By DON THOMPSON Associated Press
Posted: 12/26/2010 11:03:05 AM PST
Updated: 12/26/2010 11:07:05 AM PST
SACRAMENTO, Calif.—California will create an Internet-based insurance exchange to let consumers comparison-shop for affordable health insurance coverage under two of the many laws taking effect with the new year. read more
Sunday, December 26, 2010
Friday, December 24, 2010
Test of "Accountable Care Organizations" going well
Excerpt of an article By ALLISON BELL
Published 12/20/2010 Subscribe to Life & Health
The coming year could be the year when “accountable care organizations” (ACOs) get a chance to show whether they will be a fad or a classic.
An ACO is a vehicle for paying teams of health care providers to care for whole patients, instead of paying for care one service at a time.
The Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA), is requiring Medicare to use ACOs starting in 2012, and many private health carriers are now testing ACOs.
Elizabeth Mills, a senior counsel in the Chicago officer of Proskauer Rose L.L.P., a law firm, ACO organizers still face regulatory challenges.
The coming year could be the year when “accountable care organizations” (ACOs) get a chance to show whether they will be a fad or a classic.
Aetna Inc., Hartford (NYSE:AET), says an ACO it has been testing on 20,000 Medicare Advantage enrollees since 2007 seems to be working well.
This year, the ACO enrollees have been using 43% less acute hospital care than comparable enrollees in unmanaged Medicare have been using, Aetna says.
read more
Published 12/20/2010 Subscribe to Life & Health
The coming year could be the year when “accountable care organizations” (ACOs) get a chance to show whether they will be a fad or a classic.
An ACO is a vehicle for paying teams of health care providers to care for whole patients, instead of paying for care one service at a time.
The Affordable Care Act, the legislative package that includes the Patient Protection and Affordable Care Act (PPACA), is requiring Medicare to use ACOs starting in 2012, and many private health carriers are now testing ACOs.
Elizabeth Mills, a senior counsel in the Chicago officer of Proskauer Rose L.L.P., a law firm, ACO organizers still face regulatory challenges.
The coming year could be the year when “accountable care organizations” (ACOs) get a chance to show whether they will be a fad or a classic.
Aetna Inc., Hartford (NYSE:AET), says an ACO it has been testing on 20,000 Medicare Advantage enrollees since 2007 seems to be working well.
This year, the ACO enrollees have been using 43% less acute hospital care than comparable enrollees in unmanaged Medicare have been using, Aetna says.
read more
Tuesday, December 21, 2010
A doctors take on universal heath insurance mandate
The Insurance Mandate: Is It Legal?
Published: December 21, 2010
Re “Can Congress Force You to Be Healthy?,” by Jason Mazzone (Op-Ed, Dec. 17), defending a federal judge’s ruling that the health insurance mandate is unconstitutional:
We need to look at the consequences to patients, interstate commerce and the economics of health care if the mandate provision of the Affordable Care Act is overturned. When an individual with limited income chooses to forgo health insurance and comes down with appendicitis, how should the health system respond?
Mr. Mazzone uses the analogy of someone forgoing auto insurance alternatively taking the bus. What is the alternative to an appendectomy?
The care providers must either (1) explain to the patient that he did not choose wisely, provide him with some pain tablets and push him to the parking lot or (2) treat him appropriately. The former is both illegal and unethical; the latter (current practice) is where the commerce issues arise.
The costs of care for illness must be borne by someone. Currently these costs are paid by the state (taxpayers) and, through cost-shifting, the insurance carriers, many of whom are national companies.
The bus analogy, while clever, is inappropriate and trivializes the dire status of our current system and our public’s health.
Tim Carey
Chapel Hill, N.C., Dec. 17, 2010
Published: December 21, 2010
Re “Can Congress Force You to Be Healthy?,” by Jason Mazzone (Op-Ed, Dec. 17), defending a federal judge’s ruling that the health insurance mandate is unconstitutional:
We need to look at the consequences to patients, interstate commerce and the economics of health care if the mandate provision of the Affordable Care Act is overturned. When an individual with limited income chooses to forgo health insurance and comes down with appendicitis, how should the health system respond?
Mr. Mazzone uses the analogy of someone forgoing auto insurance alternatively taking the bus. What is the alternative to an appendectomy?
The care providers must either (1) explain to the patient that he did not choose wisely, provide him with some pain tablets and push him to the parking lot or (2) treat him appropriately. The former is both illegal and unethical; the latter (current practice) is where the commerce issues arise.
