Pages

Thursday, May 29, 2014

Health Care Reform Articles - May 29, 2014




MGMA statement on effect of ACA exchange implementation on medical group practices

Please attribute to Susan Turney, MD, MS, FACP, FACMPE, president and CEO of MGMA
“Physician group practices are expressing dissatisfaction with the complexity and lack of information associated with insurance products sold on ACA exchanges. The more administrative complexity introduced into the healthcare system, the less time and resources practices can devote to patient care. Even though there hasn’t been a huge influx of patients into physician offices as many predicted, simple tasks such as obtaining patient insurance coverage information or finding specialists for in-network referrals have proven to be significant challenges.”
MGMA conducted research in April to assess the effect of ACA exchange implementation on medical group practices. The research includes responses from more than 700 medical groups in which more than 40,000 physicians practice nationwide. Access a summary of the research. 
Overview
Medical Group Management Association (MGMA) conducted member research in April 2014 to better understand the impact of the Affordable Care Act’s (ACA) insurance exchange implementation on medical group practices. This research follows up our September 2013 study, which
helped shed light on a number of ACA exchange implementation issues. The survey includes responses from more than 700 medical groups in which more than 40,000 physicians practice nationwide.
Almost 80% of survey respondents reported their practice is participating with new health insurance products sold on the ACA exchanges (ACA exchange products) and more than 90% of these practices have already seen patients with this coverage. Of practices participating with ACA exchange products, 85% are contracting with one to five products and almost 60% reported they are participating in order to remain competitive in their local market.
While more than 8 million consumers have enrolled in health insurance coverage through the ACA exchanges, 56% of respondents reported no change in their practice’s patient population size through April and 24% reported a slight increase. Practices expect a small shift in this trend through the end of the year. Thirty percent of respondents projected no change to their practice population size by the end of 2014 and 44% predicted a slight increase. These figures illustrate that most practices are not being inundated by new ACA exchange patients but do expect to treat somewhat more of these patients as the year progresses.
This research also revealed key issues practices are experiencing with ACA exchange implementation.
Summary of Findings
MGMA noted three main themes within the findings.
Obtaining coverage information
Practices have experienced difficulty identifying patients with ACA exchange coverage and obtaining essential information related to that
coverage.
  • 62% of respondents reported moderate to extreme difficulty with identifying a patient that has ACA exchange coverage as opposed to traditional commercial health insurance.
  • Compared to patients with traditional commercial coverage, nearly 60% of respondents indicated that for patients with ACA exchange coverage it is somewhat or much more difficult to:
    • Verify patient eligibility
    • Obtain cost-sharing or network information
    • Obtain information about the plan’s provider network in order to facilitate referrals
      “We are going to have to hire additional staff just to manage the insurance verification processs.”
      “Identification of ACA plans has been an administrative nightmare.”
      “We thought we would be able to identify ACA insurance exchange products by their insurance card, but quickly found out this isn’t so. “
      Patient cost-sharing
      Practices are facing a number of challenges related to patient cost-sharing for ACA exchange coverage.
  • 75% of respondents reported that patients with ACA exchange coverage are very or extremely likely to have high deductibles compared to patients with traditional commercial coverage.
  • Practices reported significant patient confusion about the substantial cost-sharing related to many ACA exchange products, and practices are working to help patients understand the complexities of their coverage.
  • Practices cited some of the main reasons for not participating with ACA exchange products were related to concerns about financial burdens from patient collections (such as burdens related to collecting high deductibles from patients and concerns about financial liability from the 90-day grace period).
    “Patients have been very confused about benefits and their portion of the cost. Once the patients find out their deductible, they’ve cancelled appointments and procedures.”
    “The at-risk piece of eligibility is tremendously hard to determine and explain to patients.”
    “Patients don’t always understand how health insurance works, so we’ve been engaging in educational events for the community.”

