Archive for March, 2009
Drugstore company Walgreen Company, known as Walgreen's Drug Stores, said on Monday it would pull almost half its pharmacies in Washington State from the U.S. Medicaid program to protest against the state's plan to cut reimbursements for drugs.
Cash-strapped Washington State plans to insist on cheaper, generic drugs for low-income Medicaid clients whenever available and equivalent to brand-name drugs, and is also cutting the rate of reimbursements on all drugs to pharmacies which supply them.
Cutting the reimbursement rate of generic and brand-name drugs would severely impact the "economic viability of doing business in Washington," Walgreen said in a statement. However, this is not only being considered in Washington State. There are several other states going through the same financial issues - especially with Medicaid. Washington State is simply the first state that Walgreen's will be pulling many stores out of, severely limiting choices for some seniors who have dealt with Walgreen's for many years when it has come to their medication and other Medicaid needs.
Walgreen, one of the largest U.S. pharmacy chains, is to withdraw 44 of its 111 pharmacies in the state of Washington from the Medicaid program. Medicaid provides health insurance to low income individuals.
Unlike Medicare, the federal health program for seniors, Medicaid is partially funded by states. In order to cut the costs of the program, Washington state announced last week it would cut Medicaid reimbursements for brand-name prescription drugs by 6 percent, effective on Wednesday.
Walgreen said it would withdraw the 44 pharmacies from Medicaid as of May 1, a month after Washington introduces its plan. It said those pharmacies represent more than 60 percent of its total Medicaid business in the state.
There is a chance other pharmacies such as CVS Caremark Corp and Rite Aid Corp will follow suit in pulling out of Washington's Medicaid program
Some information from Reuters.
In the near future, Louisiana could face an even larger shortfall than expected in the money needed to provide health care to the poor, elderly, uninsured and children. Tax collections inflated by the recovery from the 2005 hurricanes are the source of the problem, state Health Secretary Alan Levine said Monday.
Instead of paying 67.6 percent of Medicaid costs in Louisiana, the federal government is expected to only pay 63.1 percent beginning October 2010. Federal funding cuts also are projected for a children’s health-care program. The difference in the percentages amounts to millions of dollars.
“The problem is nobody — and I mean nobody including myself — thought the reduction … would be this large,” Levine said.
Governor Bobby Jindal and his administration is proposing a $26.7 billion budget that trims the state’s health-care costs by more than $400 million in the fiscal year that starts July 1. The reduction would decrease the state Medicaid budget from $6.5 billion to $6.18 billion, affecting hospitals, nursing homes, physicians and others.
The federal “stimulus” package is helping with some health-care expenses. From October 2009 to December 2010, states do not have to bear the cost of changes in the percentage of Medicaid expenses that the federal government pays. The “stimulus” will get the state through part of the 2010-2011 fiscal year, Levine said.
But once the money runs out, the state will have to deal with a shortfall that now is larger than anticipated, he said.
The Federal Funds Information for States estimates Louisiana stands to lose $268 million in health-care dollars in a single federal fiscal year. “This is a massive, massive impact to Louisiana,” Levine said.
The decrease is in the percentage of costs that the federal government picks up for the Medicaid and Children’s Health Insurance programs.
There are other states that are going through very similar plights, however, since Louisiana - and a few surrouding states - is still recovering in many ways, especially financially from Hurricane Katrina, there are difficult issues that have to be ironed out to get the situation together economically so that Medicaid coverage will drop as little as possible and the people that truly need it will be able to have it continuously.
We have written and discssed some o the positives involved in home health care. There are a lot of home health care agencies who make home visits - especially elderly patients and/or those who have a very difficult time getting around. These agencies do a great service and are so valuable to the people they serve. The only negative is that if a patient needs extensive care, tests, or medical care by a physician most of the home health care companies do not have physicians available, which can often result in individuals ending up in the emergency room, which is always an expensive situation. However, if there is a doctor available, much of the care - and many times, all of it - can be taken care of at home, on the spot and without causing extra stress and strain on the patient.
It used to be very common for doctors to make house calls, but expense and other factors all but eliminated. That situation has started to change in the last few years for quite a few reasons. When looking at the changes that have taken place in the past decade or more, portability has made it possible for doctors and other healthcare professionals.
