Tag: Medicare

Myths and reality about Medicare and Medicaid

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A pair of recent studies use evidence to challenge two widely held beliefs, namely that undocumented immigrants are draining the Medicare trust fund and Medicaid provides poor quality medical care.

In the first instance, a study conducted by investigators from Harvard Medical School and the City University of New York and published online in mid-June by the Journal of General Internal Medicine, found that undocumented immigrants pay more into the Medicare Hospital Insurance Trust Fund than they take out.

The second study, released June 25 and conducted by researchers at The Commonwealth Fund, found that in 2014, 95% of Medicaid patients who were covered all year had a regular doctor, and 55% said they received excellent or very good care.

“I think this underscores the need for evidence-based policymaking,” Sara Collins, PhD…a co-author of the organization’s study told MedPage Today. “It’s important that everyone look at the data that’s available.”

Between 2000 and 2011, unauthorized immigrants generated a substantial surplus for the Medicare Trust Fund — $35 billion, according to the Harvard study. That ranges to between $2.2 billion and $3.8 billion per year, or $316 per capita for that population, compared with $106 per capita for the rest of the American population…

On the Medicaid side of the equation, according to the Commonwealth Fund report…Medicaid patients ages 19-64 had similar experiences to people with private insurance and were in far better circumstances than those who lacked insurance altogether. Among the uninsured, the survey found, 77% of people reported having a regular doctor, with only 40% saying they received good care.

“There’s some conventional wisdom that Medicaid is not very good coverage, but this shows how well Medicaid does in enabling people to protect themselves,” Collins said. “It may be a surprise to many, but these figures do demonstrate that it’s certainly better to have Medicaid than to have no coverage at all.”…

Perhaps most telling, 19% of Medicaid beneficiaries reported having some kind of issue related to paying medical bills. About one-third of people with private insurance – and 47% of uninsured – reported the similar struggles.

Given the still-controversial Medicaid expansion called for by the Affordable Care Act, and the beating Medicaid coverage has taken in some quarters as a result, the survey findings call for a fresh look at what Medicaid really delivers, Collins said…

I hope you’re not surprised that evidence and data-driven analysis reveals a more positive outlook than conventional wisdom or conservative ideology. Now, let’s make it even better!

Expansion of Medicare to all citizens within a single-payer system reduces costs by cutting out the insurance industry slice of the pie. Congress isn’t likely to have the courage for that. But, the experience of Social Security – with operating costs about 80% cheaper than anything the insurance industry offers – proves the possibility.

The same holds true for Medicaid. And I may as well throw in my favorite criticism of the provisions as designed by Congress. There is no legitimate reason preventing taxpayers in general from enjoying the same fixed, government-negotiated rates for prescription drugs that are offered members of the armed services.

Hospitals buy up doctors’ practices — we get screwed with higher charges

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Imagine you’re a Medicare patient, and you go to your doctor for an ultrasound of your heart one month. Medicare pays your doctor’s office $189, and you pay about 20 percent of that bill as a co-payment.

Then, the next month, your doctor’s practice has been bought by the local hospital. You go to the same building and get the same test from the same doctor, but suddenly the price has shot up to $453, as has your share of the bill.

Patients around the country are getting that unpleasant surprise, as more and more doctors’ offices are being bought by hospitals. Medicare, the government health insurance program for those 65 and over or the disabled, pays one price to independent doctors and another to doctors who work for large health systems — even if they are performing the exact same service in the exact same place.

This week, the Obama administration recommended a change to eliminate much of that gap. Despite expected protests from hospitals and doctors, the idea has a chance of being adopted because it would yield huge savings for Medicare and patients.

In the dry language of the annual budget, the White House asks Congress to “encourage efficient care by improving incentives to provide care in the most appropriate ambulatory setting.” In normal English, that means reducing financial incentives that are causing many doctors to sell their practices to hospitals just to take advantage of extra revenue.

The heart doctors are a great example. In 2009, the federal government cut back on what it paid to cardiologists in private practice who offered certain tests to their patients. Medicare determined that the tests, which made up about 30 percent of a typical cardiologist’s revenue, cost more than was justified, and there was evidence that some doctors were overusing them. Suddenly, Medicare paid about a third less than it had before.

