December 10, 2013
Perhaps most importantly for hospitals, though, the Affordable Care Act required Medicare to start penalizing hospitals that frequently readmit the same patients, and in 2012 some 70 percent of hospitals took a financial hit for their high readmission rates. Observation status doesn\’t count as admission, so using it helps hospitals avoid the penalty.
Here’s the problem for the patients: Medicare beneficiaries seen as inpatients are only charged their inpatient deductible, which was $1,184 in 2013, for hospital stays, but those under observation status can be on the hook for thousands of dollars more because they’re billed separately for every procedure and drug.
What’s more, a patient’s follow-up treatment in a nursing home, which doctors frequently recommend after an ER visit, isn’t covered by Medicare unless the person has first been a hospital inpatient for three days, and observation status doesn’t count.
via How Hospitals Pass Their Obamacare Penalties on to Patients – Olga Khazan – The Atlantic.
December 4, 2013
On November 16, The Wall Street Journal reported that UnitedHealth Group has dropped thousands of doctors in at least ten states from its Medicare Advantage networks. This is a consequence of the federal government’s cutting payments to Medicare Advantage plans ― by $156 billion over ten years ― to fund ObamaCare. Earlier this month, Evan Gahr of the Daily Caller wrote an article describing how plans nationwide are shrinking, and citing a report by consultants at Avalere which projected reduction in Medicare Advantage plans, especially in rural areas.
via Will ObamaCare Finally Cause American Seniors to Turn Against Government Health Care? | John Goodman’s Health Policy Blog | NCPA.org.
November 26, 2013
In fact, both the Centers for Medicare and Medicaid Services and the Congressional Budget Office projected in 2010 that millions would be pushed off Medicare Advantage entirely and back into traditional Medicare over ObamaCare\’s first 10 years.
Recognizing the political risk of deep cuts to a popular program in an election year, the administration created a dubious $8.3 billion \”quality improvement\” demonstration project, with the bulk of the money given to Medicare Advantage plans in 2012.
Not only did this project dwarf any previous federal demonstration project, it was so poorly designed that it was unlikely to \”produce meaningful results,\” according to a Government Accountability Office audit.
But the funds masked nearly all of ObamaCare\’s scheduled Medicare Advantage cuts for 2012, and much of cuts for this year.
In addition to plan cancellations, seniors are starting to feel the impact of these ObamaCare spending cuts via higher costs.
via Obama Breaks ‘Keep Your Doctor’ Promise With Seniors – Investors.com.
November 26, 2013
Although most Americans are now aware of the disastrous rollout of Obamacare health-insurance exchanges for privately insured people, they may not yet have noticed that Obamacare is inflicting pain on Medicare beneficiaries, too.
On November 16, the Wall Street Journal reported that UnitedHealth Group has dropped thousands of doctors in at least ten states from its Medicare Advantage networks. This is a consequence of the federal government’s cutting payments to Medicare Advantage plans — by $156 billion over ten years — to fund Obamacare. Earlier this month, Evan Gahr of the Daily Caller wrote an article describing how plans nationwide are shrinking and citing a report by consultants at Avalere, which projected reduction in Medicare Advantage plans, especially in rural areas.
via Will Obamacare Finally Cause American Seniors to Turn Against Government Health Care? | The Beacon.
November 9, 2013
MIT professor Jonathan Gruber, architecht of the Massachuseets health insurance law that was the model for Obamacare, told the Daily Caller that seniors who stand to lose their doctors and Medicare Advantage plans must be sacrificed for the greater good.“It is a tiny effect compared to the benefits of this law. There is small fraction of Americans who might need to change doctors or plans because of the law.”Medicare Advantage covers 14.4 million people.Asked if Obama had betrayed seniors with his famous promise to Americans that they could keep their doctor and health plan Gruber insisted that, “He was not really talking about seniors.” But in fact, the president’s promise, in dozens of televised speeches was all-inclusive and unqualified.
via The Daily Caller » Seniors lose insurance and doctors under Obamacare » Print.
October 19, 2013
In that scenario, the Democratic Party would probably end up pushing, not for the pipe dream of true single payer, but for a further bottom-up/top-down socialization, in which Medicare is offered to 55- to 65-year-olds and Medicaid is eventually expanded even more.
Meanwhile, the task for serious conservative reformers — already not the most politically effective bunch — might actually become harder, because they would have to explain how their plan to build an effective, exchange-based marketplace differed from the Obama White House’s exchange fiasco.
So while Republican politicians may be salivating over a potential Obamacare crisis, the conservative policy thinkers I know are not. They’re hoping, as I’m hoping, that this isn’t as bad as it looks. The chance to say “I told you so” is always nice, but not if the price is a potentially irrecoverable disaster.
via Obamacare, Failing Ahead of Schedule – NYTimes.com.
October 18, 2013
The prediction that over a decade 15% of hospitals will become unprofitable as a result of the ACA’s Medicare cuts is consistent with the results of Wu and White, described above. So, we can give CMS full marks on that prediction, at least based on what we know now.
CMS’s other prediction, that Medicare prices will be half the value of commercial market ones by 2040, isn’t looking so good.
via Hospitals’ responses to Medicare cuts.
July 30, 2013
In particular, as Medicare experiments with accountable care organizations, bundled payments and other new strategies, the agency will inevitably need to make adjustments. Questions will come up, such as: How should the payments to doctors, hospitals and other providers be changed to reflect what is learned about the quality of care they provide? How much should the penalties or bonuses be? Is it better to have hospitals face all the costs associated with patient (as in an accountable care organization) or only the costs incurred during a specific episode of care (as in bundled payments)?
As even preliminary answers come in, the Independent Payment Advisory Board is supposed to make the adjustments, allowing Medicare to move as smoothly and quickly as possible toward an improved system for rewarding value in health care. Congress could never act so nimbly.
via Critics Are Wrong About the Medicare Payment Board – Bloomberg.
July 29, 2013
To date, 22 Democrats have joined Republicans in the House and Senate in support of legislation to do away with the IPAB. Yet because of the extraordinary partisanship on Capitol Hill and Republican threats to defund the law through the appropriations process, it is unlikely that any change in the Affordable Care Act will take place soon.
The IPAB will cause frustration to providers and patients alike, and it will fail to control costs. When, and if, the atmosphere on Capitol Hill improves and leadership becomes interested again in addressing real problems instead of posturing, getting rid of the IPAB is something Democrats and Republicans ought to agree on.
via Howard Dean: The Affordable Care Act’s Rate-Setting Won’t Work – WSJ.com.
July 29, 2013
The number of doctors who opted out of Medicare last year, while a small proportion of the nation’s health professionals, nearly tripled from three years earlier, according to the Centers for Medicare and Medicaid Services, the government agency that administers the program. Other doctors are limiting the number of Medicare patients they treat even if they don’t formally opt out of the system.
Even fewer doctors say they won’t accept new Medicaid patients, and the number who don’t participate in private insurance contracts, while smaller, is growing—just as millions of Americans are poised to gain access to such coverage under the new health law next year. All told, health experts say the number of doctors going “off-grid” isn’t enough to undermine the Affordable Care Act, but they say some Americans may have difficulty finding doctors who will take their new benefits or face long waits for appointments with those who do.
via More Doctors Steer Clear of Medicare – WSJ.com.