ObamaCare’s impact on health costs.
•In an effort to reduce the backlog of contested Medicare claims, the Centers for Medicare and Medicaid Services has offered to pay hospitals 68% of what they say they are owed for short-term inpatient stays.
•The system of hearings on challenged claims has been on hold since December, when the HHS Office of Medicare Hearings and Appeals temporarily suspended most new requests for administrative law judge hearings on payment denials by recovery audit contractors.
•Hospitals will have 60 days to decide whether to accept CMS’ offer, which does not apply to any short-term hospital admission that occurred after October 1, 2013.”
“Over the past few weeks, the American Medical Association has complained publicly and privately to the Centers for Medicare and Medicaid Services over its so-called Open Payments database, which will display what drug and device makers pay physicians. The system was created in response to concerns that medical practice and research may be unduly influenced by industry. But the database has been plagued by delays and technical glitches. The AMA is concerned that physicians lack the needed time to ensure correct data is displayed and that the public will understood what they see. The database is expected to go live on Sept. 30, but the AMA wants a six-month postponement to compensate for the problems. So far, CMS says no. We spoke with AMA president Robert Wah about the frustrations. This is an edited version.”
“The District of Columbia U.S. Circuit Court of Appeals in Washington on Thursday said the full 11-member court will rehear (PDF) the controversial case that ruled Americans could not receive subsidies to help pay for plans on federally run health insurance exchanges. Oral arguments will begin Dec. 17.
The court’s decision to rehear the case en banc, which experts said is rare for the D.C. appellate court, vacates the judgment issued earlier this summer. On July 22, a three-judge panel ruled 2-1 in Halbig v. Burwell that the Patient Protection and Affordable Care Act forbade people with lower incomes from receiving tax subsidies from insurance marketplaces run by the federal government, effectively making those subsidies illegal in 36 states.
Opponents of the Affordable Care Act greeted the D.C. court’s initial ruling with praise, saying the judges upheld the text of the law. The law’s supporters, however, argued the court read the text too narrowly and applied an unreasonable and inaccurate interpretation of exchange subsidies.
The July ruling dealt a fresh blow to President Barack Obama’s healthcare law, which relies on the insurance subsidies to make coverage more affordable for millions of people. However, the Obama administration vowed at the time to petition for a full court review of the decision.”
“Federal officials are floating the idea of expanding Medicare’s Pioneer model for accountable care organizations, but they might struggle to recruit any new participants.
Some prominent ACO leaders shared their skepticism in letters to the CMS that the agency released this month. The program, designed and administered by the CMS Innovation Center, is the government’s earliest and most aggressive test under the Patient Protection and Affordable Care Act of new financial incentives for hospitals and doctors to hold down medical costs and meet quality targets.
The Pioneer initiative’s rules put doctors and hospitals at too much risk of losing money with too little control, officials with Universal American, CHE Trinity Health, St. Vincent’s Health Partners, the Franciscan Alliance and others said in the comment letters to federal officials.
Pioneers must agree to accept potential losses with the promise of bonuses after the first year. ACOs participating in the Medicare shared-savings program, in contrast, can go three years without the risk of owing Medicare money if they fall short.
“Organizations are not gravitating toward the Pioneer ACO model because the downside risk is not outweighed by the opportunity for economic gain—the business case is not compelling,” wrote officials with CHE Trinity Health, a Michigan-based system. The system’s CEO is Dr. Richard Gilfillan, who oversaw the launch of Pioneer ACOs as the Innovation Center’s director before his departure last June.”
“Republicans vying to wrest the Kentucky House from Democratic control for the first time in nearly a century promised Tuesday to try to repeal the state’s Medicaid expansion and rein in other parts of the federal health care overhaul.
House Republican leaders made stops in western Kentucky as part of a multi-day tour to promote their legislative agenda, called the “Handshake with Kentucky.” They said they would push for legislation prohibiting mandatory participation in a workplace union and for a revamped state tax code and creation of medical expert panels to review proposed medical malpractice claims before they could be pursued in court.
“If the people of Kentucky entrust us with the majority, we are committing to immediately begin debate with the intention of passing each of these pieces of legislation,” House GOP Floor Leader Jeff Hoover said.
State Democratic Party Chairman Dan Logsdon called them “warmed over” ideas repackaged to get Republicans to the polls.
“It’s not leadership,” he said. “It’s pandering to their base.”
Republicans have not had a majority in the Kentucky House since 1920. Democrats have been whittled to a 54-46 majority, putting the GOP within striking distance of consolidating power in the Kentucky General Assembly. Republicans have solid control of the state Senate.”
