Tuesday, December 31, 2013
“Ultimately, there is wide acceptance of the goal of ACOs and the means of ACOs to obtain better outcomes. That being said, despite the wide acceptance it’s going to be a painful process….It’s wishful thinking [to think the fee-for-service payment system will be ending in two years]. It is going to take several years and it’s going to take a lot of pain as the details of these programs are worked out. And even then I don’t think FFS will be completely replaced by the kind of innovations that CMS and commercial plans are just now experimenting with.” — Mike Taylor, M.D., president of Medical Audit & Review Solutions in West Chester, Pa., told AIS’s Health Plan Week.
Monday, December 30, 2013
A report from the U.S. Department of Health and Human Services that examined data from the 34 Federally-facilitated and State Partnership Marketplaces finds that out of 2.9 million single young adults ages 18 to 34 who may be eligible for coverage in the Marketplace, 1.3 million (46 percent) could purchase a bronze plan for $50 per month or less after tax credits. In the 34 states, a total of 1.9 million young adults, representing nearly 7 in 10 (66 percent) of the potentially Marketplace-eligible uninsured ages 18 to 34, may be able to pay $100 or less for coverage in 2014. According to the report, an additional 1 million eligible uninsured single young adults may qualify for Medicaid in the states that have opted to expand the program in 2014. Today's report also shows that if each of the 34 states expanded its Medicaid program, the proportion of young adults who could obtain low-cost coverage would be even greater. If each of the 34 states expanded its Medicaid program, 4.9 million uninsured single young adults would be eligible for Medicaid. Source: U.S. Department of Health and Human Services
59 percent of expats said they were unaware of their employer's repatriation assistance and didn't know whether their employer would track what happens to them after they return home. This low awareness score can be translated into dissatisfaction, as expats perceive lack of employer interest in them after their assignment concludes. 78 percent of expats or their family members have accessed medical care while on assignment. Expats under age 34 were considerably less informed about the specifics of their health plans. Source: Cigna
Physicians who were educated outside the United States account for about 25 percent of the U.S. physician workforce, with the largest groups being from India, the Philippines, Pakistan, Mexico and the Dominican Republic. Foreign-born registered nurses account for 12 percent to 15 percent of the total RNs in the United States, with 5.4 percent both foreign born and foreign educated. The largest number of foreign-educated and foreign-educated RNs are from the Philippines, followed by Canada, India, the United Kingdom and Nigeria. Among direct care workers, a category that includes nursing aides and home health aides, foreign-born individuals account for 20 percent to 24 percent of the workforce. The largest numbers of foreign-born direct care workers are from Mexico, the Philippines, Jamaica, Haiti and the Dominican Republic. It is estimated that 20 percent of direct care workers are undocumented immigrants. Source: RAND Corporation
Dual Eligible Beneficiaries Affected in Nine States Where CMS Has Approved Financial and/or Administrative Alignment Demonstrations as of November 2013
Beneficiaries Washington 21,000 Minnesota 36,000 South Carolina 53,600 Virginia 78,600 Massachusetts 90,240 Ohio 115,000 Illinois 135,825 New York 170,000 California(Other Than L.A. County) 256,000 L.A. County 200,000 Total 1,156,265 Source: Kaiser Family Foundation
Most individuals have not taken steps to plan for health care costs in retirement. Across age groups, only about one-third (36%) have tried to estimate how much money they will need to save and have set money aside to cover these expenses in the future. Adults age 60-64 (40%) are just slightly more likely than those age 50-59 (35%) to have money set aside although these differences are not statistically significant. Estimates of the actual costs of health care in retirement vary significantly. More than four in ten adults age 50-64 (42%) believe they will need to accumulate less than $100,000 to cover out-of-pocket health care expenses during their retirement. In addition, sixteen percent believe it will cost less than $50,000 and 15% say they simply do not know. Source: AARP
Profession Annual Media Salary Projected Growth Biomedical Engineer $86,960 62% Dental Hygienist $70,210 38% Occupational Therapist $75,400 33% Optometrist $97,820 33% Physical Therapist $79,860 39% Chiropractor $66,160 28% Speech Pathologist $69,870 23% Pharmacist $116,670 25% Podiatrist $116,440 20% Respiratory Therapist $55,870 28% Medical Records Technician $34,610 21% Physician Assistant $90,930 30% Source: Career Cast
