Pages

Wednesday, February 5, 2014

Health Care Reform Articles - February 5, 2014

REPUBLICANS SAY HEALTH CARE IS A WINNING ISSUE IN 2014

Republicans nationwide are hoping to capitalize on states’ struggles to implement the Affordable Care Act as a political tool to leverage their candidates in the midterm elections, and Vermont is not immune.
Senate Minority Leader Joe Benning, R-Caledonia, is hopeful the rocky rollout of Vermont Health Connect will make voters question Democrats’ ability to overhaul the health care system, he said.
Vermont State Republican Committee Chair David Sunderland, as well, questioned Democrats’ competence.
“If Vermonters experience this kind of trouble with a website, how much confidence should they have that the state can administer the entire health care system?” he said.
The national Republican Party is planning to target Democratic governors and state legislators in states that set up their own exchanges where rollouts were similarly rough, the New York Times reported.
Although the Times story did not mention Vermont among them, Rafi Williams, a spokesman for the Republican National Committee, said in an email that the state is on its radar.
The RNC made a public records request last month for information about compensation and vacation time for Mark Larson, commissioner of the Department of Vermont Health Access.
It made similar requests in at least five other states that created their own exchanges and that have Democratic governors whose terms are up this year.
“Like almost every other state, Vermont has had a terrible experience with the rollout of Obamacare and we think it will benefit Republicans up and down the ballot,” he said.
The Rothenberg Report, a nonpartisan political ranking service, rates Shumlin’s seat as currently safe for Democrats, and thus far no candidate has emerged to challenge him.
There are a “tremendous amount” of winnable seats for Republicans in the state Legislature, said Jay Shepard, one of Vermont’s representatives to the RNC.
He disagrees with Rothenberg’s assessment of Vermont’s gubernatorial race, saying that Shumlin is vulnerable against the right candidate.

Invitation to a Dialogue: Health Care for Profit


o the Editor:
Recent accusations against the for-profit hospital chain Health Management Associates (“Hospital Chain Said to Scheme to Inflate Bills,” front page, Jan. 24), including that it put pressure on doctors to admit patients to increase profits, demonstrate the destructive power of the corporatization of medicine on the practice of medicine. The ethical base is lost when businesspeople take over and destroy the traditions of medical practice. Hospital Corporation of America, the nation’s largest for-profit hospital chain, is under investigation for similar practices.
Leaders of corporate America care little about the credo that established medicine as a noble profession, operated not for profitability but for the good of the patients. Sadly, doctors within the corporate system who have opposed fraudulent and illegal practices designed to maximize profitability are punished and terminated. Meanwhile, the white-collar criminal behavior of corporate executives is not adequately punished.
Such practices have a corrosive effect on independent doctors as well. This leads many to game the system and find loopholes to maximize profits. Costs soar. Hospitals and medical schools are often complicit.
Many decent doctors deplore the changes in health care delivery systems that foster such abuses. But I find it hard to be heard when I speak of accountability. I call on our current and next generation of medical school graduates to have the vision and courage to take back the leadership of medicine and restore its right to be considered a noble profession.
HOWARD A. CORWIN
Naples, Fla., Feb. 3, 2014
The writer was a clinical professor of psychiatry at Tufts University School of Medicine.
Editors’ Note: We invite readers to respond briefly by Thursday for the Sunday Dialogue. We plan to publish responses and a rejoinder in the Sunday Review. Email: letters@nytimes.com
http://www.nytimes.com/2014/02/05/opinion/invitation-to-a-dialogue-health-care-for-profit.html?emc=edit_tnt_20140204&tntemail0=y

The Republican Alternative to Obamacare––Their Aversion to Fixing It May Prove to Be a Political Mistake

The Republicans have an alternative to Obamacare and they may have given the Democrats a big political gift.

The proposal was unveiled last Monday by Republican Senators Richard Burr, (NC), Tom Coburn (OK), and Orrin Hatch (UT).

