High-End Health Plans Scale Back to Avoid ‘Cadillac Tax’
By REED ABELSON
Say goodbye to that $500 deductible insurance plan and the $20 co-payment for a doctor’s office visit. They are likely to become luxuries of the past.
Get ready to enroll in a program to manage your diabetes. Or prepare for a health screening to determine your odds of developing a costly health condition.
Expect to have your blood pressure checked or a prescription filled at a clinic at your office, rather than by your private doctor.
Then blame — or credit — the so-called Cadillac tax, which penalizes companies that offer high-end health care plans to their employees.
While most of the attention on the Obama administration’s health care law has been on providing coverage to tens of millions of uninsured Americans by 2014, workers with employer-paid health insurance are also beginning to feel the effects. Companies hoping to avoid the tax are beginning to scale back the more generous health benefits they have traditionally offered and to look harder for ways to bring down the overall cost of care.
In a way, the changes are right in line with the administration’s plan: To encourage employers to move away from plans that insulate workers from the cost of care and often lead to excessive procedures and tests, and galvanize employers to try to control ever-increasing medical costs. But the tax remains one of the law’s most controversial provisions.
Bradley Herring, a health economist at Johns Hopkins Bloomberg School of Public Health, suggested the result would be more widely felt than many people realize. “The reality is it is going to hit more and more people over time, at least as currently written in law, ” he said. Mr. Herring estimated that as many as 75 percent of plans could be affected by the tax over the next decade — unless employers manage to significantly rein in their costs.
The changes can be significant for employees. The hospital where Abbey Bruce, a nursing assistant in Olympia, Wash., worked, for example, stopped offering the traditional plan that she and her husband, Casey, who has cystic fibrosis, had chosen.
As Maine hospitals grow, prices and access to medical care are put on the line
Posted May 27, 2013, at 6:04 p.m.
Dr. Michael Ciampi took over his father’s practice, located in the home on Stevens Avenue in Portland where he and his five siblings were raised, in 1999. Back then, he was one of many independent doctors in Maine.
That changed a decade ago when Ciampi moved his practice to a facility run by an offshoot of Mercy Health System of Maine, parent to Mercy Hospital. Ciampi’s father recommended the move as a way to relieve Ciampi of the burdens of running a practice, from billing paperwork to nonexistent paid time off.
At the time, moves such as Ciampi’s weren’t as common, and today, 80 percent of all primary care doctors in Maine are affiliated with hospitals or federally supported community health centers, according to the Maine Medical Association.
In some rural areas, no independent physicians remain.
Beginning in the late 1990s, health care mergers swept across Maine and the rest of the country, cementing hospitals’ market power and, many would argue, freedom to charge higher prices. In the beginning, mergers were driven by the rise of health maintenance organizations, also known as HMOs. More recently, the recession has sparked merger talks.
More than a dozen health care mergers have been proposed or completed in Maine over the last decade — a planned deal between Mercy, Ciampi’s former employer, and Eastern Maine Healthcare Systems of Brewer as the most recent.
Today, 18 of Maine’s 38 acute-care and psychiatric hospitals are members or affiliates of the state’s two largest hospital systems, EMHS and Portland’s MaineHealth.
The growing clout of hospital systems, both in Maine and nationwide, has wide-ranging implications for the cost and quality of medical treatment. Some say it has diminished insurers’ bargaining power, leading to higher prices.
Others contend that big, sophisticated systems are best positioned to halt the rise of health care costs by transforming how care is paid for and delivered.
Increasingly, decisions about the hospitals that anchor many Maine communities are made in the boardrooms of big health systems, from whether a hospital continues to deliver babies, perform certain surgeries, or in the case of Boothbay Harbor, keep its emergency room open.
South Portland doctor stops accepting insurance, posts prices online
Posted May 27, 2013, at 4:07 p.m.
SOUTH PORTLAND, Maine — Dr. Michael Ciampi took a step this spring that many of his fellow physicians would describe as radical.
The family physician stopped accepting all forms of health insurance. In early 2013, Ciampi sent a letter to his patients informing them that he would no longer accept any kind of health coverage, both private and government-sponsored. Given that he was now asking patients to pay for his services out of pocket, he posted his prices on the practice’s website.
The change took effect April 1.
“It’s been almost unanimous that patients have expressed understanding at why I’m doing what I’m doing, although I’ve had many people leave the practice because they want to be covered by insurance, which is understandable,” Ciampi said.
Before the switch, Ciampi had about 2,000 patients. He lost several hundred, he said. Some patients with health coverage, faced with having to seek reimbursement themselves rather than through his office, bristled at the paperwork burden.
But the decision to do away with insurance allows Ciampi to practice medicine the way he sees fit, he said. Insurance companies no longer dictate how much he charges. He can offer discounts to patients struggling with their medical bills. He can make house calls.