Which would you choose if you were elderly or disabled or both and had to keep going to the doctor? Would you rather have the doctor come to you once every 3 to 6 weeks and keep you healthier and more comfortable and, in addition have the capacity to perform most tests and procedures from the patient's home, fax or send information by computer and receive results without the patient having to go through the difficulty, inconvenience, and sometimes, discofort of having to get to the doctor's office.
In addition, research shows that most of the patients served in their homes stay healthier, live longer, stay out of the hospital and emergency room, and it is all because they are getting regular care. If they didn't have regular care, studies show that they would end up seeing the doctor much less often and end up in the emergency room or hospital mor often. With changes in healthcare and with improvements in Medicare and Medicaid coverage, it is possible for many more people who need care at home to receive it.
If you are in a situation that would make it better for you to get treatment at home, checkk with Medicare, Medicaid and any other health coverage you have to see if you can receive care by a physician at home. Then talk to your physician and see if he or she proides that type of care or can recomment a colleague who makes house calls. It may take a little time finding a doctor to make house calls, but there are more and more who are willing to do so.
Once you are able to make the arrangements and get started you will likely feel much more relaxed about seeing the doctor. So, which would you choose? Look at your circumstances and see if you would rather get out of the house, see the doctor, go to the grocery store or go to lunch - which many people do, and it makes them feel better - or if it would be easier for you and more comfortable for the doctor to make a house call to you. Either way, do what you think is the best for your situation and will keep you healthy.
Washington is trying to fix heath care and Medicare. Mark McClellan, a well respected think tank guru, said recently "It's a lot harder to come up with ways to implement reforms than it is to come up with ideas for reform," he said.
McClellan, 45, is an Austin native from a strongly political family. Brother Scott was President George W. Bush's press secretary. Their mother, former Texas Comptroller Carole Keeton Strayhorn, ran for governor in 2006.
Mark McClellan was a major policy figure in health care during the Bush administration. While most of his former colleagues are now in the political wilderness, McClellan is using his post at Washington's Brookings Institution to keep moving in the circle of implementers who want to "bend the curve" of rising health care costs.
Along with several other health care experts, McClellan is trying to persuade President Barack Obama's reform team and Congress to pay hospitals and doctors more if they can show they're improving treatment for Medicare patients while lowering costs.
McClellan argues that sharing savings could keep Medicare viable without bankrupting the federal government. "Right now, we are getting what we pay for – high-volume, high-intensity health care," he said. "Often, there's no support for preventive care."
White House Budget Director Peter Orszag says McClellan's approach is extremely closely aligned with the Obama administration's views on the need to change payment incentives.
"We have the same basic philosophy," Orszag said. "There are huge variations in health care costs across different regions of the country that can't be explained other than because of the intensity of care. ... We need to change the incentives so we get better care, not more care."
Medicare accounts for 20 percent of health care spending, pays providers on a fee-for-service model. Each visit, each test, each procedure a doctor performs pays a certain amount. The system creates an incentive to see lots of patients, lots of times.
For many years, reformers have argued in favor of payment systems based on performance rather than volume. Pay-for-performance advocates argue their approach gets patients the most effective type of care rather than an uncoordinated cascade of diagnostic tests, prescriptions and treatments.
Dr. Elliott Fisher of Dartmouth's Institute for Health Policy and Clinical Practice developed a pay-for-performance approach called Accountable Care Organizations that McClellan is now backing in Washington.
Fisher came to his model after sifting data that shows Medicare pays twice or even three times as much per patient in different parts of the country. The average enrollee in Medicare in Dallas, for example, consumes $10,103 a year in medical treatments, while Medicare enrollees in Salem, Ore., get by on half as much.
Fisher argues the regional cost disparities can be bent toward lower costs if physicians group together around hospital networks where each Medicare patient's care is coordinated and each treatment is evaluated for quality and effectiveness.
If the network can demonstrate its care regimen reduces average spending by 2 percent or more a year, the doctors and hospital would get bonuses amounting to 80 percent of the savings. If the network fails to meet either its quality or savings targets, its compensation would be penalized. "We need some big changes to address quality and regional disparities," McClellan said.
Len Nichols, a health care economist who worked on the Clinton administration's failed reform effort, said the reform emphasis now was less about ideas like pay-for-performance than ways to implement them. "None of these are new ideas," he said. "What we have is a sense of economic urgency driven both by the fiscal realities of our Medicare program and, obviously, the economic situation we're in right now. "We really shouldn't dither any longer about doing serious reconstructive surgery on our health system...We should start this afternoon. The longer we wait, the greater the costs."