3 MGMA ACA Exchange Implementation Survey Report, ©2014. Medical Group Management Association. All rights reserved.
page3image23568
Network limitations
Practices have concerns about the impact of the network design of many ACA exchange products.
  • Almost half of respondents reported they have been unable to provide covered services to ACA exchange patients because the practice is out of network.
  • 20% of respondents reported that their practice was excluded from a narrow network that they would have liked to participate in and 10% of respondents chose not to participate in a narrow network.
  • Narrow networks may create challenges related to patient referrals for appropriate treatment and hospital care. Even if the practice is included in the network, without robust representation by a wide range of providers, it may be difficult for a practice to coordinate a continuum of care consistent with the patient’s needs.
    “Many patients purchased products with a very narrow network and didn't understand the ramifications. They are very upset once they learn that they can't go to the specialist or hospital of their choice. As primary care providers, we are now faced with the extra burden of trying to find them care within their new narrow network. Payer directories are woefully inaccurate and impossible to rely on.”
    “Former patients were shocked to learn about their very narrow network of providers. It was terrible to have to inform them of their lack of coverage.”
    “We are consistently denied "out of network" approvals for the very sick who truly need to continue their care with providers who have worked with the patient for years.”
    http://www.mgma.com/government-affairs/issues-overview/aca/aca-exchange-implementation-report/aca-surveyreport_online_2?ext=.pdf

  • Do Not Resuscitate: What Young Doctors Would Choose

    By PAULA SPAN
     
    The researcher was presenting her findings to a room full of geriatricians, at the American Geriatrics Society annual scientific meeting last week in Orlando, Fla. So a slide revealing one particular statistic didn’t cause an audible gasp or murmur. Talking to geriatricians about end-of-life treatment practically defines preaching to the choir, as a member of the audience told me later.
    Among other kinds of doctors, or the public, this number might be more surprising. Dr. V.J. Periyakoil, a geriatrics and palliative care specialist at Stanford University, was talking about her survey of nearly 1,100 physicians who were completing clinical training at two university-affiliated medical centers.
    She and her colleagues wanted to learn more about the attitudes of young doctors towards advance directives. So the researchers asked what choices they would make for themselves if they were terminally ill.
    Their reply: 88.3 percent would choose a do-not-resuscitate or “no code” status. An allow-me-to-die status, in other words.


    Californians gripe about Obamacare enrollment snags, lack of doctors

    by  CHAD TERHUNE

    Nearly 1,500 Californians have complained to state regulators in the last four months about their Obamacare coverage purchased through California's insurance exchange.
    New data reveal the biggest category of complaints centers on getting confirmation of health plan enrollment and basic issues such as getting an identification card to obtain care.
    Many consumers have also encountered difficulty finding a doctor who accepts their new coverage, as well as frustration with inaccurate provider lists, according to the California Department of Managed Health Care.
    "If you have a medical condition and can't get care that is a very serious issue," said Marta Green, spokeswoman for the managed healthcare agency. "We are still working to resolve many of these cases."
    Health insurers and officials at the Covered California exchange say they are working hard too to address consumers' gripes. They say some problems are inevitable from such a massive overhaul and that the number of complaints is a small fraction of the more than 1 million Californians who signed up under the Affordable Care Act.

    Insurance plan for farmworkers falls short of Obamacare rules


    o landmark liberal healthcare achievements are on a collision course in California, and the result could be higher costs for taxpayers.
    Years ago, legendary activist Cesar Chavez helped create the first health insurance plan for farmworkers who toiled for meager wages in California's fields. The plan, funded by the workers and their employers, is named after Democratic icon Robert F. Kennedy, who allied himself with Chavez.
    But like many other insurance plans around the country, it doesn't fully meet requirements set by President Obama's healthcare law. Unless supplemental insurance is purchased, the farmworkers say, 10,700 people could lose coverage.
    Some Democrats want taxpayers to pick up the $3.2 million tab for the extra insurance so the healthcare plan can keep operating.
    But the proposed subsidy has sparked concern about Democrats trying to prop up one union's healthcare coverage when other insurance plans have also struggled to meet new federal requirements.
    "There is a question of fairness here," said Timothy Jost, a health policy expert and professor at Washington and Lee University School of Law in Lexington, Va.
    The proposal is being pushed by United Farm Workers, once led by Chavez. A legislative panel last week recommended including the money in the state budget, which is being negotiated by lawmakers and Gov. Jerry Brown ahead of a June 15 deadline.