“I’m freed up to do what I think is right for the patients,” Ciampi said. “If I’m providing them a service that they value, they can pay me, and we cut the insurance out as the middleman and cut out a lot of the expense.”
The Republican Party’s big squeeze
Posted May 28, 2013, at 6:02 a.m.
WASHINGTON — Over the last few years, Republicans have been retreating from policy ground they once held and salting the earth after them. This has coincided with, and perhaps even been driven by, the Democratic Party pushing into policy positions they once rejected as overly conservative. The result is that the range of policies you can hold and still be a Republican is much narrower than it was in, say, 2005. That’s left a lot of once-Republican wonks without an obvious political home.
Health care is the most obvious example. The basic architecture of the Affordable Care Act is, as has been pointed out ad nauseam, a Republican idea. It was first proposed in a 1993 plan that had 20 Senate Republicans as co-sponsors. It was passed and implemented by then-Gov. Mitt Romney in Massachusetts. It was supported by Newt Gingrich. Through much of this time, Democrats viewed it with skepticism: They wanted something closer to single payer, and it seemed borderline offensive to insist that Americans buy products from for-profit insurers. But key Democrats dropped those objections in order to actually pass health reform.
Republicans could’ve pocketed the Democratic concession as a win. They could’ve celebrated the triumph of their ideas and the Democratic abandonment of single payer. They could’ve used the Affordable Care Act as a vehicle to push some of their other health policy initiatives, like medical malpractice reform, capping the employer tax exclusion and spreading health savings accounts.
Instead, they abandoned every idea even vaguely related to the Affordable Care Act. In fact, they pretty much abandoned all ideas related to universal coverage, or even big expansions of coverage. They decided some of them were downright unconstitutional. Today, House Majority Leader Eric Cantor , R-Va., can’t even get high-risk pools past his members. The health policy space on the right is radically narrower than it was a decade ago. If you’re a Republican who hasn’t been willing to change your positions on those issues, you’re a heretic today.
Health care isn’t the only example. There was a time when Republicans were leading the way on ideas to fight climate change. The first cap-and-trade bill to reduce carbon emissions was introduced into the Senate by John McCain, R-Ariz. The McCain-Palin ticket included a cap-and-trade plank. Some Republicans, like Tennessee’s Sen. Bob Corker, supported a carbon tax.
There’s no serious support in today’s Republican Party for doing anything about climate change. Even Jon Huntsman, who made headlines during the presidential election for saying he believed in global warming, didn’t want to do anything about it when he was governor of Utah. Today’s Republican Party doesn’t want a cap-and-trade plan or a carbon tax or even money for renewable-energy research. Whereas a decade ago a policy wonk who worried about the future of Earth could comfortably fit in the GOP, today anyone who wants to do anything serious about climate change has been written out of the party.
Health Care Is Spread Thin on Alaskan Frontier
By KIRK JOHNSON
BETHEL, Alaska — Americans in some rural places fret at how far away big-city medical help might be in an emergency, or at the long drives they are forced to make for prenatal care, or stitches, or chemotherapy.
Dr. Ellen Hodges only wishes it could be so easy.
She oversees health care for a population of 28,000, mostly Alaska Natives, here in the state’s far west end, spread out over an area the size of Oregon that has almost no roads. People can travel by boat or snow machine at certain times of the year, but not right now: the Kuskokwim River, which wends through Bethel to the Bering Sea, is choked with unstable melting ice in late May, magnifying the isolation that defines everything in what may be America’s emptiest corner.
“If you have a road, you’re not remote,” Dr. Hodges said.
The complex machinery of health care is being reimagined everywhere in the nation through the combined prism of new regulations and shifting economics, even here on the continent’s frosted fringe.
The grandly named Yukon-Kuskokwim Health Corporation, for example, where Dr. Hodges is chief of staff, is scrambling this spring to install a new electronic medical records system. That is a hallmark of the federal health care overhaul, compounded out here by the fact that computers run by generators in far-flung villages are subject to brownouts and fuel shortages.
Cost controls are also the way of the medical frontier no matter where you look. In other places, such constraints may be driven by insurance companies; here, by sequester-driven budget cuts to the federal Indian Health Service. The agency is the 50-bed hospital’s main support in treating the tribes and villagers who have lived for thousands of years in the boggy crescent of lowlands where the Yukon and Kuskokwim Rivers carve their paths to the sea.
My Near Miss
By DANIELLE OFRI
IT was probably our eighth or ninth admission that day, but my intern and I had given up counting. I was midway through my medical residency, already a master of efficiency. You had to be, or you’d never keep up. This one was a classic eye-roller: a nursing home patient with dementia, sent to the emergency room for an altered mental status. When you were juggling patients with acute heart failure and rampant infections, it was hard to get worked up over a demented nonagenarian who was looking a little more demented.
