Compare website redesigned to help consumers search for physicians

Physician Compare, a website that allows consumers to search and compare information about hundreds of thousands of physicians and other health care professionals, has been redesigned to make the site easier to use and provide new information for consumers. The Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner announced the redesign, which includes an improved search function and more frequently updated information.

“Nearly a million physicians and other health care professionals serve the Medicare population,” said CMS Administrator Marilyn Tavenner. “This vastly improved website will provide new information in an improved, easy-to-use format.”

Physician Compare was improved based on user and partner feedback, as part of improvements in the Affordable Care Act. The redesign includes new information on physicians, such as: 

o    Information about specialties offered by doctors and group practices;

o    Whether a physician is using electronic health records;

o    Board certification; and

o    Affiliation with hospitals and other health care professionals. 

Physician Compare is also now connected to the most consistently updated database so that consumers will find the most accurate and up-to-date information available. In 2014 quality data will be added, and this will help users choose a medical professional based on performance ratings.

Visit the Physician Compare website at http://www.medicare.gov/physiciancompare You can also go to www.medicare.gov and click on “Find doctors & other health professionals.”

A video highlighting the main features of the redesign is available at: http://www.youtube.com/user/CMSHHSgov

Medicare by the Scary Numbers

June 25, 2013

When the latest Medicare trustees report came out at the end of May, the White House spin masters told us Medicare's finances have improved and one of the reasons is ObamaCare, say John C. Goodman, president and CEO of the National Center for Policy Analysis, and Laurence J. Kotlikoff, a senior fellow with the National Center for Policy Analysis and an economist at Boston University.

Here's the real story:

·         In their report, the trustees acknowledge that current law envisages dramatic reductions in future Medicare outlays which may be "difficult to sustain."

·         The unfunded liability in Medicare, the trustees tell us, is $34 trillion over the next 75 years.

·         Looking indefinitely into the future, the unfunded liability is $43 trillion -- almost three times the size of today's economy.

·         Based on more plausible assumptions, such as those reflected in the "alternative" scenario for Medicare produced by the Congressional Budget Office in June 2012, the long-term shortfall is more than $100 trillion.

The trustees report's predicted expenditures are based on the assumption built into the law that next Jan. 1 there will be a 25 percent decrease in the fees that Medicare pays doctors. The reason has nothing to do with ObamaCare. In the Balanced Budget Act of 1997, Congress declared that Medicare physician fees could grow no faster than the economy as a whole. Since then, though, Congress has postponed the cuts on 14 occasions, not allowing them to take place. Why assume things will be different now?

A second problem does stem from ObamaCare. In order to pay for the expansion of health insurance for the young, the new health law calls for steep cuts in the growth of health care spending on the elderly.

·         Whereas Medicare spending per person in real terms has been increasing at about the rate of growth of real gross domestic product (GDP) per person plus two percentage points, the ObamaCare law calls for a spending growth rate of GDP plus 0.04 percent.

·         Assuming this slower growth rate will materialize, over the next decade it produces about $716 billion in savings.

But the savings don't stop there. The health reform law mandates slower growth in health care costs forever through the use of such initiatives as electronic medical records and "coordinated care." However, three separate Congressional Budget Office (CBO) reports have found that these programs don't work to cut costs.

As a result, Medicare will have to resort to a fallback mechanism: more cuts in provider fees. Were these cuts to be implemented, and if Medicare spending grew no faster than the economy as a whole, the problem of Medicare would be solved.

Yet studies by the Medicare actuaries in 2012 show that for this formula to work, the suppression of provider fees would have to be draconian. In the end, from a financial point of view, senior patients would become less desirable than welfare recipients.

Source: John C. Goodman and Laurence J. Kotlikoff, "Medicare by the Scary Numbers," Wall Street Journal, June 24, 2013.

http://www.ncpa.org/sub/dpd/index.php?Article_ID=23313&utm_source=newsletter&utm_medium=email&utm_campaign=DPD

Today's Datapoint

More than
150 … different languages will be spoken via the interpretation and translation services attached to HHS’s 24-hour call center that will encourage people to sign up for health coverage starting Oct. 1

Quote of the Day

“The people who will benefit most from expanded coverage had never heard of [the ACA]. That means we have to be very creative because the traditional sources of information are not going to be sufficient for getting the word out. Over the last couple of months, we have hired a digital team, because a huge piece of the outreach effort is going to be social media. That’s where people get their information now, and we need to make sure that we are getting our message out where people will see and hear it.”