“Medicaid expansion is expanding profits for a bunch of hospitals.
A new analysis of major for-profit health systems found that hospitals in states that expanded Medicaid eligibility under Obamacare are seeing far fewer uninsured patients, a large rise in paying patients and more revenue as a consequence—which stands in stark contrast to hospitals in nonexpansion states.
For example, there was about a 47 percent decrease in the rate of admissions of uninsured or self-paying patients at the hospitals in expansion states in the first half of 2014. Yet, hospitals in nonexpansion states either saw a slight reduction in such admissions or no decreases at all, according to the PricewaterhouseCoopers Health Research Institute. ”
“Reduced costs for medical services and labor have trimmed the 10-year projected cost of Medicare and Medicaid by $89 billion, the Congressional Budget Office said Wednesday.
Medicare spending is projected to drop by $49 billion — or less than 1 percent — from 2015 and 2024, while Medicaid spending is expected to drop by $40 billion — or about 1 percent — over the next decade, CBO said in an update to its April forecast.
Despite the long-term projected drop, federal spending for major health care programs will jump this year by $67 billion — or about 9 percent — the agency estimated. The largest increase will be for Medicaid, which is projected to grow by $40 billion, or 15 percent. Most of this short-term increase is attributable to the Affordable Care Act, including its Medicaid expansion and the financial assistance to help people purchase health insurance.”
“Two years ago, Massachusetts set what was considered an ambitious goal: The state would not let that persistent monster, rising health care costs, increase faster than the economy as a whole. Today, the results of the first full year are out and there’s reason to for many to celebrate.
The number that will go down in the history books is 2.3 percent. It’s well below a state-imposed benchmark for health care cost growth of 3.6 percent, and well below the increases seen for at least a decade.
“So all of that’s really good news,” says Aron Boros, executive director at the Center for Health Information and Analysis (CHIA), which is releasing the first calculation of state health care expenditures. “It really seems like…the growth in health care spending is slowing.”
Why? It could be the pressure to comply with of the federal health law in its first year.
“We have to believe that’s the [first] year,” Boros says, “that insurers and providers are trying their hardest to keep cost increases down.”
But then, health care spending growth slowed across the U.S., not just in Massachusetts, last year.
“There’s not strong evidence that it’s different in Massachusetts; we really seem to be in line with those national trends,” Boros adds. “People are either going to doctors and hospitals a little less frequently, or they’re going to lower-cost settings a little more frequently.”
The result: Health insurance premiums were basically flat overall in the state in 2013.
“2013 was a year in which we were able to exhale,” says Jon Hurst, president of the Retailers Association of Massachusetts. But he’s worried the break on rates was short-lived. This year, Hurst’s members are reporting premium increases that average 12 percent.”
“If you get health insurance through your workplace, you’ll probably have a chance this fall to make important decisions about your coverage and costs.
Because many corporate health plans hold their annual open-enrollment periods in October and November, many employees can expect to get a packet of benefits, or instructions for making elections online, as well as updates on changes to their plans required by the Affordable Care Act. Some 55% of Americans have employer-based coverage, according to Mercer, a human-resources consultant.
“From the employee perspective, if there is any year to pay attention to the information, this is the year,” says Brian Marcotte, president and chief executive of the National Business Group on Health, a nonprofit representing large employers.
Starting next year, one change could be an ACA provision requiring some large employers—generally those with 50 or more full-time or equivalent workers—to offer affordable, adequate coverage to employees working more than 30 hours a week.”
“Consumers getting government subsidies for health insurance who are later found ineligible for those payments will owe the government, but not necessarily the full amount, according to the Treasury Department.
The clarified rule could affect some of the 300,000 people facing a Sept. 5 deadline to submit additional documents to confirm their citizenship or immigration status, and also apply broadly to anyone ultimately deemed ineligible for subsidies.
First reported by the newsletter Inside Health Policy on Thursday, the clarification worries immigration advocates, who say many residents are facing website difficulties and other barriers to meeting the deadline to submit additional details. Those who don’t know about the deadline, or can’t meet it because of glitches, could be deemed ineligible for subsidies and lose their coverage.
“We’re very concerned about the implications of this on hundreds of thousands of low-income individuals who are likely eligible, but have encountered significant difficulties with the website, uploading or sending documents,” said Mara Youdelman, managing attorney at the National Health Law Program.
If found ineligible, residents could owe thousands of dollars.”