August 13, 2010
9:53 am
We should be concerned about a report this week in the Journal of the American Medical Association (JAMA), which presents a picture of increased crowding in the nation’s hospital emergency rooms, with Medicaid patients making up the lion’s share of the rising demand for ER services.
According to JAMA:
• The number of patients visiting emergency rooms rose from 95 million in 1997 to 117 million in 2007. This 23 percent increase in a decade significantly exceeds what could have been reasonable expected based on population growth.
• In 1999, there were almost 694 ER visits, on average, for every 1,000 Medicaid enrollees. In 2007, there were over 947 visits for every 1,000 individuals on Medicaid.
• The ER visit rate stayed relatively stable over that time period for Medicare patients, the privately insured and even the uninsured, telling us that Medicaid beneficiaries are driving the growth in emergency room traffic.
With Medicaid expansion playing such an important role in the implementation of health reform and the projected decline in the nation’s uninsured population, the JAMA study takes on great importance. Because Medicaid pays such comparably low reimbursement rates to physicians, many doctors won’t see Medicaid patients. This increase in patient traffic has caused ER wait times to jump by 50 percent during the 1997-2007 period examined in the study.
As the study’s authors wrote, it is a “critical concern” how emergency rooms are going to deal with the 16 million Americans who are expected to be added to Medicaid rolls once health reform is fully implemented.
August 10, 2010
11:02 am
The predominant headlines emerging from the release last week of the Medicare trustees report was that the longevity of the Medicare program has been ostensibly increased as a result of the new health reform law.
There’s a story of consequence, though, in the trustees report that was overlooked. In looking at the Medicare Part D prescription drug program, the trustees lowered their estimates of future spending from where they had it in last year’s report. This reduction is particularly striking when you consider that there will be additional dollars spent on the program in order to close the so-called “donut hole.” Even with the donut hole closure, Part D expenditure estimates still declined.
This further underscores what many of us have said from the beginning about the efficacy of the Part D structure. Making consumer choice the centerpiece of the program, and having multiple prescription drug plans compete for the loyalties of beneficiaries, generates greater value. This competition-and-choice approach, combined with increased use of generic pharmaceuticals, is placing downward pressure on spending estimates for future years.
The costs of the Part D program felt by senior citizens also continue to fall below original estimates. The average monthly premium for 2010 is $30. Original government estimates projected they would reach $50 by this point.
It’s no wonder the program enjoys nearly 90 percent approval ratings – almost unheard of for a federal initiative.
The Medicare Today coalition issued a press release on the Part D findings.
July 30, 2010
6:35 am
Some ideas on Capitol Hill make so much sense that you can’t help but wonder why they haven’t become law already.
But, then again, tort reform has proven many times to be the legislative swamp where good ideas go to die.
This week, the House Energy and Commerce Committee passed a measure that would have the federal government provide medical liability coverage to physicians who volunteer their time at free clinics or community health centers. Current law, the Federal Tort Claims Act, provides malpractice coverage to community health center employees, but not to volunteering physicians.
When doctors have to pay their own extensive liability coverage for doing a good deed and bringing their services to a community health center, it’s no wonder that many can’t afford to do so.
The bipartisan authors of the Family Health Care Accessibility Act that won House Energy and Commerce passage, Representatives Gene Green (D-TX) and Tim Murphy (R-PA), say extending liability protections would let physicians provide coverage to 20 million Americans, 70 percent of them below the poverty line.
Legislation like this is particularly important when you consider that the number of people receiving care from community health centers is expected to double to 40 million by 2015.
This bill has been introduced twice in the last two years and failed to make it to the finish line both times. In 2008, it was cut from a community health center reauthorization bill in conference committee. Last year, it was incorporated into the House’s version of health reform legislation but not the Senate’s, and it was the Senate bill that went to the President this spring.
Anytime you get into tort reform issues, it becomes a sticky, sensitive political matter. On this legislation, though, it’s hard to make an argument that the medical liability status quo should stay intact if it means denying care to some of America’s most vulnerable citizens.
July 21, 2010
5:23 pm
Yesterday, the Arkansas surgeon general told a state legislative committee that the state’s physician shortage would be worsening once health reform is implemented. Dr. Joe Thompson testified that 80 to 90 percent of Arkansas’ 500,000 uninsured residents will become newly insured, most of them through an expansion of the Medicaid program. He emphasized that the state already has severe doctor shortages in its rural areas.
At the same time, Physicians News Digest is quoting a report by the New Jersey Council of Teaching Hospitals which projects that New Jersey will have a shortage of approximately 2,800 physicians (and as many as 3,250) by the year 2020. In New Jersey, health reform will add roughly 1.3 million patients to the newly-insured rolls. The Council projects severe shortages in primary care as well as neurosurgery and pediatric subspecialties.
We’re going to be hearing more warnings like these, most likely from every state. There’s no debating that addressing the uninsured problem in America is a good and necessary thing. But, we can’t be complacent in believing that expanded coverage necessarily leads to expanded access. It’s quite clear that our rapid increase in covered individuals is going to outpace the supply of physicians, nurses and other healthcare professionals able to provide care. As policymakers revisit health reform, which it inevitably will, addressing these shortages has to be an urgent priority.
July 09, 2010
2:44 pm
Let’s begin with a couple of basic truths.
First, that government-imposed price controls are antithetical to genuine, consumer-focused health reform. The only way to achievable sustainable reform that improves health outcomes and contains cost is through medical innovation, developing new treatments, technologies and medications to keep people healthier and making healthcare more cost-effective.
The second truth is that the health reform process taking place right now will not follow a simple linear path. Regulators and lawmakers will face a number of forks in the road and will have to make decisions that will determine the ultimate course of reform and the way patients and health providers will be affected.
With those premises in mind, it’s becoming increasingly clear that health reform at the national level must avoid some of the paths being taken by the state of Massachusetts.
A Wall Street Journal op-ed piece this week by Joseph Rago points out that while the Bay State has succeeded in its goal of achieving an insured populations (not counting those who are gaming the system by buying insurance, keeping it long enough to avoid state penalities, and then dumping it), cost containment has not been accomplished. Consequently, state politicians are trying to force costs down through government controls.
Governor Deval Patrick’s insurance commissioner has rejected the vast majority of requested premium increases submitted by state insurers. These increases are deemed necessary to cover expected claims, with health costs rising at eight percent annually. With these artificial price caps in place, insurers are essentially being forced to sell their products at a financial loss.
A state appeals board has reversed many of these price controls, saying they ignored “economic realities” – “economic realities” being the fact that three major insurers are now under administrative oversight because of concerns about their financial viability.
And now, the governor wants to extend this rate review process to cover hospitals and physician groups, which could effectively impose the same price controls on providers that are currently undermining health insurers. Also, as Rago points out, the state is using its “determination of need” process to restrict the use of certain medical technologies.
At a time when our population needs improved access to insurance, a growing supply of healthcare providers and medical innovation that can achieve long-term quality improvements and cost reductions, government price controls take us farther away from all of those goals.
What we’re learning from the Massachusetts experience is that there are certain roads that deserve to be less traveled.
CATEGORIES: