Archive for April, 2009
The current administration is trying to create big changes in Medicare as they try to overhaul and reform the healthcare system. This could mean something quite new for seniors and may be a template for reforming healthcare in this country in general.
The idea is to create less waste in the entire healthcare system and strengthen Medicare, as well as covering the uninsured.
Medicare covers about 45 million Americans who are elderly or disabled, and its policies are followed by many private insurance companies when they set up their internal systems. The new approach and ideas for seniors would helMedicare p medical professionals stress and help patients with follow-up care by their family doctors and nurses so that more chronically ill patients could avoid being hospitalized and re-hospitalized when chronic problems such as high blood pressure get out of control.
There would be changes for doctors and hospitals, too. Primary care doctors who care for patients on a more constant basis would be paid more, while specialists would be watched more closely, especially as they order more tests and procedures. Hospitals could have to pay penalties if they did not provide adequate follow-up care, therefore having the same patients continually being readmitted for the same problem.
Medicaid would also see similar changes, which would affect most of the 50 million low income people that they cover.
“Medicare is going to be the driver to achieve quality reforms, in large part because the other players tend to follow Medicare,” said Sen. Max Baucus, D-Mont., the Finance Committee chairman. Baucus aims to have a bill on the Senate floor this summer that would restrain costs and cover the estimated 50 million uninsured.
The committee meetings that are slated will iron the details out, and some of the meetings have already started. This effort is aimed at helping even out who pays for these benefits and how. The sickest 10% of the patients account for nearly 2/3 the cost that Medicare spends per year. These are frail individuals who usually have more than one serious chronic condition such as high blood pressure, diabetes and heart disease. The cost is so high because they are seeing several specialists for each issue. If the changes that are being examined can be put into place, they could be seeing one doctor who could control and coordinate the other treatment they receive, eliminating duplicate procedures and eliminating waste.
If and when lawmakers are able to straighten the health care fragmentation out, it is very possible that everyone could get good care and save money at the same time.
The current administration inherited a lot of problems, not the least of which is the healthcare issue – both Medicare/Medicaid and private health care plans. Trying to balance all these out is difficult at best and, though people are looking at the “first 100 days”, 3 months is not actually a lot of time to deal with these issues on top of the other national and international issues this country faces, not to mention that even Superman and all his super-hero friends could not come up with a plan to solve all these problems in 3 months – period.
However, Obama and lawmakers are trying to iron things out. Healthcare is extremely critical because of the number of families without it and the number of seniors who depend upon it.
There have been many ideas explored to try to solve the problems inherent in the system at this point, but no solutions yet. One of the ideas on the table is something called entitlement reform, which means that Social Security and Medicare/Medicaid would be rationed (no examples given yet) and supposedly save the system, the government and the taxpayers trillions of dollars, partially by eliminating or rationing services – including education and prevention programs to keep people from getting worse and having to use the system in the first place.
Proponents of this entitlement reform in the form of rationing, feel that this would then balance the budget because of the trillions of dollars saved. They blame President Obama for not offering this type of reform, but instead trying to initiate universal health options so that everyone in this country would be able to have at least some sort of health care – even if it was very basic.
They seem to forget that Obama did not create the problem; he inherited it and is simply trying to fix it somehow with the help of Congress. Lawmakers are working on adjustments to try to make all of this work, however this will take time. As promised, the president and lawmakers hit the ground running minutes after inauguration. Is it possible that the pundits who say that the only answer to the healthcare issues is rationing can just give the actual lawmakers enough time to work on this mess – that has taken decades, especially the last 8 years – to get to this point? It’s like gaining 50 pounds in 5 years and expecting to lose it in 3 weeks. It is impossible for that to happen. It took time to get to that point. It will take some time to get fixed.
A quote from Charles Krauthammer of the Washington Post, a proponent of rationing sums it up this way:
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“It is estimated that a third to a half of one’s lifetime health costs are consumed in the last six months of life. Accordingly, Britain’s National Health Service can deny treatments it deems not cost-effective —- and if you’re old and infirm, the cost-effectiveness of treating you plummets. In Canada, they ration by queuing. You can wait forever for so-called elective procedures like hip replacements.
Rationing is not as alien to America as we think. We already ration kidneys and hearts for transplant according to survivability criteria as well as by queuing. A nationalized health insurance system would ration everything from MRIs to intensive care by a myriad of similar criteria.
