Copyright

(c) 2010-2024 Jon L Gelman, All Rights Reserved.
Showing posts with label Kaiser Family Foundation. Show all posts
Showing posts with label Kaiser Family Foundation. Show all posts

Tuesday, December 3, 2013

Medicare Seeks To Curb Spending On Post-Hospital Care

Long term care is a huge part of medical care benefits. What Medicare ultimately does will control workers' compensation costs. Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

After years of trying to clamp down on hospital spending, the federal government wants to get control over what Medicare spends on nursing homes, home health services and other medical care typically provided to patients after they have left the hospital.
Researchers have discovered huge discrepancies in how much is spent on these services in different areas around the country. In Connecticut, Medicare beneficiaries are more than twice as likely to end up in a nursing home as they are in Arizona. Medicare spends $8,800 on each Louisiana patient getting home health care, $5,000 more than it spends on the average New Jersey senior. In Chicago, one out of four Medicare beneficiaries receives additional services after leaving the hospital—three times the rate in Phoenix.
Medicare per capita spending on these services, collectively known as post-acute or post-hospital care, has grown at 5 percent a year or faster in 34 of the nation’s 50 most populous hospital markets in recent years, according to an analysis health care economist Chapin White conducted for Kaiser Health News.
Last year $62 billion — one out of every six dollars Medicare spent in the traditional fee-for-service program — went to nursing and therapy for patients in rehabilitation facilities, nursing homes, long-term care hospitals and in their own homes, according to a congressional advisory panel.  
Most of them got those services after coming out of the hospital. Some of these...
[Click here to see the rest of this post]

Monday, December 2, 2013

How Much Is That X-Ray? Still Hard To Say, Even In Massachusetts

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org
Finding out how much an X-ray costs sounds like a simple question. But it is actually very difficult to get an answer. In Massachusetts, a new state law requires insurers to be able to tell members how much a test, treatment or surgery will cost.
But while the new law pulls back the curtain on prices of health procedures to some degree, the burden is still on the patient to ask for information. And, as a recent test drive of the new law showed, there are quite a few hoops for patients to jump through.
I threw out my back in September playing squash and went to the doctor. She sent me down the hall for X-rays. I may need more. I'm curious about what my costs will be, so I call my insurer, Blue Cross.
The recorded menu option doesn't mention health care prices, so I press zero, for all other inquiries.
Eventually, I connect with Jamie D. (customer service reps at Blue Cross don’t give their last names). I explain that I'd like to compare the price of lower back X-rays at a few facilities.
She starts in with the questions: What's the doctor's name? What's the facility where I want to have the X-ray? I have the doctor's name and facility, but I’m stuck on the next question. Blue Cross wants the procedure codes for each X-ray I may need, my doctor's national ID number and the name, address and ID number for my hospital or lab, so it can consolidate all the charges into one estimate.
Jamie directs me to a form online. I call my doctor and get the info. If I...
[Click here to see the rest of this post]

Sunday, November 17, 2013

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...
[Click here to see the rest of this post]

Tuesday, November 12, 2013

FAQ: How The Health Law Impacts Federal Employees’ Health Benefits

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

Open enrollment season begins Monday for the approximately eight million federal workers and their dependents who receive health care coverage through the Federal Employees Health Benefits Program or FEHB. The 2010 health law calls for some changes in that coverage. Below are some frequently asked questions and answers about how the measure will impact federal workers’ health insurance.
Q: I work at a federal agency and am enrolled in FEHB. Does the Affordable Care Act require me to purchase health insurance on the law’s new online marketplaces, known as exchanges?
A: No, you do not have to buy coverage on the marketplace. You can stay with FEHB. But if you want to shop for a health plan on the exchange, you will not qualify for a subsidy because the federal government pays up to 75 percent of the cost of your FEHB coverage.
Q: I work on Capitol Hill. Do I have to purchase coverage through the exchanges?
A: Yes. A provision of the health law, originally authored by  Sen. Charles Grassley, R-Iowa, requires that, if you are a member of Congress  or work on a lawmaker’s personal staff, you must obtain your health coverage through the online insurance marketplace. And, according to a recent ruling from the Office of Personnel Management, or OPM, whether or not you are employed in the D.C. Metro area,  you must purchase coverage on the District of Columbia small business exchange.
“Given the location of Congress in the District of Columbia,...
[Click here to see the rest of this post]

Monday, November 11, 2013

Worried About Costs And Unaware of Help, Californians Head Into New Era of Health Coverage

