic and industrial Midwest, where the fall off has ranged between 21 percent and 36.7 percent.
Reflecting this decline, as well a general trend toward more outpatient services, many VA hospitals in these areas, including flagship facilities, want for nothing except sufficient numbers of patients to maintain their long-term viability. I have visited VA hospitals around the county and often been unnerved by how empty they are. When I visited two of the VA’s four state-of-the-art, breathtakingly advanced polytrauma units, in Palo Alto and Minneapolis, there was hardly a patient to be found.
But at the same time there is a comparatively small countertrend that results from large migrations of aging veterans from the Rust Belt and California to lower-cost retirement centers in the Sun Belt. And this flow, combined with more liberal eligibility standards that allow more Vietnam vets to receive VA treatment for such chronic conditions as ischemic heart disease and Parkinson’s, means that in some of these areas, such as Phoenix, VA capacity is indeed under significant strain.
http://www.pnhp.org/print/news/2014/june/va-care-still-the-best-care-anywhere
VA Care: Still the Best Care Anywhere? Part II
By Phillip Longman
Washington Monthly, June 5, 2014
On Tuesday, I offered some background information that called into question the now almost universal assumption that there is a “systemic” problem at VA hospitals with excessive wait times. Yes, VA hospitals in some Sunbelt retirement meccas like Phoenix face serious capacity issues due to the large number of aging vets who have moved to such areas. But in most parts of the country a shrinking population of vets threatens to force the closure of many VA hospitals for lack of patients.
Now let’s consider another, more serious, and often conflated wait time issue surrounding the VA—one that also been bringing forth all kinds of claims and accusations that are in desperate need of being put into context. I’m talking about the huge backlog of vets caught in the often protracted process of just trying to establish their eligibility for VA care.
This issue is confusing to most people, including many in the military, because they assume that vets are legally entitled to VA care, just like most seniors are entitled to Medicare or Social Security. But VA care is not an entitlement. Rather, reflecting the public’s deeply conflicted and often changing views about veterans, access to VA care is limited to vets who can establish that are “deserving” according to convoluted, arcane, and often impossible-to-prove sets of ever evolving metrics and standards.
In general and on paper, combat vets returning from Afghanistan and Iraq have access at least some VA health care for five years, few questions asked. But after that, they join most vets in having to demonstrate their worthiness for treatment by the VA. In general, to get or keep access to VA care most vets must either meet a strict means test or prove that they suffer from specific disabilities directly resulting from their military service.
Now if you want a sense of how inane, insane and time consuming the process of adjudicating such rules can be, then check out this, very typical case, recently brought before the Board of Veterans’ Appeal. Here we have an aging vet who is seeking access to the VA health care by claiming that during his service as a marine in late 1950’s and early 1960s he was exposed to the sound of grenades and gunfire, and that this exposure has since resulted in his hearing becoming so bad that it is disabling.
Now think of what proving (or disproving) this claim involves. Just establishing that he was in the military may well be a problem, due a 1973 fire in St. Louis that destroyed many military service records going back decades before. Today, if one picks up the membership magazine of the Vietnam Veterans of America, one finds pages of fine-print notices in which vets with missing records are searching for witnesses who can testify they were indeed once in the service.
But let’s assume the man filing this case can prove he was in the military and honorably discharged. Then he has to come up with the hearing test he took upon joining the military in 1956. And then he needs to get his hands on the hearing test he took upon discharge in 1962. And then he needs paperwork from doctors showing the extent of his hearing loss now. And then (and here’s the really big one) he needs to prove that his initial hearing loss really did result from being to exposed to too much gun fire and explosions during military service, as opposed to too much rock and roll, and that the subsequent worsening of his condition is not just a function of aging or some other chronic problem.
http://www.pnhp.org/print/news/2014/june/va-care-still-the-best-care-anywhere-part-ii
Washington Monthly, June 5, 2014
On Tuesday, I offered some background information that called into question the now almost universal assumption that there is a “systemic” problem at VA hospitals with excessive wait times. Yes, VA hospitals in some Sunbelt retirement meccas like Phoenix face serious capacity issues due to the large number of aging vets who have moved to such areas. But in most parts of the country a shrinking population of vets threatens to force the closure of many VA hospitals for lack of patients.