According to the 2013 Healthcare Benefits Trends Benchmark Study by Evolution1's Healthcare Trends Institute, healthcare reform is prompting employers to look at defined contribution health plans and the use of health insurance exchanges in offering employee healthcare benefits in the future. 59.4% of respondents indicated they were somewhat to very familiar with Defined Contribution Plans (DCPs) with a majority of those interested in DCPs for the future considering for 2015. When asked about health insurance exchanges, 62.1% indicated they were somewhat to very familiar with public exchanges and 55.5% were somewhat to very familiar with private exchanges. Source: Evolution1
According to a survey from Intel, more than 70 percent of respondents are receptive to using toilet sensors, prescription bottle sensors or swallowed monitors to collect ongoing and actionable personal health data. Sixty-six percent of people prefer a personalized healthcare regimen designed specifically for them based on their genetic profile or biology. And 53 percent of those surveyed said they would trust a test they personally administered as much or more than if it came from a doctor. The survey revealed an overwhelming majority of people (84 percent) globally would anonymously share their personal health information, such as lab results, if it could lower medication costs or overall cost to the healthcare system. A higher percentage of people said they are more willing to share their health records (47 percent) than their phone records (38 percent) or banking information (30 percent) to aid innovation. Source: Intel
The percentage of young adults with private health insurance coverage increased from the last 6 months of 2010 through the last 6 months of 2012 (52.0% to 57.9%). Except for an increase in the first 6 months of 2011, the percentage of privately insured young adults who had a gap in coverage during the past 12 months decreased from the first 6 months of 2008 through the last 6 months of 2012 (10.5% to 7.8%). The percentage of privately insured young adults with coverage in their own name decreased from 40.8% in the last 6 months of 2010 to 27.2% in the last 6 months of 2012. The percentage of privately insured young adults with employer-sponsored health insurance increased from the last 6 months of 2010 to the last 6 months of 2012 (85.6% to 92.5%). Source: Centers for Disease Control and Prevention, National Center for Health Statistics
Body mass index (BMI) is a measurement of a person's weight adjusted for his or her height, and can be used to screen for possible weight-related health problems. A healthy or normal BMI is 19-24, while overweight is 25-29 and obese is 30 and above. For example, a 5-foot-6-inch person who weighs 117.5 pounds has a BMI of 19, while a person of the same height weighing 279 pounds has a BMI of 45. According to a study published in the journal Obesity, the average annual health care costs for a person with a BMI of 19 was found to be $2,368; this grew to $4,880 for a person with a BMI of 45 or greater. Source: Duke Medicine
According to a study from the Perelman School of Medicine at the University of Pennsylvania, Nearly two-thirds (65 percent) of the nation's leading health care executives say they believe the health care system will be somewhat or significantly better by 2020 than it is today as a result of national health care reform. Additionally, 93 percent believe that the quality of care provided by their own hospital or health system will improve during that time period. Overall, the expected average operating cost reduction was 11.7 percent. These savings could be achieved by such strategies as reducing the number of hospitalizations (54 percent), reducing the number of readmissions (49 percent), and reducing the number of emergency room visits (39 percent). Source: Perelman School of Medicine at the University of Pennsylvania
A WellPoint survey, which examines how Americans (age 45 and older) view dental coverage benefits, reveals that Americans over age 45 understand that good oral care can positively affect their overall heath. However, while 83 percent of Americans surveyed say they have medical coverage (from either an employer or the government), only half as many are covered by dental insurance. And, as baby boomers plan for retirement, those with dental coverage say they need more information about future costs and changes to their dental plan upon retirement. This survey also shows that nine out of 10 older Americans (93 percent) believe good dental care is important to their overall health and that routine dental check-ups can help prevent heart disease and other chronic conditions (90 percent). This awareness contrasts with the fact that only four in 10 older Americans (41 percent) say they currently have dental coverage (from an employer, private and/or supplemental). Furthermore, 32 percent of those without insurance admit to forgoing dental benefits because they have other expenses to worry about. Source: WellPoint
