Brett Coldiron, M.D., president of the American Academy of Dermatology, says, reports Dermatology Times, that cuts to Medicare Advantage plans caused insurers to eliminate their most expensive patients by eliminating the doctors who treat them from their network. ”Despite the fact their government reimbursement has declined from 114 percent to 104 percent of fee for service Medicare, the overall profit margin of insurers has increased.”
“In the long run, they will not save money,” he said. “They are de-listing physicians for treating the sickest patients. Delayed care means greater risk of mortality and more expensive care later on. What does it cost to treat someone with metastatic melanoma [compared to melanoma that has not metastasized]?”
Dermatology Times reports: “One of the distressing realities of this de-listing phenomenon is that patients who will be most affected are retirees, typically over 65 years of age, who have been making Medicare contributions throughout their working years, according to Dr. Coldiron.”
This last remark is rather misleading. It’s common to say that since people paid into Medicare and Social Security in their working years that they have more than paid for what they get from services later in life. But because of increased longevity and the world’s most expensive medical care, most older people take out considerably more than they pay in, helping to intensify the nation’s long-term fiscal challenge.
“About a year ago, a young boy wasn’t allowed to be in our ICU with his grandfather, who had raised him, because it was after visiting hours. The grandfather passed away and the two lost the chance to say goodbye.
“That incident really hit home for me and our entire staff. We knew we could do better – for our patients and their families.”
”Our old policies treated family members like visitors, until we realized that we are the visitors in people’s lives, not the other way around. This was a huge cultural shift, and one that the staff here was courageous enough, bold enough and caring enough to undertake.”
”This experience was one of the reasons we implemented a “welcoming” policy at the end of 2013, eliminating restrictive visiting policies and the whole concept of “visitors” .
”Since then, we’ve had more than 7,000 people come after hours to be with their loved ones. Tracking the data is an important part of assessing success and we’re gathering input and feedback from staff and patients and their families.”
”We need policies that challenge expansions and preserve competition, not those that assist the dominant player {like Partners}. …encouraging payment reform that rewards quality and cost-effectiveness; liberalizing scope-of-practice regulations, licensing rules, and other prohibitions to allow more efficient use of human resources; ensuring that professional regulations, state boundaries, and FDA rules do not impede telemedicine and digital products that enable mobile health management; and refining anti-kickback rules and reimbursement restrictions to enable providers to pursue creative, integrated ventures that could revolutionize the delivery of care. And there is much that {state} attorneys general can do to promote such innovation-oriented policies.”
One could guess that she says that in part because less-selective medical schools like hers would like to be seen as a good source of young physicians to meet this challenge, though some hospitals are leery on hiring students from them.
“Having led medical education programs for a decade, I want to reassure aspiring doctors: It’s not that bad. It is certainly not a reason to abandon a dream of becoming a doctor, especially not when the country faces a growing shortage of physicians.”
“Though the number of residencies per graduate may be decreasing, it is not worsening as rapidly as the ‘cliff’ metaphor implies. Overall, the number of U.S. allopathic medical students is growing by about 2 percent. Comparing this to the 1-2 percent growth in first-year residency positions, we can see that there is a squeeze, but by no means an imminent drop-off. ”
“Schools like AUC are doing their part to address this imbalance by providing a pipeline of mainly primary care physicians to care for underserved U.S. populations.”
John Nelson, M.D., a co-founder of the Society of Hospital Medicine, also urges ending “load-leveling” — a daily half-hour meeting of four or more physicians to evenly distribute patients because, he says, it wastes money and time. practice wastes money and time. “
Discussion between Mary Agnes Carey, of Kaiser Health News, where this originated, and Jennifer Haberkorn, of Politco Pro:
MARY AGNES CAREY: Welcome to Health on the Hill, I’m Mary Agnes Carey. The troubled Medicare Physician payment formula is one step closer to repeal. After 17 short-term fixes over the last decade, the House of Representatives voted overwhelming to scrap Medicare’s Sustainable Growth Rate, or SGR, and replace it with a system that pays doctors based on the quality of care rather than the quantity.
The Senate is expected to act on the measure next month. Jennifer Haberkorn of Politico Pro joins us now with the latest. Thanks, Jen.
JENNIFER HABERKORN, POLITICO PRO: Thanks, MAC.
AGNES CAREY: The House voted 392-37 to pass an SGR overhaul. President Obama supported this plan and there was a lot of pressure on the Senate to act, but it didn’t. Why didn’t the chamber vote on the SGR bill before it left town for a two-week recess?
JENNIFER HABERKORN, POLITICO PRO: The Senate was wrapping up its “vote-o-rama,” which is a purely Washington term for 15 hours of straight voting on amendments to the budget. Some hoped, and some thought that they would then move to this and pass this Sustainable Growth Rate repeal immediately. But the Senate feels like they have some time – the Obama administration can delay Medicare payments, essentially delaying the cuts to doctors, for two weeks. So they have time to return to this and pass it before physicians would actually see a cut in their rates.