This need to implement change is where Nichols and others see McClellan playing a role in the current debate. John Goodman, president of the Dallas-based, conservative National Center for Policy Analysis, said McClellan is "the single-most respected person in health care policy. He's both a medical doctor [Harvard Medical School] and a Ph.D. in economics [Massachusetts Institute of Technology]," Goodman said. "Most people in this debate are neither."
The health care debate is just getting started, and how much success McClellan will have is uncertain. For now, though, he's a busy man, shuttling between the White House, Congress and federal health care agencies. His phone directory includes the heads of major health centers across the nation, including Parkland and Baylor.
"We're gathering momentum," McClellan said. "I'm optimistic."
Some material reprinted from the Dallas Tribune
The new present and Congress are under a lot of pressure to clean up a lot of messes. The fact that most of these messes started long ago and far away under other administrations is somewhat irrelevant. The main issue is that right now, the economy is in a mess and it is affecting a lot of things, not the least of which is Medicare.
AIG has long been a staple in the financial area. The main problem is that as the government continues to try to shore up medicare, help it go further and help it assist more people who depend on Medicare benefits to stay healthy - or even stay alive - AIG has been finding ways to get money in sneaky and unscrupulous ways over and over. In addition, AIG has managed to get millions and milllions of dollars from the government to keep runing, because AIG is connected to tons of financial institutions that everyone seems to be worried will go under if AIG does, since AIG is the sugar mama.
The latest information on AIG after they have taken plenty of money to continue operating, they have been and continue to pass out millions in bonuses and "retention" money, as well as tell the overnment and everyone who will listen that this is someting they must do and that "legally" they can't get out of the situation.
Meanwhile, Medicare is struggling to take care of those other millions of people - you know, the ones wh depend on them to get o stay healthy. Lawmakers and the president are doing all they can to get Medicare on more stable fotting. The unfortunate thing is that this whole mess started in preious adminisrations and
for the most part, until this administration there has been little effort to really examine AIG or Medicare.
The Obama administration has made its share of mistakes and misjudgements, however, let's be fair - they inherited a miss that has been growing and growing, as well as getting messier. more complicated and more sinister over the previous years. Now it is up to the current administration to get this fixed. At least this administration is really trying to get it right. There are some lawmakers on both sides of the aisle that are trying to put bipartisanship aside and work on these urgent issues.
If the rest of the lawmakers could simply put their partisinship aside and worry aboutfixing the problems rather than blaming people, a lot coud be fixed faster. Things will get fixed, there will be mistakes and oversights along the way, and these, also, will be ixed.
It's time to continue trying to make Medicare run as it should and stop shoveling money to corporations who are - and have been - using it on unncessary luxuries while those who are struggling can't even get basic, decent medical care.
It will take some time, and at east for the first time in nearly a decade, there is a trye effort to fix these issues and put the oney where it should be. Now, if we could just get everyone to stop playing the blame game and clean up the mess, things would go faster and and definitely turn out better.
Doctor's Visits 21st Century Style
So you are on Medicare and you have to go to the doctor. 10 years ago it cost a mere pittance for the Medicare premiums and the copay for the doctor. Little by little over the years the mere pittance has risen to a ore hefty amount and has become confusing to boot.
Now there is regular basic Medicare and a barrage of Medicare supplements. This was all created to save money for Medicare recipients and doctors, too, but soehow it has all turned into a confusing mess. Even the people at Medicare and at Center for Medicare and Medicaid Services (CMS) who are trained in this stuff have a hard time explaining it to us so that it makes sense and so that we can decide what plan we need to be on to cover our needs the best.
For instance, a person with dibetes or heart problems who needs to see the doctor and go to the hospital repeatedly and often probably needs a different or additional plan than a person who has asthma and only sees the doctor once every month or two unless there is an unusual problem.
On top of everything else, everyone is a specialist now. You just can't go to a regular general practicioner for a problem and, if, in his or her opinion be sent to a specialist if absolutely necessary. You are sent from one doctor to another to another, often without ever getting an answer because each doctor has a piece of your medical puzzle.