1. Connecting with Leaders- To be lead, you must know what your leaders are thinking 2. Connecting with Followers- As physicians, you are a leader. Whether it ‘s in your office or elswhere 3. Networking- The importance of professional networking cannot be understated 4. It makes me an active learner- All through my education I took notes 5. I can educate the world- This is a grandiose statement, but Twitter makes it real 6. I can attend multiple conferences simultaneously, year round 7. It’s a forum for debate- Healthy debate is part of our lives as physicians 8. My mom taught me to share- We are all online, all the time 9. The world at any given moment- Whenever I have a free moment, Twitter is my go to activity 10. It broadens my mind- In patient care we are emphasizing a team-based approach that values the roles of every individual in a healthcare team Source: Med City News
General Criteria a Health Reimbursement Account Must Meet In Order to be Integrated With Other Group Health Plan Coverage
1. The employer must offer a group health plan that provides coverage beyond excepted benefits 2. The employee receiving the HRA must actually be enrolled in such a group health plan, regardless of whether the employer sponsors that plan 3. Under the terms of the HRA, an employee must be permitted to opt out of and waive future reimbursements from the HRA at least annually 4. Upon termination of employment, either the remaining amounts in the HRA are forfeited or the employee must be permitted to opt out of and waive future reimbursements from the HRA Source: Mondaq
Percentage of Privately Insured Young Adults Who Obtained Their Coverage Through Some Other Family Member
Percentage of Privately Insured Young Adults Who Obtained Their Coverage Through Some Other Family Member 1. Last 6 months of 2012 - 72.8% 2. Last 6 months of 2010 - 59.2% 3. First 6 months of 2008 - 55.6% Source: CDC/National Center for Health Statistics
• 41% of Americans have used urgent care facilities for their health needs • Of those patients, 20% used them for X-rays or lab tests • 12% used them for ongoing care for chronic illness • 5% used them to receive flu shots • 25% of patients returned to the urgent care center for follow-ups Source: "Alternative Care Facilities Are The Preferred Medical Option For Younger Generation," Vitals.com Press Release, November 19, 2013, http://www.vitals.com/posts/press-center/press-releases/alternative-care-facilities-are-the-preferred-medical-option-for-younger-generation
59% of the uninsured have put off medical treatment in the past year because of cost, compared with 25% of those with private health insurance, and 22% of those with Medicare or Medicaid. Source: "Costs Still Keep 30% of Americans From Getting Treatment," Gallup Inc., December 9, 2013, http://www.gallup.com/poll/166178/costs-keep-americans-getting-treatment.aspx
51% of respondents said they set aside more money for potential medical costs than before they had HSAs; 29% say they have more discussions with their doctors about the cost of care; and 13% say they manage their chronic disease more actively. Source: "New Survey Reveals Employees Are More Active in Managing Their Health after Enrolling in a Health Savings Account," Xerox/Buck Consultants Press Release, December 11, 2013, http://news.xerox.com/news/Buck-Consultants-Survey-Reveals-Health-Savings-Accounts-Foster-Active-Health-Management
Texas Department of State Health Services NEWS RELEASE Dec. 20, 2013 Texas Encourages Vigilance in Flu Treatment, Precautions Though recent increases in flu activity are not unusual, Texas issued flu testing and treatment guidance today to doctors and is continuing to encourage everyone to get vaccinated now to protect themselves. The level of flu-like illness is classified as “high” in Texas, and medical providers are seeing an increase in flu in multiple parts of the state. Unusually severe cases of flu-like illness are routinely investigated during the flu season by local health departments in coordination with the Texas Department of State Health Services. H1N1 is the most common circulating flu strain so far this season. This year’s flu vaccine includes protection against the most common flu strains, including H1N1. DSHS advises clinicians to consider antiviral treatment, even if an initial rapid-flu test comes back negative. A negative result does not exclude a diagnosis of flu in a patient with suspected illness. Antiviral treatment is recommended for anyone with confirmed or suspected flu who is hospitalized, has severe or progressive illness or is at a higher risk for complications. “Flu is on the rise and causing severe illness in certain people. It is not unexpected this time of year, but it’s a good reminder for people to get vaccinated and stay home if they’re sick,” said Dr. David Lakey, DSHS commissioner. “Flu can be deadly. People who have not been vaccinated should do so now. It’s the best defense we have.” Flu is a serious disease that kills an average of 23,600 Americans a year, according to estimates from the Centers for Disease Control and Prevention. People over 65, pregnant women, young children and people with chronic health conditions are most at risk for complications, so it’s especially important for them to be vaccinated. Flu cases and flu-related deaths in adults are not required to be reported to DSHS. Healthcare providers are required to report pediatric flu deaths to their local health department within one business day. There are no confirmed pediatric flu deaths in Texas this season. DSHS recommends everyone six months old and older get vaccinated. People should talk to their health care provider about the best type of flu vaccine for them. A nasal spray version is available for healthy people ages 2 to 49 who are not pregnant, and a high-dose vaccine is approved for people 65 and older. Dr. Lakey also urged people to follow standard illness-prevention steps: • Wash hands frequently with soap and water or alcohol-based hand sanitizer; • Cover coughs and sneezes; • Stay home if sick For more information, go to www.TexasFlu.org. DSHS Influenza Health Alert: www.dshs.state.tx.us/news/releases/Influenza-Health-Alert-122013.pdf