Now let’s consider another, more serious, and often conflated wait time issue surrounding the VA—one that also been bringing forth all kinds of claims and accusations that are in desperate need of being put into context. I’m talking about the huge backlog of vets caught in the often protracted process of just trying to establish their eligibility for VA care.
This issue is confusing to most people, including many in the military, because they assume that vets are legally entitled to VA care, just like most seniors are entitled to Medicare or Social Security. But VA care is not an entitlement. Rather, reflecting the public’s deeply conflicted and often changing views about veterans, access to VA care is limited to vets who can establish that are “deserving” according to convoluted, arcane, and often impossible-to-prove sets of ever evolving metrics and standards.
In general and on paper, combat vets returning from Afghanistan and Iraq have access at least some VA health care for five years, few questions asked. But after that, they join most vets in having to demonstrate their worthiness for treatment by the VA. In general, to get or keep access to VA care most vets must either meet a strict means test or prove that they suffer from specific disabilities directly resulting from their military service.
Now if you want a sense of how inane, insane and time consuming the process of adjudicating such rules can be, then check out this, very typical case, recently brought before the Board of Veterans’ Appeal. Here we have an aging vet who is seeking access to the VA health care by claiming that during his service as a marine in late 1950’s and early 1960s he was exposed to the sound of grenades and gunfire, and that this exposure has since resulted in his hearing becoming so bad that it is disabling.
Now think of what proving (or disproving) this claim involves. Just establishing that he was in the military may well be a problem, due a 1973 fire in St. Louis that destroyed many military service records going back decades before. Today, if one picks up the membership magazine of the Vietnam Veterans of America, one finds pages of fine-print notices in which vets with missing records are searching for witnesses who can testify they were indeed once in the service.
But let’s assume the man filing this case can prove he was in the military and honorably discharged. Then he has to come up with the hearing test he took upon joining the military in 1956. And then he needs to get his hands on the hearing test he took upon discharge in 1962. And then he needs paperwork from doctors showing the extent of his hearing loss now. And then (and here’s the really big one) he needs to prove that his initial hearing loss really did result from being to exposed to too much gun fire and explosions during military service, as opposed to too much rock and roll, and that the subsequent worsening of his condition is not just a function of aging or some other chronic problem.
http://www.pnhp.org/print/news/2014/june/va-care-still-the-best-care-anywhere-part-ii
How VA Outsourcing Hurts Veterans
By Phillip Longman
Washington Monthly, June 8, 2014
On Thursday, Sen. Bernie Sanders, chairman of the Senate Veterans Affairs Committee, announced that he had reached a compromise with John McCain and other Senate Republicans on how to fix whatever it is that needs fixing at the VA. The legislation contains some good ideas, like providing for the hiring of more doctors and nurses where they are needed. But the bill also contains one provision that is a significant concession to Republican enemies of government. If enacted, it would lower the quality of health care received by veterans while setting back the movement for health care delivery system reform generally.
This is the provision in the draft legislation that would, according to a Senate Veterans Committee press release, “allow veterans living more than 40 miles from a VA hospital or clinic to access more convenient private care.” Given all the headlines about excessive wait times and backlogs at the VA, that might sound smart at first hearing, but in practice it could well lead to a disaster.
To begin with, as most people in this debate don’t seem to know or care to remember, the VA already engages in extensive outsourcing of medical services. For example, under the Bush Administration, the VA began contracting with Humana to provide care to veterans in rural areas, a program that continues under the Access Received Closer to Home project. In 2009, the Senate Veterans Affairs committee determined that the VA was already outsourcing some $3 billion year to private providers.
