ORLANDO, Fla. — Maria Rubin is one of the coveted independent voters in this swing state — so independent that she will not say whether she is voting for President Obama or Mitt Romney. She does share her age (63) and, more quickly, her opinion on
Medicare: “I’m not in favor of changing it, or eliminating it.”
Her attitude speaks directly to one of the biggest challenges facing the Republican ticket this year: countering the Democrats’ longstanding advantage as the party more trusted to deal with Medicare.
In the 2010 Congressional races, successful Republicans believed that they had finally found a way to do that, by linking the program’s future to Mr. Obama’s unpopular health insurance overhaul and accusing Democrats of cutting Medicare to pay for it. This summer Mr. Romney resumed the offensive, eventually joined by his running mate, Representative Paul D. Ryan.
Initially, polls suggested that the Republican strategy was working. Democrats fretted that Mr. Romney would win the retiree-heavy Florida and increase his support nationwide among older voters, who lean Republican anyway. David Winston, a Republican pollster, wrote a month ago of “a structural shift in the issue” that left the parties in “a dead heat” and Mr. Obama unable to mount an effective response.
But in recent weeks Mr. Obama and his campaign have hit back hard, and enlisted former President Bill Clinton as well, to make the case that the Romney-Ryan approach to Medicare would leave older Americans vulnerable to rising health care costs. Now their counterattack seems to be paying off.
Doctors, others billing Medicare at higher rates
By Fred Schulte, Joe Eaton and David Donald | Center for Public Integrity, Published: September 15
Thousands of doctors and other medical professionals have billed Medicare for increasingly complicated and costly treatments over the past decade, adding $11 billion or more to their fees — and signaling a possible rise in medical billing abuse, according to an investigation by the Center for Public Integrity.
Between 2001 and 2010, doctors increasingly moved to higher-paying codes for billing Medicare for office visits while cutting back on lower-paying ones, according to a year-long examination of about 362 million claims. In 2001, the two highest codes were listed on about 25 percent of the doctor-visit claims; in 2010, they were on 40 percent.
Similarly, hospitals sharply stepped up the use of the highest codes for emergency room visits while cutting back on the lowest codes.
Medical groups say the shift to higher codes reflects the fact that seniors have gotten older and sicker, requiring more complex care. “I rarely have a person who comes to me for a cold,” said Brantley B. Pace, who has practiced family medicine for more than a half-century in Monticello, Miss., and whose bills were among the highest in the sample of claims.
Although patients at individual practices such as Pace’s may be older and sicker, many health-care experts say the age and health of Medicare beneficiaries as a group has not changed, and research supports that contention.
The Center for Public Integrity’s analysis shows no increase in the average age of patients during the decade. Medicare billing data do not indicate that patients are getting more infirm, as their reasons for visiting their doctors were essentially unchanged over time. And annual surveys by the federal Centers for Disease Control and Prevention have found little increase in the amount of time physicians spend with patients.
That suggests that at least part of the shift to higher codes is due to “upcoding” — also known as “code creep” — a form of bill-padding in which doctors and others bill Medicare for more expensive services than were actually delivered, according to health experts and the data analysis by the center.
http://www.washingtonpost.com/national/health-science/doctors-others-billing-medicare-at-higher-rates/2012/09/15/27047458-f2fa-11e1-adc6-87dfa8eff430_print.html
| GLOBE STAFF
SEPTEMBER 17, 2012
Fast-growing Steward Health Care has hired away a leading heart surgeon from Massachusetts General Hospital, part of the for-profit hospital company’s strategy to win back patients who are leaving its system for routine surgical care at major Boston teaching hospitals.
It is not uncommon for Boston hospitals to lure well-respected doctors from competing institutions. But Steward is pumping resources into struggling hospitals it inherited when it bought the Caritas Christi hospital system from the Archdiocese of Boston, intensifying the tug-of-wars in the industry.