Texas Department of State Health Services NEWS RELEASE Dec. 23, 2013 Texas Quitline Can Help Tobacco Users Quit in the New Year Many tobacco users make a New Year’s resolution to give up their habit, and the state’s Quitline is ready to take calls from people looking for help. The Texas Department of State Health Services encourages people who are ready to quit, or are thinking about quitting, to seek assistance and advice by calling the Texas Quitline at 1-877-YES QUIT or visiting www.yesquit.org. Quitline services are available in English and Spanish. Callers to the Quitline, which uses the American Cancer Society’s Quit for Life Program, receive free, confidential counseling services and personalized tools and strategies from trained professionals to help them quit. The www.yesquit.org website has tips, success stories, motivational videos and an online community of people dedicated to quitting and encouraging others to stick to it. People can create an online quitting plan that helps them take steps toward a tobacco-free life. The Texas Quitline was first offered in 2001 and serves about 10,000 people a year. The U.S. Public Health Service’s clinical practice guidelines say that Quitline counseling can more than double a smoker’s chances of quitting. According to the Centers for Disease Control and Prevention, tobacco use is the leading cause of preventable and premature death in the United States. Additional Facts: • More than 24,000 Texans die from smoking or exposure to secondhand smoke each year. • In the United States, nearly 1 in 5 deaths is attributed tobacco use. • Lung cancer is the leading cause of cancer death in the United States for men and women, and 90 percent of lung cancer cases are attributed to smoking. (News Media Contact: Chris Van Deusen, DSHS Press Officer, 512-776-7753)
More partnerships between doctors and hospitals strengthen coordinated care for Medicare beneficiaries
U.S. Department of Health & Human Services News Division 202-690-6343 firstname.lastname@example.org www.hhs.gov/news FOR IMMEDIATE RELEASE Monday, December 23, 2013 More partnerships between doctors and hospitals strengthen coordinated care for Medicare beneficiaries 123 New Accountable Care Organizations Join Program to Improve Care for Medicare beneficiaries Doctors, hospitals and other health care providers have formed 123 new Accountable Care Organizations (ACOs) in Medicare, providing approximately 1.5 million more Medicare beneficiaries with access to high-quality coordinated care across the United States, Health and Human Services Secretary Kathleen Sebelius announced today. Doctors, hospitals and health care providers establish ACOs in order to work together to provide higher-quality coordinated care to their patients, while helping to slow health care cost growth. Since passage of the Affordable Care Act, more than 360 ACOs have been established, serving over 5.3 million Americans with Medicare. Beneficiaries seeing health care providers in ACOs always have the freedom to choose doctors inside or outside of the ACO. ACOs share with Medicare any savings generated from lowering the growth in health care costs when they meet standards for high quality care. “Accountable Care Organizations are delivering higher-quality care to Medicare beneficiaries and are using Medicare dollars more efficiently,” Secretary Sebelius said. “This is a great example of the Affordable Care Act rewarding hospitals and doctors that work together to help our beneficiaries get the best possible care.” “This program puts the control in the hands of physicians and allows them to take the lead in an innovative way to deliver the right care to the right patient at the right time,” said Kelly A. Conroy, executive director of the Palm Beach ACO and South Florida ACO. “We are honored to be a Medicare Shared Savings Program Accountable Care Organization, and after 18 months in the program, can proudly say that we have seen measurable success. We are so impressed with our participating physicians’ enthusiasm towards the cultural shift, and it demonstrates that physicians are primed for the future of medicine.” The ACOs must meet quality standards to ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe, and timely. The Centers for Medicare & Medicaid Services (CMS) evaluates ACO quality performance using 33 quality measures on patient and caregiver experience of care, care coordination and patient safety, appropriate use of preventive health services, and improved care for at-risk populations. The new ACOs include a diverse cross-section of