Category: Investigations

“Last week, Americans for the first time could look up their doctor to see what payments, if any, they received from pharmaceutical and medical device companies. And Morning Consult polling shows patients will make decisions based off that information: The majority of registered voters say they would be less likely to choose a certain physician if they took money from a drug or medical device company. It’s this mindset that has physicians, pharmaceutical and medical device companies worried.
The database, which was established in the Affordable Care Act, went public Tuesday afternoon. It allows users to see how much money doctors were paid by drug and medical device companies between August and December 2013. There were 4.4 million payments made totaling $3.5 billion, according to the Centers for Medicare and Medicaid Services (CMS). Payments were made to 546,000 physicians and nearly 1,360 teaching hospitals. CMS directly acknowledges the database does not differentiate between payments that could be interpreted as a positive, like a physician doing clinical research, or negative, like money for a trip to promote a certain drug or device.”

“Medicare is fining a record number of hospitals because they readmitted too many patients within 30 days for more treatment, according to federal records released this week.
During the next year, 2,610 hospitals will see their reimbursement levels reduced and 39 hospitals will be hit with the largest penalty allowed, according to Kaiser Health News.
The federal government’s penalties are designed to make hospitals pay more attention to their patients after they are discharged.”

“As soon as Air Force One touched down in Indiana on Friday, Gov. Mike Pence met President Barack Obama on the tarmac with a plea: Expand the state’s access to government-sponsored health insurance.
The catch: Pence wants to do it with a conservative twist.
At least, that’s how he’s selling his proposal. And his political future could hinge on whether the first-term Republican can convince conservatives that he’s not just rebranding Obamacare.
Pence has spent much of his first two years in office trying to strike a bargain on one of the health care law’s core components. Indiana will expand Medicaid coverage, Pence says, but only if it’s allowed to do it through a tweaked version called the “Healthy Indiana Plan,” which also requires users to make small payments into health savings accounts.”

“The ObamaCare exchanges that opened for business last fall to disastrous consequence are expected to be largely improved with better technology and more insurance plans when they re-open next month, but critics are still raising concerns about consumer costs and choices.
The Department of Health and Human Services said in a preliminary report released Sept. 23 that the number of insurers has increased by 25 percent, which officials argue should lower premium costs through competition, in addition to offering customers more choices.”

“Last week, the Department of Health and Human Services announced that the number of insurers participating in state marketplaces was on the rise. But it didn’t say whether that improved competition was taking place everywhere, or just in the urban markets that already had a lot of insurance carriers.
The week before, it announced that 7.3 million Americans were currently enrolled in marketplace plans created by the Affordable Care Act. But it didn’t share a breakdown by health plan, state, age or income.”

“Thousands of consumers who were granted a reprieve to keep insurance plans that don’t meet the federal health law’s standards are now learning those plans will be discontinued at year’s end, and they’ll have to choose a new policy, which may cost more.
Cancellations are in the mail to customers from Texas to Alaska in markets where insurers say the policies no longer make business sense. In some states, such as Maryland and Virginia, rules call for the plans’ discontinuations, but in many, federal rules allow the policies to continue into 2017.”

“Who’s up for the latest batch of bad Obamacare-related news?
(1) Consumers brace for the second full year of Obamacare implementation, as the average individual market premium hike clocks in at eight percent — with some rates spiking by as much as 30 percent.
(2) “Wide swings in prices,” with some experiencing “double digit increases.”(Remember what we were promised):
Insurance executives and managers of the online marketplaces are already girding for the coming open enrollment period, saying they fear it could be even more difficult than the last. One challenge facing consumers will be wide swings in prices. Some insurers are seeking double-digit price increases…”

“Last month’s launch of the Apple Watch is indicative of the big potential that companies are seeing in digital health. And the market is buying into digital health in a big way, judging by the record amount of money these firms have been raising this year.
Through the first nine months of 2014, digital health companies have raised $5 billion, almost double what they did in all of 2013, according to publicly reported data compiled by StartUp Health. The actual number of deals are on a slower pace this year, which StartUp Health says is an indication that the relatively young market is maturing.”

“One year ago, every network, every member of Congress and certainly HHS and CMS watched or tried to log into HealthCare.gov. It proved to be a long, long wait. The collective frustration at the end of the day was the site did not work.
Despite repeatedly assuring both Congressional committees and the American public that the new marketplace and this bold new experiment on shopping for government controlled health insurance was to be smooth as silk and easy as pie, the rollout was a colossal failure for the HHS Secretary and her team. Ultimately, she admitted being responsible for the ‘debacle’ but not much has been done to eliminate the problems and clean up the process. HealthCare.gov is still broken.
The rollout was a failure, but my hope is the bureaucracy has learned some lessons. Here are five things I hope we can file away as lessons learned.”

“Lance Shnider is confident Obamacare regulators knew exactly what they were doing when they created an online calculator that gives a green light to new employer coverage without hospital benefits.
“There’s not a glitch in this system,” said Shnider, president of Voluntary Benefits Agency, an Ohio firm working with some 100 employers to implement such plans. “This is the way the calculator was designed.”
Timothy Jost is pretty sure the whole thing was a mistake.
“There’s got to be a problem with the calculator,” said Jost, a law professor at Washington and Lee University and health-benefits authority. Letting employers avoid health-law penalties by offering plans without hospital benefits “is certainly not what Congress intended,” he said.”