For New Medicaid Patients, The Doctor Is In (Generally). But You May Have To Wait.

http://khn.org/news/for-new-medicaid-patients-the-doctor-is-in-generally-but-you-may-have-to-wait/

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More than 14 million adults have enrolled in Medicaid since the health law passed, and that has caused some hand-wringing over whether there would be enough primary care providers to meet the demand. But a study out this week suggests that the newly insured people are generally able to get timely appointments for primary care.

For the study, which was published online in JAMA Internal Medicine, trained field workers posing as new Medicaid or privately insured patients called physician practices in 10 states and requested a new-patient appointment for either a checkup or newly diagnosed high blood pressure. They recorded whether they were able to get an appointment and how soon it could be scheduled.

The states in the study — Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania and Texas — represented a mix of states that expanded Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level (about $16,600) and those that haven’t done so. An initial round of fieldworker calls to more than 9,700 practices was made in 2012 and 2013, before most states had expanded Medicaid coverage, followed by a second round of calls to more than 7,300 practices in 2016.

Over the time periods studied, appointment availability improved for Medicaid callers by 5.4 percentage points, while it stayed stable for privately insured callers (though Medicaid callers still had a tougher time getting appointments in general).

But, during the second study period, callers from both groups were less likely to be able to schedule an appointment within a week. The proportion of Medicaid callers who waited a week or less decreased by 6.7 percentage points, to 49.1 percent; the share of those who said they were privately insured who waited a week or less declined by 4.1 percentage points, to 52.7 percent.

“Some of these offices were getting a little more full,” said Daniel Polskyexecutive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania and the study’s lead author. “One way doctors were making room for more patients was that instead of making an appointment in a week’s time, some were making it in two weeks.”

There are many factors that may have contributed to the ability of primary care providers to absorb more patients, including increased funding for federally qualified health centers and the growth of retail clinics, among others.

The study should ease concerns that the health law will exacerbate the shortage of primary care providers, Polsky said, though there may still be regional challenges accessing care.

“It’s still true that fewer doctors are willing to see Medicaid patients than are willing to see commercial patients,” he said. “But if you have Medicaid, your access to doctors is still good.”

 

With ‘Trumpcare’ On Horizon, Voters Go Wobbly On Repeal

http://khn.org/news/with-trumpcare-on-horizon-voters-go-wobbly-on-repeal/

UNITED STATES - FEBRUARY 22: Protesters gather outside before Rep. Leonard Lance, R-N.J., holds a town hall meeting at the Raritan Valley Community College in Branchburg, N.J., on Wednesday, Feb. 22, 2017. (Photo By Bill Clark/CQ Roll Call)

As candidate Donald Trump hammered the Affordable Care Act last year as “a fraud,” “a total disaster” and “very bad health insurance,” more Americans than not seemed to agree with him.

Now that President Trump and fellow Republicans show signs of keeping their promise to dump the law, many appear to be having second thoughts.

Multiple polls show rising support for the ACA, including two recent ones indicating Americans feel more positively about it than ever. True, many still dislike what’s known as Obamacare. One survey showed 42 percent see it unfavorably while 48 percent viewed it favorably.

But as the national conversation swells on the fate of a law that affects millions of people in multifaceted ways — and the issue takes center stage at raucous town hall meetings — it’s increasingly clear that many Americans don’t see the ACA as an either-or proposition.

“At first it was a good deal — that was three or four years ago,” said Mark Bunkosky, 56, an independent contractor in Michigan who buys coverage through one of the law’s online portals. “Every year it’s gone up. From where it started, the premium has doubled, and now my deductible has also doubled. And my income has not doubled.

Bunkosky, a Republican, views the ACA unfavorably but believes Washington should fix it, not toss it. He supports keeping some of the law’s Medicaid coverage for low-income people and its prohibition on discriminating against those with preexisting illness.

his week Trump acknowledged that health care is “so complicated.” So are voter opinions on what to do next with the ACA, which expanded coverage to some 20 million.

“I didn’t like that it mandated people to carry health insurance. And I thought it was just a lie” when it promised affordability, said Amber Alexander, 27, a Pennsylvania independent whose seasonal income puts her on Medicaid in winter and a commercial plan the rest of the year.

However, she said, “I don’t think it should be thrown out altogether. There are people that do benefit from it, but there are also a lot of people that get screwed.”

Carol Friendly, 67, is an Oregon Republican who voted for Hillary Clinton for president and favors the health law’s Medicaid expansion, which many Republican policymakers excoriated but has gained support among some GOP governors. She objects to the ACA’s reproductive health coverage, saying consumers opposed to birth control and abortion shouldn’t have to pay for them.

On the other hand, “I know it put 22 million in the health care system that weren’t there before,” she said. “So that’s a plus.”

Adding to the political fog are mixed signals from Republicans.

 

Drowning In A ‘High-Risk Insurance Pool’ — At $18,000 A Year

http://khn.org/news/drowning-in-a-high-risk-insurance-pool-at-18000-a-year/

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Some Republicans looking to scrap the Affordable Care Act say monthly health insurance premiums need to be lower for the individuals who have to buy insurance on their own. One way to do that, GOP leaders say, would be to return to the use of what are called high-risk insurance pools, for people who have health problems.

But critics say even some of the most successful high-risk pools that operated before the advent of Obamacare were very expensive for patients enrolled in the plans, and for the people who subsidized them — which included state taxpayers and people with employer-based health insurance.