The costs of care for illness must be borne by someone. Currently these costs are paid by the state (taxpayers) and, through cost-shifting, the insurance carriers, many of whom are national companies.
The bus analogy, while clever, is inappropriate and trivializes the dire status of our current system and our public’s health.
Tim Carey
Chapel Hill, N.C., Dec. 17, 2010
Thursday, November 11, 2010
No Social Security until age 65?
November 11,2010
The author of the recently released report, Andrew Biggs, a scholar in residence at the American Enterprise Institute, a conservative think tank , outlines these advantages:
•Prolong the life of the Social Security trust fund by five years, a modest but significant increase.
•Raise median income of older Americans by $7,500 a year, including both increased Social Security benefits and savings and other pension income.
•Boost gross domestic product by about 5 percent through increased productivity, adding billions to the economy and tax revenues.
Biggs says keeping people working until 66 or 67 isn't a physical problem for most these days. Biggs would offer one big concession. He suggests reducing significantly or eliminating Social Security payroll taxes for people who work and contribute to Social Security longer than 35 years, Eliminating payroll taxes would "sweeten the pot" for those asked to work longer, he says.
for full textclick here
The author of the recently released report, Andrew Biggs, a scholar in residence at the American Enterprise Institute, a conservative think tank , outlines these advantages:
•Prolong the life of the Social Security trust fund by five years, a modest but significant increase.
•Raise median income of older Americans by $7,500 a year, including both increased Social Security benefits and savings and other pension income.
•Boost gross domestic product by about 5 percent through increased productivity, adding billions to the economy and tax revenues.
Biggs says keeping people working until 66 or 67 isn't a physical problem for most these days. Biggs would offer one big concession. He suggests reducing significantly or eliminating Social Security payroll taxes for people who work and contribute to Social Security longer than 35 years, Eliminating payroll taxes would "sweeten the pot" for those asked to work longer, he says.
for full textclick here
Monday, October 25, 2010
New health law is a prescription for distortion
By: JO CIAVAGLIA
Bucks County Courier Times
The onslaught of misinformation and distortions about the Patient Protection and Affordable Care Act this political season isn't helping the many Americans who are confused about the law.
Who hasn't seen political ads claiming that under the health law, Medicare will be cut $500 billion.
But are any of these claims true?
Yes and no. Mostly it depends on what health coverage you have, who pays for it, how much you earn and how you earn it, according to health care policy and reform experts.
Next year employers will be required to list the value of employee health benefits on W2 forms. No, you won't be taxed on it.
But combine a take-no-prisoners political season with a law as voluminous and complex as the Patient Protection and Affordable Care Act, and confusion explodes. Experts who've studied the new reforms say the truth is out there, but it can be hard to find.
Four out of 10 surveyed believed the health care law would require Americans to provide a government ID card to get hospital care. (It doesn't.)
Almost as many believed that committees would review medical histories of some people and decide whether they can get medical care paid for by the government. (That's also untrue).
Six in 10 think the law increases the federal deficit. (The nonpartisan Congressional Budget Office projects the law will shrink the deficit.)
"The great irony is the law was designed to avoid a government takeover," said Timothy Jost, a law professor at Washington and Lee University who specializes in health care reform and policy. "It's a law that is intended to make private insurance work and it's troubling that it's being attacked as a (government) takeover of the markets
By: JO CIAVAGLIA
Bucks County Courier Times
The onslaught of misinformation and distortions about the Patient Protection and Affordable Care Act this political season isn't helping the many Americans who are confused about the law.
Who hasn't seen political ads claiming that under the health law, Medicare will be cut $500 billion.
But are any of these claims true?
Yes and no. Mostly it depends on what health coverage you have, who pays for it, how much you earn and how you earn it, according to health care policy and reform experts.
Next year employers will be required to list the value of employee health benefits on W2 forms. No, you won't be taxed on it.
But combine a take-no-prisoners political season with a law as voluminous and complex as the Patient Protection and Affordable Care Act, and confusion explodes. Experts who've studied the new reforms say the truth is out there, but it can be hard to find.
Four out of 10 surveyed believed the health care law would require Americans to provide a government ID card to get hospital care. (It doesn't.)
Almost as many believed that committees would review medical histories of some people and decide whether they can get medical care paid for by the government. (That's also untrue).
