March 14, 2012
1:47 pm
There was a disturbing juxtaposition of news items this week.
First, the Congressional Budget Office came out with new forecasts showing that, under health reform, the number of Americans enrolled in the Medicaid program will be even greater than expected. Even before these new numbers emerged, it was estimated that more than 15 million Americans would be moved into the Medicaid program because of the new eligibility thresholds established by the Patient Protection and Affordable Care Act.
We saw a preview of the potential impact of Medicaid expansion through a study issued by the Annals of Emergency Medicine. The study, authored by Dr. Atil Ginde of the University of Colorado School of Medicine, found that, between 1999 and 2009, 39.6 percent of Medicaid patients visited an emergency room compared to just 17.7 percent of privately insured patients.
The reason, Dr. Ginde determined, that Medicaid patients are more than twice as likely to be in an ER is because not only are they in poorer health generally, but they are less likely to be seeing a primary care physician. This situation is not likely to improve once health reform is fully implemented. In fact, it could severely worsen. As Dr. Ginde put it, “Our findings are particularly worrisome in light of the additional 16 million people who will be added to the Medicaid rolls over the next decade. The shortage of primary care providers in the U.S. seems to affect Medicaid patients disproportionately and more harshly.”
And, I would add, Medicaid’s significantly lower reimbursement rates compared to private insurance make it even more difficult for physicians to see Medicaid patients.
If the CBO trends, showing fewer people receiving employer-based private coverage and more individuals enrolled in Medicaid, continue, policymakers are going to have to revisit the mechanisms being used to provide Americans with health coverage.
March 08, 2012
3:32 pm
We’re all concerned about how our healthcare workforces will keep up with an increasing patient population. Not only is Medicare growing at the rate of 7,500 new beneficiaries per day, but the Affordable Care Act will lead to millions more Americans having health coverage when fully implemented.
We’re seeing one answer in the form of technology that is helping to reduce hospital readmissions and enable health facilities to evaluate patient conditions and needs without requiring them to come to the doctor’s office.
This week, the Geisinger Health Plan and AMC Health announced the results of a two-year evaluation of a telemonitoring program developed by AMC. Geisinger found that home telemonitoring of patients with congestive heart failure reduced 30-day hospital readmission rates by more than 40 percent.
Here’s how the system works. Patients receive scheduled calls from an interactive voice response system. The patients report their symptoms, with those responses immediately stored in their electronic health record and evaluated. A determination is made whether the patient needs a follow-up with a nurse or a case manager. 96 percent of the Geisinger case managers said the system was allowing them to monitor heart failure patients more effectively.
This also bolsters our argument that there are better ways to address healthcare’s cost issues than simply axing dollars out of the system and consequently reducing patient access and care quality. There are technological solutions, as shown in this innovative work by AMC Health and Geisinger, that can make the system more cost-effective while providing even better care to patients.
March 02, 2012
2:34 pm
Following the House Energy and Commerce health subcommittee’s 17-5 bipartisan vote on Wednesday to repeal the Independent Payment Advisory Board (IPAB), there has been some important commentary on the issue worth spotlighting.
The National Minority Quality Forum pointed out that IPAB – the 15-member appointed board that will be empowered to cut Medicare spending – could endanger necessary investments in healthcare research and delivery.
A seniors’ organization, RetireSafe, made it clear that IPAB will do tremendous “collateral damage to Medicare beneficiaries.”
Former Congressional Budget Office Director Douglas Holtz-Eakin co-authored an op-ed in Real Clear Politics, pointing out that IPAB will cause more healthcare providers to cease accepting Medicare patients.
We’ll have more on this issue in the very near future. The House Ways and Means health subcommittee will have a hearing on the IPAB issue on Tuesday, March 6 at 10 a.m. We will be planning to live-tweet that hearing at @HealthInFocus.
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.
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