April 06, 2011
2:48 pm
Before we get too far along in the week, I didn’t want to miss the opportunity to highlight an article by Robert Pear of the New York Times that appeared in the newspaper’s Monday edition. Mr. Pear went to Louisiana to see firsthand the scope, or lack thereof, of healthcare services available to Medicaid patients. If you’re concerned about the ability of our healthcare system to adequately serve at least 15 million new Medicaid beneficiaries as a result of health reform, this article won’t alleviate your worries.
The thrust of the Pear article is that states are making cuts in their Medicaid programs in order to balance their budget, and that these cuts are making it more difficult for patients to get the services they need, particularly if they need to see a specialist of some kind.
This is not a new problem, though, but an exacerbation of an already-existing one. There were already a significant number of physicians that do not see Medicaid patients because of the program’s comparatively small provider payments, lower than Medicare and substantially lower than private insurance plans.
For his story, Mr. Pear interviewed a woman in Opelousas, LA because of three herniated discs in her neck that require surgery. She can’t, however, find a surgeon that will take her because she is a Medicaid patient. Holding up her Medicaid card, she said, “It’s a useless piece of plastic. I can’t find an orthopedic surgeon or a pain management doctor who will accept Medicaid.”
The new health reform law allows states to cut their Medicaid budget, but they can’t touch eligibility for the program. That means cuts are going to come either through further reductions in provider payments or by limiting the scope of services beneficiaries can receive.
A critical goal of health reform is to make certain that all Americans have access to quality healthcare. The Medicaid issue is one that remains to be addressed if this objective is to be met.
March 24, 2011
1:19 pm
There has been much ado made this week over the one year anniversary of the passage of the Affordable Care Act. And, just as was the case a year ago, controversy continues to rage over health reform. Polls show the public continues to be divided on the issue and Congress is in a partisan deadlock over what the next steps should be in, depending on your point of view, ACA implementation, repeal or defunding.
This post isn’t about the controversy or the debate.
Instead, I want to call attention to one of the indisputably positive provisions of the health reform measure. This week, the Center for Medicare and Medicaid Innovation (CMMI), created through the Affordable Care Act, launched its new website. It’s more than just an informational site. In fact, it’s a portal through which all participants in the healthcare system can submit ideas on how to improve U.S. healthcare to improve both quality and cost-effectiveness. That’s the purpose of CMMI — to test new ideas aimed at providing better patient care in a more sustainable way. It’s one of the aspects of health reform that, I believe, should be preserved and utilized to the fullest extent.
In fact, members of the Healthcare Leadership Council have already provided several examples of practices, tools and technologies that are, in fact, addressing both the quality and affordability of care. We provided these to CMS administrator Don Berwick in the form of our HLC Value Compendium. We’re working on an expanded volume of that compendium now with more metrics-supported case studies, as well as a Wellness Compendium with information on how HLC member companies and organizations are promoting better health and preventing disease.
The controversy over health reform will undoubtedly continue to rage on for some time. Let’s just keep the quest for ideas on how to improve our healthcare system outside of the firing zone.
February 15, 2011
11:35 am
Now that gasoline is over three dollars a gallon, I wince a little every time I fill up my car. It would be nice to have the power to simply decree that gas prices be 50 cents lower, but I understand that my pocketbook preferences do not take precedence over basic marketplace factors that range from the cost of oil exploration to rising energy demand in China and India.
There is still an insistence on the part of some, though, that governments should set healthcare prices (more than is already the case in Medicare and Medicaid), regardless of actual cost of producing and delivering healthcare goods and services.
This issue arises because of a report from Boston’s National Public Radio affiliate, WBUR-FM, that the Massachusetts Governor may ask the state legislature for the authority to set the rates that hospitals can charge. That authority would kick in if, after three years, hospitals are requesting increases of more than two percent.
This idea of government setting prices is, of course, neither new nor limited to the Bay State. During the debate over health reform, proponents of a government-run health insurance option cited Medicare as a model of “efficiency” because it establishes the payment levels that physicians and hospitals can receive. That’s fiat, not efficiency. Similarly, there are constantly proposals bandied about to affix price ceilings to virtually every healthcare sector from insurers to pharmaceuticals to medical devices. That’s also the problem with the Independent Payment Advisory Board, scheduled to be implemented as part of the Affordable Care Act. It’s an entity empowered to slash healthcare spending without regard to achieving greater quality or value.