    LePage may seek refund from Alexander Group after plagiarism reports

    The governor has come under fire for handpicking the controversial consultant to do a $925,000 welfare analysis.

    By Eric Russellerussell@pressherald.com
    Staff Writer
    Gov. Paul LePage said Tuesday that he is considering asking for a refund from a consultant he commissioned to analyze and report on Maine’s welfare programs, in response to reports that The Alexander Group plagiarized other sources.
    I will take every action we can,” LePage said in a statement released by his press secretary, Adrienne Bennett. “I am not happy about this.”
    The governor said last week that he will withhold part or all of the more than $400,000 the state still owes to the Rhode Island-based Alexander Group. On Tuesday, he said he may “go back after what we paid,” referring to the $500,000 that Gary Alexander has already collected.
    “It’s all a matter of the extent of what the damage is,” he said.
    A decision could come soon, Bennett said.
    The LePage administration has come under fire since last fall for hiring The Alexander Group, led by Alexander, a former human services commissioner in Pennsylvania and Rhode Island, to conduct a $925,000 evaluation of Maine’s welfare system.
    Democrats first criticized the fact that LePage, without seeking bids for the contract, picked a consulting group with a history of promoting welfare policies that directly align with the governor’s conservative beliefs.
    They later criticized the group for missing deadlines spelled out in the contract and for overstating the projected cost of expanding Maine’s Medicaid program, MaineCare, in a report it issued in January.
    Until recently, the governor and Health and Human Services Commissioner Mary Mayhew have stood behind The Alexander Group and its work.
    Last week, The Alexander Group came under fire again, for lifting passages from other published reports while providing limited or no attribution.

    http://www.pressherald.com/politics/LePage_not_ready_to_ask_for_repayment_from_Alexander_Group__but_says_he_s__not_happy__about_alleged_plagiarism_.html

    Maine Democrats urge LePage to recoup funds for flawed welfare study

    But Senate President Justin Alfond and House Speaker Mark Eves also say the no-bid contract may not have protections against poor performance, including plagiarism.

    By Steve Mistler smistler@pressherald.com
    Staff Writer
    AUGUSTA –– Democratic legislative leaders are urging Gov. Paul LePage to cancel the embattled $925,000 contract to review the state’s public welfare system, while also raising concerns that the state may not be able to reclaim its money.
    The request, from Senate President Justin Alfond of Portland and House Speaker Mark Eves of North Berwick, follows statements the governor made Tuesday in which he said he was considering pursuing a refund from The Alexander Group.
    The governor’s comments followed revelations that the recent installment of the study contained several instances of plagiarism and unsourced material.
    Democratic leaders said Wednesday they were pleased with the governor’s comments, but worry that the no-bid contract may not contain any provisions to recover payments because of poor performance by The Alexander Group.
    The firm is headed by Gary Alexander, the former human services chief in Pennsylvania and Rhode Island.
    LePage announced last week that he had suspended more than $400,000 in payments to Alexander following the plagiarism revelations. However, it’s not clear whether the contract signed last year provides a mechanism for the state to reclaim the $500,000 it has already paid The Alexander Group.
    The administration has used approximately $180,000 in federal money designated for cash welfare benefits, known as Temporary Assistance for Needy Families, to pay Alexander. The entire study is funded with state general fund money that includes approximately $250,000 in federal funds.
    The Office of Inspector General in the federal Department of Health and Human Services will review the state’s contract with Alexander to ensure that it complies with standards for the use of federal funds, according to the Sun Journal.



