Tag Archives: health reform

Health Officials to Docs: Help Save ACA

Health officials are encouraging doctors who support the health law to help save it. By telling patients about how the Affordable Care Act will benefit them and the entire system, physicians can help garner support for the ACA, said Kathleen Sebelius, secretary of Health and Human Services.

“The notion that [you] are going to share factual information and have people share that information with friends and neighbors and patients on websites, in blogs, and church groups, and at [parent/teacher organization meetings], that’s really what makes a huge impact,” Ms. Sebelius said while addressing primary care and specialist physicians at the annual conference of Doctors for America. She added that doctors should not only spread the news, but become a part of the process as well.

“Your comments, certainly, about what is happening in rulemaking is helpful … but more than that is participating in some of the new models of care,” Ms. Sebelius said.

Many physicians are skeptical about the ACA according to some surveys. However, Doctors for America is among those who support of the law. It remains to be seen whether there’s enough agreement among doctors to make a difference.  What do you think? Tell us in the comments section.

—Frances Correa (@FMCReporting on Twitter)

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Poll: Most Want the Mandate Nixed. Do You?

As the Supreme Court prepares to take on challenges to the Affordable Care Act, new data suggests that Americans remain divided on the constitutionality of the law’s requirement that all Americans purchase health insurance. Little more than half of Americans (54%) think the individual mandate should be ruled unconstitutional and that the Supreme Court will likely agree (55%), according to a recent poll by the Kaiser Family Foundation. The poll was based on telephone interviews with 1,206 adults in the United States from. Jan 12-17.

Courtesy Kaiser Family Foundation

The poll also found that more than half (59%) of Americans think the Supreme Court Justices will base their ruling on their own opinions.  That sentiment is being echoed by the conservative interest group Freedom Watch, which recently filed its second petition to request Justice Elena Kagan to recuse herself. Supporters of the petition take issue with Justice Kagan’s former position as Solicitor General and close adviser to President Obama while the law was being written.

If the mandate were ruled unconstitutional, it’s not clear if the rest of the law would remain solvent. According to the poll, 55% of American thought remaining provisions of the law would survive but 30% said it would mean the end of the law entirely.

Courtesy Kaiser Family Foundation

Further, the Kaiser poll shows that Americans are split on their own opinions of the ACA. According to the poll, 44% are against the law, 37% support the law, and 19% are unsure.

However, a majority (67%) oppose the mandate because it forced American to do something they don’t want to do (30%) or because health insurance is unaffordable (25%). An additional 22% just don’t like the idea of paying a fine for not having insurance.

Those who do support the mandate (30%) said it guarantees that everyone needs health coverage (32%) and that the mandate can guarantee that (17%). Some also said the mandate could control costs (15%).

Do you agree with these findings? Tell us more.

– Frances Correa (FMCReporting)

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Innovation Center Seeks to Renovate Medicare

Government officials have stood before doctors many times and talked about the need to change the perverse incentives that pay them more for caring for sick patients than for keeping people healthy to start. Dr. Richard Gilfillan, who runs the new Center for Medicare and Medicaid Innovation, had a similar pitch when he talked to more than 1,000 people who recently convened at a Washington, D.C. hotel for a day-long summit on health care innovation. The difference is, Dr. Gilfillan has some leverage.

Under the Affordable Care Act, his new center is charged with rapidly testing alternative payment and health care delivery models. If those pilot projects are proven to both improve the quality of care and bring down health care costs, the Secretary of Health and Human Services can roll out the program nationally. There’s a little more paperwork involved, but that’s the general idea.

Dr. Richard Gilfillan (R), with HHS Secretary Kathleen Sebelius and former head of the Centers for Medicare and Medicaid Services, Dr. Don Berwick, in November. HHS Photo by Chris Smith.

What that means is that in a relatively short amount of time, Medicare could fundamentally change the way it pays doctors. That is, if the pilot projects sponsored by the Innovation Center are successful.

