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Friday, August 29, 2014

Health Care Reform Articles - August 29, 2014


TUESDAY, AUGUST 26, 2014
The Study You’ll Never Hear About
According to a new Commonwealth Fund
sponsored study published in Health Affairs,
“Small Primary Care Physician Practices Have
Low Rates Of Preventable Hospital
Admissions”. The study of over one thousand
practices of various sizes and ownerships,
conducted by some of the most respected names
in health care, found that the smallest
independent primary care practices, that are
physician owned, provide better care at lower
overall cost. Considering the current, and rather belligerent, advocacy and policy efforts to eradicate small independent medical practice, and the massive move of physicians from private practice to hospital employment in the name of efficiency, quality, value and economies of scale, this study should have created quite the furor. It has not, and chances are excellent that it never will.
The study, consisting of 1045 practices and 284,000 patients, is a combination of survey responses regarding practice characteristics, and Medicare claims data used to calculate rates of ambulatory care-sensitive admissions (ACSA). As the title implies, Lawrence Casalino and colleagues found that practices with one or two physicians had 30% lower rates of these presumably preventable admissions. But this was by no means the only finding, because in general, physician owned practices, as opposed to hospital owned practices, regardless of size, had lower ACSA rates. Furthermore, the study also found that all sorts of innovative practice models foisted on physicians nowadays have marginal and sometimes negative effects on ACSA rates: “Neither the patient-centered medical home score, nor pay-for-performance incentives, nor the acceptance of risk for the cost of hospital care for the practice’s patients was significantly associated with the ambulatory care–sensitive admission rate ... . Practices exposed to public reporting had somewhat higher rates.”
http://content.healthaffairs.org/content/early/2014/08/08/hlthaff.2014.0434.full.html 

Expansion of Mental Health Care Hits Obstacles

by Abby Goodenough
LOUISVILLE, Ky. — Terri Hall’s anxiety was back, making her hands shake as she tried to light a cigarette on the stoop of her faded apartment building. She had no appetite, and her mind galloped as she grasped for an answer to her latest setback.
In January, almost immediately after she got Medicaid coverage through the Affordable Care Act, she had called a community mental health agency seeking help for the depression and anxiety that had so often consumed her.
Now she was getting therapy for the first time, and it was helping, no question. She just wished she could go more often. The agency, Seven Counties Services, has been deluged with new Medicaid recipients, and Ms. Hall has had to wait up to seven weeks between appointments with her therapist, Erin Riedel, whose caseload has more than doubled.
“She’s just awesome,” Ms. Hall said. “But she’s busy, very busy.”
The Affordable Care Act has paved the way for a vast expansion of mental health coverage in America, providing access for millions of people who were previously uninsured or whose policies did not include such coverage before. Under the law, mental health treatment is an “essential” benefit that must be covered by Medicaid and every private plan sold through the new online insurance marketplaces.
The need is widely viewed as great: Nearly one in five Americans has a diagnosable mental illness, according to the Department of Health and Human Services, but most get no treatment. If the law’s goal is met, advocates say, it will reduce not only personal suffering but also exorbitant economic costs, like the higher rate of general health problems among those with mental illnesses, and their lost productivity.
Kentucky has been trying to overhaul its mental health system, partly by allowing private psychologists and social workers to accept Medicaid patients for the first time. The change is crucial, state officials say, because 85 percent of the 521,000 Kentuckians who got coverage through the state’s new insurance exchange this year were poor enough to enroll in Medicaid. Previously, only psychologists and social workers at community health centers like Seven Counties, which are quasi-governmental agencies, could provide outpatient therapy to Medicaid recipients here. Now, more than 1,000 private mental health providers statewide have signed up to treat Medicaid enrollees, according to the state.
http://www.nytimes.com/2014/08/28/us/expansion-of-mental-health-care-hits-obstacles.html?smid=nytcore-ipad-share&smprod=nytcore-ipad&_r=0

