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Post SGR battle, still tough realities for physicians

July 3, 2015by Robert Whitcomb in Uncategorized tagged , , , ,

 

David Cutler, a healthcare economist at Harvard, writes in JAMA that while physicians are relieved that the fight over the Sustainable Growth Rate for Medicare payments is over, they should know that the pressure on them is far from over. He says at the end of his essay:

“When the SGR was repealed, physicians may have thought they were going back to the good old days of Medicare, before the SGR was introduced. But that is not in the cards. To paraphrase the old expression that war is too important to be left to the generals,’ healthcare payers have concluded that medicine is too important to be left to physicians alone.

“Physicians may not like living under alternative payment systems or being judged on outcomes for patients who avoid necessary care because of cost-sharing. But they will have to accept these new realities.  Over time, they may even come to embrace them. After all, what is the alternative?”

ACA foes regroup

June 28, 2015by Robert Whitcomb in Uncategorized tagged , , ,

 

After their defeat in the Supreme Court, foes of the Affordable Care Act plan to chip away at the law by actions in Congress and state legislatures. Still,  some opponents, such as the liberatarian Cato Institute, vow to  keeping trying to overturn the whole law.

But as “Obamacare” becomes more entrenched as millions of people become dependent on it, getting any major changes will become more difficult. For years after the introduction of Social Security, Medicare and Medicaid there were Republican-led campaigns to eliminate those laws but the millions who benefited from them eventually made the demise of these laws politically impossible.

Remember how strongly Tea Party folks opposed any limits on their Medicare benefits?

Long jail sentences for hospital crooks are right

June 25, 2015by Robert Whitcomb in Uncategorized tagged ,

 

jail

Their new home.

Evan Sweeney, writes in Hospital Impact:

“If you had any doubt that federal prosecutors are serious about bringing the hammer down on healthcare executives who oversee fraud schemes, look no further than the sentences handed down to three administrators at {Houston’s} Riverside  General Hospital.”

“Collectively, three administrators of the notoriously mismanaged hospital will be spending 115 years in prison. That includes a 45-year sentence for Riverside’s president, Earnest Gibson III, and a 40-year sentence for Mahammad Khan, the hospital’s former assistant administrator and Gibson III’s right-hand man. Gibson’s son, Earnest Gibson IV, who operated a satellite psychiatric facility linked to Riverside, will also receive 20 years for his role in a scheme that netted more than $150 million. Another administrator that operated a separate satellite location is awaiting sentencing.”

“There’s no shortage of sordid details in the multimillion-dollar theft. The three administrators worked with seven others to concoct a scheme that took advantage of mental health and drug rehab patients. The hospital billed for intensive outpatient therapy known as a partial hospitalization program (PHP) for these patients even though many of them were watching TV in place of therapy.”

“Schemes of this magnitude that target federal healthcare funds are reprehensible not just in terms of stolen Medicare dollars, but in the cost to patient care. Hundreds of patients, used as pawns in the scheme, never received the mental health and drug treatment they needed. Furthermore, as a result of the scandal, Riverside was forced to surrender its substance abuse treatment license last August, effectively washing away any notable progress the hospital made in previous years.”

 

 

Tufts Medical Center’s core challenge

June 23, 2015by Robert Whitcomb in Uncategorized tagged , , , , ,

 

Tufts Medical Center seeks new ways to market itself as it competes with giant competitors after the collapse of its merger talks with Boston Medical Center.

As The Boston Globe notes: “Tufts … straddles the ground between an elite academic medical center and a safety net hospital. Tufts surgeons, for example, perform more heart transplants than at any other hospital in the state. Still, about 60 percent of its patients are covered by … Medicare and Medicaid, a higher portion than at many other hospitals.”

“If Tufts fails to grow, it risks losing business to larger systems that can serve more patients and use their market clout to extract higher payments from insurers.

The Globe says: “Tufts executives say the end of the BMC talks underscores that the hospital’s future lies beyond Boston, where they will seek to link up with other hospitals and expand their network of doctors. They point to the merger with Lowell General as a model.”

How about a merger with Providence-based Lifespan? Or does Partners HealthCare want that for itself?

“Our goal is not to be a big megamedical center in downtown Boston that would require pulling patients into Boston to basically fill the beds. Our goal is to be a nimble, small, academic medical center that works in partnership with the community,” Michael Wagner, M.D., told The Globe.

Geriatrician argues for lower Medicare age

June 18, 2015by Robert Whitcomb in Uncategorized tagged , , ,

 

Americans are living longer, so why not lower the eligibility age for Medicare?

That prescription might sound  paradoxical: Rising longevity often is used as an argument for delaying Medicare eligibility past age 65. However, one of America’s top  geriatricians  thinks that Medicare should start covering preventive healthcare when we turn 50.

Dr. Linda Fried, dean of the Mailman School of Public Health at Columbia University, says that Medicare should start covering preventive healthcare for everyone when they turn 50, Reuters reports.

She argues that could help people not just live longer, but enjoy more healthy years, while saving Medicare money on treatment of  seniors’ chronic illnesses.

Her argument is founded on the idea that age 50 to 65 is the period of greatest risk of disability because of  cancer, heart disease and stroke, obesity and diabetes.