health care providers across the country, including providers delivering care in underserved areas. More than half of ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries. Approximately 1 in 5 ACOs include community health centers, rural health clinics, and critical access hospitals that serve low-income and rural communities. Affordable Care Act provisions have a substantial effect on reducing the growth rate of Medicare spending. Growth in Medicare spending per beneficiary hit historic lows during the 2010-2012 period, and this trend has continued into 2013. Projections by both the Office of the Actuary at CMS and the Congressional Budget Office estimate that Medicare spending per beneficiary will grow at approximately the rate of growth of the economy for the next decade, breaking a decades-old pattern of spending growth outstripping economic growth. The next application period for organizations interested in participating in the Shared Savings Program beginning January 2015 will be in summer 2014. More information about the Shared Savings Program, including previously announced ACOs, is available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/News.html For a list of the 123 new ACOs announced today, visit: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/2014-ACO-Contacts-Directory.pdf
Friday, December 20, 2013
• 10.4% of the hospital stays were for observation • Mean observation length of stay was 33.3 hours, with 44.4% of stay durations less than 24 hours and 16.5% more than 48 hours • Observation care had a negative margin per stay (−$331) • The inpatient margin per stay was positive (+$2163) Source: "Hospitalized but Not Admitted: Characteristics of Patients With “Observation Status” at an Academic Medical Center," JAMA Internal Medicine, abstract only, November 25, 2013, http://archinte.jamanetwork.com/article.aspx?articleID=1710122&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=ArchivesofInternalMedicine%3ANewIssue11%2F25%2F2013
Wednesday, December 18, 2013
1.9 million customers made it through the process but have not yet selected a plan; an additional 803,077 assessed or determined eligible for Medicaid or CHIP Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that nearly 365,000 individuals have selected plans from the state and federal Marketplaces by the end of November. November alone added more than a quarter million enrollees in state and federal Marketplaces. Enrollment in the federal Marketplace in November was more than four times greater than October’s reported federal enrollment number. Since October 1, 1.9 million have made it through another critical step, the eligibility process, by applying and receiving an eligibility determination, but have not yet selected a plan. An additional 803,077 were determined or assessed eligible for Medicaid or the Children’s Health Insurance Program (CHIP) in October and November by the Health Insurance Marketplace. “Evidence of the technical improvements to HealthCare.gov can be seen in the enrollment numbers. More and more Americans are finding that quality, affordable coverage is within reach and that they'll no longer need to worry about barriers they may have faced in the past – like being denied coverage because of a pre-existing condition,” Secretary Kathleen Sebelius said. “Now is the time to visit HealthCare.gov, to ensure you and your family have signed up in a private plan of your choice by December 23 for coverage starting January 1. It's important to remember that this open enrollment period is six months long and continues to March 31, 2014.” The HHS issue brief highlights the following key findings, which are among many newly available data reported today on national and state-level enrollment-related information: • November’s federal enrollment number outpaced the October number by more than four times. • Nearly 1.2 million Americans, based only on the first two months of open enrollment, have selected a plan or had a Medicaid or CHIP eligibility determination; o Of those, 364,682 Americans selected plans from the state and federal Marketplaces; and o 803,077 Americans were determined or assessed eligible for Medicaid or CHIP by the Health Insurance Marketplace. • 39.1 million visitors have visited the state and federal sites to date. • There were an estimated 5.2 million calls to the state and federal call centers. The report groups findings by state and federal marketplaces. In some cases only partial datasets were available for state marketplaces. The report features cumulative data for the two month period because some people apply, shop, and select a plan across monthly reporting periods. These counts avoid potential duplication associated with monthly reporting. For example, if a person submitted an application in October, and then selected a Marketplace plan in November, this person would only be counted once in the cumulative data. To read today’s report visit: http://aspe.hhs.gov/health/reports/2013/MarketPlaceEnrollment/Dec2013/ib_2013dec_enrollment.pdf To hear stories of Americans enrolling in the Marketplace visit: http://www.hhs.gov/healthcare/facts/blog/2013/12/americans-enrolling-in-the-marketplace.html.