But the government didn’t cut what it paid cardiologists who worked for a hospital and provided the same test. It actually paid those doctors more, because the payment systems were completely separate. In general, Medicare assumes that hospital care is by definition more expensive to provide than office-based care.

You can imagine the result: Over the past five years, the number of cardiologists in private practice has plummeted as more and more doctors sold their practices to nearby hospitals that weren’t subject to the new cuts. Between 2007 and 2012, the number of cardiologists working for hospitals more than tripled, according to a survey from the American College of Cardiology, while the percentage working in private practice fell to 36 percent from 59 percent. At the time of the survey, an additional 31 percent of practices were either in the midst of merger talks or considering it. The group’s former chief operating officer once described the shift to me as “like a migration of wildebeests.”

Cardiologists are not the only doctors who have been migrating toward hospital practice. In the last few years, there have been increases in the number of doctors working for hospitals across the specialties. And spreads between fees for office services exist in an array of medical services, down to the basic office visit.

RTFA for more disheartening details. The crux remains, Obama and Congress in those first couple of years managed to get changes through to lower costs for some healthcare. The lawyers, lobbyists and other professional creeps working for the medical-industrial complex figured out a way around the changes – and increased profits to boot. Doctors around the country lined up to join the money parade. Not all of them. There remains a principled class in the corner here and there.

But, who noticed the changes? Who did anything about it? Certainly not Congress. They may be elected to represent the people of America, every state; but, they only listen to the Sound of Money riffling into their bank accounts.

It’s taken Obama till the last half of his second term to stand up and notice the change, propose new legislation to sort the problem. How much of a chance do you think we have of getting regulations through a Congress controlled by greenback conservatives, both Republican and Democrat – and restore a human focus to healthcare and family practice?

Health care is getting more affordable — see that on the local news, yet?

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Every two years, the Commonwealth Fund surveys Americans on how difficult it is to afford medical care. The 2014 survey showed something new: for the first time in a decade, the number of Americans who say they can afford the health care they need went up.

The Commonwealth Fund fielded the survey during the second half of 2014, meaning they captured the people who signed up for Obamacare during the open enrollment period earlier in the year. And it showed, for the first time in the survey’s 10-year history, a decline in the number of Americans who reported having difficulty paying medical bills or who carried medical debt.

The Commonwealth Fund also looked at Americans who said they put off care because it was too expensive. And there, too, they saw a decline: 36 percent of Americans reported delaying care because of the price, an all-time low in the survey’s history.

This also coincided with an increase in the number of Americans who reported having health insurance, a finding that lines up with other national surveys on coverage.

In a way, it seems obvious that more people with health insurance would mean more Americans able to afford care. But that notion hasn’t always been taken for granted with Obamacare. Some of the plans sold on the new marketplaces have had especially narrow networks that limit coverage to a smaller set of doctors. These plans have also had particularly high deductibles, often over $2,000.

So it hasn’t been totally clear whether these plans would make it easier for Americans to afford coverage: would enrollees with a $2,000 deductible, for example, still find it too expensive to go to the doctor?

The Commonwealth Fund survey suggests that the answer is no: that the plans sold on the marketplace are making it easier for the people who buy them to see the doctor — which is one of the main points of having health insurance to begin with.

Makes sense to me. My Medicare Advantage has gone up a very small percentage; but, I’m entering the second year with a new provider – and all the insurance companies seem to play the same game of lowballing the first year.

The few other folks and family members I chatted with on the topic – admittedly a short sample – all agree with the article.

Medicaid rolls surge under Obamacare

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bilde

In Idaho, the number of people who signed up for Medicaid has jumped by 13.4 percent. In Georgia, it’s up 12.9 percent. In North Carolina, the rate has climbed 12.4 percent.

None of those states opted to expand their Medicaid programs as part of the Affordable Care Act, but all have seen substantial enrollment increases in state health insurance.

The explanation for the change is a phenomenon sometimes called the woodwork effect or the “welcome mat effect.” I’ve written about the idea before: Essentially, people who were always eligible for a public program will often enroll when there’s publicity about an expansion. That’s what appears to have happened with the Affordable Care Act. Even though state policy wasn’t changing everywhere, all the talk about new health insurance options and the resources devoted to helping people sign up led to a surge among people who had always been eligible for the program.