Loving and Hating Obamacare With One Muddled Mind

E.J. Dionne has a nice column pointing out that while “Obamacare” remains unpopular, most of the provisions are well-liked, and thus Democrats should run on the issue. As regular readers know, I certainly agree that the individual components of reform are far more popular than reform overall. However, the column's headline -- “Obamacare has growing support, even if its name does not” -- isn't really buttressed by the article. Actually, support for key provisions of the law, including coverage of pre-existing conditions, health-insurance exchanges offering subsidies to middle-income policy holders and Obamacare's Medicaid expansion, have always polled well.
Moreover caution is always in order with issue polling. When these kinds of polls show public opinion fractured, it’s tempting to believe that one side or the other represents voters' “true” support. That’s the wrong way to interpret such polls. Yes, the ACA polls badly while most of its components poll well. But that doesn’t mean that the ACA is genuinely unpopular (as most opponents suggest) or that it’s genuinely popular (as most supporters contend). There is no underlying truth to be excavated from the results; the best we can do is say that public opinion is inconsistent.
Well, that’s the best we observers can do. Campaign operatives, in contrast, can counsel their candidates to stress whatever is popular. What those operatives shouldn't do is to fall for their own spin, or let their candidates fall for it. That applies both to Republican consultants encouraging candidates to bash Obamacare, and Democratic consultants urging candidates to highlight the law's most popular provisions.

What Doctors Can’t Do

By 
 
Mary White makes house calls. She’s a senior community health worker in Philadelphia in the IMPaCT program at the Penn Center for Community Health Workers. She has 25 of the University of Pennsylvania Health System’s toughest patients. It’s her job to help them set health goals and, step by step, carry them out.
One of her patients is Grover Wilson, an engaging man of 56 who weighs 515 pounds. Wilson had long been athletic and sociable, the organizer of a long-running community volleyball game. But depression and an injury led him to gain weight. Now he lives in a tiny basement apartment packed floor to ceiling with boxes of his possessions, and is trapped and isolated by his weight.
White has been visiting Wilson for three months. He’s lost 15 pounds during that time, with the help of a group class at the Penn Center and her visits. “How are you doing on your goal to cut down on sugary drinks?” she asks. What about your snacks? “I’ve finished all my hummus and pretzels,” he says. “I’m going to get some baby carrots, and more hummus, and pita chips.”
“That’s good, that’s good,” White says. “They’re having a sale on hummus.”
They talk about his exercise goal: walking up and down his hallway. “As usual, I’m not doing a great job on my own,” he said. “It’s very easy when you’re alone and obese and have sleep apnea and other problems to say, ‘I just want to give up.’ Depression comes and goes. But today’s a good day.” He means because White is visiting.
http://opinionator.blogs.nytimes.com/2014/08/28/what-doctors-cant-do/?_php=true&_type=blogs&_php=true&_type=blogs&emc=edit_tnt_20140828&nlid=1311158&tntemail0=y&_r=1&

Pennsylvania to Purchase Private Care for Its Poor

By 
WASHINGTON — Pennsylvania will become the 27th state to expandMedicaid under the Affordable Care Act, the Obama administration announced Thursday, using federal funds to buy private health insurance for about 500,000 low-income residents starting next year.
Gov. Tom Corbett, a Republican, had proposed the plan as an alternative to expanding traditional Medicaid under the health care law, which he opposes. Now that federal officials have signed off, Pennsylvania will join Arkansas and Iowa in using Medicaid funds to buy private coverage for the poor.
The Republican governor of Indiana, Mike Pence, has proposed a similar plan but has not yet received approval from the Obama administration. The so-called private option has increasingly appealed to some conservatives as a free-market alternative to traditional Medicaid, a government-run program that critics say has out-of-control costs.
Pennsylvania’s plan includes requirements for the Medicaid expansion population that go beyond the traditional program. For example, people with annual incomes above the poverty level — $11,670 for an individual — will have to pay premiums equaling up to 2 percent of their household income starting in 2016.