Social Security was the third rail of American politics. Not anymore. Health care rationing has ascended —- which is why Obama, the consummate politician, knows to offer the candy (universality) today before serving the spinach (rationing) tomorrow. It will work for a while, but there is no escaping rationing. In the end, the spinach must be served.”
Charles Krauthammer may be right in the end, however, exploring other avenues that could possible help more people in a broader way and bring in premiums to offset costs might not be a horrible answer, either.
We will all have to see what happens as things get hammered out, and when they do, if Charles is right, I’ll be eating my spinach right along with everybody else.
The cost to Medicare for managing chronic kidney disease (CKD) is high; however, IPRO is urging health care providers in New York to work together to both improve patient care and reduce costly complications from the disease.
Medicare costs for CKD and end-stage renal disease (ESRD) exceed $70 billion annually according to United States Renal Data System (USRDS) data. IPRO is one of only eleven organizations from across the country that has been chosen by the Centers for Medicare & Medicaid Services (CMS) to work on a new pilot project that has the potential to both help patients and save taxpayers a substantial amount of money.
"We are partnering with primary care physicians, nephrologists and vascular surgeons to improve care for patients at risk of, and with CKD by preventing or slowing the progression of the disease," explained Clare Bradley, MD, MPH, Chief Medical Officer at IPRO. According to the USRDS, the savings to Medicare for each patient who does not progress to dialysis is estimated to be $288,000.
Bradley said improving the health and well-being of CKD patients could have a substantial economic impact considering Medicare beneficiaries with CKD account for 16.5 percent of Medicare costs in the year the disease is diagnosed, and 11.1 percent in the next year.
"We are confident that better care for these patients can lead to considerable cost savings, improved outcomes and better quality of life because it can mean less reliance on drugs, dialysis, and hospitalization," said Bradley. The IPRO project encourages prevention and early detection of CKD and proper medication recommendations to slow the progression of the disease.
IPRO also supports the nationwide Fistula First effort which addresses the need for patients who suffer from ESRD to have safer, higher-quality access to hemodialysis through a fistula. Bradley explained that a fistula is a "connection" surgically created by joining a vein and an artery in the forearm allowing blood from the artery to flow into the vein for safe and easy access for dialysis.
"Fistulas make a real, proven difference in the health of the patient. By providing a method of dialysis that is safer, longer lasting, and less likely to cause infection, fistulas are seen as the gold standard for vascular access," said Bradley.
Fistulas reduce serious infections and complications leading to hospitalizations and mortality often associated with other forms of vascular access for kidney patients. Vascular access complications account for 16 to 25 percent of all hemodialysis patient admissions, contributing to about $1.5 billion in Medicare costs annually. In addition, fistulas cost less to maintain than other forms of access and are associated with less re-work and complications requiring hospitalization.
IPRO is part of the nationwide Quality Improvement Organization (QIO) Program. QIOs work with health care providers, consumers and stakeholder groups to refine care delivery systems to make sure all people - particularly those from underserved populations - get the right care every time.
This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy.
This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy.
A lot of people think that Medicare and Medicaid are the same thing. They are however, not the same, not even close. Yet both in our minds and in the news media, Medicare and Medicaid are always lumped together.
On July 30, 1965, President Lyndon Johnson signed both Medicare and Medicaid into law as part of Title XIX, The Social Security Act. Both are related to healthcare. Both have substantial Federal involvement. There are some individuals who are eligible for both. That is where similarities end.
Medicare
Before 1965, only those who were in the workforce could get employer-subsidized health insurance. Thus, the retired (and the non-working) were effectively prevented from acquiring medical insurance coverage. The Medicare Program was planned, like social security, as a pay-in-advance-of-need system where the worker paid a certain amount each month into a government-run fund. At age 65, when the worker retired, this pot of money called Medicare would provide all his or her medical coverage funding. Initially, the Medicare Fund was maintained and accounted separately but quickly the Federal government lumped it into the General Fund.
Twenty-five years later (1990), the GAO measured how much Medicare was actually costing versus what was projected. Medicare then cost more than 800% over projections! This was a medical insurance plan whic intended to pay for itself but instead had become a Federal entitlement that was never intended.
Medicaid
Medicaid was always intended as an entitlement - a social welfare and protection plan funded jointly by State and Federal government funding. Initially, the Program covered low-income and non-working people, children and indigent people.