Dr. Gilfillan offered an example: Let’s say the Innovation Center launches a project where it pays primary care physicians an extra $10 per patient per month to coordinate care. If officials at the Innovation Center can prove that the project improves outcomes and reduces costs, HHS can publish regulations to roll it out to primary care physicians around the country. “As you can see, this is a powerful tool for changing the way we deliver care,” Dr. Gilfillan said at the summit.

The Innovation Center has been around for about a year and officials there have been busy putting together a set of pilot projects that look at new ways to deliver primary care and home-based care. They are also testing other concepts like bundled payments and accountable care organizations. Check out the Innovation Center’s report on its first year for descriptions of all the projects.

One thing they are trying to do in each of the projects, Dr. Gilfillan said, is to work closely with private payers. The goal, he said, is to make life a little simpler for doctors by ensuring that when they find new payment mechanisms that work, all the payers, both public and private, will adopt it in the same way.

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

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Filed under Family Medicine, Health Policy, health reform, IMNG, Internal Medicine, Pediatrics, Physician Reimbursement, Practice Trends, Primary care

HHS Cries Foul on Insurance Hikes

Nowhere in the thousands of pages of the Affordable Care Act does it give the federal government the power to stop insurance companies from charging excessive premiums. But the controversial health reform law does grant the Department of the Health and Human Services the right review some large rate increases and to tell consumers when they think health plans are charging too much.

HHS did just that today when it held a press conference to protest what it said were “unreasonable” rate hikes by Trustmark Life Insurance Company in five states. The company recently proposed premiums hikes of 13% or more for its plan members inAlabama, Arizona, Pennsylvania, Virginia, and Wyoming.

Courtesy Wikimedia Commons/FBI Buffalo Field Office/Public Domain

Gary Cohen, the Acting Director of Oversight at the HHS Center for Consumer Information and Insurance Oversight, said it wasn’t just that the increases were so high. HHS officials, after consulting with a team of outside analysts, concluded the rates were unreasonably high because the health insurance company was spending only a small percentage of its premium dollars on medical care and quality improvements. Trustmark also based its increases on “unreasonable assumptions,” HHS said. You can read more about HHS rate review authority here.

In its challenge to Trustmark, HHS called on the company to immediately rescind the rates, issue refunds to consumers, or publicly explain why they are standing by such a large rate hike.

It looks like Trustmark is going to stand by its rate increase. Following the HHS press conference, Trustmark issued its own statement saying that they disagreed with the federal government’s assumptions and conclusions. “Our premiums are driven by the rising cost and increased utilization of medical services,” the company wrote. “As a smaller carrier, our loss ratios can vary significantly from year to year, and we take that volatility into consideration.” As for spending too little of its premium dollars on medical care, the company said it has been in compliance with the federal Medical Loss Ratio requirements in that area. However, if they should fail to meet the federal standards, they will offer rebates to consumers.

So is this an effective strategy for bringing down health insurance rates? Share your thoughts on whether rate review by HHS and public disclosure will be powerful enough to force companies to keep premiums low or if you think insurers will be willing to ride out some bad press.

— Mary Ellen Schneider

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Walmart Downplays Its Designs on Primary Care

As Wednesday dawned, many media outlets were atwitter over the report from Kaiser Health News and NPR that Walmart was seeking to build a gargantuan network of primary care clinics.

Courtesy Wikimedia Commons/RemiOo/Creative Commons License

But by late afternoon it wasn’t so clear exactly what Walmart was up to, as it issued what sounded like a “don’t pay attention to the man behind the curtain” non-denial denial.

The initial NPR report linked to a confidential 14-page “request for information” from Walmart to potential partners in this apparently new business venture.  A Walmart spokeswoman confirmed the existence of the RFI to Kaiser and to the Wall Street Journal. But in the WSJ story, the spokeswoman “downplayed” the importance of the RFI.

