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Patient Access to Medical Services Varies by Individual Physician ’ s Will to Fight Insurance Companies
American healthcare reform debates are focused on strategies to provide “access” to medical services for all. Lack of insurance (or under-insurance) seems to be the primary focus, as it is falsely assumed that coverage provides access. Unfortunately, the situation is far more complicated.
Once a person has health insurance, there is no guarantee that they will receive the medical services that they need. Not because their plan is insufficiently robust, but because the roadblocks for approval of services (provided in the plans) are so onerous that those providing the service often give up before they receive i...
Source: Better Health - July 3, 2017 Category: American Health Authors: Dr. Val Jones Tags: Health Policy Opinion Administrative Burden Coverage Is Not Care Health Insurance Roadblocks Pre-Authorization Underinsured Source Type: blogs
Did “Medicus economicus” Kill Medicare Part B Reform?
By DAVID, MATTHEWS and MAUGHN
When doctors complain about proposed changes to health care reimbursement, do they speak for patients or their pocketbooks? As the recent debate over Medicare Part B shows, even with access to publicly available billing data, it’s hard to disentangle financial motivations from more altruistic ones.
Since 2005, Medicare Part B has paid for physician-administered drugs like infused chemotherapeutics by reimbursing 106% of the average selling price (ASP) – a formula commonly referred to as “ASP+6”. In order to reduce overall spending and the program’s apparent incentive for physicians...
Source: The Health Care Blog - June 28, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Medicus Econ Source Type: blogs
Genentech & Escobar: Using Materiality to Escape False Claims Liability
In constructively bringing an end to a False Claims Act (“FCA”) whistleblower suit alleging Genentech, Inc. (“Genentech”) of defrauding Medicare by way of concealing substantive health care analytics data involving purported side effects of the company’s cancer drug Avastin, the Third Circuit of Appeals in a recent decision determined that the Plaintiff in this matter had failed to demonstrate that any noncompliance had an impact on government payments. Specifically, the Court applied the prevailing standard in Escobar that an FCA lawsuit must demonstrate that any misrepresentation is “material” to the govern...
Source: Policy and Medicine - June 26, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Medicaid Round Two: The Senate ’s Draft “Better Care Reconciliation Act Of 2017”
Although it differs in important details, the draft Medicaid provisions of the Better Care Reconciliation Act — the Senate’s version of Affordable Care Act “repeal and replace” — share the vision of its House-passed counterpart, the American Health Care Act: to, as much as possible, shield the federal government from the cost of Medicaid. Like the House, the Senate would accomplish this goal by fundamentally altering the terms of Medicaid itself rather than by ending it and replacing its entitlement structure with a new, successor program as Congress did in 1996 when it replaced the Aid to Families with...
Source: Health Affairs Blog - June 24, 2017 Category: Health Management Authors: Sara Rosenbaum Tags: Featured Following the ACA Medicaid and CHIP Uncategorized ACA repeal and replace block grants Medicaid per capita cap Trumpcare Source Type: blogs
Will Senate Republicans Get 50 Votes to Repeal the ACA?
By DAVID INTROCASO
THCB readers are well aware this coming week Senate Republicans plan to begin debate on passing their amended version of the House-passed American Health Care Act (AHCA), titled the Better Care Reconciliation Act. As of today, June 23rd, immediate reactions by Republican senators to the June 22nd released discussion draft have been limited largely because members immediately left town after the draft’s release. The Congressional Budget Office’s (CBO’s) score, that will again be influential, is expected this Monday or Tuesday. Senate debate on the legislation will likely begin next W...
Source: The Health Care Blog - June 24, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized AHCA CBO David Introcaso Repeal Replace Senate Republicans Source Type: blogs
A Primer For Conservatives: Health Insurance is not Really Insurance
By MICHEL ACCAD, MD
Is health insurance a plan to help healthy people mitigate against an unexpected illness, or an income subsidy to help the sick pay for medical care?
Conservatives ought to have a clear answer to that question. Not long ago Congressman Morris Brooks from Alabama did not and found himself on the receiving end of liberal ridicule.
By suggesting that those who take better care of themselves should pay lower health insurance premiums, Brooks implied that health insurance is indeed a type of insurance arrangement. After all, the risk adjustment of premiums is a practice proper to all other kinds of insurance...
Source: The Health Care Blog - June 23, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Examining How Senate Republicans Frame Their Health Care Bill
Discussion Draft of Senate Amendment to H.R. 1628
Help stabilize collapsing insurance markets that have left millions of Americans with no options.
Short-Term Stabilization Fund: To help balance premium costs and promote more choice in insurance markets throughout the country, this stabilization fund would help address coverage and access disruption – providing $15 billion per year in 2018 and 2019; $10 billion per year in 2020 and 2021.
Jason Chung writes: S. 106(h)(1) specifies that these amounts are intended to “fund arrangements with health insurance issuers to address coverage and access disruption…” Rand P...
Source: The Health Care Blog - June 22, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Jason Chung Senate Bill Source Type: blogs
Healthcare Does Not Need Faster Radiologists
Radiologists (and all physicians for that matter) are compensated based on RVU, or relative value unit. RVUs are measured using a variety of factors: work, expenses, and liability insurance. Those variables are divided into different components that evaluate time, skill, judgement, equipment, and supplies. The Medicare rate is determined by multiplying the RVU by a dollar conversion factor. RVUs were conceived in the late 1980s by Harvard University researchers who estimated the work put into a series of patient vignettes.According to the National Health Policy forum, “Estimating and updating the RVUs is a labor-intensiv...