The problem with having government simply decree what any one sector may charge for its services is that this approach ignores the interrelationship between insurers, providers, manufacturers and consumers in determining the value of healthcare services. It also undermines the ability of health system participants to provide greater value through innovation.
There’s no question that we do need to focus on improving healthcare’s affordability. The way to do that, though, is through new, innovative health delivery mechanisms, a greater reliance on evidence-based medicine, a more intense focus on wellness and prevention and strengthening the ability of consumers to be discerning healthcare shoppers.
For government to simply declare that certain prices must be lower may bring a measure of short-term relief, but there’s a price to be paid, whether it’s in the form of cost-shifting, reduced access, impaired quality or less innovation. Just saying a cost is lower isn’t the same as actually making it lower through marketplace mechanisms or greater ingenuity.
November 29, 2010
12:23 pm
Some in the news media are simply determined to portray the healthcare industry, or at least individual sectors of it, as strident opponents of health reform, no matter how strongly the facts state otherwise.
A recent example came earlier this month when CIGNA CEO David Cordani spoke at a Reuters health conference and said that he did not think it was in “society’s best interest to expend energy on repealing the (health reform) law.” That led to a series of articles expressing various degrees of surprise that health insurers weren’t actively trying to repeal the Affordable Care Act.
It would be nice to get this straight, once and for all. No sector of the healthcare industry – and I feel safe in making this assertion since the membership of the Healthcare Leadership Council includes companies from virtually every sector – has stood against comprehensive improvement of the U.S. healthcare system or against making certain every American has access to affordable health coverage.
Too often, news reports wrongly describe disagreements about aspects of the new health reform law as outright opposition. We don’t agree, for example, that expanding Medicaid is the best means for reducing the uninsured population, and we have concerns about the impact of the forthcoming Independent Payment Advisory Board. But neither the HLC nor any other major healthcare association has asserted that the status quo should be preserved.
In fact, it’s often forgotten that leaders from the health insurance industry were calling for reform and a fully-insured American even before President Obama moved into the White House.
To this day, health industry leaders are working to improve the reform law, at the risk of having these actions described as trying to oppose it, repeal it, or undermine it. In actuality, we have deep concerns over any steps that would repeal mechanisms to have more people acquire health insurance, while keeping intact the Affordable Care Act’s health insurance system reforms. That would cause extreme market instability and harmful price increases.
So, next time a health industry leader gives a speech in which they say they’re not in favor of repealing the health reform law, let’s not treat it as a man-bites-dog story, ok?
November 08, 2010
4:26 pm
…to hold, that is, the entirety of the health reform debate.
While Republicans and Democrats on Capitol Hill are still sorting out the reverberations from last Tuesday’s elections and what it means in terms of legislative strategies to repeal or pare back the Affordable Care Act, it’s becoming increasingly clear that the states are going to play their own important role in this process.
Texas state legislators, for example, are contemplating dropping out of the Medicaid program and instead creating their own state-run healthcare program for low-income citizens. This is no idle rhetoric. The Texas Health and Human Services Commission is going to release a study within the next couple of months on the effects of ending the state’s Medicaid participation, and the Heritage Foundation has already weighed in with a study estimating that Texas could save $60 billion between 2013 and 2019 by withdrawing from Medicaid and the Children’s Health Insurance Program.
This isn’t a step that Texas can take lightly. If a state-run alternative is a smaller, leaner version of Medicaid, hospital emergency rooms in the state could see an escalation in the number of Texas using the ER as a healthcare access point. Yet, the fact the debate is occurring shows the concerns states have about the Medicaid expansion that is a centerpiece of the Affordable Care Act. Texas legislators said that, with the federal government tying their hands on the ability to change eligibility or benefit structures, the program will become increasingly unaffordable.
And with Republicans taking over more governorships and state legislative bodies in 2011, it’s very likely that the GOP will flex its muscles on state-level implementation issues, such as those affecting the creation of health insurance exchanges. This was the subject of a discussion on CNN’s State of the Union program this weekend with outgoing Minnesota Governor Tim Pawlenty (R) and re-elected Texas Governor Rick Perry (R). They made it clear that Republican leaders beyond the Beltway won’t stand on the sidelines when the health reform fight re-ignites.
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