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org
As uninsured Californians head into a new era of health coverage, they're worried about costs and unaware of the help they'll get from the government, a new survey finds.
The survey, by the Kaiser Family Foundation, found that three out of four Californians who earn modest incomes and could buy government-subsidized private coverage believe, wrongly, that they're not eligible for federal assistance or they simply don't know if they qualify.
In addition, many undocumented immigrants, who comprise about a fifth of the state's uninsured population, erroneously believe they will be eligible for coverage. The law specifically bars them from getting coverage from the state's new health insurance exchange, which opens Oct. 1, for coverage beginning Jan.1, 2014.
"This has been, for so long, a political debate," said Anthony Wright, executive director of Health Access, a Sacramento-based consumer advocacy group. "We're just starting to move it into a practical reality. Now that the benefits are close at hand, there is a concerted effort to educate people about what their benefits are."
California is one of two dozen states preparing to dramatically expand Medicaid, the federal-state insurance program for the poor, yet the survey found only half of newly eligible low-income Californians presume they will qualify. The nonpartisan Kaiser Family Foundation surveyed some 2,000 uninsured Californians from mid-July until the end of August, a summertime lull before a burst of...
[Click here to see the rest of this post]

Thursday, November 7, 2013

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...
[Click here to see the rest of this post]

Friday, November 1, 2013

Prevention For Profit: Questions Raised About Some Health Screenings

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


Messiah United Methodist Church in Springfield, Va., is unusually busy for a Thursday morning. It's not a typical time for worship, but parishioner Stacy Riggs and her husband have come for something a little different: a medical screening.

"I'm getting ready to turn 50 sooner than I'd like to say, and just thought it was a good time to get an overall screening," said Riggs, of Fairfax, Va. She doesn't have any symptoms, but she stopped by the church, which is offering a day of testing by the company Life Line Screening as a service to parishioners.

(Photo by Jenny Gold)
Life Line Screening medical assistant Kennea Blake prepares Stacy Riggs for an atrial fibrillation screening at Messiah United Methodist Church in Springfield, Va.

For less than $200, Riggs is getting six different screenings for stroke, heart disease and osteoporosis. Life Line says they've checked 8 million Americans this way at churches and community centers, and up to 10 percent of them are found to have some sort of abnormality.

But several of the tests performed by Life Line are on a list of procedures for healthy people to avoid.

The tests can potentially do more harm than good, according to the U.S. Preventive Services Task Force, an independent panel that recommends evidence-based treatments. Even though the screening tests may be noninvasive, follow-up exams and procedures often are not, and can increase a person's odds of being injured or over treated.

One of those tests is the carotid artery...
[Click here to see the rest of this post]

Monday, October 14, 2013

National Survey: Working Longer—Older Americans’ Attitudes on Work and Retirement

The Associated Press-NORC Center for Public Affairs Research has released the results of a major new survey exploring the views of older Americans about their plans for work and retirement.  It provides in-depth information about a rapidly growing segment of the population that by choice or circumstance is working longer.  The Great Recession has had a marked impact on retirement plans.

“The survey illuminates an important shift in Americans’ attitudes toward work, aging, and retirement,” said Trevor Tompson, director of the AP-NORC Center.  “Retirement is not only coming later in life, it no longer represents a complete exit from the workforce.  The data in this survey reveal strikingly different views of retirement among older workers today than those held by the prior generation.”

With funding provided by the Alfred P. Sloan Foundation, the Associated Press-NORC Center for Public Affairs Research conducted a national survey of 1,024 adults ages 50 and over.  It is a segment of the population that is not only growing rapidly in numbers, but is also becoming substantially healthier.  Projections show that the U.S. population age 65 and over will increase to 19 percent of the population by 2030, up from 13 percent in 2010, an estimated 72 million people. At the same time, people age 55 and over comprise the fastest growing segment of the workforce. By 2020, approximately one fourth of American workers will be...
[Click here to see the rest of this post]

Thursday, October 10, 2013

Costliest 1 Percent Of Patients Account For 21 Percent Of U.S. Health Spending

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


A 58-year-old Maryland woman breaks her ankle, develops a blood clot and, unable to find a doctor to monitor her blood-thinning drug, winds up in an emergency room 30 times in six months. A 55-year-old Mississippi man with severe hypertension and kidney disease is repeatedly hospitalized for worsening heart and kidney failure; doctors don't know that his utilities have been disconnected, leaving him without air conditioning or a refrigerator in the sweltering summer heat. A 42-year-old morbidly obese woman with severe cardiovascular problems and bipolar disorder spends more than 300 days in a Michigan hospital and nursing home because she can't afford a special bed or arrange services that would enable her to live at home.