By 2012, the Obama administration had continued the trend to the point that the public employee unions that represent VA employees were screaming. “Contract physicians and nurses lack the specialized skills and best practices of clinicians who dedicate their lives to serving the veteran population as VA employees,” complained Alma Lee, National VA Council President for the American Federation of Government Employees. “Excessive contracting out has put many medical centers in the red, without benefitting the patient.”
Now to be sure, some of this outsourcing makes sense. It’s not cost-effective to maintain VA hospitals or even clinics in many remote areas. Due to the declining population of veterans, the VA lacks a sufficient volume of patients even in some developed areas to be able to justify using its own specialists.
But even at its current scale, the outsourcing of VA care has already been fraught with problems. One comes from just the generic hazards of government contracting. In 2009, the VA Inspector General (pdf) found that 37 percent of the $3.2 billion the VA had paid out the year before to private health care providers was improperly paid. Not only does outsourcing create new administrative costs and burdens for procuring and managing contracts. It also opens up opportunities for crony deals and all the kinds fraudulent billing by private doctors that bedevils Medicare and Medicaid.
Far more potentially tragic, however, is what further privatization of the VA would do the quality of care received by veterans. It’s not just that it would threaten the closure of more VA hospitals, thereby making the highly specialized prosthetic and trauma care they offer to disabled veterans more difficult to obtain. Even routine care would suffer in quality as well.
To understand why, consider that health care quality experts are virtually unanimous in identifying fragmentation of care as the one of the largest, if not the largest failures of U.S. health care outside of the VA. Here, for example, is the diagnosis of the of the National Quality Forum, a non-profit organization dedicated to improving healthcare quality:
http://www.pnhp.org/print/news/2014/june/how-va-outsourcing-hurts-veterans
Washington Monthly, June 8, 2014
On Thursday, Sen. Bernie Sanders, chairman of the Senate Veterans Affairs Committee, announced that he had reached a compromise with John McCain and other Senate Republicans on how to fix whatever it is that needs fixing at the VA. The legislation contains some good ideas, like providing for the hiring of more doctors and nurses where they are needed. But the bill also contains one provision that is a significant concession to Republican enemies of government. If enacted, it would lower the quality of health care received by veterans while setting back the movement for health care delivery system reform generally.
This is the provision in the draft legislation that would, according to a Senate Veterans Committee press release, “allow veterans living more than 40 miles from a VA hospital or clinic to access more convenient private care.” Given all the headlines about excessive wait times and backlogs at the VA, that might sound smart at first hearing, but in practice it could well lead to a disaster.
To begin with, as most people in this debate don’t seem to know or care to remember, the VA already engages in extensive outsourcing of medical services. For example, under the Bush Administration, the VA began contracting with Humana to provide care to veterans in rural areas, a program that continues under the Access Received Closer to Home project. In 2009, the Senate Veterans Affairs committee determined that the VA was already outsourcing some $3 billion year to private providers.
By 2012, the Obama administration had continued the trend to the point that the public employee unions that represent VA employees were screaming. “Contract physicians and nurses lack the specialized skills and best practices of clinicians who dedicate their lives to serving the veteran population as VA employees,” complained Alma Lee, National VA Council President for the American Federation of Government Employees. “Excessive contracting out has put many medical centers in the red, without benefitting the patient.”
Now to be sure, some of this outsourcing makes sense. It’s not cost-effective to maintain VA hospitals or even clinics in many remote areas. Due to the declining population of veterans, the VA lacks a sufficient volume of patients even in some developed areas to be able to justify using its own specialists.
But even at its current scale, the outsourcing of VA care has already been fraught with problems. One comes from just the generic hazards of government contracting. In 2009, the VA Inspector General (pdf) found that 37 percent of the $3.2 billion the VA had paid out the year before to private health care providers was improperly paid. Not only does outsourcing create new administrative costs and burdens for procuring and managing contracts. It also opens up opportunities for crony deals and all the kinds fraudulent billing by private doctors that bedevils Medicare and Medicaid.
Far more potentially tragic, however, is what further privatization of the VA would do the quality of care received by veterans. It’s not just that it would threaten the closure of more VA hospitals, thereby making the highly specialized prosthetic and trauma care they offer to disabled veterans more difficult to obtain. Even routine care would suffer in quality as well.