FOR IMMEDIATE RELEASE December 10, 2013 Contact: HHS Press Office 202-690-6343 HHS announces Affordable Care Act mental health services funding $50 million from the health care law will expand mental health and substance use disorder services in approximately 200 Community Health Centers nationwide The U.S. Department of Health and Human Services (HHS) today announced that it plans to issue a $50 million funding opportunity announcement to help Community Health Centers establish or expand behavioral health services for people living with mental illness, and drug and alcohol problems. Community Health Centers will be able to use these new funds, made available through the Affordable Care Act, for efforts such as hiring new mental health and substance use disorder professionals, adding mental health and substance use disorder services, and employing team-based models of care. “Most behavioral health conditions are treatable, yet too many Americans are not able to get needed treatment,” said Health Resources and Services Administration (HRSA) Administrator Mary K. Wakefield, Ph.D., R.N. “These new Affordable Care Act funds will expand the capacity of our network of community health centers to respond to the mental health needs in their communities.” “These new funds will further the Department’s work to develop integrated primary and behavioral health care services to better meet the needs of people with mental health and substance use conditions,” said Substance Abuse and Mental Health Services Administration Administrator, Pamela S. Hyde. It is estimated these awards will support behavioral health expansion in approximately 200 existing health centers nationwide. Over the past year the Obama administration has taken a number of steps to reduce the barriers that too often prevent people from getting the help they need for behavioral health problems. The Affordable Care Act expands mental health and substance use disorder benefits and parity protections for approximately 60 million Americans. The President’s Fiscal Year 2014 Budget includes a new $130 million initiative to help teachers recognize signs of mental illness in students and refer them to services, support innovative state-based programs to improve mental health outcomes for young people ages, and train 5,000 more mental health professionals. For more information please visit: http://www.whitehouse.gov/omb/budget/factsheet/improving-mental-health-prevention-and-treatment-services. The Administration has also finalized rules under the Mental Health Parity and Addiction Equity Act. Because of these parity protections, many insurance plans will now include coverage for mental health and substance use conditions that is comparable to their medical and surgical coverage. The Administration also launched www.mentalhealth.gov a new website featuring easy-to-understand information about basic signs of mental health problems, how to talk about mental health, and how to find help.
More than 25 million Original Medicare beneficiaries received free preventive services through November 2013
CMS NEWS FOR IMMEDIATE RELEASE Contact: CMS Media Relations December 17, 2013 (202) 690-6145 | email@example.com More than 25 million Original Medicare beneficiaries received free preventive services through November 2013 According to new data released by the Centers for Medicare & Medicaid Services (CMS) today, more than 25.4 million people covered by Original Medicare received at least one preventive service at no cost to them during the first eleven months of 2013, because of the Affordable Care Act. Today’s news comes after last month’s announcement showing that the health care law also saved seniors $8.9 billion on their prescription drugs since the law’s enactment. “Thanks to the Affordable Care Act, millions of seniors have been able to receive important preventive services and screenings such as an annual wellness visit, screening mammograms and colonoscopies, and smoking cessation at no cost to them,” said CMS Administrator Marilyn Tavenner. “Prevention and early detection are so vital to ensure that Americans are healthy and Medicare is healthy. The Affordable Care Act makes Medicare stronger and improves the wellbeing of millions of beneficiaries who have taken advantage of preventive services and wellness visits.” Today’s announcement exceeds the comparable figure from last November, when an estimated 24.7 million people with Original Medicare received one or more preventive benefits at no out of pocket costs by this point in time during 2012. When factoring in Medicare Advantage utilization rates and a full year of experience, an estimated 34.1 million people with Medicare took advantage of at least one preventive service in 2012. Moreover, in the first eleven months of 2013, more than 3.5 million beneficiaries with Original Medicare took advantage of the Annual Wellness Visit established by the health care law – a significant increase from the 2.8 million who used this service by this point in the year in 2012. Before the Affordable Care Act, Medicare recipients had to pay part of the cost for many preventive health services. These out-of-pocket costs made it difficult for people to get the important preventive care they needed. For example, before the Affordable Care Act, a person with Medicare could pay as much as $160 in cost-sharing for a colorectal cancer screening. Today, this important screening and many others are covered at no cost to beneficiaries (with no deductible or co-pay). The Affordable Care Act helps tear down a significant barrier for some seniors to staying healthy and helps their care providers prevent, identify and treat problems early. For state-by-state information on utilization of free preventive services for people with original Medicare, please visit: http://downloads.cms.gov/files/Preventive_Services_Utilization_by_State_Jan-Nov_2013.pdf
NEWS RELEASE Dec. 17, 2013 Flu on the Rise in Texas; DSHS Encourages Vaccination, Prevention With flu season ramping up in Texas, the Texas Department of State Health Services reminds people who haven’t gotten a flu shot yet this season not to put it off any longer. The level of flu-like illness is currently classified as “high” in Texas, and medical providers are seeing an increase in flu in multiple parts of the state. Getting vaccinated is the best way for people to protect themselves and their families from the flu during the holiday season, when there is typically an increase in flu cases. DSHS recommends everyone six months old and older get vaccinated. People should talk to their health care provider about the best type of flu vaccine for them. A nasal spray version is available for healthy people ages 2 to 49 who are not pregnant, and a high-dose vaccine is approved for people 65 and older. Flu is a serious disease that kills an average of 23,600 Americans a year, according to estimates from the Centers for Disease Control and Prevention. People over 65, pregnant women, young children and people with chronic health conditions are most at risk for complications, so it’s especially important for them to be vaccinated. Getting vaccinated is the best way to stop the spread of the flu. Additionally, cover all coughs and sneezes, wash hands frequently with soap and water or use hand sanitizer, and stay home if sick. (News Media Contact: Chris Van Deusen, DSHS Press Officer, 512-776-7753)
Tuesday, December 17, 2013
“Some people have suggested that COBRA is dead … and it might be for some employers, but they are still on the hook for sending [COBRA] notices [to outgoing employees]. Even though it might make sense to repeal COBRA [because of ACA provisions], it’s doubtful it will be repealed by this Congress … even if both sides agree.” — Chantel Sheaks, major medical consultant at American Fidelity Administrative Services, LLC, told AIS’s Inside Health Insurance Exchanges.