    Time bureau chief not informed on health care

    By Joseph SparksSparks Remarks blog, May 24, 2014
    Which statement is true?
    1. The earth is flat.
    2. The sky is red.
    3. “Health care, especially in this country, is an enormously expensive laborious undertaking, and … no one’s figured out how to do it economically and efficiently.” – Michael Scherer, Washington Bureau Chief, Time Magazine on “Now with Alex Wagner” on May 22, 2014 (at about 5:45 minutes into the video).
    4. None of the above.
    The correct answer is: “None of the above.” The earth is nearly spherical; the sky is blue, and there are at least 19,000 people who know how to make health care efficient and economical in this country. It can be done with a single-payer system, and legislation has been proposed that would implement single-payer, H.R. 676.
    It is downright frightening that a Washington bureau chief would make such an egregious error.
    A single-payer system has several advantages. They include:
    • Covers everybody – Single-payer provides universal coverage. There are no signups because everyone is automatically covered.
    • Eliminates co-pays and deductibles for medical care and pharmaceuticals – Since co-pays and deductibles are not required, out-of-pocket expenses are eliminated making health care affordable for everyone. Imagine going to a doctor or hospital and not needing your wallet. Further, when you are admitted, no clerk needs to check on your insurance status. That becomes a reality with single-payer.
    • Allows you to choose any caregiver or hospital – Single-payer provides more freedom because there are no restrictions imposed by limited insurance networks.
    • Stabilizes costs – Single-payer would lower or maintain costs at current levels making health care affordable now and in the future.
    (A more detailed description of the problems with the current health care system and the benefits of a single-payer system can be found here.)
    So, to say that nobody’s figured out how to do health care economically and efficiently is flat out wrong. When journalists do not discuss single-payer as the solution to the current health care crisis, they perform a disservice to their profession and the public.
    In fact, when discussing any alternative health care system in this country, the questions that need to be asked are:
    • “Would this system cover everybody as a single-payer system would?”
    • “Would this system eliminate out-of-pocket expenses as a single-payer system would?”
    • “Would this system allow patients to choose any caregiver or hospital as a single-payer system would?”
    When (not if) the answers are no, then next question needs to be, “Could you explain how your proposal is better than a single-payer system?”
    If a Washington bureau chief does not know about single-payer, then it is unlikely that the public knows. It is vital that journalists inform other journalists of the single-payer option, and it is the responsibility of all journalists to inform the public because it is the only viable solution for economic and efficient health care.
    (I urge everybody to go here and demand that MSNBC correct their mistake. If enough people protest, networks might start discussing single-payer.)
    Joseph Sparks is a freelance journalist who resides in Washington, D.C. He covers health care, politics, and technology. 


    With Special Clinics, Hospitals Vie for Hesitant Patients: Men

    By 
    From the gleaming limestone lobby to the chocolate and oxblood exam room walls to the percussive address, 555 Madison Avenue, a new clinic in Midtown Manhattan exudes masculinity, and that is no accident.
    Still smelling of fresh paint, it is NYU Langone Medical Center’s health center devoted to men, one of two such centers opened in the last two years by major New York hospitals, within 10 blocks of each other, and using marketing techniques common to lifestyle companies and luxury spas.
    “The glass ceiling has been broken; now there’s a health center just for men,” goes one NYU Langone advertising slogan, with a tongue-in-cheek hint of transgression. Says another: “It’s the gentlemen’s club your wife would approve of.”
    NYU Langone and other medical institutions have long had services devoted to women, an outgrowth of the belief that the male-dominated medical establishment had not paid enough attention to their particular needs.
    Now men are beginning to get equal treatment as hospitals try to take advantage of an enormous untapped market: men who, studies show, avoid doctors for virtually anything short of a bullet wound. The new clinics offer one-stop shopping for services ranging from heart monitoring to hair removal to hormone therapy, from the life-prolonging to the life-enhancing, if medically debatable.
    The Men’s Health Center at the Miriam Hospital in Providence, R.I., affiliated with Brown University, opened in 2008 and was one of the first in the nation. The Curtis D. Robinson Men’s Health Institute was founded in 2010 at St. Francis Care in Hartford. The Iris Cantor Men’s Health Center at NewYork-Presbyterian/Weill Cornell opened in summer 2012, and NYU Langone’s center opened six months ago.
    Dr. Martin Miner, co-director of the Miriam men’s center, had to draw up several business plans before one was approved. The initial reaction, he said, was, “Health is about men, the whole world is about men, so what do we need it for?”
    One focus is prostate health; the Curtis D. Robinson center, named after a black businessman in Hartford who financed much of the center’s start-up costs, is geared toward black men, who have a higher rate of prostate cancer than the general population.

