Author: admin

“Angry Americans voice outrage at being asked to pay more for health coverage. Lawmakers and the White House say the public just doesn’t appreciate the benefits of the new health law. Opponents clamor for repeal before the program fully kicks in.”

Sound familiar? As the Repeal & Replace conversation transitions to a debate about Medicare-For-All, let’s revisit the demise of the Medicare Catastrophic Coverage Act of 1989:

Lesson Is Seen in Failure of Law on Medicare in 1989

From US News:

“While short-term policies generally cover major medical benefits, which include unexpected medical expenses from an accident or hospitalization for a serious illness, there are coverage limits – and, typically, a deductible that must first be met. According to KFF, there are other coverage limits as well:

“many Americans will likely need more savings than cited in this report,” said Paul Fronstin, director of EBRI’s Health and Research and Education Program and co-author of the report, in a statement. That’s because the study doesn’t factor in long-term care expenses and other health expenses not covered by Medicare… and cutbacks are expected in the Medicare program as well as in private employment-based retiree health programs.”

More from EBRI:https://www.ebri.org/pdf/briefspdf/EBRI_IB_460_Medicare.8Oct18.pdf

 

“We are committed to price transparency across-the-board, and prescription drugs are no different,” said CMS Administrator Seema Verma. “Today’s proposed rule would ensure that those list prices are included in television advertisements, so patients have the information they need to make informed decisions.”

Dr. Barbara L. McAneny, president of the American Medical Association, said, “Although the American Medical Association is opposed to direct-to-consumer advertising of prescription drugs, as long as the practice is allowed, the ads should come with at least a small dose of transparency. Last year, the AMA called for regulations requiring the ads to include the manufacturer’s suggested retail price of those drugs, and we supported similar legislative efforts by Senators Grassley and Durbin earlier this year.  While this proposed rule alone won’t remove the often-misleading nature of prescription drug ads, it will give consumers a data point that is currently unavailable. That is a step in the right direction.”

More reading: https://www.healthcarefinancenews.com/news/drug-companies-are-being-required-post-list-prices-television-ads

“Moody’s added that more hospitals reported operating deficits in 2017. That coincided with lower absolute operating cash flow. It said 28.4% of nonprofit hospital experienced operating losses”

Lower revenue growth came from lower reimbursements, the shift to outpatient care, increased M&A activity and additional ambulatory competition. It said the move away from inpatient to outpatient moved into its fifth year.

“Reversing sluggish volume trends and growing profitable service lines will be critical to improving the sector’s financial trajectory over the near-term as most hospitals continue to operate in a fee-for-service environment,” Sverdlik said.”

“Hospitals, especially nonprofit facilities, are facing difficult times. Morgan Stanley recently reported that about 18% of more than 6,000 hospitals studied were at a risk of closure or are performing weakly. About 8% of studied hospitals were at risk of closing and 10% were called “weak,” according to that report.

For perspective, just 2.5% of hospitals closed over the past five years.”

Read more: https://www.healthcaredive.com/news/nonprofit-hospitals-on-an-unsustainable-path-moodys-says/531245/

About 60 percent of workers who get coverage through their job have self-insured plans, and 18 percent of people with coverage through a large employer who were admitted to the hospital in 2016 received at least one bill from an out-of-network provider, according to an analysis by the Kaiser Family Foundation.

Read more about the problem of out of network balance billing and some of the possible solutions:

The Remedy For Surprise Medical Bills May Lie In Stitching Up Federal Law

MedPAC staff regularly survey a sample of Medicare beneficiaries and privately insured patients to determine whether they are having problems getting to see a physician. In the latest survey, about 30% of Medicare beneficiaries who were looking for a new primary care physician in 2017 reported either a big or a small problem in finding a doctor, compared with 40% of privately insured patients seeking a new doctor, MedPAC senior analyst Kate Bloniarz reported on Thursday.

“Private insurance payment rates are significantly higher than Medicare, and have grown significantly faster [in the] past decade, but they don’t seem to make a difference in patient-reported access to care,” she said. If they had, “we would have expected to see improvement in access for privately insured patients relative to Medicare, but that doesn’t seem to be happening.”

In addition, the small payment rates haven’t affected the supply of physicians willing to take Medicare patients, she said. “Despite the relatively modest updates for clinician services, the number of clinicians billing the program has steadily grown, keeping pace or outpacing fee-for-service enrollment. The number of primary care and other specialty physicians grew by 2% and 1.5% per year, respectively, from 2009 through 2016. The growth in direct billing by advance practice registered nurses and physician assistants was [also] quite robust, averaging over 10% per year … despite payment updates averaging 0.5%.”

Full story: https://www.medpagetoday.com/practicemanagement/reimbursement/74991

Anthem and The South Bend Clinic announced today that Anthem will be adding The South Bend Clinic to its preferred list of care providers for its Anthem MediBlue Access (PPO) and will continue to be a preferred provider for Anthem MediBlue Plus (HMO) and Anthem MediBlue Dual Advantage (HMO SNP). Beginning in September 2018, South Bend Clinic’s care providers will be considered in-network for these health plans, resulting in lower out-of-pocket costs for consumers compared to seeing a care provider outside of Anthem’s network.

https://www.businesswire.com/news/home/20180911005040/en/Anthem-Blue-Cross-Blue-Shield-Adds-South

“The future is the home, and the home of the future is going to be not just a place called a home. It’s also going to be a medical site,” Tyson said. “The whole shift thinking about what’s the ecosystem around individuals in their own setting is the significant difference that we are going to see over the next decade.”

For example, Kaiser’s managed to make a procedure like a hip replacement just a one night stay in a hospital, versus the one to four days you might typically see. But through Kaiser, patients get sent home after surgery with nurses and physical therapists.

More: https://www.businessinsider.com/kaiser-permanente-ceo-tyson-on-future-of-healthcare-2018-8