To understand why, consider that health care quality experts are virtually unanimous in identifying fragmentation of care as the one of the largest, if not the largest failures of U.S. health care outside of the VA. Here, for example, is the diagnosis of the of the National Quality Forum, a non-profit organization dedicated to improving healthcare quality:
CARE COORDINATION IS A VITAL aspect of health and healthcare services. Many patients often see multiple physicians and care providers a year, which can lead to more harm, disease burden, and overuse of services than if care were coordinated. This is particularly evident for people with chronic conditions and those at high risk for co-morbidities, who often are expected to navigate a complex healthcare system. Despite efforts to reduce problems through various initiatives and programs—such as care/case management—poor communication, medication errors, and preventable hospital readmissions are still substantial.Indeed, they are. And superior coordination of care is one main reason why the VA, despite it flaws, continues to outperform most other health care providers in most measures of health care quality.
http://www.pnhp.org/print/news/2014/june/how-va-outsourcing-hurts-veterans
A progressive alternative to Obamacare
—UPDATED
It’s an apt description of the new job Gobeille stumbled into last fall. As the chair of Vermont’s Green Mountain Care Board, this plainspoken entrepreneur is overseeing one of the boldest social experiments in Vermont’s history, or the nation’s for that matter. Under his board’s guidance, the state is creating a health care system that will insure every Vermonter—regardless of income or employment—through a public entity that defines benefits, sets uniform prices for medical services, and covers patients’ bills.
That’s the dream anyway. President Obama’s Affordable Care Act gives private insurers control of the market through 2016, but Vermont lawmakers have voted to adopt a single-payer system as soon as that federal mandate expires. If state officials can devise a viable financing plan—and keep all the critical stakeholders onboard—the transformation could come as soon as 2017.
“We’ve already agreed we want universal health care,” Gobeille says. “The challenge is to fund and deliver it in ways that everyone can live with. Some groups will benefit more than others, but we can’t leave anyone feeling ripped off. The winner-loser issue is the place where the alligators live.”
A bold alternative to Obamacare
Vermont’s plan is a radical departure from Obamacare, but it embodies the bolder vision the president once embraced as a candidate. “I see no reason why the United States of America, the wealthiest country in the history of the world, is spending 14 percent—14 percent!—of its gross national product on health care and cannot provide basic health insurance to everybody,” Obama told an AFL-CIO audience in 2008. “A single-payer health care plan, a universal health care plan—that’s what I’d like to see.”
By the time he signed the Affordable Care Act in March 2010, Obama had ditched that idea—along with the more modest one of letting consumers choose between public and private insurance plans. The advent of Obamacare was an epochal achievement, to be sure, but it leaves commercial insurers a dominant role, bets on market forces to control spiraling costs, and keeps large employers in charge of most people’s health care. Beyond the small subset of Americans (about 7% of those under 65) who buy insurance on the individual market, Obamacare simply preserves the status quo.
A Health Insurer Calls, With Questions
Not
long after she signed up for health insurance under the Affordable Care
Act, Judy Shoemaker received a phone call that puzzled her.
The
caller said she was welcoming new members to the insurance network and
then asked Ms. Shoemaker to take a survey about health care issues, so
information could be provided to her physician. Ms. Shoemaker declined,
saying she didn’t understand why her insurer would be seeking medical
information to give to her doctor. “I thought it was strange,” said Ms.
Shoemaker, a consultant to nonprofits in Indiana. “I can talk to my
doctor myself.”
James
Tuck, who runs a dog care business in Chicago, got a similar call after
signing up for insurance through the Affordable Care Act in March. The
caller said he was contacting Mr. Tuck on behalf of his new insurer,
Blue Cross Blue Shield of Illinois, to go over his benefits and ask him
some questions. Mr. Tuck hadn’t yet received his insurance card and was
hesitant to answer questions, especially after he consulted a private
health advocate, who had helped him evaluate insurance options. She
advised him not to answer the queries. “She said their goal is to find a
reason to get you booted off your insurance.”
