Requirement that Carriers Justify Double-Digit Rate Increases a Teachable Moment? « The Alan Katz Health Care Reform Blog

December 28, 2010

Reasonableness, like a host of other things, can be in the eye of the beholder. Regulating reasonableness, consequently, is nothing like a science. Yet the Patient Protection and Affordable Care Act requires health insurance carriers to disclose their reasons for “unreasonable premium increases.” The Department of Health and Human Services has issued a preliminary version of the regulation aimed at determining how and where this rate increase disclosure will take place.

More at Requirement that Carriers Justify Double-Digit Rate Increases a Teachable Moment? « The Alan Katz Health Care Reform Blog.


Review & Outlook: PolitiFiction – WSJ.com

December 24, 2010

So the watchdog news outfit called PolitiFact has decided that its “lie of the year” is the phrase “a government takeover of health care.” Ordinarily, lies need verbs and we’d leave the media criticism to others, but the White House has decided that PolitiFact’s writ should be heard across the land and those words forever banished to describe ObamaCare.

“We have concluded it is inaccurate to call the plan a government takeover,” the editors of PolitiFact announce portentously. “‘Government takeover’ conjures a European approach where the government owns the hospitals and the doctors are public employees,” whereas ObamaCare “is, at its heart, a system that relies on private companies and the free market.” PolitiFact makes it sound as if ObamaCare were drawn up by President Friedrich Hayek, with amendments from House Speaker Ayn Rand.

More at Review & Outlook: PolitiFiction – WSJ.com.


CMS, Finance leaders look to curb Medicare waste – The Hill’s Healthwatch

December 24, 2010

The Medicare agency and Senate Finance Committee leaders are calling for new guidelines on Medicare quality-of-care reviews after a new report said that federal dollars may be going to waste.

The Centers for Medicare and Medicaid Services (CMS) is unable to determine if Medicare quality-of-care budgets are excessive because CMS does not provide specific guidance on how much data should be recorded on quality reviews, according to a Government Accountability Office (GAO) report released Wednesday.

More at CMS, Finance leaders look to curb Medicare waste – The Hill’s Healthwatch.


Reviews of rate hikes might be extended to large groups – The Hill’s Healthwatch

December 24, 2010

Federal regulators will consider applying new health insurance consumer protections that were announced Tuesday to the large group market, a Health and Human Services Department official told The Hill.

The proposed rule unveiled yesterday would require health insurers that increase premiums by more than 10 percent to publicly justify the higher rates, and it empowers HHS to impose its own review if states do not have an effective process in place.

The rule, which implements a healthcare reform law provision, applies only to insurance plans in the individual and small group market, but an HHS official said the department still might choose to apply the regulation to the large group market. If review requirements are extended to large groups, it would provide new oversight to a market that isn’t accustomed to such scrutiny.

More at Reviews of rate hikes might be extended to large groups – The Hill’s Healthwatch.


New York Medical Schools Fight to End Caribbean Schools’ Path – NYTimes.com

December 24, 2010

For a generation, medical schools in the Caribbean have attracted thousands of American students to their tiny island havens by promising that during their third and fourth years, the students would get crucial training in United States hospitals, especially in New York State.

But in a fierce turf battle rooted in the growing pressures on the medical profession and academia, New York State’s 16 medical schools are attacking their foreign competitors. They have begun an aggressive campaign to persuade the State Board of Regents to make it harder, if not impossible, for foreign schools to use New York hospitals as extensions of their own campuses.

More at New York Medical Schools Fight to End Caribbean Schools’ Path – NYTimes.com.


A Few More Unrelated Health Care Reform Items « The Alan Katz Health Care Reform Blog

December 23, 2010

When it comes to health care reform the CBO was instrumental in providing meaningful input to the debate. And now those reports – and other health care related studies – are compiled in a greatest hits collection entitled “Selected CBO Publications Related to Health Care Legislation, 2009-2010.” The information contained in this 364-page compendium is invaluable. But what will be even more fun five or 10 years from now will to look back on the CBO’s projections and see how rarely the world world abides by the predictions of even well-informed and well-intentioned economists.

More at A Few More Unrelated Health Care Reform Items « The Alan Katz Health Care Reform Blog.


A Few More Unrelated Health Care Reform Items « The Alan Katz Health Care Reform Blog

December 23, 2010

Here’s a not surprising headline: “Doctors with ownership in surgery center operate more often: U-M study.” Shocking, no? The University of Michigan study shows the financial incentives gained by doctors when they have a financial stake in a a surgery center. One possible explanation the researchers mention for this is “that these physicians may be lowering their thresholds for treating patients with … common outpatient procedures.” Those financial incentives can be hefty, amounting to what the authors call a “triple dip.” Doctors with a stake in a surgery center “collect a professional fee for the services provided … share in their facility’s profits and [in] the increased value of their investment.”

More at A Few More Unrelated Health Care Reform Items « The Alan Katz Health Care Reform Blog.


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