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. 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... |
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(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
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. 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... |
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Sunday, November 17, 2013
California sends misinformation to 246,000 new Medicaid enrollees
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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Tuesday, November 12, 2013
FAQ: How The Health Law Impacts Federal Employees’ Health Benefits
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. 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,... |
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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. "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... |
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Thursday, November 7, 2013
For Many Workers, It’s Time To Consider Insurance Options
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. 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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Friday, November 1, 2013
Prevention For Profit: Questions Raised About Some Health Screenings
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.
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... |
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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...
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Thursday, October 10, 2013
Costliest 1 Percent Of Patients Account For 21 Percent Of U.S. Health Spending
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.
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... |
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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
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.
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Sunday, September 22, 2013
Kaiser Permanente, Unions Launch New Employee Wellness Program
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 ProgramUnder the voluntary program, Kaiser's 133,000 workers could earn up to $500 each if participants in their region collectively:
Kaiser will issue all payouts in 2015. The total cost of the program could reach $66.5 million, according to the Bee. Comments From KaiserKathy 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... |
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Saturday, September 21, 2013
Health Spending Over The Coming Decade Expected To Exceed Economic Growth
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. 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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Wednesday, September 18, 2013
For Workers Leaving Their Jobs, Health Exchanges Offer Insurance Choices Beyond COBRA
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.
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... |
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