Altogether, enrollment in the nonexpansion group of states has increased by 6.8 percent, or about 1.5 million people.

Guaranteed to piss off Republicans who hate the working poor.

Of course, the increases in states that have expanded Medicaid are more extreme. In Kentucky, the state with the biggest increase, the Medicaid rolls have grown by 71 percent. Overall, states that expanded Medicaid saw substantially larger reductions in the number of people without health insurance. If every state had expanded, we could expect many more people to be insured through the program…

The Obamacare law didn’t make anyone new eligible for these states’ Medicaid programs, but the publicity around the act encouraged more people to sign up.

Perish the thought that the uninsured gain some level of healthcare insurance. What is the nation ever coming to – when working people get something worthwhile for their tax dollars. How can the Koch Bros. sleep at night?

The Medicare “miracle” arrives as expected, on time

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So, what do you think about those Medicare numbers? What, you haven’t heard about them? Well, they haven’t been front-page news. But something remarkable has been happening on the health-spending front, and it should (but probably won’t) transform a lot of our political debate…

…A funny thing has happened: Health spending has slowed sharply, and it’s already well below projections made just a few years ago. The falloff has been especially pronounced in Medicare, which is spending $1,000 less per beneficiary than the Congressional Budget Office projected just four years ago…

First, our supposed fiscal crisis has been postponed, perhaps indefinitely. The federal government is still running deficits, but they’re way down. True, the red ink is still likely to swell again in a few years, if only because more baby boomers will retire and start collecting benefits; but, these days, projections of federal debt as a percentage of G.D.P. show it creeping up rather than soaring. We’ll probably have to raise more revenue eventually, but the long-term fiscal gap now looks much more manageable than the deficit scolds would have you believe.

Second, the slowdown in Medicare helps refute one common explanation of the health-cost slowdown: that it’s mainly the product of a depressed economy, and that spending will surge again once the economy recovers. That could explain low private spending, but Medicare is a government program, and shouldn’t be affected by the recession. In other words, the good news on health costs is for real…

But what accounts for this good news? The third big implication of the Medicare cost miracle is that everything the usual suspects have been saying about fiscal responsibility is wrong…

It turns out, however, that raising the Medicare age would hardly save any money. Meanwhile, Medicare is spending much less than expected, and those Obamacare cost-saving measures are at least part of the story. The conventional wisdom on what is and isn’t serious is completely wrong…

What’s the moral here? For years, pundits and politicians have insisted that guaranteed health care is an impossible dream, even though every other advanced country has it. Covering the uninsured was supposed to be unaffordable; Medicare as we know it was supposed to be unsustainable. But it turns out that incremental steps to improve incentives and reduce costs can achieve a lot, and covering the uninsured isn’t hard at all.

RTFA, wander through some of the details.

Please, understand that this nation is also capable of implementing the single-payer system that every sensible nation already has in place. Just like the sudden “solution” to a percentage of school loan debt – you don’t need a middleman to process the paperwork. Funneling compensation through insurance companies is like funneling government loans through banks. You only add a additional layer of profit on top of what’s necessary – to reward corporations for adding nothing of value.

Palliative care, end-of-life counseling moves forward even if politicians don’t

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Pain

Five years after it exploded into a political conflagration over “death panels,” the issue of paying doctors to talk to patients about end-of-life care is making a comeback, and such sessions may be covered for the 50 million Americans on Medicare as early as next year.

Bypassing the political process, private insurers have begun reimbursing doctors for these “advance care planning” conversations as interest in them rises along with the number of aging Americans. People are living longer with illnesses, and many want more input into how they will spend their final days, including whether they want to die at home or in the hospital, and whether they want full-fledged life-sustaining treatment, just pain relief or something in between. Some states, including Colorado and Oregon, recently began covering the sessions for Medicaid patients.

But far more significant, Medicare may begin covering end-of-life discussions next year if it approves a recent request from the American Medical Association, the country’s largest association of physicians and medical students. One of the A.M.A.’s roles is to create billing codes for medical services, codes used by doctors, hospitals and insurers. It recently created codes for end-of-life conversations and submitted them to Medicare.

