2011 Potpourri XXXI

Mercer issued a release on its survey of employers regarding issues relating to the reform law.  Among the findings are that employers have already seen a 2% enrollment jump due to having to cover children up to age 26, and that over 40% of employers expect the full implementation of the law to raise their costs an additional 3% or more.  So much for reducing insurance premiums.  Eight percent said they were likely or very likely to terminate their coverage after the exchanges are operational, which is a smaller number than the McKinsey survey indicated but still a lot of employers.  Employers say they are relying primarily on making employees more health conscious as a way to control spending.   A number of employers are considering defined contribution-type strategies.   (Mercer Survey)

The Kaiser Foundation issued a brief describing variation in individual health insurance premiums across the country.  The average per month premium was $215, but the range was from over $400 to a low of $136.  Massachusetts, Vermont, Rhode Island, New York and New Jersey were the highest states and Alabama, California, Arkansas, Idaho and Delaware were the lowest.  These numbers are unadjusted for either benefit structure or health status of the enrollees.  As might be expected all the high premium states have enacted “reform” laws which force insurers to take all applicants at basically the same price.  This raises costs and consequently premiums and results in a death spiral where healthier people don’t see the benefit of paying for expensive coverage so they drop out, leaving the average cost of the people in the pool higher, premiums therefore go up, rinse and repeat.  Really great reforms that price people out of the market!   (Kaiser Brief)

The Centers for Medicare and Medicaid Services announced the latest results for its Physician Group Practice demonstration.  Ten physician practices have participated in the demo and this was the fifth year of results.  Seven of the groups hit all of the performance measure targets, and the remaining three hit at least 30 out of the 32 measures.  The practices have shown continuing improvement in each year of the demonstration.  All the groups are continuing to participate in a two-year add-on to the demonstration.  Four of the groups will receive incentives totaling $29.4 million because they not only met the quality benchmarks but also showed an ability to control the amount Medicare spent on the beneficiaries they cared for.   (CMS Announcement)

The Government Accountability Office issued yet another statement on Medicare’s improper payments.  As previously reported, Medicare had at least $48 billion in improper payments in 2010.  GAO’s current statement reviews its past recommendations to CMS on how to reduce these improper payments and CMS’ progress in implementing these recommendations.  GAO’s primary recommendations include strengthening provider enrollment processes, improving prepayment reviews, focusing on known areas of vulnerability, like home health care or durable medical equipment and improving oversight of contractors, like the Part D plans.  On the whole, GAO finds that CMS has not made a lot of progress on the recommendations, which is stating the obvious when one looks at the size of that $48 billion number.   (GAO Report)

For decades physicians have waged war to prevent other health professionals from being able to deliver services that physicians do, or to do so without active physician oversight.  The physicians are gradually losing the war, which has the potential to lower costs, and it appears that quality will not suffer.  A recent article in Nursing Economics reviewed outcomes for services delivered by nurse practitioners.  The research was a systematic review of studies over an 18 year period.  Looking at over 100 studies, for outcomes like patient satisfaction, functional status and length of stay, there was a high level of evidence demonstrating that care by nurse practitioners was at least equivalent to physician care and in some cases had better outcomes.   (Nursing Article)