Source: radRounds - June 16, 2017 Category: Radiology Authors: Julie Morse Source Type: blogs
The American Health Care Act Could Chip Away At The Medicare Savings Programs
The American Health Care Act (AHCA) is not just an alarming, slapdash effort to repeal the Affordable Care Act—it’s also a plan to radically weaken Medicaid, our nation’s health care safety net. Indeed, the US House-passed bill’s most dramatic savings—$834 billion according to Congressional Budget Office estimates—are achieved by slashing federal funding to Medicaid, which provides health coverage to nearly 75 million low-income Americans, and undoing the program’s basic guarantee.
Nevertheless, these draconian reforms have been among the lesser told stories of the AHCA’s anticipated impact. The...
Source: Health Affairs Blog - June 15, 2017 Category: Health Management Authors: Maura Calsyn and Stacy Sanders Tags: Costs and Spending Following the ACA Insurance and Coverage Medicaid and CHIP Medicare Payment Policy ACA repeal and replace American Health Care Act dual eligibles Source Type: blogs
Replicating Effective Models Of Complex Care Management For Older Adults
Improving our system of care for older adults with complex, chronic illnesses requires wrestling with a vexing dilemma. Models of care that are readily scalable have limited effectiveness, and effective models are difficult to scale. As an example of the former, the patient-centered medical home (PCMH) has become widespread, but its impact on population health and health care costs varies and has been modest overall. As a stand-alone solution, the PCMH appears insufficient to deliver the diverse set of interventions required by chronically ill, older adults with complex needs—a growing segment of the US population th...
Source: Health Affairs Blog - June 7, 2017 Category: Health Management Authors: Ken Coburn, Charlotte Grinberg, Sophia Demuynck and Margaret Hawthorne Tags: Costs and Spending Diffusion of Innovation Featured Medicare chronically ill older adults complex care management health and aging Health Quality Partners Source Type: blogs
What to do when dementia patients cannot eat
I'm so distraught over my father. He has a Peg tube in, and hasn't had any solid food for over 2 months.Our reader Denise wrote: I'm so distraught over my father. Has a Peg tube andhasn't had any solid food for over 2 months.He asks me all the time for food. Seeing him suffer is too much. If I give him food and then he'll aspirate and he is DNR.I feel like by giving him food i will be contributing to his death sooner. Oh Lord ...so painful.Article -16 Ways to Get a Dementia Patient to Eat More FoodSubscribe to the Alzheimer's Reading RoomEmail:By Dr. Rita A. JablonskiAlzheimer's Reading RoomTo the reader, I would reco...
Source: Alzheimer's Reading Room, The - June 4, 2017 Category: Neurology Tags: alzheimers alzheimers care can't eat care of dementia patients dementia care feeding health lifestyle Source Type: blogs
Health Insurance Benefits Should Be Equitable, Not Necessarily Equal
As policy makers grapple with potentially undoing or modifying the largest expansion of health insurance in a generation, the cost and generosity of benefits hold center stage. Traditional underpinnings of insurance plans—premiums, deductibles, copayments, and coinsurance—frequently create barriers to the optimal use of these plans by consumers. They also can exacerbate inequities in health care, by inhibiting the use of services known to benefit health. Novel approaches to insurance plan design to produce a more equitable and efficient distribution of health care expenditures are warranted.
Following the princ...
Source: Health Affairs Blog - May 22, 2017 Category: Health Management Authors: Betsy Q. Cliff, Michael Rozier and A. Mark Fendrick Tags: Costs and Spending Featured Health Equity Insurance and Coverage health insurance benefits insurance plan design value-based insurance design Source Type: blogs
The Humanity In End-Of-Life Care
Health care is personal, especially when it comes to caring for someone as they approach death. However, half of Americans feel they have too little control over end-of-life medical decisions.
As the industry moves toward a more holistic approach to care delivery, health care organizations are beginning to rethink how they treat patients and starting to embed end-of-life care plans into the overall approach earlier on, sometimes before people even become ill. In a recent report on end-of-life care by the Aspen Health Strategy Group, several principles are discussed that take a broader view around caring for seriously ill p...
Source: Health Affairs Blog - May 19, 2017 Category: Health Management Authors: Susan DeVore Tags: Costs and Spending End of Life & Serious Illness Long-term Services and Supports Payment Policy Quality advance care planning Palliative Care Source Type: blogs
Those Nasty Complications
I often wonder in cancer treatment, which is worse - treatment or complications? I think complications win that one. To me complications mean more doctor visits, more drugs, more expense, more whininess, and less happy results.In recent years, we have had the whats-her-name effect (this is what happens when you blog too early in the day) where women are getting bilateral and unilateral mastectomies at higher rates than in the past. There is no real proof that mastectomies are better than lumpectomies with radiation for early stage breast cancer but many women opt for them anyway.But there is a problem. New research (becaus...
Source: Caroline's Breast Cancer Blog - May 19, 2017 Category: Cancer & Oncology Tags: breast cancer treatment doctor appointments medical complications medical costs side effects Source Type: blogs
Why Health Reform is a Risky Business for Politicians: Even Winning Can Cost You at the Polls!
By JEFF GOLDSMITH
In August 1989, Chicago Congressman Daniel Rostenkowski, then Chairman of the “powerful” House Ways and Means Committee, narrowly escaped an angry mob of seniors in his own district who attacked his car with umbrellas. His crime: eliminating the gaping patient financial exposure built into the Medicare program in 1965 by raising taxes on the “high income” elderly. In November, 1989 Congress rescinded the so-called Catastrophic Coverage Act, a bipartisan reform signed into law by Ronald Reagan just sixteen months earlier.
In the spring of 1994, Bill and Hillary Clinton abandoned their famously ...
Source: The Health Care Blog - May 19, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
