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 17, 2012
12:40 pm
There’s a very illuminating story in the newest edition of National Journal (no, I can’t link to the article because it’s subscription-only material, but I urge you to check out the Meghan McCarthy article “A Fair Share” on page 38) regarding the actual out-of-pocket healthcare costs for Medicare beneficiaries.
The President’s proposed budget, released this past Monday, calls for over $32 billion in new beneficiary costs over the next decade assessed in the form of higher co-pays, deductibles and premiums for higher-income seniors. (More on the President’s proposed Medicare provisions here.) As President Obama said last fall, he is asking “the wealthiest Americans…to pay their fair share.”
What Ms. McCarthy points out in her article is that seniors, without even accounting for any Obama-proposed increases, are already paying plenty for Medicare coverage. As she writes:
- Americans under 65 spend, according to the Kaiser Family Foundation, about three percent of their income on healthcare. Medicare beneficiaries spend 16 percent, and that figure is expected to reach 26 percent by 2020.
- Under the Affordable Care Act, private sector employees who pay more than 9.5 percent of their income for health insurance will qualify for coverage in a state exchange and possibly be eligible for premium subsidies. According to Kaiser, seniors were spending an average eight percent of their incomes on Medicare premiums in 2006 and had no access to competitive insurance exchanges or subsidies.
- The White House wants 25 percent of beneficiaries, or 19 million people, to pay higher Medicare premiums or “more of their fair share.” Kaiser, according to Ms. McCarthy, has estimated that this 25 percent threshold will affect people not typically considered wealthy.
The National Journal article gets right to the heart of the dilemma. Under Medicare’s current structure, there are limited options to achieve financial solvency. Ms. McCarthy wrote, “And without an alternative to Medicare’s fee-for-service system, the government is limited to cutting provider payments – which the president’s budget also does, or asking seniors to cough up extra cash.”
And that raises the question, should there be other options? More to the point, shouldn’t Medicare beneficiaries, who are paying plenty for their healthcare, have the same option under-65 consumers will soon enjoy to shop in a competitive exchange for the health plan that offers the best value for their particular health needs and status?
February 03, 2012
3:57 pm
Earlier this week, I posted in this space about the need for Congress to take the issue of entitlement reform seriously, and to avoid undermining serious discussion about proposals to improve Medicare with glib 30-second sound bites and attack ads during the upcoming campaign season.
But I only addressed half of the equation that is instrumental to constructive discussion on this issue. As a group of physicians serving in Congress pointed out this week, organizations representing the interests of different population groups also have critical roles to play in this dialogue.
In an open letter to AARP, 18 doctors serving in the House and Senate point out, accurately, that “the American people deserve a mature, informed and thoughtful conversation about how to save the Medicare program and shore up its financing.” They add that, absent reform, “AARP members aged 50-56 today – as well as future members – will see the end of Medicare as we know it.”
The doctors, in the letter, invite AARP to participate in publicly urging all members of Congress, regardless of political party, to “acknowledge the approaching insolvency of the Medicare trust fund and the program’s structural financing challenges.”
They’re right. Structural change to Medicare, which is necessary if we’re to achieve long-term sustainability while maintaining quality and innovation for patients, will face a steep uphill battle if influential interest groups marshal their resources in opposition. To the contrary, progress relies not just on officeholders, but also powerful advocacy groups, acknowledging that the status quo cannot be maintained and that change is necessary.
All of us who are engaged in healthcare policy advocacy bear this responsibility.
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