— Rachel Klein, former Executive Director of Enroll America who now heads up the navigator program at Families USA, told AIS’s Inside Health Insurance Exchanges.

New Report Compares the Challenges Faced with the Implementation of Part D and the Affordable Care Act

The Center on Health Insurance Reforms (CHIR), based at Georgetown University’s Health Policy Institute, recently released a report discussing the challenges that led up to the launch and implementation of Medicare Part D, the prescription drug program delivered exclusively through private plans, and ways in which state and federal officials working on the Affordable Care Act’s (ACA’s) health insurance exchanges can learn from Part D implementation. The report, written with support from the Robert Wood Johnson Foundation (RWJF), acknowledges that while past efforts to design and launch Part D were far from perfect at the outset, the program is overall a success.

According to the CHIR report, state and federal officials implementing Part D faced several challenges, including unfavorable public opinion of the program, uncertainty about plan participation, high projected costs for consumers, concerns from states, and a need for consumer assistance and post-enrollment complications. At the launch of Part D, more people had an unfavorable opinion of the new program than a favorable one, but just one year into implementation, people began to react more positively—initial public opinion of the ACA was also low, and it may be that public opinion will take a similar turn for the better once the exchanges have been implemented. Beneficiary advocates were concerned that Part D would create high premiums. However, program costs were lower than actually projected, and they remain lower than initial projections. Some policymakers have predicted “rate shock” that will create exorbitant premiums for plans through the exchanges. However, with federal premium and cost-sharing subsidies being applied to most consumers using the exchanges, it is possible that the fear of rate shock may be overstated.

Medicare Part D faced considerable challenges educating beneficiaries about the program, and similarly, efforts to educate the public about the health insurance exchanges have been unsuccessful, according to the CHIR report. While a major public education campaign is slated to begin this summer, policymakers should learn from Part D implementation and ensure that consumers have access to information about the exchanges, including access to consumer assistance such as written materials, online tools, call centers, and in-person counseling.

Read the CHIR report.

CMS PROPOSES PAYMENT CHANGES FOR MEDICARE HOME HEALTH AGENCIES FOR 2014

FACT SHEET

FOR IMMEDIATE RELEASE                                                Contact: CMS Media Relations

June 27, 2013                                                                                      (202) 690-6145

CMS PROPOSES PAYMENT CHANGES FOR MEDICARE HOME HEALTH AGENCIES FOR 2014 

The Centers for Medicare & Medicaid Services (CMS) today announced proposed changes to the Medicare home health prospective payment system (HH PPS) for calendar year (CY) 2014 that would foster greater efficiency, flexibility, payment accuracy, and improved quality. Based on the most recent data available, CMS estimates that approximately 3.5 million beneficiaries received home health services from nearly 12,000 home health agencies, costing Medicare approximately $18.2 billion in 2012.

In the rule, CMS projects that Medicare payments to home health agencies in calendar year (CY) 2014 will be reduced by 1.5 percent, or $290 million based on the proposed policies. The proposed decrease reflects the effects of the 2.4 percent home health payment update percentage ($460 million increase), the rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates, and the non-routine medical supplies (NRS) conversion factor ($650 million decrease), and the effects of ICD-9-CM coding adjustments ($100 million decrease).  

In addition, the rule proposes routine updates to the HH PPS payment rates such as updating the payment rates by the HH PPS payment update percentage and updating the home health wage index for 2014.  

Background 

To qualify for the Medicare home health benefit, a Medicare beneficiary must be under the care of a physician, have an intermittent need for skilled nursing care, or need physical therapy, speech -language pathology, or continue to need occupational therapy. The beneficiary must be homebound and receive home health services from a Medicare approved home health agency (HHA).