The Republican plan targets many of the most unpopular parts of the Affordable Care Act such as expensive mandated benefits and the resulting lack of choice, the individual mandate, the employer mandate, and age-rating disruptions.

My sense is that most independent voters––the ones that matter in an election-year––don't want Obamacare repealed; they want it fixed.

The problem for Republicans is that they have such a visceral response to the term "Obamacare" that they just can't bring themselves to fix it. The notion that Obamacare might be fixed and allowed to continue as part of an Obama legacy and as a Democratic accomplishment is something they can't get past.

So, the only way Republicans can propose an alternative to Obamacare is to first wipe the health insurance reform slate clean and start over.

There is a problem with that strategy. Have you heard the one about, "If you like your health insurance you can keep it?"

It is now 2014. The Affordable Care Act is law. The Republican alternative would mean taking lots of things away the Democrats will quickly pounce on:
http://healthpolicyandmarket.blogspot.com



Health Care Law May Result in 2 Million Fewer Full-Time Workers

By  and 

WASHINGTON — A Congressional Budget Office analysis released Tuesday predicted that the Affordable Care Act would shrink the work force by the equivalent of more than two million full-time positions and recharged the political debate over the health care law, providing Republican opponents fresh lines of attack and putting Democrats on the defensive.
The nonpartisan budget office’s analysis, part of a regular update to its budget projections, was far more complicated than the Republican attack lines it generated. Congressional Republican leaders called the findings “devastating,” “terrible” and proof that the health care law was a job killer.
The report did say that the law would reduce hours worked and full-time employment, but not because of a crippling impact on private-sector job creation. With the expansion of insurance coverage, the budget office predicted, more people will choose not to work, and others will choose to work fewer hours than they might have otherwise to obtain employer-provided insurance. The cumulative reduction of hours is large: the equivalent of 2.5 million fewer full-time positions by 2024, the budget office said.
The report “rightfully says that people shouldn’t have job lock,” said Senator Harry Reid of Nevada, the Democratic leader. “We live in a country where we should be free agents. People can do what they want.”
“Republicans talk about losing millions of jobs. That simply isn’t true,” Mr. Reid said.
But Republicans, even those versed in the nuances of the budget reports, did not hold back. Senator Roy Blunt of Missouri, a member of the Republican leadership, acknowledged the administration’s position — that the coming decline in the work force could be the result of workers’ choosing different career paths. But, he noted, the budget office had previously projected a far smaller impact.
“No matter how you calculate this number or how the administration tries to explain it away, it’s about two and a half times as high as the number was when they looked at it the first time,” Mr. Blunt said. “They can say anything they want, but this number is a lot worse than anybody thought.”
Republicans seized on the report as evidence of the health care law’s adverse effect on the economy.
http://www.nytimes.com/2014/02/05/us/politics/budget-office-revises-estimates-of-health-care-enrollment.html?hp

Freeing Workers From the Insurance Trap

By 
The Congressional Budget Office estimated on Tuesday that the Affordable Care Act will reduce the number of full-time workers by 2.5 million over the next decade. That is mostly a good thing, a liberating result of the law. Of course, Republicans immediately tried to brand the findings as “devastating” and stark evidence of President Obama’s health care reform as a failure and a job killer. It is no such thing.
The report estimated that — thanks to an increase in insurance coverage under the act and the availability of subsidies to help pay the premiums — many workers who felt obliged to stay in a job that provided health benefits would now be able to leave those jobs or choose to work fewer hours than they otherwise would have. In other words, the report is about the choices workers can make when they are no longer tethered to an employer because of health benefits. The cumulative effect on the labor supply is the equivalent of 2.5 million fewer full-time workers by 2024.
Some workers may have had a pre-existing condition and will now be able to leave work because insurers must accept all applicants without regard to health status and charge premiums unrelated to health status. Some may have felt they needed to keep working to pay for health insurance, but now new government subsidies will help pay premiums, making it more possible for them to leave their jobs.
The report clearly stated that health reform would not produce an increase in unemployment (workers unable to find jobs) or underemployment (part-time workers who would prefer to work more hours per week). It also found “no compelling evidence” that, as of now, part-time employment has increased as a result of the reform law, a frequent claim of critics. Whether that will hold up after a mandate that requires employers to provide coverage, which was delayed until 2015, kicks in is uncertain.
http://www.nytimes.com/2014/02/05/opinion/freeing-workers-from-the-insurance-trap.html?hp&rref=opinion