Medicaid as specific qualifications. To qualify, you must make less than a minimum income level, plus you must meet one of the categorical requirements such as age, pregnancy, disability, blindness, HIV, legal citizenship, etc. In contrast to Medicare, Medicaid recipients pay nothing into any fund. It always was and is an entitlement.
Beware when we tout single payer health insurance funded by the government as a means to provide universal health care that will reduce costs. The upward spiral of healthcare costs will reach the stratosphere - the truly unsupportable - for two reasons. 1) As entitlements expand, costs go UP certainly not down. 2) The government is a notoriously inefficient provider of, well, anything. When Government takes over an activity, the bureaucracy and its associated costs expand exponentially. Just think of the postal service or HIPAA. If you need additional proof of how costly government-run programs are, just remember the initial estimate for cost of Medicare and compare to the reality.
As time has progressed, there has been more attention given to Medicare and Medicaid. The current lawmakers are making some cutbacks wile at the same time trying to make both of these work. We will see what happens in the near future as some of the legislation that is being worked on is rolled out. In the meantime, at least there is an attempt to bring both programs forward into te 21st century.
Medicare is looking for a way to create more seamless transitions from the hospital to home, skilled nursing care, or home health care. These transitions include helping te patients stay well enough that they don't have to return to the hospital.
For years, it has been said that most people who are readmitted into the hospital do not have to be - more often than not - they should be able to go home (or to a skilled nursing care facility), and with the proper care, they should be able to stay home and progress. The Centers of Medicare & Medicaid Services has collected a great deal of data that indicates that many hospital readmissions of Medicare patients are preventable and the agency announced a program in 14 communities aimed at eliminating these “unnecessary” hospital readmissions.
The Care Transitions Project has been created by CMS to improve health care processes so that patients, their caregivers, and their entire team of providers have what they need to keep patients from returning to the hospital for ongoing care needs, according to CMS.
There are several important components to keeping a individual from returning to the hospital. Two of the most important components are having excellent home care to help the patient stay healthy. Bcing up and coupling this type of care with regular follw-up visits with the doctor will ensure that the patient's health will improve.
The total cost of unplanned hospital readmissions exceeds $17 billion annually, and varies widely across states. One of five Medicare beneficiaries discharged from the hospital is readmitted within 30 days, and half of non-surgical patients are readmitted to the hospital without having seen an outpatient doctor in follow-up, according to a Commonwealth Fund-supported study in the New England Journal of Medicine.
By promoting seamless transitions from the hospital to home, skilled nursing care, or home health care, this community-wide approach seeks, not only to reduce hospital readmissions but to yield sustainable and replicable strategies that achieve high-value health care for Medicare beneficiaries
“Our data show that nearly one in five patients who leave the hospital today will be re-admitted within the next month, and that more than three-quarters of these re-admissions are potentially preventable,” said CMS Acting Administrator Charlene Frizzera.
“This situation can be changed by approaching health care quality from a community-wide perspective, and focusing on how all of the members of an area’s health care team can better work together in the best interests of their shared patient population.”
CMS will monitor the success of this project by watching the rates at which patients in these communities return to the hospital. Re-admission rates for hospitals have been tracked by CMS for some time, and will be available to consumers later this year through the Hospital Compare Web site at http://www.hospitalcompare.hhs.gov.
“The Care Transitions Project is a new approach for CMS,” added Barry M. Straube, M.D., chief medical officer for CMS and its Office of Clinical Standards & Quality director.
“Rather than focusing on one global problem and trying to apply a one-size-fits-all solution across the country, Care Transitions experts will look in their own backyards to learn why hospital re-admissions occur locally and how patients transition between health care settings. Based on this community-level knowledge, Care Transitions teams will design customized solutions that address the underlying local drivers of re-admissions.”
Communities in the following regions have been selected to participate in the project:
Providence, R.I.;
Upper Capitol Region, N.Y.;
Western Pennsylvania;
Southwestern New Jersey;
Metro Atlanta East, Ga.;
Miami, Fl;
Tuscaloosa, Ala.;
Evansville, Ind.;
Greater Lansing Area, Mich.;
Omaha, Neb.;
Baton Rouge, La.;
North West Denver, Colo.;
Harlingen, Texas; and
Whatcom County, Wash.
The work of the Care Transitions Project will respond to the unique needs of each of the 14 communities, says CMS.