NPR later updated its web story with an addendum — that is, the non-denial denial.

“The RFI statement of intent is overwritten and incorrect. We are not building a national, integrated, low-cost primary care health care platform,” John Agwunobi, Senior Vice President & President of Walmart U.S. Health & Wellness, said in a statement.

But it seems hard to believe that a corporation run seemingly as tightly as Walmart would put out a request with a Nov. 22 response date and a Jan. 13 “final vendor selection” date as a big old trial balloon.

The RFI states that “Walmart will use its retail and multi-channel footprint to offer the lowest cost primary healthcare services and products in the nation.”

That may be overly ambitious, but I doubt it was overwritten.

—Alicia Ault (on Twitter @aliciaault)

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Reform Repeal “A Step Backwards”

Dr. Louis W. Sullivan is respected as an elder statesman on many aspects of medicine, from public health strategies to recruiting more minorities to the health professions. The founding dean of the Morehouse School of Medicine, Atlanta, also happens to be a former Secretary of the Dept. of Health and Human Services (HHS) under the Republican administration of George H.W. Bush.

Via Flickr Creative Commons user mariko

He’s also making it clear that he disagrees with talk about getting rid of Medicare or Medicaid, or gutting the Affordable Care Act. Dr. Sullivan spoke Monday at the American Association of Cancer Research’s Science of Cancer Health Disparities meeting in Washington.

While addressing many of the challenges to eliminating disparities in the quality of care that minorities receive in America, compared with whites, he listed access to care as one of the biggest issues.  The Affordable Care Act goes a long way toward helping ease the access problem, said Dr. Sullivan, who was HHS secretary from 1989 to 1993.

Politics have always played a role in attempts to reform health delivery in America, he said, noting that the first President Bush had delivered his own overhaul plan in 1992 (for a description, see Dr. Sullivan’s 1992 New England Journal of Medicine article, here). But that plan was dead on arrival because it was an election year, said Dr. Sullivan.

He has made no secret of his support for the Affordable Care Act, but he expressed exasperation with the ways things have gone since its passage. “There’s too much political ideology in our system,” he said.

The cost of doing nothing from 1992 to the present has been a ballooning percentage of gross domestic product being devoted to more and more health spending. Despite all that spending, the United States ranks near the bottom among industrialized nations for many measures of health. “We should be the healthiest nation on earth — far from it,” Dr. Sullivan said, sounding like he might be bucking for an appointment in the Obama administration.

I spoke with Dr. Sullivan after his talk and asked him if he agreed with those who wanted to repeal the Affordable Care Act. Definitely not, he said. The health reform law is not perfect, but, he said, “we should start with this and then work to improve it.”

Added Dr. Sullivan, “To repeal would be a step backwards as a nation.”

—Alicia Ault (on Twitter @aliciaault)

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Here Comes the Super Committee: The Policy & Practice Podcast

photo courtesy of iStock

The names are in and the lobbying has begun. Physicians — and others — are weighing in with their priorities for the Joint Select Committee on Deficit Reduction — better known as the Super Committee. The group is charged with cutting $1.5 trillion of federal spending by Thanksgiving.

At the top of most doctors’ list: A permanent fix to the Sustainable Growth Rate (SGR) formula, which could lead to a 30% pay cut on Jan. 1. But physicians from several specialties have other concerns they want addressed as well.

Meanwhile, a federal appeals court in Atlanta ruled that the Affordable Care Act’s (ACA) individual mandate is unconstitutional, pushing the law one step close to its much-predicted airing in front of the Supreme Court.

Regardless of legal wranglings, the feds are busy pushing ACA programs along, with announcements of more than $200 million worth of programs last week.

LISTEN:  For details, check out this week’s Policy & Practice Podcast. Let us know what you think.