Insurers
say they are doing nothing of the sort. Lauren Perlstein, a spokeswoman
for the Health Care Service Corporation, parent of Blue Cross Blue
Shield of Illinois and plans in four other states, said in an email that
the company contacted new policy holders to help “new members get the
proper coverage and medical assistance they need, by helping guide them
through the health care system.”
The
company’s “experts” contact new members to explain benefits and answer
any questions, she said, as well as to “identify members who can benefit
from our personalized medical management program so they can best
manage their health.”
Residency shortage leaves hundreds of med students in debt-laden limbo
The shortage comes at a time when demand for doctors is increasing nationwide.
Hundreds of thousands of dollars in debt, and no residency. That’s the situation for 412 medical school graduates this year in the United States.
A residency — paid, on-the-job training — is an essential step in becoming a medical doctor. In some cases, students’ failure to obtain a residency has nothing to do with their performance, but rather with the supply and demand of the system that allocates them, the National Resident Match Program.
It also has to do with simple math. The National Resident Match Program’s annual report, released in May, shows 26,678 positions. For the second year in a row, the number of graduates exceeded the number of residencies available.
Medicare funds those residencies, costing $10 billion a year. Congress set this allocation in 1997, and it has remained unchanged since then.
But not for lack of trying. In 2013, lawmakers introduced two bills, the Resident Physician Shortage Reduction Act and the Training Tomorrow’s Doctors Today Act. Neither bill passed the House of Representatives.
Janis Orlowski, the senior director in health care affairs for the Association of American Medical Colleges, said Congress needs to increase funding to prevent a catastrophic shortage of doctors.
“We’ve gotten to a choke point where there are more students graduating than are getting a residency,” Orlowski said.
This residency shortage comes at a time when demand for doctors is increasing, she said. An aging population, an increase in the pool of insured people due to the Affordable Care Act, and the fact that almost a third of all physicians are expected to retire in the next decade all contribute to the rising need for new doctors. Her organization, interpreting U.S. Census data, predicts a shortage of 130,000 physicians by 2025.
Orlowski said that when she was in medical school during the 1980s, the country faced a similar physician shortage, which led to a federal investment in building and expanding medical schools.
This time around, medical schools have increased class sizes in response to the shortage, which is a good start, she said. But without an increase in the number of residency positions, the number of doctors cannot increase — no matter how many people graduate from medical school.
Currently, students select and rank desired residencies through the National Resident Match Program, which uses an algorithm to meet the needs of both the students and hospitals. For the unlucky ones who don’t get a match, it’s often just a matter of too many applicants for certain specialties.
This year — Match Day was March 31 — the number of unmatched graduates decreased to 412 from last year’s 528, which Orlowski attributes in part to students’ increased willingness to apply for primary care positions.
“Some primary care residencies did not fill in the past, and they did now, which is good,” Orlowski said. “Rather than everyone wanting to be a dermatologist — a very lucrative but hard-to-fill spot — people selected wisely, especially in competitive areas.”
James E. Wilberger, a neurosurgeon and vice president for graduate medical education at Allegheny Health System, said that unless something is done, the residency shortage will continue to get worse.
“Right now the number is small, but the trend is disturbing,” he said.
Wilberger said he knew one graduate who failed to get a residency this year. Describing the graduate as a “top-notch student,” an aspiring orthopedic surgeon with “excellent credentials,” he said there is sometimes no predicting which students will fail to match.
Officials at University of Pittsburgh Medical School would not comment on whether they had any unmatched graduates.
But Alexis Chidi, a Pitt medical student who also is seeking a Ph.D., said she was aware of at least two Pitt medical school seniors who had failed to get a residency in the past two years. Chidi said that each student’s choice of specialty and his or her desired locale both may have played a role.
“Everybody goes into medical school wanting to have unlimited choice of specialty and geographic areas,” she said. “But depending upon a number of factors, including performance in medical school or what school you go to, might affect your ability to match into a program.”