Friday, December 13, 2013
“The challenge that [new]anti-obesity medications have is one of legacy. The products that have been available in the past haven’t been all that dramatic or effective in weight loss and that sort of stuck in the mind, I believe, of prescribers. So the new products [Belviq and Qsymia] are going to have to demonstrate efficacy before they’re going to get widespread use.” — Craig Oberg, R.Ph., a managing consultant with The Burchfield Group, told AIS’s Drug Benefit News.
By ROBERT PEAR Published: December 9, 2013 WASHINGTON — For months, the Obama administration has heralded the low premiums of medical insurance policies on sale in the insurance exchanges created by the new health law. But as consumers dig into the details, they are finding that the deductibles and other out-of-pocket costs are often much higher than what is typical in employer-sponsored health plans. Until now, it was almost impossible for people using the federal health care website to see the deductible amounts, which consumers pay before coverage kicks in. But federal officials finally relented last week and added a “window shopping” feature that displays data on deductibles. For policies offered in the federal exchange, as in many states, the annual deductible often tops $5,000 for an individual and $10,000 for a couple. Insurers devised the new policies on the assumption that consumers would pick a plan based mainly on price, as reflected in the premium. But insurance plans with lower premiums generally have higher deductibles. In El Paso, Tex., for example, for a husband and wife both age 35, one of the cheapest plans on the federal exchange, offered by Blue Cross and Blue Shield, has a premium less than $300 a month, but the annual deductible is more than $12,000. For a 45-year-old couple seeking insurance on the federal exchange in Saginaw, Mich., a policy with a premium of $515 a month has a deductible of $10,000. In Santa Cruz, Calif., where the exchange is run by the state, Robert Aaron, a self-employed 56-year-old engineer, said he was looking for a low-cost plan. The best one he could find had a premium of $488 a month. But the annual deductible was $5,000, and that, he said, “sounds really high.” By contrast, according to the Kaiser Family Foundation, the average deductible in employer-sponsored health plans is $1,135. “Deductibles for many plans in the insurance exchanges are pretty high,” said Stan Dorn, a health policy expert at the Urban Institute. “These plans are more generous than what’s prevalent in the current individual insurance market, but significantly less generous than most employer-sponsored insurance.” Caroline F. Pearson, a vice president of Avalere Health, a consulting company that has analyzed hundreds of plans, said: “The premiums are lower than expected, but consumers on the exchange will often face high deductibles and high co-payments for medical services and prescription drugs before they reach the cap on out-of-pocket costs,” $6,350 for an individual and $12,700 for a family. Those limits provide significant protection, even though those sums are substantial for most consumers. In addition, the federal website, HealthCare.gov, informs people that they may qualify for subsidies to reduce their out-of-pocket costs if their household income is below 250 percent of the federal poverty level, meaning that it is less than $28,725 for an individual or $48,825 for a family of three. These “cost-sharing reductions” are available for a specific kind of midlevel plan known as a silver plan. People with lower incomes can get more help with out-of-pocket costs, but only if they choose silver plans. Mr. Dorn said the government had not done much to inform people of these potential savings. “Consumers are giving up cost-sharing reductions of enormous value if they enroll in a bronze plan because it has the lowest premium,” he said. Plans in the marketplace are separated into four categories — bronze, silver, gold and platinum — indicating the generosity of coverage, or the share of costs paid by insurance for an average enrollee. Many people buying insurance on the federal and state exchanges are expected to qualify for subsidies. But in the first month, for reasons that are not clear, only 30 percent qualified. The others must pay the full premium and will be subject to the full deductible. Most people shopping in the exchanges are expected to choose bronze or silver plans, which provide less generous coverage than most employer-sponsored plans. A study by Jon R. Gabel and colleagues at NORC, a research organization affiliated with the University of Chicago, found that 65 percent of employees in group health plans had higher-value coverage that would be classified as gold or platinum under the Affordable Care Act. At the same time, most policies in the exchanges are more generous than what people have been buying