Each of the CTP communities is led by a state Quality Improvement Organization (QIO). QIOs work throughout the country as part of CMS’s quality program to help health care providers, consumers and stakeholder groups to refine care delivery systems to make sure all Medicare beneficiaries get the high-quality, high-value health care they deserve.
Each QIO in the project is required to work with partners to implement the following:
a) Hospital and community system-wide interventions;
b) Interventions that target specific diseases or conditions; and
c) Interventions that target specific reasons for admission.
The following QIOs serve as Care Transitions leaders throughout the country:
Quality Partners of Rhode Island;
IPRO Inc. (in New York);
Quality Insights of Pennsylvania;
Healthcare Quality Strategies Inc. (in New Jersey);
Georgia Medical Care Foundation Inc.;
FMQAI (in Florida); AQAF (in Alabama);
Health Care Excel (in Indiana);
MPRO (in Michigan);
CIMRO of Nebraska;
Louisiana Health Care Review;
Colorado Foundation for Medical Care;
TMF Health Quality Institute (in Texas); and
Qualis Health (in Washington).
The Care Transitions Project will continue in all 14 communities through summer 2011. For more information about the Care Transitions Project, visit http://www.cfmc.org/caretransitions/. To learn more about the work that QIOs are doing across the country, visit http://www.cms.hhs.gov/qualityimprovementorgs.
The Obama administation has taken an important first step toward reducing what are basically a set of handouts to private insurers, embedded in the Medicare system. These government subsidies to private industry enrich insurance companies at the expense of taxpayers and beneficiaries. The particular handouts in question come in the form of subsidies to so-called Medicare Advantage plans. As the Wall Street Journal reported on Monday:
The federal government made good on its plan to cut 2010 payments for private Medicare plans, diminishing the subsidies to health insurers sooner than the industry originally expected.
The cuts, announced late Monday by the Centers for Medicare and Medicaid Services (CMS), are slightly less severe than the 5% reduction the federal agency signaled in February, but still raise concerns about what has been a critical source of profit growth for many health insurers. Reimbursements to private insurers that administer so-called Medicare Advantage plans would fall by as much as 4% to 4.5% next year.
There have been numerous acknowledgements that the Bush Admiistration pushed for private insurance companies to become more and more involved and imbeded in the system and it is beyond time that everyone has had enough.
Here is th description of the genesis of Medicare Advantage plans in more detail in a post back in January on a blog called Unsilent Generation:
Medicare Advantage (MA) plans–-which offer managed care run through private insurers, paid for by the federal government–-are the point of the stake that conservatives have long been trying to drive into the heart of traditional Medicare (which, for all its shortcomings, is the closest thing to a single-payer program that this country has ever seen). Columnist Saul Friedman recently wrote about the history of of this effort, recalling a 1995 press briefing in which Dick Armey, Newt Gingrich’s collaborator on the “Contract With America,” announced their intent to “wean our old people away from Medicare.” The first step was to introduce private Medicare HMOs–-what later evolved into Medicare Advantage plans, with a big boost from the Republicans’ 2003 Medicare bill.
MA plans have come under increasing fire for their hard-sell tactics to elderly Medicare recipients, shoddy coverage, and rip-offs of the public purse. “Competition” from the private plans was supposed to reduce growth in Medicare spending–but in fact, they cost the government more. A September 2008 report from the Commonwealth Fund calculated that “payments to MA plans in 2008 will be 12.4 percent greater than the corresponding costs in traditional Medicare–-an average increase of $986 per MA plan enrollee, for a total of more than $8.5 billion. Over the five-year period 2004-2008, extra payments to MA plans are estimated to have totaled nearly $33 billion.”
If the Commonwealth Fund’s figures hold true for this year as well, then by my calculations the Medicare Advantage plans are still getting a subsidy of some 8 percent over traditional Medicare, even after a 4 percent cut. (In fact, the baseline payments to private plans will still go up slightly in 2010, but they’ll be offset by adjustments in other areas—so the 4 percent is just an estimate.) Nonetheless, the insurance companies are already whining about (and lobbying against) the cuts, claiming that they will harm the 10 million Medicare beneficiaries who’ve been convinced to switch to private plans. According to Reuters:
Analysts say the new rates will force insurers to cut benefits for elderly and disabled patients enrolled in Medicare Advantage plans or increase premiums in order to maintain profit margins.