Steward persuaded Dr. Arvind Agnihotri to leave his job as director of minimally invasive and robotic heart surgery at Mass. General and oversee cardiac surgery at Steward’s largest hospital, St. Elizabeth’s Medical Center in Brighton.
Agnihotri’s hiring may allow St. Elizabeth’s, which performs about 280 heart operations annually, a relatively small number, to double that caseload, said Dr. Frank Pomposelli, chairman of surgery at St. Elizabeth’s.
| GLOBE STAFF
SEPTEMBER 17, 2012
A stay-at-home mom for 10 years, Martha Tuff wanted a career in medicine. But at 38 and raising four boys, she decided the decade-long preparation to become a doctor “would be too much for me.’’ So she enrolled in a two-year master’s degree program to become a physician assistant. She will be ready to care for patients by next fall.
Under the state’s new health care cost-control law, legislators are counting on physician assistants like Tuff as critical partners in the effort to curb medical spending, improve the coordination of treatment, and give patients easier access to basic care amid a shortage of primary care doctors.
A little-known provision of the law, which Governor Deval Patrick signed in August, expands the role of physician assistants by requiring health plans to list them as primary care providers in directories and allow patients to choose a physician assistant as their provider. They still will work on teams with doctors, but they will have their own group of patients for whom they are primarily responsible. Nurse practitioners were given similar status in a 2008 state law.
Beyond Obamacare
By STEVEN RATTNER
WE need death panels.
Well, maybe not death panels, exactly, but unless we start allocating health care resources more prudently — rationing, by its proper name — the exploding cost of Medicare will swamp the federal budget.
But in the pantheon of toxic issues — the famous “third rails” of American politics — none stands taller than overtly acknowledging that elderly Americans are not entitled to every conceivable medical procedure or pharmaceutical.
Most notably, President Obama’s estimable Affordable Care Act regrettably includes severe restrictions on any reduction in Medicare services or increase in fees to beneficiaries. In 2009, Sarah Palin’s rant about death panels even forced elimination from the bill of a provision to offer end-of-life consultations.
Now, three years on, the Republican vice-presidential nominee, Paul D. Ryan, has offered his latest ambitious plan for addressing the Medicare problem. But like Mr. Obama’s, it holds limited promise for containing the program’s escalating costs within sensible boundaries.
The Obama and Ryan plans are not without common ground; both propose an identical formula for capping the growth in Medicare spending per beneficiary. And both dip into the same toolbox (particularly lower payments to providers) to achieve a reduction of nearly $1 trillion in Medicare expenditures over the next decade from projected levels.
That’s where the agreement ends. Mr. Ryan believes that meeting the goal over the long term requires introducing more competition into Medicare through vouchers to purchase private insurance.
But Ryan’s approach was rendered toothless when the issue’s brutal politics forced him to retreat from his initial tough plan to simply cap the growth in government spending on Medicare and stick the inevitable overage onto beneficiaries. Under his revised plan, private insurers would be required to offer the same level of benefits as traditional Medicare, meaning that any savings would have to come from unidentified efficiencies (the ever-popular “waste, fraud and abuse”).
If the cap was breached — as it almost certainly would eventually be — Mr. Ryan blithely says, “
Congress would be required to intervene.” Fat chance; Congress regularly does the opposite when it rolls back caps on payments to doctors and hospitals.
Rationing Health Care More Fairly
Older adults are understandably anxious about the political sniping over the future financing of
Medicare. That is precisely the intention of the presidential campaigns.
Yet the cross-fire over who will cut Medicare by how much sidesteps a critical issue about the future of our medical care: If we must ration our care to hold down costs in the future, how can we do it in a fair, efficient and transparent way?
Mitt Romney’s campaign was brazenly misleading in its charge that the president’s health plan would cut medical services to older adults by reducing Medicare spending by $716 billion. The president’s savings will come mostly from smaller payments to managed care companies, which provide the same services as Medicare at a higher cost, and from slower growth in reimbursement rates to health care providers.