Six in 10 think the law increases the federal deficit. (The nonpartisan Congressional Budget Office projects the law will shrink the deficit.)
"The great irony is the law was designed to avoid a government takeover," said Timothy Jost, a law professor at Washington and Lee University who specializes in health care reform and policy. "It's a law that is intended to make private insurance work and it's troubling that it's being attacked as a (government) takeover of the markets
Sunday, October 24, 2010
New Healtrh reform drives cost acutting
SAN DIEGO 10/23/2010 — According to Van Gorder of Scripps Ihnstitute of San Diego.
"....the health reform plan, signed by Obama this year, was health insurance reform. It was not a reform that went to the heart of escalating health care costs.
But now Scripps Health, which runs 5 hospitals and 20 clinics in the San Diego area, is in the midst of a corporate restructuring they claim will make a big difference in cost. CEO Chris Van Gorder, in fact, believes their reorganization will eventually save $150 million a year.
Scripps Health was built from the union of several large hospitals. But the vertical corporate structure, in which each hospital had a chief operating officer who ran the place, remained intact. That meant every hospital within the system did things in a different way. They used different staffing levels and different materials. And that has required different levels of funding.
“We know, for example, that at one of our hospitals an open-heart case costs $3,000 more than it does to do the same kind of operation at another one of our hospitals,” said Van Gorder.
He said they’re trying to solve that problem by getting horizontal, in a corporate sense…. by getting rid of the silos and putting everything in one bin.
Van Gorder said the company has reassigned the top managers of its five hospitals to make them responsible for operations across the system. The goal is to standardize hospital operations and bring best practices to each site. This even applies to serving coffee.
“We’re spending $680,000 dollars a year for coffee and we’re using 15 different brands,” said Van Gorder. “If we standardize and buy at a larger scale we can get better buying power.”
Scripps claims it can save $200,000 dollars on coffee alone.
But if this is such a good idea, why didn’t Scripps do it five years ago? Van Gorder says strained relations between Scripps doctors and the company administration in the past have made it difficult to make dramatic changes.
"....the health reform plan, signed by Obama this year, was health insurance reform. It was not a reform that went to the heart of escalating health care costs.
But now Scripps Health, which runs 5 hospitals and 20 clinics in the San Diego area, is in the midst of a corporate restructuring they claim will make a big difference in cost. CEO Chris Van Gorder, in fact, believes their reorganization will eventually save $150 million a year.
Scripps Health was built from the union of several large hospitals. But the vertical corporate structure, in which each hospital had a chief operating officer who ran the place, remained intact. That meant every hospital within the system did things in a different way. They used different staffing levels and different materials. And that has required different levels of funding.
“We know, for example, that at one of our hospitals an open-heart case costs $3,000 more than it does to do the same kind of operation at another one of our hospitals,” said Van Gorder.
He said they’re trying to solve that problem by getting horizontal, in a corporate sense…. by getting rid of the silos and putting everything in one bin.
Van Gorder said the company has reassigned the top managers of its five hospitals to make them responsible for operations across the system. The goal is to standardize hospital operations and bring best practices to each site. This even applies to serving coffee.
“We’re spending $680,000 dollars a year for coffee and we’re using 15 different brands,” said Van Gorder. “If we standardize and buy at a larger scale we can get better buying power.”
Scripps claims it can save $200,000 dollars on coffee alone.
But if this is such a good idea, why didn’t Scripps do it five years ago? Van Gorder says strained relations between Scripps doctors and the company administration in the past have made it difficult to make dramatic changes.
Monday, August 9, 2010
Medicare revisited
Medicare celebrated its 45th birthday on July 30.
In 1965, President Lyndon B. Johnson signed the Medicare bill into law, providing government-sponsored health insurance for Americans 65 and older and younger people with disabilities.
Although every senior in the United States grew up without Medicare, most Americans today accept this single-payer, government-created and government-administered system as one of their rights as citizens, much like the right to vote.
Yet before we reach the age of 65, most of us don't have a clue how Medicare works. We only know it's there.
Misunderstandings about the Medicare program surfaced during recent discussions over the administration's sweeping health reform bill that finally passed in March.
Unclear on the concept, elders in some states vented outrage against the Obama administration, whose bill included Medicare changes, for "meddling" in "their" Medicare.
Others, also unclear on the facts, protested a provision in the bill that would have reimbursed physicians for time-consuming conversations with patients and family regarding the patient's wishes at the end of life. Mistakenly condemning these as "death panels," they raised loud and confusing voices, and the provision was removed from the bill.