The Centers for Medicare and Medicaid Services, which runs Medicare, would not discuss whether it will agree to cover end-of-life discussions; its decision is expected this fall. But the agency often adopts A.M.A. recommendations, which are developed in meetings attended by its representatives…and discussion with bible-thumping populist idjits is useless as ever. Why waste the time?…

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New Obamacare customers are happy

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We’ve known for a few months now that lots of people signed up for health insurance this year in new marketplaces. A new survey shows that the people who did so are also pretty happy with their purchases.

The survey, from the Commonwealth Fund, a research group, came to similar conclusions as other surveys about the expansion of health insurance. It found that about 15 percent of adults younger than 65 now lack health insurance, down from 20 percent before the Affordable Care Act rolled out in January.

What was more surprising is that people who got the new coverage were generally happy with the product. Overall, 73 percent of people who bought health plans and 87 percent of those who signed up for Medicaid said they were somewhat or very satisfied with their new health insurance. Seventy-four percent of newly insured Republicans liked their plans. Even 77 percent of people who had insurance before — including members of the much-publicized group whose plans got canceled last year — were happy with their new coverage.

Larry Levitt, the senior vice president for special initiatives at the Kaiser Family Foundation, another research group that polls on the Affordable Care Act, said he wasn’t sure we’d see such high satisfaction so early…

The Commonwealth poll appears to be the first national survey since the health-law passed to have gone beyond questions about insurance status and asked about satisfaction and usage.

Of course, since the article appears in the newest copout version of the NY TIMES, they meet the editorial requirement of stuffing the end of the article with beaucoup “what-ifs” just in case you might take a positive view – of a positive poll.

Perish the thought that changing times, a wee bit of change in politics as usual, might support even further movement in a population world-reknowned for ennui.

RTFA for more good news about legislation that benefits 99.9% of this nation.

Obamacare does at least 21 things that you may not know about

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Obamacare is the law that extends health insurance coverage to millions of Americans.

It is also the law that requires restaurants to post calorie labels, employers to provide adequate break times for breast feeding and starts funding programs meant to train people for adulthood (seriously).

Tucked inside the Affordable Care Act’s 2,000 pages of legislation are hundreds of new programs that have little, if anything, to do expanding insurance coverage. Some are pet favorites of legislators, who tacked a tiny provision into a very large law. Others raise small amounts of revenue to help pay for the insurance expansion. And others are just… weird. There are 21 programs that are, indeed, part of Obamacare.

1. Obamacare makes funds available for “training for adulthood.” True story…

2. And it imposes a 10 percent tax on indoor tanning…

5. Discrimination against plans and providers not offering assisted suicide is explicitly prohibited.

Physician-assisted suicide is an incredibly controversial topic, and different states have different laws about the practice. A federal law in 1997 prohibited federal funds appropriated by Congress from being used to pay for assisted suicide.

Accordingly, the Affordable Care Act contains language prohibiting discrimination against insurance plans and health care providers who refuse to provide physician-assisted suicide. The law appears to be silent on whether insurers discriminate against providers who do offer physician-assisted suicide.

6. The law authorizes funding for grants that target postpartum depression.

The Secretary of HHS is authorized to make grants available for treating individuals who have postpartum depression and psychosis (conditions that occur in women following childbirth). The law also encourages the National Institute of Mental Health to conduct long-term study from 2010-2019 on how pregnancy affects women’s mental health…

7. And it created the Elder Justice Act.

Over 500,000 elderly adults are victims of “elder abuse”—this can take the form of physical, sexual, or psychological abuse, as well as neglect, abandonment, and financial exploitation. As the Boomers reach retirement age and the population’s share of elderly individuals grows, so will this problem…

13. Employers are required to provide reasonable break time for nursing mothers.

Employers must provide a reasonable amount of break time — and a private place that isn’t a bathroom — for an employee to express breast milk for up to one year after giving birth. Breastfeeding the first six months, at a minimum, is recommended by the American Academy of Pediatrics. Prior to health reform, there was no federal law that protected nursing mothers; state laws on the issue tended to be very general…

19. It’s easier for students going into primary care and nursing to get loans.

There is a shortage of doctors who practice primary care, which has been attributed to the high cost of medical school and the low compensation for primary care physicians (relative to physicians who specialize). Health reform eased several rules that govern federal loans to medical students who commit to practicing primary care…

Loan limitations have been used by the Feds – at the behest of the American Medical Association – for decades to limit the number of doctors in the United States. An outdated guild solution guaranteeing the highest income in the world for doctors. Like any Congressional mandate it is out-of-date and the Party of NO wasn’t about to respond even to requests from the AMA to join the 21st Century.