Obamacare and the Decline of Work

 by Ross Douthat

New York Times

The headlines for the new Congressional Budget Office report on the health care law emphasize the botched roll-out’s potential impact on enrollment, but this strikes me as quite possibly the bigger deal:
The Affordable Care Act will also reduce the number of fulltime workers by more than 2 million in coming years, congressional budget analysts said in the most detailed analysis of the law’s impact on jobs.
The CBO said the law’s impact on jobs would be mostly felt starting after 2016. The agency previously estimated that the economy would have 800,000 fewer jobs as a result of the law.
The impact is likely to be most felt, the CBO said, among low-wage workers. The agency said that most of the effect would come from Americans deciding not to seek work as a result of the ACA’s impact on the economy. Some workers may forgo employment, while others may reduce hours, for a equivalent of at least 2 million full time workers dropping out of the labor force.
It’s crucial to understand what’s being projected here: It’s not that the law’s regulations will be killing jobs wholesale, as some conservatives have predicted, but rather that its benefits (and phase-outs) will induce workers to reduce their hours and/or cease working entirely. Hence the term “dropping out”: The C.B.O. doesn’t expect large-scale layoffs due to the law’s regulatory burden, but it does expect fewer people to hold and seek work, “given the new taxes and other incentives they will face and the financial benefits some will receive.”
I’ve written about this issue in the past, making the point thatsome version of the workforce-participation phenomenon is inevitable in a health care reform that tinkers — as any serious health care reform must — with the employer-provided model for insurance. When you link insurance directly to employment, as the American system has done these sixty years, you will get some people working primarily or exclusively because it’s the fastest path to having health coverage. If you weaken or sever that link, in the interests of equity, efficiency or both, you will give those same people a reason to work less, or work not at all. Whether this is problematic at all depends on how much you worry about declining workforce participation. But even for those of us who worry about it a great deal, the problems with the employer-provided health insurance model are significant enough to make some downsides worth accepting on the road to a different, be

New Medicaid Enrollees In Oregon Report Health Care Successes And Challenges

  1. Katherine Baicker3

    Abstract

    Medicaid expansions will soon cover millions of new enrollees, but insurance alone may not ensure that they receive high-quality care. This study examines health care interactions and the health perceptions of an Oregon cohort three years after they gained Medicaid coverage. During in-depth qualitative interviews, 120 enrollees reported a wide range of interactions with the health care system. Forty percent of the new enrollees sought care infrequently because they were confused about coverage, faced access barriers, had bad interactions with providers, or felt that care was unnecessary. For the 60 percent who had multiple health care interactions, continuity and ease of the provider-patient relationship were critical to improved health. Some newly insured Medicaid enrollees recounted rapid improvements in health. However, most reported that gains came after months or years of working closely and systematically with a provider. Our findings suggest that improving communication with beneficiaries and increasing the availability of coordinated care across settings could reduce the barriers that new enrollees are likely to face.