    THE SMART MONEY

    The high cost of prescription drugs
    Gina Hamilton
    The other day, I picked up my prescription and discovered a new feature my pharmacy had recently begun. On my receipt, the pharmacy printed the co-pay price, $10, and the “cash” price, $137.57, so I would know what my pharmacy benefit was.
    When I checked the price of the tablets at a Canadian pharmacy, the “cash” cost in U.S. funds would have been $29.66 for the same medication. It is even cheaper in Mexico, at $17.26 for 120 tablets.
    It’s a generic medication.
    The pills are exactly the same, same strength, same manufacturer, same everything. So why is there a difference?
    In Canada, and in Mexico, the government controls the price of the medication. For instance, a Canadian law authorizes a review board to order a price reduction whenever the price of a drug exceeds the median of the prices in six European countries plus the United States.
    The U.S. is almost always the statistical outlier on the high end of the scale. Since all the European countries intervene in various ways to hold down drug costs, Canada uses other countries' price controls to create its own.
    In the U.S., a pharmaceutical trade group, PhRMA, lobbies incessantly to keep prices higher. According to their website, they say they are for:
    • Broad patient access to safe and effective medicines through a free market, without price controls,
    • Strong intellectual property incentives, and
    • Transparent, efficient, regulation and a free flow of information to patients.
    They have had many notable successes in preventing price controls, most recently during the negotiations for the Affordable Care Act, when the new law forbade reimportation of cheaper drugs from Canada. Pharmaceutical lobbyists have also successfully defeated government price controls for any agency except the Veterans Administration.
    None of this makes much sense, since the U.S. government pays for prescription drugs for a vast number of people, from people on Medicaid, to people on Medicare, to members of the military, to government employees from the President to a lowlevel clerk in an Interior office in Alaska. The federal government pays for more than 60 percent of all prescription drugs in the United States, and if the government were able to negotiate for better prices, studies predicted that the cost for the government would decline by about 68 percent.
    Drug companies instead compete openly. In the U.S., the costs of researching, developing, and advertising new brand name medications are passed to customers as part of a medication’s price. Pharmaceutical companies also say that the cost of drugs is elevated by the costs of litigation in cases where the drugs have caused harm, although harm caused by specialized drugs, including vaccinations, are covered by the federal government now.
    Drug manufacturers say that they would be less incented to put R&D money toward new medications. But in Europe, where several large pharmaceutical companies exist and create new products annually and where price controls exist, this doesn’t appear to be much of a problem.

    DHHS wants flexibility to run MaineCare? Prove the need first

    Posted May 29, 2014, at 9:33 a.m.
    Health and Human Services Commissioner Mary Mayhew has spoken often of her desire for a “global waiver” from the federal government that allows her department substantial flexibility in administering a Medicaid program governed by legions of complicated federal rules.
    Gary Alexander, the discredited welfare consultant hired by the LePage administration last fall to review Maine’s government assistance programs, made a name for himself in the Medicaid world for his tenure as health and human services chief in Rhode Island.
    His crowning achievement? Securing a “global waiver” from the federal government for Rhode Island’s Medicaid program.
    And when his “Baseline Analysis” of Maine’s government assistance programs came out earlier this month, his primary recommendation for Maine’s Medicaid program was, unsurprisingly, a “global waiver.” He made the same recommendation for Arkansas last year in a report for lawmakers in that state.
    “If granted, a global waiver would grant Maine the ability to appropriately tailor benefit packages, increase provider competition, and introduce innovative services,” the Alexander Group wrote in its 228-page document.
    Payments to the consulting firm have stopped following revelations that much of its work was plagiarized. But should any of the group’s policy recommendations live on in state government or on the campaign trail, voters and policymakers should know the Medicaid waiver is an unrealistic, and even dangerous, recommendation.
    The Alexander document listed several supposed advantages to a global waiver — from allowing the state wider latitude to charge Medicaid’s low-income enrollees premiums, to allowing the state not to cover transportation to medical appointments. It barely discussed how Maine should design its Medicaid program upon receiving global waiver authority.
    Alexander touted the waiver his agency secured for Rhode Island in 2009 as a “national model for Medicaid reform” in a paper he authored for the conservative Galen Institute the following year. He reported in the paper that it saved the Ocean State $100 million in its first 18 months.
    But, like the quality of the analyses he has produced for Maine DHHS, Alexander’s claims simply don’t hold up.

