An NBER paper analyzes the accuracy of the CBO projections of the enrollment, insurance cost and health spending effects of the PPACA, using the similar Massachusetts reforms as a case study. The paper concludes that the projections are likely conservative, but the author is not likely to be unbiased and he ignores the last two years of experience in Massachusetts.
In the last couple of years CMS has begun providing feedback reports to physicians treating Medicare beneficiaries. A Government Accounting Office Report underlines the challenges CMS has had implementing the program and making it likely to affect physician behavior.
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)
A new report from Thomson Reuters examines geographic differences in health spending among a commercially insured population. While there is significant variation among areas, the pattern is different from that found by analyses based on the Medicare population and changes among regions based on type of spending and age.
Most seniors tend to purchase Medigap or Medicare Supplement insurance, which mutes the effect of Medicare’s cost-sharing provisions, potentially increasing utilization and costs for the program. A Kaiser brief examines the effect of proposed changes in permissible Medigap benefit structures.
A study reported in Health Affairs finds that American physicians spend much more time at a much higher cost interacting with insurers than do Canadian physicians, who only have to deal with a single-payer system. The data, however, is based on surveys and uses somewhat dated cost comparisons.
Further evidence that hospitals with market power raise prices almost at will and disregard opportunities to cut costs is provided by research reported in Health Affairs. Hospitals in concentrated markets have enormous margins on their private insurers payments.
This week’s Potpourri features dropped malpractice claims, the quality benefits of EHRs, improper Medicare payments, health insurer customer satisfaction, the utilization and cost effects of using hospitalists, and determining if a patient has decision-making capacity.
Research published in the Journal of the American Medical Association finds that the onset of Part D prescription drug coverage helped reduce relative non-drug spending for those beneficiaries who previously had limited drug coverage.
The Government Accounting Office examined various interventions designed to improve the quality of health care and/or lower costs and analyzed the strength of the evidence supporting the effect of the intervention. In general, not many interventions have high-quality research results to support efficacy.
Projections of national health expenditures through 2010 show a continued relentless upward trend, at a rate faster than GDP growth; with spending reaching 20% of GDP by the end of the projection period and government accounting for half of the payments.
A recent report from the Commonwealth Fund describes the status of plans to have accountable care organizations and other provider systems take on financial risk for their patients, finding that there is a gap between the plans and the providers capabilities to manage the risk.
Our current Potpourri contains nuggets on use of robotic surgery for prostate cancer, the effect of mandated rebates in Medicare Part D on patient costs, FDA guidance on device modifications, state Medicaid EHR incentive programs, patient understanding of trial data, and use of FQHC’s by Medicaid enrollees.
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
© 2024 Healthy Skeptic.
Apple Podcasts
Google Podcasts
Spotify
Overcast
PocketCasts
Radio Public
Stitcher
Anchor
RSS - Posts