For example, a friend of mine took a fall at work at the beginning of August, 2008. She filled out the right papers and did all she was told to do by her employer and Worker's Comp. Worker's Comp paid her for a couple of weeks because she couldn't work, but then stopped because they decided that a knee injury that happened in 1975, was fullly healed, and never required further treatent after surgery and physical therapy is considered a pre-existing condition. In the 30 years since the knee injury, this woman has been hiking and camping numerous times, horseback riding, scuba diving, playing basketball with her grandchild who is now almost 15, oh, and she has also worked full time - trudging through disasters for FEMA to make sure that people are OK. Yet, this is still a pre-existing condition.
On top of everything else, while she is waiting for Medicaid approval, she is being shuffled from "specialist" to "specialist" to determine what to do. Some doctors won't see her because she can't pay them and they won't wait until Medicaid kicks in. The problem is that the most important doctor who insists she needs surgery on both knees will not see her until he gets some money. That has become a full time job with a lawyer and everything. The doctor sent her to another doctor to deal with the pain. He is a gem and is more worried about the patient than the money. He is trying to help her with the pain and trying to help her get on Social Security because he recognizes - as the first doctor should - that this will definitely take at least a year and there is no guarantee as to how things will turn out.
The third doctor who both other doctors referred her to will not see her until she has Medicaid or something. The problem is that the pain from the accident has dirven up her blood pressure to stroke level, averaging 225/135 when it should be less than 140/90 at most. A simple change of medications - which the patient has all the information on from her old internest from a year ao - would lessen the danger of a heart attack or stroke, yet this doctor will not wait for her $55 dollars for a patient visit just to talk for 5 or 10 minutes and give the patient the prescriptions to help lower the blood pressure and the risk.
This is the state of medical care today. If you have Medicare it is much better, but you need to know which coverage is the best for you so that you don't have to run from doctor to doctor only to find out that you are at the wrong doctor who can 't or won't help you. Do your research, stay as healthy as possible - especially through exercise and diet, and find out all you can about syptoms and medications so that you walk into the doctor's office with the upper hand and a clue of what you need to get help.
As people become seniors, especially if they are dealing with various serious ilnesses, worry about end-of-life care. Their families worry about it, too. This is not just dealing with funerals. It is the cost of taking care of an individual and keeping them as healthy as possible as long as possible so that they can have a full life or at least a pain free life as the end nears.
Here are some of the latest health and medical news developments, compiled by editors of HealthDay:
Dying Hispanics and black Americans have much higher treatment costs than whites, because they get more costly, intensive treatments as they near death, say researchers who analyzed data from the last six months of life of almost 160,000 Medicare patients.
The average cost for Hispanic patients in those final months of life was $31,702, compared with $26,704 for blacks and $20,166 for whites. Compared to white patients, costs were about 30 percent higher for blacks and almost 60 percent more for Hispanics, the Associated Press reported.
The study was published Monday in the journal Archives of Internal Medicine.
The reason: studies show that throughout their lives, minorities are less likely than whites to get aggressive medical care. In addition, minorities have less access to adequate health care througout their lives and especially as they get older - for a myriad of reasons including transportation, lack of local neighborhood doctors, clinics and hospitals, and lack of funds. These findings suggest that medical resources for minority patients are far too often "misallocated over a lifetime," with minority patients receiving more treatment and more extensive and expensive treatment when their illness has become extreme due to lack of care and when there's little chance of improving or extending their lives.
Let us hope that putting partisan politics aside, lawmakers will work with the President and with each other to come up with a plan that helps everyone so that instead of suffering needessly at the end of life and spending enormous amounts of government/taxpayer's money, individuals will have heathcare that will help keep them healthier longer and allow them to die with dignity.
President Obama's budget chief has made it clear to health insurance executives that the fun is over and it’s time to get serious.
On Tuesday, White House Budget Director Peter Orszag said the government will no longer overpay companies that offer Medicare Advantage plans, the privately run portion of the government health program for seniors.
Companies like Humana Inc. and UnitedHealth have been defending their plans for over a decade, pointing out that in their opinion, they offer lower premiums and extra benefits compared with government-run Medicare. More than 10 million of the 44 million seniors enrolled in Medicare are signed up for Medicare Advantage.