How to Complain to Medicare

by Paula Span
How Medicare handles complaints and appeals is no trivial matter — the Centers for Medicare and Medicaid Services says it reviews more than 100,000 of them a year. Beneficiaries file roughly 16,000 annually related to hospital care (mostly contesting discharges) and 18,000 about nursing homes, home health services and hospice programs. And 30,000 other complaints and appeals concern Medicare Advantage programs.
On Aug. 1, Medicare made what should be a simple change in this process: There are new toll-free phone numbers to call. You may have already received the new numbers on the forms a hospital or nursing home provided about your rights. But if a health care provider hasn’t yet caught up with the change, you may not have.
And if you’re looking on the Medicare.gov website for phone numbers, I wish you luck. I went rummaging through the site several times without finding them, and so did the folks at the United Hospital Fund, until they finally located the proper tool.
The new phone numbers, which I’ll pass along in a minute, reflect a larger change. Each state has a quality improvement organization, aQ.I.O., which until now worked with providers on issues like reducing hospital readmissions or preventing infections, and reviewed beneficiaries’ complaints and expedited appeals.
Some beneficiaries and other critics, including the Institute of Medicine, saw potential conflicts of interests: Could the organization that advised providers also fairly review complaints against them? They recommended separating those functions.

MaineHealth acquires Farmington hospital network

By Jackie Farwell, BDN Staff
Posted Aug. 28, 2014, at 6:03 p.m.
Franklin Community Health Network has become the 13th member of the state’s largest hospital system, following a state approval issued Wednesday.
The independent health network, parent to the 65-bed Franklin Memorial Hospital in Farmington, will join Portland-based MaineHealth effective Oct. 1, both organizations announced Thursday.
MaineHealth, the parent organization to Maine Medical Center and a dozen other health care entities, plans to invest at least $2.25 million into FCHN, according to documents filed with the state’s certificate of need unit, which regulates the expansion of health care facilities in Maine. Over the next four years, the money will fund implementation of an outpatient electronic medical records system also adopted by MaineHealth.
The certificate of need unit recommended approval of the deal, which Maine Department of Health and Human Services Commissioner Mary Mayhew granted Wednesday. She noted several conditions, including the organization’s report on the success of their efforts to improve health in the community. They also must report to the state on referral patterns, which will reflect where patients in FCHN’s service area seek care after the deal.
Neighboring Central Maine Healthcare, based in Lewiston, expressed concern to state regulators about where local doctors will refer patients following the acquisition.
The Franklin health network will pay MaineHealth an annual membership fee of $375,000. Those dues are expected to be offset by savings in lab services, insurance premiums and legal fees FCHN will realize by joining the system, according to the documents.
FCHN reported an operating loss of $7.6 million in fiscal year 2013. MaineHealth expects the network’s operating costs to drop by about $523,000 within three years of becoming a member.
“Our health system has enjoyed a long-standing clinical collaboration with Franklin and its providers,” MaineHealth President Bill Caron said in a news release. “Welcoming Franklin Community Health Network as a member of the MaineHealth family is a natural next step, and we look forward to working together to care for the greater Franklin County community.”

Expanding Medicaid is good for the economy, health of Maine

By Sara Gagne-Holmes, Special to the BDN
Posted Aug. 28, 2014, at 2:52 p.m.
For many working families in Maine, a job isn’t enough to make ends meet. Between paying for rent, putting food on the table and meeting everyday expenses, there’s no money left for health insurance.
As we celebrate Labor Day, it’s a good time to reconsider a critical opportunity Maine has to improve the lives of nearly 70,000 people, including 3,000 veterans. Through the Affordable Care Act, Maine could provide access to affordable, high quality health care.
Expansion of Medicaid, called MaineCare here, would realize an incredible return on the investment by boosting our state’s economy, creating jobs and lowering health insurance costs for everyone, including those with private health insurance.
Unfortunately, Gov. Paul LePage has rejected this common-sense idea – vetoing bipartisan efforts to expand access five times – even though Republican and Democratic governors around the country have realized this opportunity is too good to pass up.
Maine, unlike the rest of New England, is missing a major opportunity for new economic growth, and thousands of Maine families are being put, unnecessarily, at risk of tragic health outcomes and bankruptcy caused by medical bills.
The facts are indisputable.
Hospitals are being hurt by refusing to expand Medicaid. As a new report by the Robert Wood Johnson Foundation found, hospitals in expansion states are seeing declines in charity care — free medical services provided to income eligible individuals by nonprofit hospitals pursuant to state law. Reductions in charity care help to reduce cost shifting onto other policyholders and protect jobs.
The same report found Maine hospitals will lose out on nearly $900 million in state and federal Medicaid reimbursement over 10 years if Maine doesn’t expand Medicaid.
But the economic impact goes much further.
Over the next 10 years, Maine would receive $3.1 billion in federal Medicaid funding if Maine expanded Medicaid. This funding and the economic activity it would generate is likely to result in 3,100 new or retained jobs in the health care sector and the rest of our communities.
In states that have expanded Medicaid, the rate of people without insurance has declined by 38 percent, compared to just 9 percent in nonexpansion states.
It’s not too late to change course.