But the uninformed ranters remain. To help clarify confusion, here are a few basic facts.
The health reform bill proposed by President Obama and passed by the
Advertisement
Congress in March is called the Affordable Care Act. You will often hear bureaucrats referring to ACA. They mean the new health care law.
Among the most immediate changes:
# The infamous "doughnut hole," in which Medicare recipients must pay full price for their medication, will close completely by 2020. This year, those in the hole will receive a $250 rebate. Starting in 2011, a 50 percent discount will be available for brand-name drugs.
# The open-enrollment period, during which a Medicare recipient may choose a prescription drug program, will be extended.
# Starting in 2011, co-payments or deductibles will be removed for annual checkups and mammograms, colonoscopies and some other preventive tests. There will be no charge for these tests.
Other provisions are designed to improve delivery of medical care, prevent frequent readmissions to hospitals and, in the process, cut health care costs.
According to the Kaiser Health Foundation, nearly 18 percent of hospital admissions among Medicare beneficiaries in 2005 occurred within 30 days of being discharged from the hospital. Critics of high costs say that readmission can be prevented by better care in the hospital and improved coordination between patients and doctors after release.
Until now, hospitals, paid separately for each hospital stay, have had no incentive to prevent readmission, experts say. Under the new law, payments to certain hospitals with high readmission rates will be reduced starting in 2013, a spokeswoman for the federal Centers for Medicare & Medicaid Services said in a phone interview.
Among health care providers, pilot projects to streamline health care delivery and coordinate care are already underway.
These are only a few of the changes and modifications included in the new law.
For more information, call the Health Insurance Counseling Advocacy Program (HICAP) at 650-627-9350 or 800-434-0222.
In 1965, President Lyndon B. Johnson signed the Medicare bill into law, providing government-sponsored health insurance for Americans 65 and older and younger people with disabilities.
Although every senior in the United States grew up without Medicare, most Americans today accept this single-payer, government-created and government-administered system as one of their rights as citizens, much like the right to vote.
Yet before we reach the age of 65, most of us don't have a clue how Medicare works. We only know it's there.
Misunderstandings about the Medicare program surfaced during recent discussions over the administration's sweeping health reform bill that finally passed in March.
Unclear on the concept, elders in some states vented outrage against the Obama administration, whose bill included Medicare changes, for "meddling" in "their" Medicare.
Others, also unclear on the facts, protested a provision in the bill that would have reimbursed physicians for time-consuming conversations with patients and family regarding the patient's wishes at the end of life. Mistakenly condemning these as "death panels," they raised loud and confusing voices, and the provision was removed from the bill.
But the uninformed ranters remain. To help clarify confusion, here are a few basic facts.
The health reform bill proposed by President Obama and passed by the
Advertisement
Congress in March is called the Affordable Care Act. You will often hear bureaucrats referring to ACA. They mean the new health care law.
Among the most immediate changes:
# The infamous "doughnut hole," in which Medicare recipients must pay full price for their medication, will close completely by 2020. This year, those in the hole will receive a $250 rebate. Starting in 2011, a 50 percent discount will be available for brand-name drugs.
# The open-enrollment period, during which a Medicare recipient may choose a prescription drug program, will be extended.
# Starting in 2011, co-payments or deductibles will be removed for annual checkups and mammograms, colonoscopies and some other preventive tests. There will be no charge for these tests.
Other provisions are designed to improve delivery of medical care, prevent frequent readmissions to hospitals and, in the process, cut health care costs.
According to the Kaiser Health Foundation, nearly 18 percent of hospital admissions among Medicare beneficiaries in 2005 occurred within 30 days of being discharged from the hospital. Critics of high costs say that readmission can be prevented by better care in the hospital and improved coordination between patients and doctors after release.
Until now, hospitals, paid separately for each hospital stay, have had no incentive to prevent readmission, experts say. Under the new law, payments to certain hospitals with high readmission rates will be reduced starting in 2013, a spokeswoman for the federal Centers for Medicare & Medicaid Services said in a phone interview.
Among health care providers, pilot projects to streamline health care delivery and coordinate care are already underway.
These are only a few of the changes and modifications included in the new law.
For more information, call the Health Insurance Counseling Advocacy Program (HICAP) at 650-627-9350 or 800-434-0222.
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