It is commonly said that the US spends more than twice as much on health care as other developed countries, yet its outcomes are worse. The inference is that too much care is provided, to no good end.
Such international comparisons are drawn from the Organization of Economic Cooperation and Development (OECD), a group of 34 developed countries. Analyzing these data is a multi-step process, like peeling an onion, and the truth resides deep within its core.
The process starts by adjusting health care spending for “purchasing power parity” (PPP) and expressing it in US dollars. By that measure, per capita spending in the US is 160 percent more than the OECD mean (Panel A, left bracket), and this is the basis for the notion that the US spends more than twice as much. But it is only the first layer.


http://healthaffairs.org/blog/2013/10/09/inequality-is-at-the-core-of-high-health-care-spending-a-view-from-the-oecd/


N.I.H. Joins Drug Makers and Nonprofits on Stubborn Diseases

By 
The National Institutes of Health, 10 large drug companies and seven nonprofit organizations announced on Tuesday an unconventional partnership designed to speed up development of drugs to treat Alzheimer’s disease, Type 2 diabetes, rheumatoid arthritis and lupus.
During the course of a five-year, $230 million effort, the participants will share data in regular conference calls and meetings, working together to determine which findings are likely to lead to effective treatments. They will make their findings and data publicly available.
The project is unique, said Dr. Francis S. Collins, director of the National Institutes of Health.
“We are getting together in a way that has not happened before,” Dr. Collins said in an interview. “We are bringing scientists from different perspectives into the same room. They will leave their egos at the door, leave their affiliations at the door.”
Such a collaboration would not have been possible five years ago, said Dr. Mikael Dolsten, president of worldwide research and development at Pfizer, which is participating in the effort. “It was a different time,” Dr. Dolsten said. “Companies had the view that going alone would be sufficient.”
http://www.nytimes.com/2014/02/05/health/nih-joins-drug-makers-and-nonprofits-on-stubborn-diseases.html?hp

WellPoint, a Onetime Critic of Health Law, May Yet Profit

By 

INDIANAPOLIS — In the midst of the sweeping transformation taking place in health insurance, the company that served as an illustration of why an overhaul was necessary could end up benefiting most from the new federal health care law.
Just a few years ago, the health insurer WellPoint outraged its customers — and regulators — by proposing an increase of nearly 40 percent in some of its annual premiums.
Now, WellPoint has captured a large portion of the government money being spent on Medicaid, the federal-state health care program for the poor, and can gamble on the new insurance marketplace because of protections offered by the federal government in the early days of the law’s introduction.
How WellPoint fares in the longer term is hard to predict and its recent earnings report was mixed, with quarterly profits lower.
But the story of how the company went from health care opponent to beneficiary provides a look at how the industry is changing — and potentially thriving — under the new Affordable Care Act.
http://www.nytimes.com/2014/02/05/business/wellpoint-a-onetime-critic-of-health-law-may-yet-profit.html?hpw&rref=business

CVS Plans to End Sales of Tobacco Products by Oct. 1

By 
CVS/Caremark, the country’s largest drugstore chain, announced on Wednesday that it planned to stop selling cigarettes and other tobacco products by October.
The company’s move was yet another sign of its metamorphosis into becoming more of a health care provider than a largely retail business, with its stores offering more miniclinics and health advice to aid customers visiting its pharmacies.
While the company’s decision will cost it an estimated $2 billion in sales from tobacco buyers, that is a mere dent in its overall sales of $123 billion in 2012.
“We have about 26,000 pharmacists and nurse practitioners helping patients manage chronic problems like high cholesterol, high blood pressure and heart disease, all of which are linked to smoking,” said Larry J. Merlo, chief executive of CVS. “We came to the decision that cigarettes and providing health care just don’t go together in the same setting.”
CVS does not sell electronic cigarettes, the highly popular but debated devices that deliver nicotine without tobacco and emit a rapidly vanishing vapor instead of smoke. It said it was waiting for guidance on the devices from the Food and Drug Administration, which has expressed interest in regulating e-cigarettes.
Some major retail stores like Walmart and convenience stores still sell cigarettes and other tobacco products, although antismoking groups and health care professionals will probably use CVS’s decision to try to pressure others to consider doing so. Municipalities have also begun enacting legislation governing where cigarettes can be sold.