LePage tells newspapers to drop dead as another GOP governor pursues people’s health

What a contrast: As Gov. LePage said it’s a plague that newspapers are “still alive,” another Republican governor is pursuing a policy that will save lives and improve health.
In deep red Wyoming, Republican Gov. Matt Mead has started negotiating with federal officials on expanding Medicaid. Like Maine, the state hospital association supports an expansion, which would reduce uncompensated care and make preventive care more available, reducing overall costs and human suffering.
LePage made his comments on a day when his electoral opponents were talking about policies to help Maine people. Eliot Cutler sketched out proposals on welfare reform. Mike Michaud put out a detailed plan, comprehensive plan to support Maine agriculture and make Maine New England’s food basket.
As LePage’s challengers and Wyoming look to solutions, LePage continues his intense rhetoric
Gov. LePage has again made it clear that he really doesn’t like Maine newspapers.

Doctor’s prognosis: American-style health care a nightmare

By Inge De Becker, M.D.
The Chronicle Herald (Halifax, Nova Scotia), Aug. 26, 2014
As a Canadian physician who now lives south of the 49th parallel, I’m alarmed that Canada’s publicly financed national health-care system is once again under attack
Nine years ago, we witnessed Dr. Jacques Chaoulli’s legal attack on medicare in Quebec. Then we saw the Harper government’s failure to renegotiate a new Canada Health Accord this past March. And now Dr. Brian Day, owner of the for-profit Cambie Surgery Centre in Vancouver, is unleashing his drive to “profitize” health care in British Columbia.
On Sept. 8, a trial to hear a constitutional challenge to B.C.’s health system that Dr. Day launched in 2008 will begin in Vancouver. Day wants to strike down provincial legislation that limits private payments for medically needed services by claiming that these laws violate the Canadian Charter of Rights and Freedoms.
Should he win, the door will open for an American-style health-care system (consistently ranked lowest in performance among wealthy nations — and the most expensive) with its profit-driven insurance companies, bloated administrative costs, and inequitable access.
Let me tell you about my experience with the U.S. health-care system. I am a pediatric ophthalmologist by training and, like all of us, I am occasionally also a patient. In 2008, for personal reasons — not for a better job — I chose to move across the border from my home in Nova Scotia to Minnesota.
I knew that the health-care system in both countries would be different. But I did not grasp what that meant until I lived the difference.
My learning curve as a patient in the U.S. was brutal: even as a “well-insured” patient, I suddenly was dealing with pre-authorizations, in-network/out-of-network issues, co-pays, co-insurance, deductibles, health savings accounts, and EOBs (Explanation of Benefits) which look like bills but aren’t.
The accounting department of my HMO (Health Maintenance Organization) overbilled me by thousands of dollars. I stalled with the payment.
On a bright Saturday morning, I received an intimidating call from a collection agency for unpaid medical bills. Never mind how that affected my credit rating.
In Canada, I paid taxes, had a Nova Scotia health card that guaranteed access to medically needed care anywhere in the country, used the health-care system if I needed it, got to choose my doctor, and did not have to worry about bills. With private insurance in the U.S., I learned not to take the Canadian experience for granted anymore.
In Canada, I benefited from superb oncology care. In Canada, my son was in a catastrophic car crash. He spent seven days in a state-of-the-art neuro-intensive care unit. Not one bill, not one phone call to or from an insurance company disrupted emotionally charged times.
My learning curve as a physician practising in the U.S. was equally unpleasant. For the first time in my professional life, I had to deal with the intrusion of third parties — health insurance companies — between the patient and me.
I had to keep in mind that a patient’s insurance may not cover the tests and treatments needed, that common procedures needed to be pre-authorized by an insurance clerk, that certain things needed to be done before the insurance ran out, or that some treatments had to be delayed to the next “benefit year.”



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