Medicare pays home health agencies through a prospective payment system that pays higher rates for services furnished to beneficiaries with greater needs. Payment rates are based on relevant data from patient assessments conducted by clinicians as currently required for all Medicare-participating home health agencies. Home health payment rates are updated annually by the home health payment update percentage. The payment update percentage is based, in part, on the home health market basket, which measures inflation in the prices of an appropriate mix of goods and services included in home health services. 

HH PPS Grouper Refinements and ICD-10-CM Conversion

The proposed rule would remove two categories of ICD-9-CM codes from the HH PPS Grouper: diagnosis codes that are “too acute,” meaning the condition could not be appropriately cared for in a home health setting; and diagnosis codes for conditions that would not impact the home health plan of care, or would not result in additional resources when providing home health services to the beneficiary. ICD-10-CM codes will be included in the HH PPS Grouper to be used starting on October 1, 2014. The new ICD-10-CM codes will replace the existing ICD-9-CM codes used to report medical diagnoses and inpatient procedures.

Rebasing the 60-day Episode Rate

The Affordable Care Act requires that beginning in CY 2014, CMS apply an adjustment to the national standardized 60-day episode rate and other applicable amounts to reflect factors such as changes in the number of visits in an episode, the mix of services in an episode, the level of intensity of services in an episode, the average cost of providing care per episode, and other relevant factors. Additionally, CMS must phase-in any adjustment over a four year period, in equal increments, not to exceed 3.5 percent of the amount (or amounts) in any given year, and be fully implemented by CY 2017.

The rule proposes a reduction to the national, standardized 60-day episode rate of 3.5 percent in each year CY 2014 through CY 2017. The proposed national, standardized 60-day episode payment for CY 2014 is $2,860.20. This reduction primarily reflects the observed reduction in the number of visits per episode since establishment of the HH PPS in 2000.

Rebasing Per-Visit Amounts

For episodes with four or fewer visits, Medicare pays on the basis of a national per-visit amount by discipline, referred to as a Low-Utilization Payment Adjustment (LUPA). The rule proposes an increase to each of the per-visit payment rates of 3.5 percent in each year CY 2014 through CY 2017 to account for changes in the costs of providing these services since the establishment of the HH PPS in 2000.

Rebasing and Updating Other Components of the HH PPS

Similar to the proposals for rebasing 60-day episodes and per-visit rates, this proposed rule would rebase the payment for NRS and update the LUPA add-on payment amount. The rule proposes a decrease in the NRS conversion factor of 2.58 percent in each year CY 2014 through CY 2017. In updating the LUPA add-on amount and proposing three LUPA add-on factors, LUPA add-on payments are estimated to increase by approximately 4.8 percent (using rebased per-visit amounts described above that were increased by 3.5 percent).

Quality Reporting

The proposed rule would add two claims-based quality measures: (1) Rehospitalization During the First 30 Days of a Home Health Stay, and (2) Emergency Department Use Without Hospital Readmission during the first 30 days of Home Health. The proposed rehospitalization measures will allow HHAs to further target patients who entered home health after a hospitalization. In addition, this rule would reduce the number of home health quality measures currently reported to home health agencies to simplify their use for quality improvement activities.

Cost Allocations for Home Health Agency Surveys

This proposed rule would ensure that Medicaid responsibilities for home health surveys are explicitly recognized in the State Medicaid Plan. CMS seeks comment on a methodology for calculating State Medicaid programs’ fair share of Home Health Agency surveys costs. For that portion of costs attributable to Medicare and Medicaid, we would assign 50 percent to Medicare and 50 percent to Medicaid, the same methodology that is used to allocate costs for dually-certified nursing homes.

For additional information about the Home Health Prospective Payment System, visit https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/index.html.

The proposed rule can be viewed: http://federalregister.gov/inspection.aspx. Please be mindful this link will change once the proposed rule is published on July 3, 2013 in the Federal Register. CMS will accept comments on the proposed rule until August 26, 2013.

