Alliance for Health Reform | ACA 101: What You Need to Know

March 30, 2015

This session was especially helpful to congressional staff members new to the issue, but is also a useful review for anyone dealing with the Affordable Care Act (ACA). The briefing took place just as the second marketplace enrollment period ended and the Supreme Court heard oral arguments in a case challenging the law’s subsidies.

What are the key provisions of the ACA? How did the ACA extend coverage to the uninsured? How does the ACA impact private and public insurance coverage, marketplaces and employer-sponsored coverage? What is the role for states? What are the requirements on employers and individuals? How was Medicaid changed by the ACA and then the Supreme Court? How is the Children’s Health Insurance Program (CHIP) affected?

via ACA 101: What You Need to Know.

HHS expanding a failed program » AEI

February 17, 2015

The Department of Health and Human Services (HHS) recently announced it will expand Value Based Payment (VBP) programs that currently account for 20 percent of Medicare payments to 30 percent by 2016 and 50 percent by 2018. While VBP is supposed to improve quality and lower costs by paying for the value and/or quality of services, rather than the volume of services, multiple studies, including some by HHS, show that VBP programs have not worked. In practice they place tremendous burdens on physicians and distort the physician-patient relationship. This flawed experiment will impact all Americans since Medicare is a benchmark for all U.S. health insurance.

via HHS expanding a failed program » AEI.

Plans for Medicare payment overhaul receive mixed reviews

February 2, 2015

Scott Becker, JD, CPA, publisher of Becker’s Hospital Review and chairman of the healthcare department at McGuireWoods, recognizes the serious outcomes the overhaul may have. “I think if this happens it will have a draconian effect on all small and mid-size hospitals, health systems and providers.” he says. “The largest providers, who can absorb the changes and take on population health, will fare fine. The small and mid-size providers will face further harm from such substantial changes in payment methods. They are already struggling to survive. Actions like this heavily favor the larger systems and are grist for more consolidation.”

Concerning HHS’ plan, Mr. Becker also says, “This may in part be a political salve aimed at getting more providers interested in a single-payer system — i.e. Medicare for all. Most mid-size and small providers would anticipate serious negative consequences from the approach set forth by CMS and might view a single-payer system as a good alternative to this. It reminds me of the old adage about hitting someone over the head. If you hit them for long enough, they say thank you for stopping here. This plan is another shot across the bow at smaller and mid-size providers of all types. They may just be thankful to stop being hit.”

via Plans for Medicare payment overhaul receive mixed reviews.

Debate Heightens Over Measuring Health-Care Quality – WSJ

January 31, 2015

“Measurement fatigue is a real problem in hospitals,” said Scott Wallace, a visiting professor at Dartmouth’s Geisel School of Medicine. “But, to me, the only metric that matters is, did you get better?”

As of last year, 33 federal programs asked providers to submit data on 1,675 quality measures, according to a government count. State, local and private health plans use hundreds more.

This year, many of the federal pay-for-performance programs carry financial penalties. Hospitals and doctors stand to lose millions in Medicare payments for missing filing deadlines or improvement benchmarks in programs that track hospital-acquired infections, readmissions and electronic-record use.

In all, about 80% of traditional Medicare spending is already tied to such pay-for-performance programs. HHS Secretary Sylvia Burwell said Monday the agency wants that to increase to 90% by 2018. She also set a goal of having 50% of Medicare spending in alternative payment models, in which providers are accountable for quality and the cost of care for groups of patients.

via Debate Heightens Over Measuring Health-Care Quality – WSJ.

HHS Takes Wrong Steps in the Right Direction | Insights | American Action Forum

January 28, 2015

Overall, ACOs have been a dismal failure, VBP has had mixed results, and hospital readmission reduction programs appear to have no impact whatsoever. Yet HHS is calling for the expansion of these programs to an ambitious 90 percent of the health care sector over the next four years.

via HHS Takes Wrong Steps in the Right Direction | Insights | American Action Forum.

Medicare Advantage improves patient outcomes | TheHill

January 15, 2015

Surprisingly, despite the Medicare Advantage program’s widespread popularity and measurable success for both patients and taxpayers, Congress has repeatedly gone after this vital program with cuts that threaten its integrity and long term sustainability. Ultimately, bolstering Medicare Advantage in order to support innovative care coordination, quality patient outcomes and lower healthcare costs is a vital step for patients everywhere.

via Medicare Advantage improves patient outcomes | TheHill.

Turmoil in Medicare Advantage hits NC seniors hard | Economy |

November 19, 2014

North Carolina senior citizens who choose private Medicare policies are seeing an unusual level of turmoil this year, with more than 57,000 notified their plans won’t be offered in 2015 and others seeing rates more than triple.

The upheaval involves Medicare Advantage, a program that lets people 65 and older choose private policies instead of federal health coverage. About 475,000 in North Carolina have those policies, including about 35,000 each in Mecklenburg and Wake counties.

No other state had so many people lose their current Medicare Advantage plans, according to a national tally by the Kaiser Family Foundation, a nonprofit group that tracks health trends. New York was second with just over 55,000 enrolled in canceled plans.

via Turmoil in Medicare Advantage hits NC seniors hard | Economy |


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