Social Security Programs Throughout the World

This publication highlights the principal features of social security programs in more than 170 countries. Published in collaboration with the International Social Security Association, one of four regional volumes is issued every six months.

via Social Security Programs Throughout the World.

ObamaCare “Glitch” Adds $50 Billion per Year to the Deficit

The true costs of ObamaCare continue to rise, as budget projections under the healthcare law are being understated by as much as $50 billion per year, according to a new report from Cornell economist Richard Burkhauser and his colleagues from Cornell and Indiana University. This alarming revelation is due to official budget forecasts that neglect to account for employees’ spouses and children — which could result in hundreds of billions more in taxpayers’ dollars over the next 10 years. “The Congressional Budget Office has never done a cost-estimate of this [because] they were expressly told to do their modeling on single [person] coverage,” Burkhauser alleged. “A very large number of workers” will have access to federal subsidies, “dramatically increasing the cost” of ObamaCare.

via ObamaCare “Glitch” Adds $50 Billion per Year to the Deficit.

The Compact | Health Care Compact

The Elements of the Health Care Compact

Pledge: Member states agree to work together to pass this Compact, and to improve the health care in their respective states.

Legislative Power: Member states have primary responsibility for regulation of all non-military health care goods and services in their state.

State Control: In member states, states can suspend federal health care regulations. Federal and state health care laws remain in force in a state until states enact superseding regulations.

via The Compact | Health Care Compact.

Hearing highlights staggering cost of improper Medicare payments – The Hill’s Healthwatch

The federal government wasted almost $48 billion in improper payments in Medicare last year, the most of any government program, federal officials testified Thursday.

The Government Accountability Office (GAO) released a new report Thursday to coincide with a hearing of the House Oversight Committee’s panel on government efficiency. The report found that the Health and Human Services Department has been making progress in cutting back on improper payments, but has a long way to go.

via Hearing highlights staggering cost of improper Medicare payments – The Hill’s Healthwatch.

CRS | Medicare Program Integrity: Activities to Protect Medicare from Payment Errors, Fraud, and Abuse

 

Since 1990, the Government Accountability Office (GAO) has  identified the Medicare program as at risk for improper payments and fraud, and, since 2004, has issued 12 products documenting various program vulnerabilities. As noted by GAO and other public and private analysts, Medicare’s vulnerability to fraud and abuse arises from the program’s size, complexity, decentralization, and administrative requirements. Although a good estimate of the dollar amount lost to Medicare fraud and abuse is open to discussion, analysts agree that billions of dollars are lost. Administering the volume of claims (more than 4.5 million per work day) from Medicare’s many providers and suppliers (over 1 million) is a daunting task. Requirements to process and pay provider reimbursement claims quickly, have set up a “pay and chase” approach that complicates program integrity  efforts.

More at medicare_program_integrity_-_a_6338.pdf 

GAO | PATIENT PROTECTION AND AFFORDABLE CARE ACT IRS Should Expand Its Strategic Approach to Implementation

 

 

In summary, IRS has responsibilities in the implementation of 47 PPACA provisions with effective dates through 2018.2 In planning to implement these provisions, IRS has generally followed leading practices. Top leadership has been involved; cost estimates for information technology projects have specified ground rules and assumptions, data sources, and supporting calculations; work has started on compliance controls; and risks are being identified and analyzed at the individual project level. However, IRS could improve aspects of its planning, particularly at an agencywide or strategic level. IRS defines strategic-level goals and project plans in multiple documents without integrating the goals or plans, IRS has no timeline for developing performance measures and collecting associated data, a cost estimate for all of the PPACA program has not been provided, and the risk management framework does not assure that all risks, especially strategic-level risks, are identified and analyzed. While implementation for some provisions is years away, making improvements to the planning process now would reduce risks and might minimize future problems.

More at d11719.pdf (application/pdf Object).

GAO | MEDICAID AND CHIP Most Physicians Serve Covered Children but Have Difficulty Referring Them for Specialty Care

Most physicians are enrolled in Medicaid and CHIP and serving children covered by these programs. On the basis of its 2010 national survey of physicians, GAO estimates that more than three-quarters of primary and specialty care physicians are enrolled as Medicaid and CHIP providers and serving children in those programs. A larger share of primary care physicians (83 percent) are participating in the programs—enrolled as a provider and serving Medicaid and CHIP children—than specialty physicians (71 percent). Further, a larger share of rural primary care physicians (94 percent) are participating in the programs than urban primary care physicians (81 percent).
Nationwide, physicians participating in Medicaid and CHIP are generally more willing to accept privately insured children as new patients than Medicaid and CHIP children.

More at d11624.pdf (application/pdf Object).

Recovery Under the Medicare Secondary Payer Act: Impact of Reporting Thresholds | RAND

Effective January 1, 2012, Medicare will require insurers and self-insured companies to report settlements, awards, and judgments that involve a Medicare beneficiary to the Centers for Medicare and Medicaid Services (CMS). In the first year of the law’s implementation, claims resolved for less than $5,000 will be exempt from the reporting requirement. In the second year, the threshold for reporting will fall to $2,000 and then $600. In the third year, all claims will have to be reported regardless of payment size. As a first step toward informing the policy debate about the costs of compliance, the amounts likely to be available for recovery under the Medicare Secondary Payer (MSP) Act, and the effects of different thresholds on these quantities, the researchers analyzed the effects of the eventual phaseout of the $5,000 threshold. The results of the analysis suggest that collecting on low-value claims provides Medicare with relatively little revenue and that such claims represent a substantial fraction of the reporting burden.

More at Recovery Under the Medicare Secondary Payer Act: Impact of Reporting Thresholds | RAND.

Physician/Hospital Alignment: Employment agreements in the reform era

Health care reform and other market dynamics are increasing the need for more effective alignment between physicians and hospitals. New incentive models such as Accountable Care Organizations (ACOs), Pay 4 Performance, quality programs, and gain sharing will likely change the way hospitals and physicians work together and are aligned in the future.

One of the most prevalent emerging models is physician employment by hospitals and health systems. A new paper from Deloitte, “Physician/Hospital Alignment: Employment agreements in the reform era,” discusses the changing dynamics of physician/hospital relationships; among them, physician employee agreements.

More at The Morning Consult – Home.

IRS to block hospitals from filing group tax return – FierceHealthFinance – Health Finance, Healthcare Finance

An Internal Revenue Service (IRS) advisory committee has recommended blocking tax-exempt organizations from filing a single tax return for all of its affiliates–a change that could make it far more complicated for hospitals to report on their operations, reports AHA News Now.

The IRS’ Advisory Committee on Tax Exempt and Government Entities suggested the change because it believed that filing a single 990 Form tax return did not provide enough transparency or accountability.

More at IRS to block hospitals from filing group tax return – FierceHealthFinance – Health Finance, Healthcare Finance.