Also the Senate really wanted to amend this policy. It was passed by the House, they were kind of miffed that they weren’t involved. So they want to be able to vote on making some changes to policy. Those amendments are unlikely to be approved, but they want to be able to make a point. There was also some concern that they didn’t have enough time to read the legislation and then all of the budget votes, and they were skeptical of passing this at about 4 in the morning.
MARY AGNES CAREY: The Senate doesn’t come back until April 13, and that leaves a lot of time for lobbying on this package – maybe people who like it, people who don’t. What are you expecting?
This KHN story can be republished for free (details).
JENNIFER HABERKORN, POLITICO PRO: Traditionally in Washington, the more time you have, the more opportunity there is for opposition to fester. That should be a concern in this case because it is two weeks before the Senate returns, but the House vote, as we said, was overwhelming: 392 votes. Advocacy groups are pretty overwhelmingly supportive of it. And I don’t see any real opposition brewing unless something new comes out – something unexpected like there’s a provision in the bill that no one realizes was there or something really significant like that. So I see the next two weeks – physician groups putting some lobbying time into ensuring the Senate vote is as strong as possible.
MARY AGNES CAREY: You mentioned Senate amendments a moment ago. What sort of amendments are we likely to see when the Senate takes up this package?
JENNIFER HABERKORN, POLITICO PRO: The Senate really wants four years of funding for the Children’s Health Insurance Program. The policy right now is only two years and they want to be able to vote on doubling that to four. I don’t think that is likely to pass, particularly because it is a pretty expensive policy change. We are also likely to see an amendment on a budget point of order, which is really just acknowledging that this policy is not fully paid for, so it would add to the deficit in the first ten years and particularly conservative budget hawks would like to be able to voice opposition to adding to the deficit.
MARY AGNES CAREY: Let’s go back to that House vote for a minute. Just want to get your impressions, I mean I found it so interesting that House Speaker John Boehner could convince many conservative Republicans to vote for this, even though as you say it wasn’t fully paid for. Nancy Pelosi, the Democratic leader, also got her troops mostly to go along, even though they had concerns, same concerns as Senate Democrats about the Children’s Health Insurance Program funding, there were some concerns that beneficiaries are picking up too much of this package. How did that all come together?
JENNIFER HABERKORN, POLITICO PRO: I think a couple really strategic decisions by leadership were key. Conservatives were able to get the early support of Americans for Tax Reform, which is really influential with conservatives who are concerned about the budget. That kind of quelled some of that opposition. Nancy Pelosi very early on made it clear that she wanted more money for the CHIP program, but just wasn’t going to be able to get it in this deal. And so, that really tapped down opposition from the far ends of both sides, Republicans and Democrats. Also, this policy was just so widely hated that there was a lot of support for getting rid of it even if you had to accept some things that you didn’t like.
MARY AGNES CAREY: Do you think that House vote, coupled with the likely Senate action on the sustainable growth rate scrapping this formula once and for all, is this a sign that we are going to see more bipartisan cooperation on healthcare in the future?
JENNIFER HABERKORN, POLITICO PRO: You know, it’s certainly a sign that it’s possible. Whether we are going to see more of this, it’s really hard to say at this time. This deal seemed to come out of nowhere. You know, we’ve been doing “doc fixes” like you mentioned earlier for a decade. No one thought the policy would going to get repaired anytime soon. And it was perhaps less about healthcare and more about just this recurring, very Washington, problem of fixing this budget problem. But I will say, this was the number one policy concern of just about every physician organization, a lot of the hospital organizations because they were always taxed to pay for these doc fixes. So it kind of clears the plate of health advocacy organizations and helps health policy people on Capitol Hill.
MARY AGNES CAREY: We’ll see were it goes. Thanks so much Jennifer Haberkorn of Politico Pro.
JENNIFER HABERKORN, POLITICO PRO: Great to talk to you.
The Affordable Care Act bans new physician-owned hospitals (about 7o facilities) and expanding their existing facilities unless specifically approved by the Centers for Medicare and Medicaid Services.
So far they’ve been overwhelmed by lobbyists from the American Hospital Association and the Federation of American Hospitals, which of course don’t want the competition.Andrew Wachler, managing partner with Wachler & Associates law firm, told Modern Healthcare that the central argument of the opposition was that physician-owned hospitals would “cherry pick” patients who needed such high profit-margins treatment as orthopedic surgery.
”And if any of these patients were treated more proactively with any consistency, imagine how many people would be put out of work overnight. The economy might grind to a halt.”
What healthcare needs is a Care Management System built to support team-based care and empower users to clearly understand and communicate the state of play of their healthcare. Given the complexity of care surrounding patients working with multiple providers, the challenge of logging, updating, and communicating the state of care activities is a constant problem for patient teams. ….Dr. John Halamka…stated the issue at hand in a recent interview, ‘What we really need is a combination of Wikipedia and Facebook. The Wikipedia part is the narrative of your life, and it’s written by a team and updated frequently. Facebook-like [timelines] contain the events that are happening now.”’
