February 28, 2012
2:12 pm
Tomorrow (Wednesday, Feb. 29), the House Energy and Commerce health subcommittee is scheduled to vote on legislation that would repeal the Independent Payment Advisory Board (IPAB). IPAB is the provision within the Affordable Care Act health reform law that empowers a 15-member board of political appointees to make recommendations to cut Medicare spending, cuts that would take effect unless Congress provides its own alternative plan. It’s a startling transfer of authority from the legislative branch to the executive, without any judicial review to provide checks and balances.
The nation’s physicians have made it clear that they think IPAB is, to put it bluntly, a bad idea that will do more harm than good to Medicare beneficiaries.
On Monday, the American Medical Association sent a letter to the health subcommittee leadership, referring to the struggles Congress has had with the issue of Medicare payments to physicians, writing, “adding additional formulaic cuts through IPAB is just not rational and would be detrimental to patient care, especially as millions of Baby Boomers enter Medicare.”
And, prior to the AMA’s communication, a group of 24 medical specialty societies sent its own letter to the Energy and Commerce health subcommittee, sharing the concern that “the strict budgetary targets and other limits imposed on the IPAB will ultimately threaten the ability of our nation’s seniors and disabled to obtain the health care they need, when they need it.” The specialists added, “Leaving Medicare payment decisions in the hands of an unelected, unaccountable body with minimal congressional oversight will negatively affect timely access to quality health care.”
The physicians have diagnosed the system correctly. At a time in which Medicare needs structural reforms to continue providing quality care, but with an emphasis on value and cost-effectiveness, IPAB is a blunt instrument that will indiscriminately cut Medicare spending in a way that undermines both quality and patient access to care.
By the way, over 290 patient and health care organizations, including the Healthcare Leadership Council, have also sent a letter to Capitol Hill urging IPAB elimination.
Let’s hope tomorrow’s subcommittee markup is the first step toward repeal of an ill-conceived idea.
February 24, 2012
7:59 am
Massachusetts received the lion’s share of attention, but one other state had also created a health insurance exchange before Congress passed the Affordable Care Act health reform law. The Utah Health Exchange (UHE) is an experiment that warrants close watching.
The Utah approach is focused heavily on the value of consumer information. As the state’s lieutenant governor Greg Bell puts it, the UHE is an Internet-based portal. In his words, “It is a single shopping point where consumers can evaluate their options, and then brokers, agents and employers can share information.” This is a consumer-centered approach that has appeal to other states. In fact, U.S. Senator Tom Coburn (R-OK) recently recommended that his state adopt the Utah model.
At the Healthcare Leadership Council, we’ve witnessed firsthand the benefits of equipping consumers with comparative health insurance information. When we launched an initiative called Health Access America a few years ago, we commissioned public opinion research that found 50 percent of uninsured Americans had no idea how or where to find information on health plan benefits and costs. By setting up web-based portals that allowed consumers to compare different plans, we saw a difference in the number of people purchasing health coverage.
It will be interesting to see statistics emerging from Utah in terms of the impact consumer-friendly information has on insurance acquisition without an individual mandate (a key difference between the Massachusetts and Utah approaches to health reform) and how head-to-head competition between plans in the web-based exchange affects coverage cost and value.
December 07, 2011
1:15 pm
There are numerous concerns these days about the nation’s supply of medical professionals to meet America’s growing elderly population as well as the millions of citizens who will gain health coverage when the Affordable Care Act is fully implemented. How will the healthcare workforce meet this rising patient demand?
We received good news this week regarding the supply of nurses. A RAND study shows that the number of young nurses – registered nurses between the ages of 23 and 26 – has grown by 62 percent between 2002 and 2009. This reverses a course projected back in 2000 by a study in the Journal of the American Medical Association, which said the U.S. would have a 20 percent shortfall in the supply of nurses by 2020.
Dr. Peter Buerhaus of the Vanderbilt School of Nursing (Colleen Conway-Welch, the nursing school’s dean, is a Healthcare Leadership Council member) was one of the authors of the earlier JAMA study and told Nashville Public Radio that he’s no longer worried about a nursing shortage. He credited more colleges adding nursing programs and successful initiatives raising awareness about personnel shortages and job openings in the nursing field.
Certainly programs like Johnson & Johnson’s Discover Nursing initiative have been extremely helpful in both pointing out the employment opportunities, available scholarships and job satisfaction in the nursing field.
This doesn’t ease all of our concerns about healthcare workforce shortages, but at least it’s a solid and important step in the right direction.
October 28, 2011
9:38 am
As a study published in Health Affairs this week points out, anyone who believes they have a handle on what will happen when Medicaid undergoes an unprecedented expansion this decade is kidding themselves.
The study by a trio of professors at Harvard University’s School of Public Health shows a huge possible variation in the number of low-income Americans who enroll in Medicaid once eligibility is expanded in 2014 to include anyone below 138 percent of the federal poverty level. The expansion, according to the researchers, could be as low as 8.5 million individuals or as high as 22.4 million, with a range of possible federal spending increases from $34 billion to $98 billion annually.
What I find particularly interesting about this study, though, is the projected impact on healthcare utilization. Because Medicaid has lower cost-sharing than private insurance, there is an expected increase in the demand for health services among those who move from private plans to Medicaid once eligibility levels change. Between the larger Medicaid population and this increased utilization, the Harvard researchers say the U.S. will need anywhere from 4,500 to 12,100 additional physicians to care for new Medicaid patients.
Here’s a critical passage in the report:
“These changes may pose major challenges in healthcare access because in recent years an increasing number of physicians have stopped accepting Medicaid patients. The Affordable Care Act does provide enhanced Medicaid reimbursement to primary care clinicians for 2013-2014, but this may not be enough to ensure an adequate supply of providers for new Medicaid patients.”
Some of us have continued to argue that coverage does not necessarily mean access. It is, without question, vitally important to provide coverage for the nation’s uninsured population, but it’s still an open question as to whether Medicaid expansion is the most effective tool for doing so.
August 22, 2011
12:31 am
When we talk about people who don’t have access to healthcare, there’s a natural assumption that it’s because they can’t afford it. A new study shows that’s not necessarily the case.
According to the study published in the journal Health Services Research, 21 percent of American adults said they had delayed care for non-financial reasons compared to 19 percent that cited cost as the primary reason for not seeking healthcare.
Those non-financial reasons included not being able to get to a doctor’s office during working hours, long commutes to the medical office, or not being able to get an appointment soon enough. As the study’s lead author said, “In reality, there are all kinds of reasons why people can’t get the care they need when they need it.”
There are at least a couple of important points to take from this report. One is that healthcare providers have to continue exploring creative ways, from telemedicine to non-traditional office hours, to meet the needs of today’s patient population.
More importantly, though, as we’ve said often over the past several months, coverage and access are not synonymous with each other. The Affordable Care Act makes health coverage available to all Americans, but that doesn’t mean that all of these newly-insured patients will have easy access to quality care. If some patients today, as the study indicates, have difficulty getting an immediate appointment with a physician, that problem may only worsen when an influx of new patients, the aging of the baby boom generation and a future shortage of healthcare professionals converge.
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In a post in this column last week, we mentioned that Texas Governor Rick Perry’s candidacy for the presidency may help ignite a national debate over medical liability reform, since Texas has adopted one of the most effective tort reform measures in the country.
It didn’t take long for those battle lines to be drawn. Politico is reporting today that the nation’s trial attorneys are ready to dig deeply into their pockets to make sure Perry is defeated.
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