Obamacare’s scorekeepers deliver a game-changer

By , Published: February 4

For years, the White House has trotted out the nonpartisan Congressional Budget Office to show that Obamacare would cut health-care costs and reduce deficits:
Live by the sword, die by the sword, the Bible tells us. In Washington, it’s slightly different: Live by the CBO, die by the CBO.
The congressional number-crunchers, perhaps the capital’s closest thing to a neutral referee, came out with a new report Tuesday, and it wasn’t pretty for Obamacare. The CBO predicted the law would have a “substantially larger” impact on the labor market than it had previously expected: The law would reduce the workforce in 2021 by the equivalent of 2.3 million full-time workers, well more than the 800,000 originally anticipated. This will inevitably be a drag on economic growth, as more people decide government handouts are more attractive than working more and paying higher taxes.
This is grim news for the White House and for Democrats on the ballot in November. This independent arbiter, long embraced by the White House, has validated a core complaint of the Affordable Care Act’s (ACA) critics: that it will discourage work and become an ungainly entitlement. Disputing Republicans’ charges is much easier than refuting the federal government’s official scorekeepers.
White House officials rushed to dispute the referee’s call — arguing, somewhat contradictorily, that the finding was both flawed and really good news if interpreted properly.
Press secretary Jay Carney quickly issued a statement saying that the CBO report was, by its own admission, “incomplete” and “does not take into account” some favorable effects of the law.
Carney postponed his daily press briefing, then arrived with Jason Furman, head of the Council of Economic Advisers, who argued that the Affordable Care Act couldn’t possibly be a job killer because 8.1 million jobs had been created since it became law. This is true — but irrelevant to the CBO finding.
Meanwhile, Gene Sperling, Obama’s top economic-policy adviser, walked to the White House lawn and told CNN’s Wolf Blitzer that he rejected the finding. “When you have two parents and they’re both working full time to provide health care and they don’t feel they’re there to do homework with their kids and this allows one of [them] to work a little less because they have health care, that’s not costing jobs,”Sperling argued.


Obamacare enrollees hit snags at doctor's offices

Many consumers faced hurdles signing up for Covered California health plans. Now they're having trouble finding in-network doctors.

By Chad Terhune
6:41 PM PST, February 4, 2014
advertisement

After overcoming website glitches and long waits to get Obamacare, some patients are now running into frustrating new roadblocks at the doctor's office.
A month into the most sweeping changes to healthcare in half a century, people are having trouble finding doctors at all, getting faulty information on which ones are covered and receiving little help from insurers swamped by new business.
Experts have warned for months that the logjam was inevitable. But the extent of the problems is taking by surprise many patients — and even doctors — as frustrations mount.
Aliso Viejo resident Danielle Nelson said Anthem Blue Cross promised half a dozen times that her oncologists would be covered under her new policy. She was diagnosed last year with non-Hodgkin's lymphoma and discovered a suspicious lump near her jaw in early January.
But when she went to her oncologist's office, she promptly encountered a bright orange sign saying that Covered California plans are not accepted.
PHOTOS: The battle over Obamacare
"I'm a complete fan of the Affordable Care Act, but now I can't sleep at night," Nelson said. "I can't imagine this is how President Obama wanted it to happen."
To hold down premiums under the healthcare law, major insurers have sharply cut the number of doctors and hospitals available to patients in the state's new health insurance market.
Now those limited options are becoming clearer, and California officials say they are receiving more consumer complaints about access to medical providers. State lawmakers are also moving swiftly to ease some of the problems that have arisen.
"It's a little early for anyone to know how widespread and deep this problem is," said California Insurance Commissioner Dave Jones. "There are a lot of economic incentives for health insurers to narrow their networks, but if they go too far, people won't have access to care. Network adequacy will be a big issue in 2014."
The latest travails come at a crucial time during the rollout of Obama's signature law. Government exchanges and other supporters of the healthcare law are trying to boost enrollment, particularly among young and healthy people, ahead of a March 31 deadline.
Of course, complaints about outdated provider lists and delays in getting a doctor's appointment were common long before the healthcare law was enacted. But some experts worry the influx of newly insured patients and the cost-cutting strategies of health plans may further strain the system.
Maria Berumen, a tax preparer in Downey, was uninsured for years because of preexisting conditions. The 53-year-old was thrilled to find coverage for herself and her husband for $148 a month after qualifying for a big government subsidy.
http://www.latimes.com/business/la-fi-obamacare-patients-20140205,0,765921,print.story