The trick to surviving was to shuttle patients to another area of the hospital as quickly as possible. This patient was a perfect candidate for the intermediate care unit, a holding station for patients with no active medical issues who were awaiting discharge. First we just had to rule out any treatable medical conditions — get the labs, head CT scan and chest X-ray. But the docs at the intermediate ward left at 5 p.m. and it was 4:45. I quickly scanned through the labs, called the ward’s doctor and ran through the case — demented patient, still demented, return to nursing home tomorrow.
I remember the doctor’s voice so clearly: “You’re sure the labs and everything are normal?” Yes, yes, I said, everything is fine. She hesitated, then said O.K. The intern and I high-fived each other, and bolted back to our other admissions.
The next afternoon the doctor tracked me down. Without mincing words, she told me that she’d been called overnight by the radiologist; the patient’s head CT showed anintracranial bleed. The patient was now with the neurosurgeons, getting the blood drained from inside her skull.
My body turned to stone. An intracranial bleed? You couldn’t do much worse than miss an intracranial bleed.
Obamacare is facing death by a thousand cuts
By Michael E. Capuano
OUTRIGHT REPEAL is one way to sabotage health care reform, but most opponents recognize they don’t have the votes for that, let alone enough to override a certain presidential veto. Of course, this has not prevented House Republicans from voting three dozen times to repeal health care reform. A 37th attempt took place earlier this month. All of this represents nothing more than political grandstanding. Since they haven’t been able to achieve an outright repeal, Republicans are also working to thwart implementation.
Over the last three years, the Obama administration and leaders in many states have been preparing for the full implementation of health care reform. At every step, the Republican majority in the House, their committed counterparts in the Senate, and their allies in many state houses across the country have sought to delay, obstruct, and undermine these efforts. Rather than fix the parts of the law that need to be fixed, they plot new ways to kill it by a thousand cuts.
With Money at Risk, Hospitals Push Staff to Wash Hands
By ANEMONA HARTOCOLLIS
At North Shore University Hospital on Long Island, motion sensors, like those used for burglar alarms, go off every time someone enters an intensive care room. The sensor triggers a video camera, which transmits its images halfway around the world to India, where workers are checking to see if doctors and nurses are performing a critical procedure: washing their hands.
This Big Brother-ish approach is one of a panoply of efforts to promote a basic tenet of infection prevention, hand-washing, or as it is more clinically known in the hospital industry, hand-hygiene. With drug-resistant superbugs on the rise, according to a recent report by the federal Centers for Disease Control and Prevention, and with hospital-acquired infections costing $30 billion and leading to nearly 100,000 patient deaths a year, hospitals are willing to try almost anything to reduce the risk of transmission.
Studies have shown that without encouragement, hospital workers wash their hands as little as 30 percent of the time that they interact with patients. So in addition to the video snooping, hospitals across the country are training hand-washing coaches, handing out rewards like free pizza and coffee coupons, and admonishing with “red cards.” They are using radio-frequency ID chips that note when a doctor has passed by a sink, and undercover monitors, who blend in with the other white coats, to watch whether their colleagues are washing their hands for the requisite 15 seconds, as long as it takes to sing the “Happy Birthday” song.
All this effort is to coax workers into using more soap and water, or alcohol-based sanitizers like Purell.
“This is not a quick fix; this is a war,” said Dr. Bruce Farber, chief of infectious disease at North Shore.
Supply low, price high for popular Lyme disease antibiotic
Posted May 28, 2013, at 10:36 a.m.
LEWISTON, Maine — Maine patients, doctors and pharmacists are dealing with another drug shortage, this one an antibiotic to treat Lyme disease, the MRSA infection, pneumonia and other illnesses.
The shortage has become such a concern nationwide that U.S. Sen Susan Collins, R-Maine, and U.S. Sen. Amy Klobuchar, D-Minn., have asked the Food and Drug Administration to take action.
“According to our state epidemiologist, the number of Maine residents diagnosed with Lyme disease continues to increase each year,” Collins said in a statement released Friday. “The antibiotic Doxycycline is critically important for treating these patients, and it’s imperative that the FDA do all it can to help alleviate this shortage.”
Doxycycline is an antibiotic that can be given orally or intravenously. It is used to treat a host of conditions, including acne, rosacea, chlamydia, some types of pneumonia, the difficult-to-treat infection MRSA and Lyme disease.
The shortage began earlier this year. According to the FDA’s website, four companies deal with the drug. One says manufacturing delays have made its supply largely unavailable. Another says increased demand has limited its supply and it is providing the medication to current contracted customers only.
Officials with the Maine Center for Disease Control and Prevention has been monitoring the situation in Maine for about a month.
“We’ve had availability, but the price is going up and that’s obviously a concern, too,” state epidemiologist Stephen Sears said. “And, sooner or later, if it’s getting to be short nationally, it’s going to get short here, just as other drugs have.”
He said the department has heard Doxycycline’s price is now five to 10 times higher than it used to be, but he said that is hard to gauge because pharmacies all price differently and insurance companies pay differently.
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