Obamacare will significantly increase the number of people with health insurance coverage. It does that by overhauling the individual insurance market — where people buy their own policies — and expanding Medicaid, a public program that covers low-income Americans.

Like the best of legislation coming from Washington DC, Obamacare supersedes much of States Rights. That credo being the last resort of reactionaries especially those of the Confederate persuasion. Fools who fear modern practices simply because they aren’t what granddad enjoyed adore States Rights. Racists adore States Rights. Conservative Libertarians adore States Rights – they needn’t update their philosophy to account for any understanding of a changing world beyond Henry Clay and the cheapskates’ standard version of tax avoidance.

Doctors continue to get million$ from Medicare after their licenses yanked

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SouthernNM H&V Group

The first time cardiologist Robert Graor lost his Ohio license to practice medicine was in 1995, after he was convicted of 10 felony theft counts for embezzling more than $1 million from the Cleveland Clinic and sentenced to three years in jail.

The second time was in 2003, after he’d won back the license following his release from prison. This time, the Ohio Board of Medicine found he repeatedly misrepresented his credentials over a two-decade period and permanently barred him from practicing medicine.

That didn’t stop Graor from participating in Medicare, the government’s health insurance program for the elderly and disabled. In 2012, Medicare paid $660,005 for him to treat patients in New Mexico, which gave him a license to practice in 1998. Graor declined to comment…

At least seven doctors who’d lost a medical license because of misconduct collected a total of $6.5 million from Medicare in 2012, according to federal data. The list includes doctors accused of gross malpractice, a brutal sexual assault and violating prescription drug laws. Their continued participation in the $604 billion program reflects what some members of Congress and others call a permissive approach that lets providers with questionable backgrounds keep billing taxpayers. All the doctors notified Medicare of the loss of their licenses, records show…

CMS has “discretionary authority” to ban a doctor from the Medicare provider list if his license to practice has been revoked by a state, spokesman Aaron Albright said in an e-mail. The agency would not reveal if it has taken any action against the providers identified by Bloomberg as having lost their licenses to practice, saying such a disclosure would be a violation of the doctors’ privacy.

The U.S. Department of Health and Human Services Inspector General also can ban a doctor from Medicare if a state has revoked a medical license. Like CMS, it isn’t required to do so. Donald White, an agency spokesman, says the revocation of a license falls into a “permissive area where they will not necessarily be excluded” from Medicare. He said doctors are “generally not excluded” in cases where one state has pulled a license but another allows that doctor to continue practicing, with the knowledge of the first state’s action.

In all seven cases identified by Bloomberg, the doctors stripped of a license in one state were allowed to practice in another state and continued to bill Medicare.

RTFA for all the gory details. Graor is practicing cardiology, etc. down in Deming, New Mexico. Wonder if folks know – or care – about his history. I wonder why the Feds consider doctor’s privacy a higher priority than patient safety. A doctor who lost his license twice.

More ICD-10 follies: Animal-drawn vehicle collides with train

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The switch to the ICD-10 billing system may have been pushed back at least a year by Congress, but MedPage Today still thinks it’s worthwhile to spotlight some of those thousands of new codes that might just be getting a bit too granular.

Today’s code:

V80.62XA: Occupant of animal-drawn vehicle injured in collision with railway train or railway vehicle, initial encounter (Hat tip to reader Debra Fischer for this one.)

There must be a special room for demented bureaucrats selected to produce some of these new – and soon-to-be required – medical codes used by Medicare, Medicaid.

Here are a few more:

V95.42XA: Forced landing of spacecraft injuring occupant, initial encounter

Fear of Easter Bunny
F40.218: Fear of the Easter Bunny

V96.1: Hang-glider accident injuring occupant

W21.11XA: Struck by baseball bat, initial encounter…

V96.03XA: Balloon collision injuring occupant, initial encounter

This last category not so unusual in New Mexico.