 

 

 

 

 

 

 

 

FQHC’s brace for Scotus ruling

June 14, 2015by Robert Whitcomb in Uncategorized tagged , , , ,

America’s 1,200 Federally Qualified Health Centers would be hit hard by a possible U.S. Supreme Court ruling this month eliminating health-insurance premium subsidies for federal exchange-plan enrollees. Modern Healthcare reports that  leaders of  some of these clinics say they’d have to provide far more uncompensated care if the Supremes throw out subsidies.
“Given the shortage of primary-care physicians, community health centers have been key primary-care providers for Americans who have received expanded private and Medicaid coverage under the Affordable Care Act,” the publication noted.
With the subsidies gone,  the centers “could draw a line and say they simply don’t have the resources to serve any more people,” Dan Hawkins, policy director of the National Association of Community Health Centers, told the publication.
Many FQHC’s have already been hit by declines in state funding.
“More broadly, a ruling striking down the subsidies would set back many years of efforts by presidents and congressional leaders of both parties to expand healthcare access to low-income Americans through community health centers,” Modern Healthcare said.
But the direness of the  situation  and its political heat could ironically lead to the long-term effect of a single-payer system like Medicare being extended to everyone.

Stop penalizing high-performing ACO’s

June 4, 2015by Robert Whitcomb in Uncategorized tagged , , , , , , ,

 

punish

James Weinstein, M.D., and William Weeks, M.D.,  both affiliated with Dartmouth’s medical complex, write that Medicare should end its penalty for high-performing hospital systems under the Accountable Care Organization model.

At the start of their piece in Modern Healthcare they write:
“Imagine a company that produces a high-quality product, operates efficiently and generates $16 million in year-over-year savings. Then imagine that the company is not allowed to retain those savings, but is assessed a financial penalty. Hard to imagine? Well, it’s a reality in the American healthcare system today.”They elaborate: “It is … important to recognize that participation in the program required these ACO’s to make the expensive upfront investments in information technology and case- management personnel that are indispensable to success in shared-savings models. And, while these investments improve quality, they also reduce healthcare utilization, which reduces per capita Medicare revenue—the basis for shared savings.”Given these high initial investments, anticipated lower Medicare revenue and the lack of well-designed incentives, this financial model is struggling for wider adoption. When Medicare established the Pioneer ACO shared-savings model in 2011, 32 healthcare systems participated in the effort; today 19 remain. ”

“{H}istorically, Dartmouth-Hitchcock {Medical Center} has had very low Medicare per-beneficiary costs. Under the Pioneer ACO model, program results are measured against an annual cost target, instead of on year-over-year improvement. Using this method, healthcare systems with high baseline costs…have a lot of room for improvement, while those with low baseline costs—such as Dartmouth-Hitchcock—do not,” they explain.

“Just as it is easier for an athlete who runs a 10 minute mile to run faster than it is for one who runs a 4 minute mile to do so, it is easier for providers with high baseline healthcare costs to reduce them than it is for providers with low baseline healthcare costs to do so.”

“Given the Pioneer ACO program’s flawed current incentive structure, Dartmouth-Hitchcock is deciding whether to continue to participate.”

More data on dubious payments to providers

June 4, 2015by Robert Whitcomb in Uncategorized tagged

 

Medicare releases previously redacted data on dubious gigantic payments to some providers.

Healthcare fragmentation’s high cost

May 29, 2015by Robert Whitcomb in Uncategorized tagged , , , , ,

dollars

The Fiscal Times reports on a HealthAffairs analysis on the  vast administrative costs associated with the Affordable Care Act.

The analysis in HealthAffairs found that the ACA would add about $273.6 billion in administrative costs in  2014-22, including $172.2 billion in higher private insurance overhead.

David Himmelstein, M.D., and Steffie Woolhandler, M.D., professors at the City University of New York School of Public Health and lecturers at Harvard Medical School, cite  rising enrollment in private plans, the law’s Medicaid expansion and the cost of setting up and running health-insurance exchanges.

Instead of the ACA, it would have cheaper, easier and more efficient to simply extend the traditional Medicare program to everyone — but that was seen as ideologically and politically impossible. So we have a system whose fragmentation and contradictory incentives and disincentives maximizes costs as each constituency demands its cut.

The latest estimate means about $1,375 in extra administrative costs per newly insured person per year, according to the report. That’s “over and above what would have been expected had the law not been enacted,” Dr. Himmelstein wrote on the Health Affairs blog.

 

 

 

 

Behind Aetna’s acquisition plans?

May 19, 2015by Robert Whitcomb in Uncategorized tagged , ,

 

Forbes reports that the health insurance industry’s  shift away from paying for volume to paying for value may be behind Aetna’s rumored deal to acquire either Cigna or Humana.

Humana’s booming Medicare business makes it an attractive acquisition target for Aetna, which focuses more on employer-sponsored health plans that have less unit growth potential than Medicare or Medicaid plans. And Humana has considerable experience in the fee-for-value world, Aetna less so.

 

“The health insurance industry deal speculation primarily focusing on Aetna’s ambitions comes just as the government plans to shift a huge amount of Medicare dollars away from the traditional fee-for-service approach to medicine that is based on volume and to medicine based on value that is tied to outcomes, performance and quality of care provided. Humana administers a large book of Medicare business Aetna may be interested in and larger amounts of capital may be needed to managed it from either insurer,” Forbes said.

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