Medicare Experiment Could Signal Sea Change For Hospice

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

Diane Meier is the director of the Center to Advance Palliative Care, a national organization that aims to increase the number of palliative care programs in hospitals and elsewhere for patients with serious illnesses. Meier is also a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York City. We spoke about a recently launched pilot program under the health law that allows hospice patients participating in the pilot to continue to receive life-prolonging treatment. This is an edited  version of that conversation. Q. There’s a lot of confusion about how hospice care differs from palliative care. Maybe we should start by clearing up what those terms mean.  A. The short, quick elevator answer is that all hospice care is palliative care -- but not all palliative care is hospice. Palliative care is a team-based type of care focused on maximizing the quality of life for people and their caregivers at any stage of illness. It focuses on treating the pain, stresses and symptoms of serious illness. The emphasis is on need, not prognosis or how long you might have to live. In contrast, the hospice benefit, which was written into the Medicare statutes about 25 years ago, had a number of limits in it to control spending. Diane Meier (Photo courtesy of Mount Sinai Hospital) ...

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Appeals Court Deals Major Blow to Implementation of Affordable Care Act

Today's post is shared by WSJ Law Blog and comes from blogs.wsj.com

A federal appeals court on Tuesday dealt a serious blow to the Obama administration’s implementation of its signature health-care law, striking down subsidies available to some consumers who purchase health coverage on insurance exchanges set up by the federal government.

WSJ’s Brent Kendall has more on the breaking legal development out of Washington:

The U.S. Court of Appeals for the District of Columbia Circuit, on a 2-1 vote, invalidated an Internal Revenue Service regulation that implemented a key piece of the 2010 Affordable Care Act. The regulation said subsidies for health insurance were available to qualifying middle- and low-income consumers whether they bought coverage on a state exchange or one run by the federal government.

The ruling potentially could cripple the Affordable Care Act by making subsidies unavailable in as many as 36 states where the federal government has run some or all of the insurance exchanges.

The court sided with challengers, four individuals and three employers, who argued the health law allowed subsidies only for insurance purchases made through state exchanges. The issue became an important one after the law was enacted because more than two-thirds of the states chose not to set up their own exchanges, relying on federally run exchanges instead.

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Consumers Beware: Not All Health Plans Cover A Doctor's Visit Before The Deductible Is Met

Will these types of medical plans encourage a medical deductible for workers' compensation coverage? Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

If you buy one of the less expensive insurance plans sold through the health law’s marketplaces, you may be in for a surprise. Some plans will not pay for a doctor visit before you meet your annual deductible, which could be thousands of dollars. "This could be the next shoe to drop, as people don't realize that if they're buying a bronze plan, they may have to pay $5,000 out of pocket before it contributes a penny," said Carl McDonald, senior analyst with Citi Investment Research, speaking at a Washington, D.C., conference last month. Experts worry that some enrollees will be discouraged from seeing doctors if they have to pay the full charge, rather than simply a copayment. Those who’ve bought their own insurance have always had to pay a set annual sum, called a deductible, before policies begin paying their claims.  But first-time insurance buyers may not realize they’re on the hook for additional costs before benefits kick in, and may choose a plan based solely on the monthly premiums. Bronze and silver plans -- which have lower monthly costs but typically, higher deductibles -- are the most likely to require consumers to spend that amount themselves before the insurer pays any claims. There is no nationwide data on how many do that. But in seven major cities, half of bronze plans on average require policyholders meet the deductible before insurers help with the cost of a doctor visit, according to an analysis by...

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Rehospitalization Rates Fell In First Year Of Medicare Penalties

Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org

During the first eight months of this year, fewer than 18 percent of Medicare patients ended up back in the hospital within a month of discharge, the lowest rate in years, the government reported Friday. This drop occurred during the first year that Medicare financially penalized hospitals for their readmission rates, and the government seized on the decrease as evidence the incentives are having an effect. revolving door300 The government is targeting rehospitalizations as a significant indicator of gaps in medical quality in the nation’s hospitals. While some elderly patients inevitably return to the hospital, the government and some researchers believe many of those returns are avoidable if hospitals monitor patients after their release to ensure they get appropriate medications and follow-up visits with doctors. In the first year of the program, which began in August 2012, Medicare fined 2,213 hospitals—about two-thirds of those it evaluated— for higher than anticipated readmission rates. Last August, Medicare issued a second year of penalties against 2,225 hospitals. The maximum penalties created by the health law have risen from 1 percent of regular Medicare payments to 2 percent, and they will increase for a third and final time next August to 3 percent. The new data reported by Medicare show that readmission rates for the first eight months of 2013 dropped below 18 percent, half a percentage point below 2012’s rate of 18.5 percent. From 2007 to...

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California sends misinformation to 246,000 new Medicaid enrollees

Today's post was shared by Kaiser Health News and comes from www.sacbee.com

LOS ANGELES -- California has mistakenly sent letters to 246,000 low-income residents, warning they may need to find new doctors next year under the state's newly expanded Medicaid program. The error frustrated counties and community health centers, which have repeatedly assured patients they can keep their providers when the Affordable Care Act takes effect in 2014. The patients are part of the state's "bridge to reform" program, which was designed to cover uninsured, poor Californians until they became eligible for Medicaid, known as Medi-Cal here. The program launched in 2011 and more than 600,000 people across the state enrolled in county-based health coverage. Many of them formed relationships with doctors and started seeking regular care. But county and clinic administrators said the incorrect mailing this month has put the counties' efforts in jeopardy. The mix-up occurred as people are scrambling to figure out how the health law impacts them, and as private policy holders have been receiving letters canceling their insurance plans. "The whole key to the success is that people seamlessly transition to Medi-Cal," said Sean South, an associate director at the California Primary Care Association. "It is vitally important that we don't confuse them." But that's what happened when the incorrect letters started going out on Nov. 1, said clinic and county officials. Patients immediately began calling and showing up with questions about the letter, said Eva Serrano, a...

