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Hospital execs’ illogical cost-shifting rhetoric

 

Austin Frakt,  a health economist, goes after the illogic of hospital executives’ assertion that they have to make up reduced reimbursement from Medicaid and Medicare by charging higher prices to insured patients.

”{P}ublic policy that holds or pushes down Medicare and Medicaid prices (or their growth) could put downward pressure on the prices hospitals can charge to all its customers and, in turn, on the premiums we pay to insurers.”

”It’s natural, then, that hospital executives continue to promote the idea of cost shifting. The widespread belief they encourage — that it promotes higher premiums — could foster support for larger public payments. It may be a politically useful argument, but it is an economically flawed one.”


Pushing indigent mentally ill into outpatient treatment

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Early Persian psychiatric treatment.

The Sacramento Bee reports that Sacramento County will spend ”$16 million this year on hospital costs for the severely mentally ill, almost three times more than originally budgeted for care at area hospitals.’

Experts link much of the increase to the greater number of patients showing up because of the expansion of California’s Medicaid program (Medi-Cal) under the Affordable Care Act.

So that jurisdiction, as are many in America, are looking at placing more emphasis on community-based outpatient treatment and less on hospital beds. This suggests more of a focus at improving  other factors besides direct psychiatric care — such as housing and transportati0n — that also affect health and whose shortages drive up medical costs by driving the mentally ill to hospital emergency departments.

“The plan, expected within three months, will include services that help the mentally ill before they reach a full-blown crisis, alternatives for those in a crisis and better assessments to avoid unnecessary hospitalizations,”  The Bee reported.

“Preliminary estimates peg the cost of those services at around $9 million a year, much of which would be offset by federal and state funds and reduced hospitalization costs.”

This is common-sensical. However, at the same time, there’s growing opinion that there should be a revival of hospitals to care for the most severely mentally for the long-term — in the case of some patients, for the rest of their lives. The deinstitutionalization movement has gone too far for some patients and their exhausted families.

The Bee noted that “Efforts to relieve pressure on emergency rooms have led to more psychiatric hospital stays, according to a county staff report.” Not exactly a fiscal triumph for the payers.

The Mental Health Improvement Coalition, which includes area hospitals and nonprofits, said: “The system of behavioral healthcare is fundamentally broken. People in crisis have little option other than to access services through hospital emergency room departments, which are the least conducive environments for behavioral health patients to become well and receive appropriate services.”

 


Supremes rule against private Medicaid providers

 

The U.S. Supreme Court ruled that private-sector healthcare providers can’t sue to make states raise their Medicaid reimbursement rates to keep up with rising medical costs. Interestingly, the 5-4 cut across the court’s usual ideological lines, with Justice Antonin Scalia writing the majority opinion.


Tenn. weighs changing Medicaid mental-healthcare

 

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Officials of TennCare, the Tennessee Medicaid program, seek to reform mental- and behavioral-health treatment under its 2016 budget.

The Nashville Tennessean reported that TennCare is proposing implementing ”an evaluation mechanism for people receiving mental health treatment under the bureau’s Level 2 case management classification. People under this categorization receive visits from case managers in addition to therapy or other treatments, such as medication.”

”The proposed changes would institute a review after three months to evaluate whether case manager visits are needed rather than everyone receiving visits, said Keith Gaither manager of managed-care organization (MCO) operations at TennCare.”

”Gaither said that the MCOs have been looking at this category of patients for more than two years to determine whether there was a way to tailor treatment on a case-by-case basis rather than extending the case management to everyone.”

It is unclear what impact all this might have on hospitals and Federally Qualified Health Centers.

 

 

 

 


GOP launches healthcare offensive

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Republican lawmakers eager to repeal the Affordable Care Act are pushing tax credits and much greater freedom for states and health insurers  to make healthcare-finance policy as the GOP  starts to present its plan  to replace the ACA.

The Republican program, which President Obama is expected to veto, would end ACA coverage requirements for individuals and employers,  end expansion of Medicaid, kill  state and HealthCare.gov federal insurance marketplaces and, indeed, end virtually everything else under the ACA,  including taxes ”it imposes on medical devices and other things to finance enlarged coverage,” the Associated Press reported.

On Medicaid, the GOP plan would give states much more freedom in how to spend money in that federal-state pr0gram — even as more conservative states now seek the ACA’s added Medicaid money.

Given President Obama’s veto pen, we suspect that most of the Republican offensive is primarily rhetorical, leading up to the 2016 presidential election.  And because the  ACA has already developed powerful constituencies of beneficiaries, it’s far from clear how the GOP program will play politically in 2016, especially given that voter turnout is always higher in presidential-election years than in others.

 


Phil Galewitz: Why GOP-run Florida is tops for signups in ACA

 

 

By PHIL GALEWITZ for Kaiser Health News 

 

When Florida workers promoting President Obama’s health-law marketplace want instant feedback, they go to an online “heat map.” The map turns darker green where they’ve seen the most people and shows bright red dots for areas where enrollment is high.

“The map shows us where the holes are” and what communities need to be targeted next, said Lynn Thorp, regional director of the Health Planning Council of Southwest Florida. She hands out information about the health law’s marketplace at rodeos, farmers markets, hockey games and almost any place where people gather.

That mapping strategy is one reason why a Republican-controlled state like Florida, whose leaders criticize the health law at every turn, is leading the nation in signing people up for private Obamacare health plans. With two weeks to go until the deadline for 2015 enrollment, Florida’s tally exceeds that of even Democrat-led California, which has embraced the law building its own online marketplace and has twice the population and uses three times as much federal funding for outreach.