Meet the woman tasked with selling PPACA

Enroll America's president Anne Filipic has to convince America to buy into PPACA

By Kathryn Mayer

June 27, 2013

The Patient Protection and Affordable Care Act isn’t as old as you think, but its history has already been long and arduous. Three years after President Obama signed it into law, it’s still overwhelmingly confusing — not to mention unpopular — among Americans across all demographics.

Sure, the law survived a Supreme Court case and a presidential election, but it hardly escaped unscathed. Many more states than expected refused to set up their own health care exchanges, instead defaulting to the federal government. House Republicans are still holding votes to repeal PPACA, though the motion isn’t likely to make it past the Democratic Senate. Carriers are proceeding with caution when it comes to setting up shop in the public exchanges while industry veterans warn of impending doom.

But perhaps the biggest challenge has been the average American. Poll after poll has found the same thing: The majority of the country still opposes the law, and perhaps even worse, they don’t understand it.

Kaiser Family Foundation underscored the problem in its latest health tracking poll when it found that nearly half of Americans don’t even realize PPACA is still law and is being implemented. And worse yet, the people who stand to benefit the most are the least aware of the changes that are coming. According to Kaiser’s poll, 58 percent of the uninsured and 56 percent of low-income households say they lack enough information to understand how PPACA will affect them.

So with all of this in mind, just how do you market something so many people are either against or blissfully unaware of?

That’s the challenge for Enroll America — a nonprofit group formed in 2011 to get the word out about PPACA — and its president, Anne Filipic.

Filipic admits it’s a big undertaking.

“There are millions of uninsured Americans across the country,” she says. “The new law is a big deal — a big win — for consumers. And many are really unaware of the opportunities. We have a challenge to raise that awareness to them.”

Enroll America is an umbrella organization for groups that will promote PPACA’s insurance exchanges, new online marketplaces where millions will shop for coverage starting Oct. 1.

Though a number of organizations are working nationally on enrollment — including the Obama administration and insurers and advocates — Filipic says Enroll America is in a unique situation because it brings all those groups together.

The success of the law depends on enrollment. Without participation, experts warn, health care costs may surge because not enough healthy people will participate to offset benefits payouts. That’s aside from the rate shock that’s already been plaguing some consumers under PPACA.

Beginning Jan. 1, uninsured Americans will be forced to pay a penalty of either $95 or 1 percent of income, whichever is greater, if they don’t buy insurance. The fine increases each year.

The basics
Enroll America’s goal is simple: To educate the public about the changes coming, and what the new law means for them and their families, Filipic says.

“We are working on maximizing the number of uninsured Americans to enroll in health coverage through [PPACA],” says Filipic, 31, from her office in Washington, D.C.

This summer marks the beginning of Enroll America’s big campaign push, called “Get Covered America.” The focus, Filipic says, is to educate consumers about the benefits of health insurance coverage and the new options available to them under PPACA.

There’s a lot of ground to cover: There are roughly 48 million uninsured U.S. residents. The Congressional Budget Office estimates 30 million will gain coverage.

The campaign — which is expected to cost tens of millions of dollars — is using tactics of a typical political campaign, including online organizing, grassroots outreach, paid advertising, and volunteers and staff going door-to-door in communities.

“What we are really focused on is having a presence in communities across the country and really building a full campaign that creates kind of an echo chamber for consumers and meets them where they are, in their communities,” Filipic says. “We want to give them the information they need to make a decision that is very personal and really allows them to choose a plan that works for them and meets their family budget.”
The group will target people in churches, in community health centers, in businesses—the list goes on. The outreach is helped by partnerships with community leaders, hospitals and insurers, Filipec says, partnerships “we’ve been working to build since Enroll America’s inception in 2011.”

Also a part of the role, Filipic insists, is health insurance brokers and agents.

“[They’re] trusted messengers and will be one important part of a multi-pronged effort to provide consumers with the information they need to apply for coverage and choose a health plan that’s right for them,” she says.

Though the campaign is nationwide, the group will devote more resources to states that are plagued by high uninsured rates, including Texas, California, Florida and Illinois. States like Texas and Florida are also where opposition to the legislation has been especially strong.

