December 5th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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In reviewing Ezekiel Emanuel’s New York Times article I thought of an interesting question. In Dr. Emanuel’s view it is not worth having tort reform or healthcare care insurance reform. He claims these reforms are an insignificant burden to the cost of the healthcare system.
I have demonstrated that the evidence for tort reform and reform of the healthcare insurance industry proves him wrong.
The question then is where is the $2.5 trillion dollars the U.S. healthcare system spends going?
President Obama and Dr. Emanuel think it is going to physicians. President Obama’s idea to control healthcare costs is to reduce physician reimbursement.
Physicians have the weakest expression of its vested interests among all the stakeholders because of lack of effective leadership.
Simple arithmetic reveals that reducing physician reimbursement will yield an insignificant reduction in healthcare costs.
Never the less on January 1st Medicare is going to decrease physicians’ reimbursement by 27%. This decrease is the result of the application of the government’s Sustainable Growth Rate (SGR).
The Sustainable Growth Rate (SGR) is a complicated and defective formula intended to contain the overall growth of Medicare spending for physicians’ services. The intent was to keep physicians’ reimbursement in line with the nation’s ability to pay for that medical care. The SGR formula uses the gross domestic product per capita in a complicated and inaccurate way. Read more »
*This blog post was originally published at Repairing the Healthcare System*
November 10th, 2011 by DavidHarlow in Health Policy, Opinion
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On my way to the annual two-day blowout health law seminar put on by Massachusetts Continuing Legal Education (MCLE) on Monday — I was second in the lineup, speaking about post-acute care and some of the innovations in that arena for dual eligibles, among other things — I heard a fascinating piece on NPR on one of the ideas floating around the supercommittee charged with cutting $1.2 trillion from the federal budget. The idea: increase the minimum age for Medicare eligibility from 65 to 67, and save a bundle for Medicare in the process.
The problem with this deceptively simple idea (Social Security eligibility is migrating from 65 to 67, too, so it seems to be a sensible idea on its face), is that while it would save the federales about $6 billion, net, in 2014, it would cost purchasers of non-Medicare coverage (employers and individuals) about $8 billion, net. Why? The 65 and 66 year olds are the spring chickens of Medicare — they actually Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
November 4th, 2011 by DavidHarlow in Health Policy, Opinion
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The final Accountable Care Organization regulations are out, the initial flurry of commentary is out (including my own ACO webinar with simultaneous #ACOchat tweetchat – available for replay; slides here : “ACOs, Bundled Payments and the Future of Health Care“), and we can now all catch our collective breath and contemplate the draft vs. final ACO regulation comparisons, the meaning of this new, final set of regulations, guidances and statements from CMS, FTC, DOJ, OIG, and IRS on ACOs and Medicare Shared Savings Programs, and all of the attendant antitrust, antikickback, Stark, and other fraud and abuse matters, and of course tax issues.
So, now that these final regulations are out, and the mythical characteristics of the ACO will soon be dispelled (see under: unicorn), I propose a new animal kingdom metaphor for discussion of Accountable Care Organizations:
The Camel’s Nose is in the Tent.
The definition of a camel, as those of you who tuned into my ACO webinar already know, is Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
October 13th, 2011 by RyanDuBosar in Research
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Hospitals that provide the lowest quality care at the highest cost care for more than twice the proportion of elderly minority and poor patients as the nation’s best performers, researchers found. And patients at the “worst” institutions are more likely than patients elsewhere to die of certain conditions, such as heart attacks and pneumonia.
These hospitals and their patients may be the ones most at risk under new Medicare payment arrangements that could cut payments to hospitals that fail to meet quality metrics, reported researchers from the Harvard School of Public Health.
The researchers examined how quality, costs and patients served correlated among 3,200 hospitals nationwide. They then identified 122 “best” hospitals, those that were in the highest quartile of quality and lowest quartile of risk-adjusted costs, and 178 “worst” hospitals, those in the lowest quartile of quality and the highest quartile of costs.
Hospital quality and performance data were Read more »
*This blog post was originally published at ACP Hospitalist*
October 7th, 2011 by BobDoherty in Health Policy, News
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Last week, Medicare’s Center for Medicare and Medicaid Innovation announced a Comprehensive Primary Care (CPC) Initiative, which asks private payers and state Medicaid programs to join with Medicare to “help doctors work with patients to ensure they:
1. Manage Care for Patients with High Health Care Needs;
2. Ensure Access to Care;
3. Deliver Preventive Care;
4. Engage Patients and Caregivers; and,
5. Coordinate Care Across the Medical Neighborhood,”
according to an email from CMS’s press office. The initiative will provide qualified practices with risk-adjusted, per patient per month care managements payments, in addition to traditional fee-for-service payments, along with the opportunity to share in savings achieved at the community level.
I believe that the Initiative is a potential game-changer in helping to support and sustain primary care in the United States. But Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