There is a process in place, known among medical students as “the scramble,” which gives students who didn’t match one last opportunity to get a residency without having to wait another year. But Chidi said that some specialties don’t have many opportunities available during the scramble, leaving some students out of luck.
Thousands stuck in MaineCare application backlog
Posted June 10, 2014, at 7:39 p.m.
AUGUSTA, Maine — Thousands of Mainers are waiting to find out if they’re eligible for Medicaid coverage, potentially putting off needed medical care while state and federal officials sort out the bureaucratic backlog.
Nationally, more than 6 million low-income Americans have gained Medicaid coverage through an expansion of the health insurance program under the Affordable Care Act. But even Maine and other states that opted against expanding Medicaid are seeing rising enrollment, through what health policy experts call the “woodwork effect.” Individuals who previously were eligible under existing Medicaid criteria but unenrolled are seeking coverage amid publicity about new, more affordable health insurance options and the requirement that most Americans get health coverage or pay a penalty.
Many applied through Healthcare.gov, the federal insurance marketplace set up under the health reform law. Applicants were encouraged to log on to the site to see if they were eligible for Medicaid, based on their income and other factors, with the state making the final determination.
Maine received basic eligibility information through Healthcare.gov on about 10,000 applications, according to the state Department of Health and Human Services. Applications can reflect more than one person seeking coverage. The state determined most applications didn’t qualify for Medicaid, leaving about 3,900 potentially eligible. Of those, 1,664 were determined eligible, and the state is still processing the remainder, according to DHHS spokesman John Martins.
Maine residents seeking Medicaid, or MaineCare, coverage also can apply directly with the state. Many were encouraged to after technical problems plagued the launch of Healthcare.gov. About 5,300 applications filed through the state also are pending, according to figures DHHS recently provided to the state’s health exchange advisory committee.
The early glitches that prevented applicants’ data from reaching states have been resolved, according to federal officials. The U.S. Centers for Medicare and Medicaid Services say Maine is one of just three states — along with Republican-led Alaska and Kansas — that can’t accept data on applicants transferred through Healthcare.gov, according to a Washington Post/Kaiser Health News report.
Maine Department of Health and Human Services Commissioner Mary Mayhew disputed that characterization, calling it a “complete distortion,” and claiming the federal government pressured states to provide Medicaid coverage despite missing information on applicants.
For months, states received only limited information on individuals seeking Medicaid coverage that lacked sufficient detail to accurately determine eligibility, she said in a Tuesday statement.
“To make matters worse, for political expediency, the federal government wanted states to ignore income verification and other missing information and simply make individuals eligible because of their inability to provide complete information,” Mayhew said.
While Maine was one of three states unwilling to “sacrifice program integrity” by granting eligibility without complete information, other states also can’t accept all of the data sent through Healthcare.gov, according to Maine DHHS. The department didn’t specify which or how many other states.
Maine will be able to accept all of the data sent through Healthcare.gov by the end of this week, Martins said Wednesday.
http://bangordailynews.com/2014/06/10/health/thousands-stuck-in-mainecare-application-backlog/print/
| Maine Hospital's Dilemma: Improved Care Shrinks Bottom Line | |||||||||
| 06/11/2014 Reported By: Patty B. Wight | |||||||||
Under the Affordable Care Act, the quality of health care you receive is supposed to improve. Hospitals, for example, are expected to reduce readmissions, cut down on unnecessary tests. But these are the kinds of services that have been the bread and butter of hospitals for years. Take them away, and the hospital loses money. So the challenge for hospitals is how to increase quality and still stay in business. Patty Wight visited one hospital in western Maine that's grappling with that task, and tonight she has the first of two reports on what she found out.