Craig Britton of Plymouth, Minn., once had a plan through Minnesota’s high-risk pool. It cost him $18,000 a year in premiums.

Britton was forced to buy the expensive coverage because of a pancreatitis diagnosis. He called the idea that high-risk pools are good for consumers “a lot of baloney.”

“That is catastrophic cost,” Britton said. “You have to have a good living just to pay for insurance.”

Vermont Tests The Waters On GOP Health Care Overhaul

http://www.healthleadersmedia.com/health-plans/vermont-tests-waters-gop-health-care-overhaul?spMailingID=10548476&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1120254532&spReportId=MTEyMDI1NDUzMgS2#

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A statewide experiment aims to test new payment systems, prevent unnecessary treatments, and constrain overall growth in the cost.

Tiny — and very blue — Vermont could be at the leading edge of the health reforms envisioned by the Trump administration and a Republican Congress.

The Green Mountain State, population around 626,000, got a broad waiver last October from the federal government to redesign how its health care is delivered and paid for. The statewide experiment aims to test new payment systems, prevent unnecessary treatments, constrain overall growth in the cost of services and drugs, and address public health problems such as opioid abuse.

The six-year initiative — an outgrowth of a failed attempt by Vermont a few years ago to adopt a single-payer plan for all residents — could eventually encompass almost all of its 16 hospitals, 1,933 doctors and 70 percent of its population, including workers insured through their jobs and people covered under Medicare and Medicaid.

The Obama administration approved the experiment, but it fits the Republican mold for one way the Affordable Care Act could be replaced or significantly modified. The Trump administration and lawmakers in Congress have signaled that they want to allow states more flexibility to test ways to do what Vermont is doing — possibly even in the short-term before Republicans come to an agreement about the future of the ACA.

The Nursing Shortage? It’s Complicated

http://www.healthleadersmedia.com/nurse-leaders/nursing-shortage-its-complicated?spMailingID=10548476&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1120254532&spReportId=MTEyMDI1NDUzMgS2#

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A workforce data analysis predicts a national nursing surplus of 340,000 registered nurses by 2025. But there is more to this story.

 

Editor’s Corner: Why are we still letting pharma pay physicians?

http://www.fiercehealthcare.com/antifraud/editor-s-corner-why-are-we-still-letting-pharma-pay-physicians

Close-up of a doctor's white coat

Last month, W. Carl Reichel was acquitted of charges that he oversaw a kickback scheme designed to induce physicians to prescribe certain drugs manufactured by Warner Chilcott LLC.

The president and CEO of the pharmaceutical company was acquitted of those charges despite the fact that the company itself pleaded guilty to “knowingly and willfully” paying off physicians in the form of sham speaking fees and meals at high-end restaurants, and agreed to pay the government $125 million in civil and criminal fines.

He was acquitted even though prosecutors trotted out nearly a dozen witnesses who worked under Reichel to testify against him, some of whom admitted to participating in the scheme that used “medical education” events–including barbecues, picnics, parties and trips to a casino–to improve physician prescribing rates. The government also alleged that Reichel oversaw the whole thing by demanding sales reps engage in “business conversations” about “clinical experience,” which was code for a physician’s prescribing rate.

But most importantly, he was acquitted because his attorneys never denied that he oversaw any of these payments, or that he instructed sales staff to take physicians out “at least twice a week.” They merely argued that “relationship building” is “widely accepted conduct” in the medical community.

They aren’t lying–allowing pharmaceutical companies to pay physicians large sums of money is a widely accepted practice. The question we should be asking ourselves is, why?

 

83% of patient advocacy groups accept payouts from pharma

http://www.fiercehealthcare.com/finance/study-more-than-80-patient-advocacy-groups-accept-payouts-from-pharma?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTVdWa05XUTROamxoTURZMCIsInQiOiJra2diVDlzMHM4TVJmcFpYSmtcLzNhOHNQUGNCaHZYOUxMMnhcL1FDdytSNm1rQ0FNNmVDZlBCWGVvXC9nS0VRZjZhRWVaT3B4RllpN1FkZUJwQU9xYUpKQzhJancrMktwTEpkTThcL2VFaDloRUtxTDQ0aStENHQ1VWhyTGFLNG1vNWoifQ%3D%3D

PillsandMoney

drug and healthcare costs, a significant majority accept payouts from the pharmaceutical industry, according to a new study.

Researchers at the University of Pennsylvania found that 83% of patient advocacy groups accepted donations from drug or medical device makers.

The study, published in the New England Journal of Medicine, also found that in close to 40% of cases, executives in the pharmaceutical industry sit on governing boards of patient groups. For some groups in the study, donations from the industry make up more than half of their annual income.

The study examined financial data for the top 104 patient advocacy groups that reported more than $7.5 million in revenue per year. Ezekiel Emanuel, M.D., vice provost at the University of Pennsylvania and one of the study’s authors, told The New York Times that these patient advocacy groups “wrap themselves in white as if they’re pure.”

He told the publication that these groups should have to disclose ties to industry in the same way as medical researchers, who are pushed to reveal connections to industry groups as they perform research and speak in public.

Some patient advocacy groups are taking aim at the study’s findings. For instance, National Health Council CEO Marc Boutin, said in a statement (PDF) that the organizations under its umbrella adhere to 38 standards, about 16 of which are designed to ensure that the group’s mission is kept separate from donations.

“Patient advocacy organizations are driven by their missions—putting patients first,” Boutin said. “To say otherwise negates the extraordinary work achieved by these organizations on behalf of their patients.”