“It’s surprising Florida has done as well compared to other states, and they will be looked at by folks who want to learn lessons to promote enrollment,” said Joel Ario, managing director for Manatt Health Solutions, a consulting firm, who worked for the administration setting up the exchanges soon after the law was passed.
As of mid-January, 1.27 million Floridians had enrolled in exchange plans, according to federal data, compared to 1.2 million Californians. Texas, which has 6 million more people than Florida, enrolled about 919,000 people in private plans. Both Florida and Texas have a 22 percent uninsured rate. California’s rate is 17 percent, according to latest Census data.

“It is truly ironic that Florida leads the nation in enrollment … with leadership that has actively opposed the law,” said Leah Barber-Heinz, executive director of Florida CHAIN, an advocacy group involved in outreach efforts. “It shows true commitment on the part of many and it portrays an extremely high need for affordable coverage.

There are other reasons cited for Florida’s robust enrollment —including intense competition among insurers in several big counties and the high degree of coordination among the nonprofits and community groups which received federal grants to sign people up.

Another key factor is the state’s decision not to expand Medicaid under the law. That’s left consumers with incomes above the federal poverty level of $11,600 per year with no coverage option other than to buy a private plan — with help from sliding-scale government subsidies. About 800,000 Floridians who make less than the federal poverty level are shut out altogether because they make too little to qualify for subsidies for private plans, but too much to qualify for Medicaid. In Florida, adults with children qualify for Medicaid only if their income is below 34 percent of the poverty level. Childless adults are ineligible. Florida is one of 22 states that chose not to expand Medicaid after the U.S. Supreme Court made that provision optional for states.

In contrast, California expanded Medicaid to those making up to 138 percent of the poverty level, or $16,100 for an individual. The program has grown by 2.3 million people since fall of 2013, boosted partly by publicity for the online marketplace.

Covered California spokesman James Scullary said the exchange is not allowed to enroll people in private plans if their incomes fall between 100 and 138 percent of the federal poverty line, because they qualify for Medicaid.

A snapshot of the “heat map” of a four-county area around Tampa used by Obamacare outreach workers. The darker the dots, the higher the percentage of enrollments in that zip code. The darker the green color, the more residents who received outreach.
A snapshot of the “heat map” of a four-county area around Tampa used by Obamacare outreach workers.
The darker the dots, the higher the percentage of enrollments in that zip code. The darker the green color, the more residents who received outreach. (Source: Family Healthcare Foundation)

Jon Urbanek, senior vice president of Florida Blue, the state’s dominant insurer, credits Florida’s strong enrollment in private plans, in part, to the state’s decision not to expand Medicaid. He also points to the intense outreach by thousands of the carrier’s insurance agents. Florida Blue has conducted about 3,000 “town-hall” style meetings at its 18 retail centers. “We knew going in that this was going to be a face-to-face, get in the community type of action to build trust with people,” he said.

Florida has also gained from having an older population which is more likely to buy coverage than younger people, Ario said. That population is centered in a handful of urban areas such as Miami, Orlando and Tampa, making them easier to target, he said.

In contrast, many uninsured Texans live outside the big markets of Dallas, Houston and San Antonio. Texas also has a higher proportion of Hispanics who have been more challenging to enroll because of language barriers.

Then there’s the unusual effort to coordinate outreach. John Gilbert, national field director for Enroll America, a nonprofit doing outreach in 10 states, said Florida has benefitted from having several large nonprofits with experience signing up children for Medicaid. They have worked together closely – helped in part by the heat map.

Thorp of the Southwest Florida Health Planning Council describes how every time she hands out Obamacare flyers at a fair, or counsels at a local library, the action get entered into a computer log, which immediately changes the heat map. That way, other outreach workers see where contacts have been made.

Data from actual enrollment in the Obamacare health plans is added using dots, although that information lags because it is controlled by the U.S. Department of Health and Human Services.

The darker the dots on the map, the more saturated the enrollments in that zip code. When users hover over a dot, it pulls up a box showing how many residents in that zip code received outreach, including how many got one-on-one help filling out an application.

“We can then make sure we are appropriately allocating resources,” said Melanie Hall, executive director of the Tampa-based Family Healthcare Foundation, which devised the mapping tool. Her group is working with the University of South Florida, which received a $5.4 million federal grant to help people anywhere in the state enroll. In all, Florida nonprofits received $6.8 million in federal “navigator” grants.

Perhaps another, harder-to-measure factor is how advocates have been fired up by the opposition of many of the state’s political leaders, said Barber-Heinz of Florida CHAIN.

“Stakeholders that didn’t work together in the past are working together on this,” she said. “It drives us to work even harder.”

Barbara Feder Ostrov contributed to this story.


Oregon’s secret to healthcare reform

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William A. Galston writes in a very important piece in today’s  Wall Street Journal that Oregon is so far succeeding with its 15 regional Coordinated Care Organizations  involving Medicaid patients “designed to break down the multiple ‘silos’ of health services and provide integrated, patient-centered  services with a focus on primary and preventive care.”

Oregon’s governor, John Kitzhaber, M.D., is leading the way in developing this national model of reform.

So far, the plan seems to be succeeding in saving money while improving healthcare delivery. If it goes on like this, says Mr. Galston, “the results would be revolutionary….for the country as a whole, implementation of the Oregon model could save Medicaid more than $900 billion over the next decade.”

Cambridge Management Group has been working  intensely in Oregon on coordinated-care community-health projects and is very pleased that Mr. Galston is touting what we at CMG also see as potentially revolutionary improvements.

He notes that the Center for American Progress suggests expansion of the Oregon model ”to cover all healthcare spending, public and private,” in the U.S.

 


Being stingy on Medicaid has big costs

 

Eduardo Porter writes in The New York Times about the  great socio-economic costs of states like Arkansas being stingy on Medicaid.


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