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| In her 30 years of nursing at Franklin Memorial Hospital in Farmington, Tracy Harty has sported about a dozen different ID badges. "I'm currently a nurse navigator," she says. As a navigator, part of Harty's job is to usher uninsured patients through the health system. On this day, she's checking on Mark Osgood, who is at the hospital because of a recent lung cancer diagnosis. "Your first treatment is Thursday morning," she says. "And, are you coming alone?" Before his diagnosis, Osgood didn't have health insurance, so Harty helped him enroll. She'll keep helping him - with paperwork, or getting whatever community resources he needs. Osgood says it's a relief. He can focus on getting better. "I need help," he says. "I mean, this is a desperate fight. I can't do this by myself. I know I can't." Last year the hospital spent more than $6 million providing care for the uninsured. Franklin County is the third poorest in the state. Charity care costs here are swelling. So the hospital put Harty to work as a navigator to figure out what kinds of diseases were going untreated, to reduce costs by enrolling patients in insurance plans when possible, and to help patients take better care of themselves. "We kind of went into this thinking it would probably be two or three chronic diseases that would be the culprit," Harty says. "And if it was diabetes and congestive heart failure, say, then we would just design programs to address those issues, and then we'd be all set." The thought was that the hospital could treat a patient before their illness became acute. But Harty's research turned up something unexpected. "A lot of the $6 million is spent on catastrophic hospitalizations - people who have been sick for a period of time, have ignored that illness, and then they've had something major happen," she says. The problems were much more complex and individualized than anyone imagined. As Harty worked with patients, she discovered that personal and social circumstances often trumped health problems. And she realized that if she wanted to get people healthy, she would need to first address their underlying issues. http://www.mpbn.net/Home/tabid/36/ctl/ViewItem/mid/5347/ItemId/34176/Default.aspx Skyrocketing salaries for health insurance CEOsIf they’re making millions, should the rest of us have to pay higher premiums?By Wendell PotterThe Center for Public Integrity, June 9, 2014 If health insurance companies announce big premium increases on policies for 2015, I hope regulators, lawmakers and the media will look closely at whether they are justified, especially in light of recent disclosures of better-than-expected profits in 2013, rosy outlooks for the rest of this year and soaring CEO compensation. Almost all of the publicly traded health insurers reported big increases in revenue and profits last year. The big winners have been the top executives of those companies, led by Mark Bertolini, CEO of Aetna, the nation’s third largest health insurer. Bertolini’s total compensation of $30.7 million in 2013 was 131 percent higher than in 2012. If the stock prices of these firms keep growing at the current pace, Bertolini and his peers can expect to be rewarded even more handsomely this year, especially if they can hike premiums high enough to satisfy shareholders. According to Health Plan Week, a trade publication, the CEOs of the 11 largest for-profit companies were rewarded with compensation packages last year totaling more than $125 million. Over the past several weeks, several of them have told shareholders and Wall Street financial analysts that their companies likely will have higher profits at the end of this year than they expected, despite having to pay more medical claims as a result of the new Obamacare customers they picked up. Those announcements have been music to the ears of shareholders, who are considerably wealthier today than they were this time last year. Of those 11 companies (Aetna, Centene, Cigna, Health Net, Humana, Molina, Triple-S Management Corp., UnitedHealth Group, Universal American, Wellcare, and WellPoint) nine saw their stocks close near 52-week highs this past Friday. The biggest gainer has been Humana, one of the largest operators of Medicare Advantage plans, whose share price has increased more than 53 percent over the past year. The increases have been equally impressive at most of the other big companies. Aetna’s share price is up 31 percent, Cigna’s 32 percent. United’s is up 28 percent. And WellPoint’s is up 39 percent. But it is the CEO compensation that has been the most eye-popping, especially at two of the publicly traded companies that specialize in managing Medicaid enrollees in several states: Centene and Molina. Centene’s CEO Micheal Neidorff saw his compensation increase 71 percent last year, from $8.5 million to $14.5 million. Even more impressive was the 140 percent raise Molina’s J. Mario Molina got. His compensation jumped from $4.95 million in 2012 to $11.9 million in 2013. All of those totals were disclosed in the proxy statements those companies filed with the Securities and Exchange Commission earlier this spring. http://www.pnhp.org/print/news/2014/june/skyrocketing-salaries-for-health-insurance-ceos | |||||||||
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