The Obamacare bailout battle
By: David Nather
February 5, 2014 05:00 AM EST
The latest Republican attack on Obamacare is powerful and simple: “no insurer bailouts.”
But never fear, Democrats are ready with a response: “Well, that’s not really what it is. The provision in question is actually called ‘risk corridors,’ which is a mechanism for compensating health insurers in case their actual costs are at least 3 percent higher than their projected costs. But it’s only temporary, until they get better data on who their customers are. And if their costs are lower than they expected, they actually pay the government. And besides … ”
You see the problem.
The last thing Democrats want to do, with a law as complicated and full of moving parts as the Affordable Care Act, is explain what the law actually does.
And yet, they’re going to have to come up with something to answer the Republicans’ latest line of attack. The program that’s causing all the trouble is supposed to help insurers get through the first few years of Obamacare if their costs are higher than they thought. And it’s not an emergency measure — it was built into the law all along.
But the “insurer bailout” charge is already lighting fires on conservative talk radio, and if House Republicans move ahead with plans to attach a repeal of the provision to the nextdebt ceiling increase, the charge could draw attention way beyond the conservative base — even if the repeal ultimately gets stripped out.
The debate is also about to get another showcase on Wednesday, when Florida Sen. Marco Rubio — one of the main Republicans making the charge — is the star witness at House Oversight and Government Reform Committee Chairman Darrell Issa’s hearing, “Obamacare: Why the Need for an Insurance Company Bailout?”
It’s a strategic problem that’s going to plague Democrats every time a fight flares up over a complicated part of the law. The website was actually a simple problem, as embarrassing as it was for the Obama administration: broken website, fix it. But when the fight moves on to the most complicated mechanisms in the law, the Democrats know they’ll lose the argument if they get drawn into the weeds.
It’s the perfect illustration of the problem Democratic Sen. Al Franken of Minnesotacaptured when Congress was debating the law in 2010: “Our bumper sticker has — it’s just way too many words. And it says, ‘Continued on next bumper sticker.’”
Or, as Democratic strategist Chris Kofinis puts it now: “If you get into the weeds of things, you’re dead.”
The Democrats actually got some good news on Tuesday that could help: The Congressional Budget Office said the provision will save the government $8 billion, not cost money. That’s because the money can flow both ways. If insurers priced their premiums too high, and their costs are lower than they thought, they pay the government.
But rather than get into a big explanation of all of that, Democrats are more likely to hit the Republicans back with a couple of catchier political points: If you take this out, premiums will rise and it will be your fault.
And by the way, you put the same thing in Medicare Part D, and you didn’t complain about it then.
http://dyn.politico.com/printstory.cfm?uuid=5290B3C5-4EAF-451A-B2E0-D4A1A19CBB2E

