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.
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 07, 2010
7:49 am
We’re not going to comment in this space on the political wisdom of President Obama’s decision use a recess appointment to install Dr. Donald Berwick as head of the Centers for Medicare and Medicaid Services, thus bypassing the Senate confirmation process. What was certain to be a contentious confirmation debate will now be a contentious debacle on cable talk shows over the merits of using recess appointments for controversial nominees.
We’ll elect not to engage in that particular crossfire. Instead, we want to offer Dr. Berwick not only best wishes in his new position but, more importantly, the advice, counsel and support of leaders from all sectors of American healthcare.
Dr. Berwick has a big job in front of him. Not only has CMS been without a permanent head for far too long, since 2006, but Dr. Berwick will find himself as a point person in the implementation of health reform. CMS will be in the center of one of the most essential components of reform, achieving progress in changing our healthcare delivery and payment systems to focus on quality and value. Fortunately, as HLC members know from our meetings with him, this is a topic on which Dr. Berwick has profound expertise and unbridled enthusiasm.
Making headway on healthcare delivery reform will depend, in large part, on building upon the successes that private sector health providers have already achieved. We stand ready to share these examples with Dr. Berwick and his CMS team and to collaborate with him in moving toward an innovative, consumer-centered, results oriented healthcare system.
July 01, 2010
12:15 pm
The new health reform law mandated that, by July 1, 2010, the federal government create a website to help consumers better understand their health coverage options. That site, healthcare.gov, went live on the Internet this morning.
The site is structured so that people in every state can answer some basic questions about themselves and their healthcare needs and then receive a list of potential options for acquiring some form of health coverage. The Department of Health and Human Services collected information from over 1,000 insurers as well as the Medicaid and Children’s Health Insurance Program in each state in order to create the site’s database. Healthcare.gov also has information on wellness and prevention as well as basic facts about the new health reform law.
HHS has also set up a Twitter feed at @healthcaregov as well as a YouTube site with information videos.
More on the site is found in this story on Politics Daily.
I haven’t had the opportunity to try out the site long enough to test its easy of usage or the breadth of its information, but I applaud HHS for getting the website up and running in such relatively quick time after the passage of health reform legislation. We know from experience with the Medicare Part D planfinder website that it takes time to work out the kinks and create a Web platform that the public can easily understand and access. The federal government has plenty of time to make these improvements before the new health insurance exchanges start in 2014.
May 03, 2010
3:25 pm
One of the concerns about using Medicaid expansion, as is the case in the new health reform law, to reduce the nation’s uninsured population is the belief that many physicians won’t see Medicaid patients because of the program’s very low reimbursement rates.
Now, we have new numbers to underscore that worry.
A new survey published today by the American Medical News, a publication of the American Medical Association, found that even with the higher Medicaid primary care reimbursements for 2013 and 2014 that was included in health reform legislation, new Medicaid patients will have difficulty finding a regular physician. Among the survey findings:
· 10 percent of primary care physicians believe new Medicaid enrollees in their area will have trouble finding a suitable primary care doctor.
· 49% of primary care doctors would be willing to see new Medicaid patients if Medicaid rates reached the same level as Medicare, 47% would not.
· 81% of primary care doctors would see new Medicaid patients if rates reached private insurance levels.
This survey, conducted by United Health Group’s Center for Health Reform and Modernization, reminds us that coverage does not necessarily equal access. This situation will bear monitoring to ensure that our nation’s uninsured crisis doesn’t simply transform into a growing healthcare access problem because of Medicaid’s inherent limitations.
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