for themselves in the individual insurance market. Mr. Gabel found that 84 percent of policyholders in the individual market had coverage that was less than or equivalent to the bronze level. James T. O’Connor, an actuary at Milliman, an employee benefit consulting firm, said: “Larger employers generally have more generous coverage than small employers, and small group plans, on average, are richer than what people can typically buy with their own money in the new health insurance exchanges.” Mark A. York, a 60-year-old freelance writer in Hailey, Idaho, said he began shopping after he received a letter saying that his current insurance policy would be canceled because it did not meet the requirements of the health care law. In the exchange, he said, he found policies with premiums similar to what he is now paying, $440 a month, but “the deductibles were so high — $4,000 to $6,000 a year — that it defeats the purpose of having insurance.” Brian H. Snoddy, 35, of Palmyra, Va., said his wife and two children had a policy with a $330 premium and a $2,500 deductible, but it is being canceled. For new plans with comparable coverage on the federal exchange, he said, “the deductibles are way higher, $5,000 or $6,000.” For visits to a medical specialist, many plans on the federal exchange require co-payments of $50 to $75 or more. Federal officials often point to premiums as evidence that the health care law has made insurance affordable. “Nearly six in 10 uninsured Americans can pay less than $100 a month for coverage in the health insurance marketplace,” Kathleen Sebelius, the secretary of health and human services, has said. Higher deductibles are one tool that insurers can use to hold down premiums. Many have also held down premiums on the exchanges by limiting the choices of doctors and hospitals available to consumers in their provider networks. Kellye Norris, 53, of Dallas said that after trying for more than a month, she completed an application on the federal exchange and enrolled in a Cigna plan with a premium of about $500 a month and no subsidies. “My deductible is nearly $3,000, which is ridiculously high, in my opinion,” Ms. Norris said. “But as someone with pre-existing conditions, I’m grateful to be able to buy insurance at all.” http://www.nytimes.com/2013/12/09/us/on-health-exchanges-premiums-may-be-low-but-other-costs-can-be-high.html?pagewanted=all&_r=0
Today, both the Senate Finance Committee and the House Committee on Ways & Means considered legislation to permanently repeal and replace the Sustainable Growth Rate (SGR) formula. Without Congressional action, the SGR calls for sizable cuts to Medicare reimbursements to physicians and other providers. For the last decade, Congress has acted on an annual basis to avert these drastic cuts, commonly known as the “doc-fix.” The legislation considered today would gradually transition Medicare to a system where doctors are paid on the basis of the value of care provided, as opposed to the volume of services ordered. Medicare Rights Center supports transitioning to a reformed payment system that emphasizes value—essentially better quality care at a lower price. Yet, Medicare Rights remains deeply concerned about the future of critical Medicare benefits annually extended alongside the annual SGR patch. Critical among these is the Qualified Individual (QI) program. The QI benefit covers the cost of the Part B premium for Medicare beneficiaries with limited incomes, from about $14,000-$15,500 a year, and less than $7,080 in assets. Amounting to about $105 per month in 2013, this vital assistance helps vulnerable seniors and people with disabilities afford health care costs and other basic needs that they might otherwise go without. Legislation approved by the House Committee on Ways & Means earlier today does not yet address the QI program and other extender programs, while the Senate Finance Committee framework only extends the QI program through 2018. Earlier this week, 112 organizations, including Medicare Rights, urged members of Congress to ensure QI is made permanent alongside a permanent SGR fix. In addition to leaving concerns regarding critical extender programs unresolved, the House and Senate Committees have yet to address how the SGR repeal and replacement policy will be paid for. As these negotiations move ahead, Medicare Rights urges Congress not to shift added costs to people with Medicare.
Thursday, December 12, 2013
...the following percentages of adults, by age group, do not have a primary care physician: • adults aged 18-29: 34% • adults aged 30-49: 25% • adults aged 50 or older: only 16% Source: "Alternative Care Facilities Are The Preferred Medical Option For Younger Generation," Vitals.com Press Release, November 19, 2013, http://www.vitals.com/posts/press-center/press-releases/alternative-care-facilities-are-the-preferred-medical-option-for-younger-generation