The problem is that industry executives have long known that the government spends significantly more money on Medicare Advantage than its own plan. When private insurers first entered the Medicare program in the late 1990s, many lawmakers assumed companies would lower costs with their managed-care strategies. Instead, over a decade has passed and the government is spending about $1.30 per Medicare Advantage patient versus $1.00 per patients who are enrolled in traditional Medicare. The cost burden falls on taxpayers as well as patients in regular Medicare, who pay higher premiums.
"I believe in competition. I don't believe in paying $1.30 to get a dollar," Orszag told conference attendees, including representatives from Aetna Inc., WellPoint Inc. and Cigna Corp.
Orszag's address came less than a week after President Obama kicked off his health reform effort with a massive summit at the White House. Orszag showed little intention of compromising on the Medicare Advantage issue.
Under President Obama's recent budget proposal, Medicare Advantage companies would have to compete to offer their services in different parts of the country. The government payment for each region would be based on the average bid submitted by companies, saving $177 billion over 10 years, according to the White House. Under the existing system, payments are calculated annually using a preset formula.
Orszag reiterated Tuesday that the best chance to solve the country's current health care predicament is to eliminate billions of dollars worth of wasteful spending. He pointed out that different regions of the country spend vastly different sums on seniors in Medicare, without showing much difference in health outcomes.
Insurers are not the only group being asked to change how they do business. As part of his economic stimulus package, Obama provided $1.1 billion in funding for research comparing the effectiveness of various medical treatments. By rewarding physicians for using the most efficient practices, the administration hopes to reduce health care costs.
"We are pushing hard on changing incentives for providers so that we are rewarding better care and not more care," Orszag said.
Some quotes from The Associated Press.
RiskAnalyzer Incorporates Johns Hopkins ACG System for Provider Profiling, Predictive Modeling, Resource Management and Rate Adjustment
BIRMINGHAM, Ala., Feb. 19 /-- DST Health Solutions today announced the launch of its new Medicare risk adjustment software, DSTHS RiskAnalyzer(TM). RiskAnalyzer uses claims experience to determine where provider coding is not capturing disease conditions under the Centers for Medicare and Medicaid Services Hierarchical Conditions Category (CMS-HCC) model. It provides an objective set of rules to prioritize provider and member records for chart audit through identification of potentially incomplete or inaccurate patterns of coding -- either retrospectively or prospectively.
RiskAnalyzer is part of DST Health Solutions' CareAnalyzer(TM) analytics solution, which helps health plans identify high-risk members for care management. RiskAnalyzer and CareAnalyzer support appropriate member management with integrated report views of cost, quality and risk.
"In 2007, CMS completed the phase-in of risk-adjusted payments for Medicare Advantage plans based on the CMS-HCC model," said Amy Salls, Business Solutions Director for Decision Support, DST Health Solutions. "The goal of risk adjustment was to pay Medicare Advantage plans based not only on member demographics, but also on health status. This means that plans with the most effective risk adjustment optimization programs will have revenue that more accurately reflects their true risk."
RiskAnalyzer is designed to help health plans evaluate claims based on the likelihood of missed diagnosis codes. The software can also help plans identify mid-year variances while there is still an opportunity to appropriately document member risk factors.
RiskAnalyzer incorporates the ACG System, a peer reviewed methodology for provider profiling, predictive modeling, resource management, and reimbursement rate adjustment. The ACG System provides a robust application for capturing disease burden and risk from medical claims. It also incorporates a unique pharmacy model that relates prescribing practices to patient morbidity, providing another route to pick up diagnoses that may have been missed by medical claims. The ACG System was developed by The Johns Hopkins University Bloomberg School of Public Health, and is distributed exclusively by DST Health Solutions.
About DST Health Solutions
DST Health Solutions, LLC delivers systems and services that help improve efficiency, reduce operational costs, increase speed to market, facilitate medical cost management and price containment -- improving both member experience and service for commercial health plans, consumer-directed plans, government plans (Medicare Advantage, Medicare Part D and Medicaid) and physician practices. DST Health Solutions' enterprise applications and ASP and BPO services include claims processing, member and provider management, benefit plan Killer headache? Migraines hike stroke risk
Some sufferers have twice the chance of heart attacks, strokes, studies say
For more information about DST Health Solutions, contact 800.272.4799, e-mail inforequests@dsthealthsolutions.com or visit www.dsthealthsolutions.com.
Web Site: http://www.dsthealthsolutions.com/
Oregon Figures Out How to Spend Less and Give Better Care
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