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For Many Workers, It’s Time To Consider Insurance Options

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

It’s annual enrollment time, the autumn period when many people with job-based health insurance ante up for another year. Although news reports have fixated on the problems with the online health marketplaces that launched Oct. 1, for the vast majority of people that’s a nonissue. If they get insurance through a job at a company that has at least 50 employees, they probably won’t be using the marketplaces, also called exchanges. That doesn’t mean people with employer-based plans are unaffected by the health law. As employers adjust plans to meet new requirements and try to reduce their costs, people can expect to see changes next year. Overall, premium increases will be moderate in 2014, averaging 5.2 percent,according to a 2013 employer survey about planned health care changes by the human resources consultant Towers Watson. Last year, the increase was projected to be 5.9 percent in 2013. But employers may raise rates disproportionately for spouses and dependents, the survey found. The health law requires plans to cover dependent children up to age 26, and most plans cover spouses too. But employers continue to try to minimize those costs by making it financially less attractive to employees to cover their family members. They may charge separately for each child on a plan, for example, or add a surcharge for covering a spouse who is also offered insurance through his or her own job. Some, such as UPS,have moved to cut off coverage...

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Health Spending Over The Coming Decade Expected To Exceed Economic Growth

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

The nation’s total health spending will bump up next year as the health law expands insurance coverage to more Americans, and then will grow by an average of 6.2 percent a year over the next decade, according to projections released Wednesday by government actuaries. That estimate is lower than typical annual increases before the recession hit. Still, the actuaries forecast that in a decade, the health care segment of the nation’s economy will be larger than it is today, amounting to a fifth of the gross domestic product in 2022. They attributed that to the rising number of baby boomers moving into Medicare and the actuaries’ expectation that the economy will improve, according to their findings published in the journal Health Affairs. The actuaries were not persuaded that experiments in the health law and new insurer procedures that change the way doctors, hospitals and others provide services will significantly curtain health spending. They assumed "modest" savings from those changes from the law. "It's a little early to tell how substantial those savings will be in the longer term," Gigi Cuckler, one of the actuaries, told reporters. The actuaries also said they are skeptical that the nation has entered a new era of lower health spending, a case that has been made by the Obama administration and many prominent economists. They have predicted a strengthening economy will not be accompanied by sharp health spending hikes. The report expects health...

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Details Lacking on Prescription Drug Coverage in New Health Law

Today's post was shared by WCBlog and comes from www.nytimes.com

Among the most troubling questions facing consumers as they shop for insurance under the Obama administration’s new health care law is whether the plans will cover the drugs they take — and how much they will have to pay for them. But with less than two weeks remaining until enrollment opens on Oct. 1, the answers are still elusive and anxiety is growing for consumers whose well-being depends on expensive medications. States running the marketplaces where the plans will be offered have not released details about which drugs will be covered. Insurers have said little about how much consumers will be asked to contribute or what types of restrictions will be placed on certain medicines. Of the few states that have revealed specifics, some have plans that will require patients to contribute as much as 50 percent of the cost of the most expensive drugs. “I’ve got to be honest and say I’m a little bit nervous,” said Jessica Thomas, a mental health counselor in North Carolina who takes the drug Tecfidera to treat her multiple sclerosis. Ms. Thomas, 34, has been enrolled for two years in a program for people with expensive medical conditions that is run by North Carolina. But that program is ending in December, and she must select a new plan in the state marketplace. At the top of her mind is how much she will have to pay for Tecfidera, which costs more than $4,000 a month. “I think that’s the hard thing right now is that it’s...

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Law Will Shift Demographics For Medicaid Toward Healthier Group, Study Finds

Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org

The health law is expected to change the face of Medicaid – literally. As part of the federal overhaul, some states have opted to expand in January this state-federal health insurance program for low income people to include Americans who earn as much as 138 percent of the federal poverty line (just under $16,000 for an individual in 2013). As a result, the new enrollees will include more white, male and healthy individuals than those eligible before the Affordable Care Act expansion, according to a study in the Annals of Family Medicine. Using statistics from the National Health and Nutrition Examination Survey, the authors found that the group of newly eligible individuals is: About 36 years old on average, compared with about 39 years old for the current enrollees. Approximately 59 percent non-Hispanic white, compared with about 50 percent in the existing group. Equally split between males and females, compared with about 67 percent female and 33 percent male in the current Medicaid population. More likely to smoke and drink, but also more likely to have lower rates of obesity and diabetes. The University of Michigan researchers hope the information will help inform health providers and policy makers who are gearing up to plan for the more than 13 million adults potentially eligible for Medicaid after Jan. 1. “It’s really a game changer,” said Dr. Tammy Chang, a lead author of the report. “A lot of providers think of Medicaid...

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