The organization is counting on “word of mouth success,” Filipic says.

“When [consumers] start to enroll and find options for them, they’ll tell their family members or neighbors,” Filipic says. “And then we’ll start to see a ripple effect.”

But before that happens, Enroll America needs to “help people move to where they want to be.” That was one of the main findings of a survey the organization commissioned to help hone its message.

Lake Research Partners, a Democratic polling group that conducted the survey, found that in addition to being unaware of their options under the new law, most Americans said the process of finding insurance was mentally and emotionally draining. When consumers were asked what feelings they would have if they had to look for health insurance now, they used the words “helpless,” “frustrated,” “stressed,” “overwhelmed,” “confused,” “worried,” and “angry.”

Other challenges

Many Americans are skeptical of the law and the promise of “quality, affordable health coverage.”
It’s a fact Filipic acknowledges.

“It’s not that they haven’t looked or thought that health coverage wasn’t important; it’s that for whatever reason they couldn’t find something that worked for them,” she says.

A recent survey from InsuranceQuotes.com found that more than three in five uninsured Americans say the main reason they currently lack health insurance is because they can’t afford it. But those uninsured also said they don’t believe PPACA will make the law any more affordable.

Enroll America’s survey found similar results. When given a brief description of the exchange, 37 percent of respondents said they thought they’d be able to find an affordable plan. But once the respondents saw hypothetical premium amounts, perceptions of affordability dropped to 29 percent.

Because of those results, Lake Research Partners actually suggested Enroll America not cite specific dollar amounts to consumers, as “using a specific premium amount may actually turn away just as many people as it might motivate.”

According to InsuranceQuotes.com, almost two-thirds of uninsured Americans haven’t yet decided whether they will purchase health insurance by the Jan. 1 deadline. That’s a big number, considering Oct. 1 — the date when open enrollment for those plans begins — lingers only a couple of months from now.

But Filipic is hopeful. She likes to talk about the many choices consumers will have under Obamacare.

Plus, there are some things that might help ease skeptics’ minds: the health subsidies available for low- and middle-income consumers under PPACA, for one, as well as popular provisions like the pre-existing condition provision and the under-26 provision that allows young adults to stay on their parents’ health plans.

The law, of course, has been plagued by politics. Support is largely divided by party affiliation, with Democrats much more heavily supporting the law than Republicans. It’s something Filipic says is a big  — and understandable — barrier to success.

Although Filipic comes from the Obama administration, having served as deputy director of the White House Office of Public Engagement, she wants to keep politics out of the conversation, admitting it turns people off and away from the main message. She is adamant that Enroll America is “completely nonpartisan,” though politics already have gotten in the way.

Health and Human Secretary Kathleen Sebelius has come under heavy criticism from Republicans for her fundraising work for Enroll America. Sebelius admitted she made calls to organizations and carriers on behalf of the organization, asking them to contribute to their efforts. While the administration has said previous administrations have done the same thing, Republicans have suggested she may have crossed legal or ethical boundaries.

Filipic says those issues miss the point of the organization. Enroll America is important because getting people health insurance is important. Period.

“The conversation around [PPACA] has been political. But really what this is all about is a consumer-focused conversation,” she says. “And that’s what resonates with folks. The people who are working hard, raising their families, day to day, what is going to reach them is when we start talking about it in a way of ‘What does this mean for you and your family?’

 “And when the conversation becomes about that, it will resonate more with folks.”

Tick tock

Oct. 1 — the date when open enrollment begins in the states — is now just a few months away. While Filipic acknowledges it’s a big date for both the administration and her, it’s not a ticking time bomb.

“We see the importance of that date,” she says. “It’s when the new options become available, so it’s important that [consumers] have a clear sense of that. But the work is just beginning in October. It will be a long process.”

http://www.benefitspro.com/2013/06/27/meet-the-woman-tasked-with-selling-ppaca?eNL=51cb665b150ba06a53000005&utm_source=BenefitsProDaily&utm_medium=eNL&utm_campaign=BenefitsPro_eNLs&_LID=144817897