Experts: Moving New Medicaid Patients Out Of ER Will Take Time

TOPICS: DELIVERY OF CARE, MEDICAID, HEALTH REFORM
By KAREN SPRINGEN, THE CHICAGO TRIBUNE
FEB 04, 2014
This story was produced in partnership with the 
Lela Morgan, a nurse, says she lived for years without health insurance after a nervous breakdown in 2005 left her unable to work.
Every 90 days, when she was running low on medications for osteoarthritis and hypertension, she commuted about 45 minutes from her Englewood home to the emergency room at Stroger Hospital. Often, she said, she waited three or four hours. "It depended who was ahead of you," she said.
But last spring, Morgan's pastor asked her to help distribute fliers about CountyCare, an early rollout of the expanded Medicaid program made possible by the Affordable Care Act. The 55-year-old took a copy of the literature for herself, filled out the paperwork and got her CountyCare card in the mail.
Now she has a personal physician who, at a clinic 15 minutes from her home, talks with her and renews her prescriptions every 90 days. "You get to know your doctor, and your doctor gets to know you," said Morgan, whose beaming face appears on CountyCare posters. "Now I don't worry."
In expanding Medicaid coverage, the architects of the national health care overhaul hoped to change the way low-income people obtain health care, moving — as Morgan did — away from emergency rooms and into the offices of doctors, where more consistent supervision may improve their health.
But some health care experts say that in many cases it will take time and considerable coaching to change their behavior. People tend to use health care more after they obtain coverage, and those unfamiliar with a traditional doctor-patient relationship may stick with what's familiar.
Researchers reported last month in the journal Science that low-income Oregon adults who obtained Medicaid coverage through a lottery system were more likely to use the emergency room than those who remained uninsured.
"Having insurance coverage gets you only halfway there," said Dr. Elbert Huang, associate professor of medicine at the University of Chicago and a former senior adviser for planning and evaluation in the U.S. Department of Health and Human Services. "There's this huge deficit of knowledge about how to use the health care system that still needs to be overcome before people can benefit from having health insurance. It's like you've given people a license to drive, but they don't have a map."

Patient Coordination Would Get Boost If Medicare Changes How It Pays Docs

TOPICS: DELIVERY OF CARE, MEDICARE, QUALITY
By Tara Kulash, St. Louis Post-Dispatch
FEB 04, 2014
This story was produced in partnership with the 
Expectations are high this year that Congress will finally reach an agreement to overhaul the way Medicare pays doctors for services, scrapping a method that’s been the target of criticism for more than a decade.
If that happens, experts say, Medicare beneficiaries will see changes in how health care is provided, with an increased emphasis on coordinated care and preventive services.
“We’re optimistic that there are a lot of opportunities in this to help make people healthier, more satisfied with their care and bring down costs,” said Dr. Joseph Craft III, a cardiologist at Mercy Clinic Heart and Vascular and president of the St. Louis Metropolitan Medical Society.
The current Medicare payment formula, enacted in 1997 as part of a budget deficit reduction measure, was designed to curb federal health spending by linking physician payments to an economic growth target.
Known as the sustainable growth rate, or SGR, the formula initially meant modest Medicare payment increases to doctors. That abruptly changed in 2002, when Medicare cut reimbursements by nearly 5 percent. Doctors protested, and Congress responded by delaying the cuts, over and over, ever since. The postponements, however, have just increased the size, and price, of the needed fix.
Under the current system, the majority of Medicare beneficiaries receive fee-for-service care. This means physicians are reimbursed a set amount for each service they provide. This method, critics say, provides financial incentives for doctors to offer more services than necessary.
The fixes working their way through three key congressional committees, while they differ, are designed to provide doctors with incentives to model their services based on value instead of volume, said Dr. Stanley Birge, an associate professor of medicine at Washington University in St. Louis.
“By value we mean the quality of the service, plus the cost efficiency of providing that service,” he said. “That represents, of course, a huge change.”
Instead of each doctor billing for each service, health care providers would be encouraged to form medical groups that coordinate their services and offer bundled bills. For example, it’s cheaper to pay a single fee to a hospital for surgery than to pay the surgeon, anesthesiologist and overhead costs separately.
The advantage to this approach is that physicians will be encouraged to communicate better about their shared patients’ care, which will likely decrease duplicated services and misdiagnoses.


Posted by at

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)