But the response of President Obama’s campaign also aimed to stoke voters’ fears. It stressed — rightly — that the plan to curb Medicare costs proposed last year by Representative Paul D. Ryan, Mr. Romney’s vice-presidential running mate, would add thousands of dollars to older Americans’ out-of-pocket expenditures. Yet it ignored Mr. Ryan’s recent efforts to soften the plan.
Both campaigns claim they are out to protect future health care. Yet the sniping hides the real issue. Protecting federal health programs over the long term, as the population ages and medical costs keep rising faster than economic growth, will require curbing the programs’ spending. And we haven’t quite figured out how to do that.
The federal government’s spending on health care consumes 4.8 percent of the nation’s economic production and is expected to eat up 9.2 percent in 25 years, according to
estimates from the Congressional Budget Office. A vast majority of
economists agree that restoring a sustainable budget will mean either cuts in Medicare and
Medicaid or a tax increase on the middle class.
Decisions will have to be made about what services are not worth the cost. Yet so far, our political leaders have failed to acknowledge this to voters, offering instead an illusion that we can resolve the matter without any pain.
State investigating medical consolidations
The California attorney general's office is seeking information about concentration among medical providers and the effect on healthcare pricing.
By Chad Terhune, Los Angeles Times
September 15, 2012
A wave of consolidation among hospitals and physician groups has drawn scrutiny from the California attorney general's office amid concerns that these alliances could boost medical prices.
Some hospital chains and insurance companies in the state said they have received civil subpoenas from the attorney general's office seeking information about market concentration among medical providers and the effect on healthcare pricing.
Sharp HealthCare, which runs seven hospitals and two affiliated medical groups in the San Diego area, said it was contacted by investigators, as were some insurers such as Health Net Inc. of Woodland Hills.
"We know that a number of other health systems and hospitals in California also received subpoenas in connection with the attorney general's inquiry," Sharp said in a statement.
A spokeswoman for California Atty. Gen. Kamala Harris declined to comment. The Wall Street Journal first reported on the inquiry Friday.
http://www.latimes.com/business/la-fi-0915-hospital-doctors-review-20120915,0,4769349,print.story
How Paul Ryan enslaves Friedrich Hayek’s ‘The Road to Serfdom’
The Republican VP nominee claims Hayek as hero. Did he miss the libertarian economist’s advocacy of universal health care?
By Bernard HarcourtThe Guardian (U.K.), Sept. 12, 2012
“Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance – where, in short, we deal with genuinely insurable risks – the case for the state’s helping to organize a comprehensive system of social insurance is very strong.”
Surprisingly, those are the words of Friedrich Hayek, straight out of “The Road to Serfdom.” And I’m not pulling them out of context: Hayek firmly believed that the government should organize comprehensive systems of social insurance, including health care; should protect citizens against poverty and should ensure, for everyone, “the certainty of a given minimum of sustenance for all.”
With vice-presidential candidate Paul Ryan claiming that his ideas are inspired by Hayek and even handing out copies of “The Road to Serfdom” “to bring new staffers up to speed” – following the earlier highjacking of Hayek by Glenn Beck and Rush Limbaugh – it’s time for some intellectual honesty.
Others have usefully begun to discuss the tension between Paul Ryan’s politics and Hayek’s thought, as well as the internal tensions between Hayek and Ryan’s other guru, Ayn Rand. But here, for a moment, let’s go back to the primary text, open our University of Chicago Press definitive edition of “The Road to Serfdom” and honestly read it in relation to the American health care debate.
By way of background, Hayek was adamant that the central economic function of government is to organize and administer markets in such a way as to promote and protect competition. His central focus was on the neutrality of government rules – or what he called (on page 117), “the Rule of Law, in the sense of the rule of formal law, the absence of legal privileges of particular people designated by authority” – not the elimination of government rules.
http://www.pnhp.org/print/news/2012/september/how-paul-ryan-enslaves-friedrich-hayek’s-‘the-road-to-serfdom’
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