    Make patients the priority, not profits

    By Scott Goldberg
    Chicago Tribune, May 27, 2014
    As a medical student, I appreciated Tribune reporter Peter Frost's story, "Lawsuit accuses Blue Cross and Blue Shield parent of funneling profit to execs" (May 22).
    Nominally nonprofit health insurers are reaping huge financial gains by employing the same practices as for-profit insurers (claim denials, restrictive networks) and paying for as little actual health care as possible. They then use these gains to pay multimillion-dollar executive salaries and bonuses and to construct lavish buildings like the BCBS Illinois Tower along East Randolph Street in downtown Chicago. Frost’s article demonstrates that the problem with our healthcare system is not whether insurers are for-profit or nonprofit, but that they exist at all.
    That is why myself and 80 other medical students from across the country demonstrated outside that tower on May 12 to denounce our healthcare system for putting the interests of private insurance companies over patient needs. We were there as part of a national movement of medical students, physicians, nurses and other health professionals calling for a single-payer national health program. The idea is straightforward — eliminate private insurers and have the government pay all medical claims directly, much like Medicare works for seniors today.
    Every other industrialized country has a similar mechanism for providing universal, affordable and high-quality healthcare. The problem with the Affordable Care Act (also known as Obamacare) is that it entrenches insurers like Blue Cross Blue Shield and even mandates that taxpayers purchase their broken product.
    Single-payer health care is not “socialized medicine.” It is simply the best way to reform our deeply flawed healthcare system.
    Scott Goldberg is a medical student at the University of Chicago Pritzker School of Medicine.

    Steve Scalise to push GOP leaders on Obamacare alternative
    By: Lauren French and John Bresnahan
    May 28, 2014 09:38 PM EDT
    Rep. Steve Scalise is gearing up to put new pressure on Speaker John Boehner and other top Republican leaders to repeal Obamacare in favor of a conservative-backed health care package.
    Scalise (R-La.) will push for a House vote on an alternative health care plan crafted by the GOP Conference’s more hard-line members during a closed-door meeting of the Republican Study Committee on Thursday.
    “The American people can’t afford to wait any longer for Congress to repeal and replace Obamacare,” Scalise said. “The time is now to bring an Obamacare replacement bill to the House floor that lowers costs and puts patients back in charge of their health care decisions.”
    (Also on POLITICO: #HashtagIdiocy)
    The RSC health care proposal, unveiled by Scalise, Rep. Phil Roe (R-Tenn.), and other House conservatives in September, would fully “repeal and replace” Obamacare.
    If Boehner allows such a vote to take place, it would give House Democrats some political ammunition in what has been an otherwise bleak political landscape for the minority party and could reignite some of the battles that played out on Capitol Hill during last October’s disastrous government shutdown.
    House Majority Leader Eric Cantor (R-Va.) has been holding a steady round of meetings with GOP lawmakers — including chairmen last week — for the past several months in a bid to find an acceptable Republican plan. So far, that hasn’t happened.
    (Also on POLITICO: Obama: U.S. 'must always lead')
    “Majority Leader Cantor continues to work towards bold legislative solutions to replace Obamacare,” said Doug Heye, deputy chief of staff.
    Under the RSC plan, Americans would instead be allowed to purchase health plans across state lines, and small businesses encouraged to pool together to purchase coverage. Families and individual Americans would be allowed to deduct health care costs from their taxes. The use of “health savings accounts,” a favored policy for conservatives since the 1990s, would be greatly expanded.
    The RSC package also calls for medical malpractice reform, a ban on the use of federal funds for abortion and retention of the current requirement that patients with preexisting conditions can purchase insurance coverage.






Posted by at

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)