These patients are among the 1 percent whose ranks no one wants to join: the costly cohort battling multiple chronic illnesses who consumed 21 percent of the nearly $1.3 trillion Americans spent on health care in 2010, at a cost of nearly $88,000 per person. Five percent of patients accounted for 50 percent of all health-care expenditures. By contrast, the bottom 50 percent of patients accounted for just 2.8 percent of spending that year, according to a recent report by the federal Agency for Healthcare Research and Quality.

Sometimes known as super-utilizers, high-frequency patients or frequent fliers, these patients typically suffer from heart failure, diabetes and kidney disease, along with a significant psychiatric problem. Some are...
[Click here to see the rest of this post]

Monday, September 23, 2013

CMS Publishes Rules to MSP Payments Under the SMART Act

Medicare has published proposed Rules to governor obtaining information concerning the conditional payments as required by the recently implemented SMART Act. The Regulations expand the bureaucratic framework for Medicare beneficiaries and their representatives in order to obtain and appeal information on condition payment demands from the government.

The Rules are effective on November 10, 2013 and the comment period closes at 5pm on that date.

The government will be establishing a multifactorial implementation process to keep information secure: DX Codes, provider names. dates of service and conditional payment amounts. Ultimately, it appears that the process will be yet another hurdle to obtain information for workers' compensation claims  and release the beneficiary from government liability for medical expenses.

The proposed CMS Rules can be reviewed at: https://www.federalregister.gov/articles/2013/09/20/2013-22934/medicare-program-obtaining-final-medicare-secondary-payer-conditional-payment-amounts-via-web-portal
….

Jon L. Gelman of Wayne NJ is the author NJ Workers’ Compensation Law (West-Thompson) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson). For over 4 decades the Law Offices of Jon L Gelman  1.973.696.7900  jon@gelmans.com  have been representing injured workers and their families who have suffered occupational accidents and illnesses.

Sunday, September 22, 2013

Kaiser Permanente, Unions Launch New Employee Wellness Program

Organized Labor is improving worker health by encouraging wellness program, a counterbalance to  the erosion of workers' compensation pre-existing disease limitations. Today's post was shared by votersinjuredatwork and comes from www.californiahealthline.org


Kaiser Permanente and the 29 unions that represent its employees in California and eight other regions have teamed up to offer incentive payments to groups of workers who improve their health, the Sacramento Bee reports.

Details of Program

Under the voluntary program, Kaiser's 133,000 workers could earn up to $500 each if participants in their region collectively:
All employees -- even those who choose not to participate -- will be eligible for payouts if:
  • 75% of workers in their region complete an online health survey, which would earn $150 incentive payments for all employees in that region;
  • 85% of workers in their region update their baseline screenings for weight, smoking, cholesterol and blood pressure, which would earn $150 payments for all workers in that region; and
  • There is an average 1.7% improvement and no declines across such measures by December 2014, which would earn $200 for all employees in that region.
The program does not apply to doctors, dentists and executives, but it does include both union and non-union employees.
Kaiser will issue all payouts in 2015. The total cost of the program could reach $66.5 million, according to the Bee.

Comments From Kaiser

Kathy Gerwig -- vice president of employee safety, health and wellness at Kaiser -- said the program is "very inclusive of everybody" and will "drive the culture toward healthier work environments and camaraderie around getting healthier."
She...
[Click here to see the rest of this post]

Saturday, September 21, 2013

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...
[Click here to see the rest of this post]

Wednesday, September 18, 2013

For Workers Leaving Their Jobs, Health Exchanges Offer Insurance Choices Beyond COBRA

The Affordable Care Act will impact all areas of the delivery of medicine in the workplace.Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org


Workers who lose their jobs and their employer-based health insurance will have new coverage options when the Affordable Care Act's state marketplaces open in October. But consumer advocates are concerned many may not realize this and lock themselves into pricier coverage than they need.

Today, the only option for many laid-off workers is to continue their employer-provided coverage for up to 18 months under the federal law known as COBRA. Because they have to pay the entire premium plus a 2 percent administrative fee, however, the coverage can be a financial hardship for people who are scrambling to keep up with expenses after losing their jobs.

Many of these people will likely be better off buying a plan on the state health insurance marketplaces, also called exchanges. Plans sold there must cover a comprehensive set of 10 "essential health benefits," and consumers can choose among four plan types with different levels of cost-sharing. Premium tax credits will be available to people with incomes between 100 and 400 percent of the federal poverty level ($11,490 to $45,960 for an individual in 2013), often making exchange coverage significantly more affordable than COBRA.

"COBRA was a transitional type of coverage while you're between jobs, but now we have a subsidized form of coverage available, exchange plans with subsidies," says Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities.
It's...
[Click here to see the rest of this post]