That last phrase, of course, is key: It’s the profit margin that matters to these companies, which is why they shouldn’t be in the Medicare business in the first place—especially if they require extra government subsidies just to make enough money to satisfy their greed. The insurers know that in order to maintain their high profits, they’ll now be “forced” to cut the benefits on their private plans, and more and more Medicare patients will just switch back to conventional, government-run Medicare.
That can’t happen soon enough. The government’s next step should be to boot the insurance companies out of the Medicare Part D prescription drug program, which would likewise save the taxpayers a bundle while improving benefits to the old and disabled. I’d love to see this done before I fall into the coverage gap, which usually happens around August. But to accomplish this change, Congress will need to act—and they’ll have to battle Big Pharma as well as the insurance giants. So I’m not holding my breath.
quotes and other information courtesy of Mother Jones
On Sunday, March 29, the Star-Ledger ran "book-end" op-eds on healthcare reform. They quibble about the cost and benefits of Obama's plan. Neither addresses a superior plan that is already before Congress but is being kept "off the table" in most discussions of healthcare reform.
President Obama insists that some consumers like their current health insurance. Most are probably unaware that illness and medical debt are the single biggest cause of personal bankruptcy in the United States, or that three out of four of those households had health insurance when illness or injury first struck. They do not realize that they will not be able to keep their plans if they lose their jobs.
In the United States, most young adults get their health insurance from their employer. If they lose their job, they have to buy health insurance, a huge expense when their income has vanished. What's worse, the high cost of health insurance has been chasing jobs away. Health insurance companies have been making money on employers of all kinds in the United States. Unlike Medicare, which has an overhead of only 3%, the insurance companies skim about 30% off the top, to pay for executive salaries and bonuses, shareholders' profits, and the cost of a wasteful bureaucracy. Many employers can't afford this, especially if they are competing with foreign companies that have efficient national health insurance. So employers from large industries to small businesses to nonprofits like your child's school have to make the nearly impossible choice between cut benefits or cutting staff.
Many citizens feel that the obvious solution is to expand and improve Medicare to cover everything for everyone: 100% of all medically necessary care, including prescription drugs and long-term care. By cutting out the private insurance companies, we could cover everyone at a reasonable cost: 90% of American families would end up paying less than they are paying now.
The United States National Health Care Act or the Expanded and Improved Medicare for All Act (H.R. 676) would be funded by a payroll tax: 4.5 percent from employers and 3.3 percent from employees. There would also be a one third of one percent tax on stock transactions and a small increase in income tax for the top income earners. So most unemployed and retired people won't have to pay a cent.
If Medicare for All is enacted, most Americans will never see another medical bill or pay for another prescription drug. They won't have to sell their home to buy long-term care for a disabled family member. All we need to do is get the House of Representatives to pass H.R. 676, and the Senate to pass the companion bill S. 703, and the President to sign it.
"But it will never pass," people say, "because Congress is in the pockets of the health insurance industry." The truth is that we can get this legislation passed. Pollsters report that most people want a "single-payer" plan like H.R. 676. Strong majorities of doctors and nurses support it. Most employers, from big manufacturers to small businesses to your children's school or your church, would save money on health insurance, while providing better health coverage to their employees. Medicare for All will help make American businesses competitive again. If patients, doctors and nurses, and most employers want this bill to pass, who can stand in its way? And why -unless you are a lobbyist for an insurance company - would you want to?
Nevertheless, getting Medicare for All will be an uphill struggle. The single-payer option is being swept "off the table" by the likes of Max Baucus, Senate Finance Committee Chair and recipient of over $2 million in campaign contributions from the insurance and healthcare industries in the last election. Fortunately, members of the House of Representatives face reelection every two years. If your Representative doesn't support H.R. 676, find someone who will and get that person elected in 2010. Senators serve longer terms, but the principle is the same. Ask Senators Lautenberg and Menendez to cosponsor S.703.
To get involved, connect with groups like Physicians for a National Health Program (www.pnhp.org) or Healthcare-Now! (www.healthcare- now.org). Beware of groups that are really fronts for the insurance companies. Learn the facts of healthcare reform options. Talk to your friends, relatives, coworkers and neighbors. Get organized, and get active. Together, we can do it!
Some quotes and material from Geoff Thomas at oped.com The views expressed in this article are the sole responsibility of the author, Geoff Thomas, and do not necessarily reflect those of this website or its editors.