—Frances Correa (@FMCReporting on Twitter)

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Lawmakers Agree on Debt Plan: The Policy & Practice Podcast

After weeks of contentious debate, lawmakers have finally reached an agreement to raise the nation’s borrowing limit. The plan includes cuts to lower the deficit by about $1 trillion over 10 years and creation of a committee to determine future cuts. The plan did not address the Sustainable Growth Rate formula and the committee could potentially reduce physician pay under Medicare and Medicaid. Congress is expected to vote on the plan today or tomorrow.

Photo courtesy of iStock

While the details of further cuts remains unclear, federal economists released their predictions on the growth of U.S. health care spending. Not surprisingly, health spending growth was low last year, due to the impact of the recession. And even in 2014, when many Affordable Care Act provisions kick in, the rate of spending growth is predicted to be just 2%  over the average annual growth rate for the rest of the decade.

In related news, a repeal to the unpopular Independent Payment Advisory board has gained bipartisan support. For details on that and more, listen to this week’s Policy & Practice podcast.


Check back next week for more on the fallout from the debt agreement and health reform implementation.

—Frances Correa (@FMCReporting on Twitter)

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Examining the IPAB: The Policy & Practice Podcast

The Independent Payment Advisory Board, the new panel that will be charged with reducing the growth in Medicare spending, was the focus of intense debate on Capitol Hill last week. In the July 18 edition of the Policy & Practice podcast, we have all the details on the two House hearings held on the panel and why physicians are worried about its impact.

The Independent Payment Advisory Board (IPAB) was created under the Affordable Care Act to help keep Medicare spending under control. But most physician groups are calling on Congress to scrap the board or substantially change how it operates. Opponents, who include the American Medical Association, say that if the IPAB goes forward, physicians would be subject to two levels of cuts: one from the IPAB and one from Medicare’s Sustainable Growth Rate (SGR) formula. Physicians are already facing a nearly 30% Medicare fee cut next year from the SGR unless Congress steps in.

HHS Secretary Kathleen Sebelius tours Frager’s Hardware Store in Washington, D.C., before an event to announce new rules on health insurance exchanges. HHS photo by Chris Smith.

This week’s Policy & Practice podcast also has news on the new federal regulations for how states can set up health insurance exchanges. Those exchanges, which aim to make it easier for Americans to buy insurance, are slated to be up and running by 2014. And check out the podcast for the latest on the debt ceiling negotiations and how Medicare could be affected.

Take a listen and share your thoughts:


Check back with us next week for more on the debt ceiling legislation and the Institute of Medicine’s recommendations on what preventive services health plans should cover for women.

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

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A Chance at an SGR Fix?: The Policy & Practice Podcast

There’s a lot at stake in the negotiations over raising the nation’s debt limit, from the impact on the global economy to the potential elimination of Medicare’s Sustainable Growth Rate (SGR) formula. That’s right, the much-despised SGR, which is used in determining physician payments under Medicare, has even made its way into the talks about increasing the debt ceiling.

House Speaker John Boehner (left) and Senate Majority Leader Harry Reid (right) met with the President on July 10 to discuss the debt limit. Official White House Photo by Samantha Appleton.

As the president and congressional leaders go into overdrive, holding daily meetings on ways to trim the deficit, the medical establishment is pushing hard for lawmakers to stop the cycle of threatened physician pay cuts followed by last-minute legislative Band-Aids. The American Medical Association, along with more than 100 state and medical specialty societies, recently sent a letter to lawmakers warning that the cost of an SGR fix will only go up. Right now, they estimate the 10-year cost of replacing the SGR is nearly $300 billion, but that figure could rise to more than $500 billion in just a few years, they wrote. The debt ceiling legislation provides “the best—and perhaps only—opportunity to ensure stability in Medicare payments, ensure continued beneficiary access to care, and address the SGR deficit in a fiscally responsible manner,” the organizations wrote in their letter.

Get the full scoop on the SGR in this week’s Policy and Practice Podcast.

Take a listen and share your thoughts:


And stayed tuned next week for all the details on new regulations on state-based health insurance exchanges.

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

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