Monthly Archives: May 2017

House Bill Targets Pre-Existing Conditions in Multiple Ways

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http://www.realclearhealth.com/articles/2017/05/18/house_bill_targets_pre-existing_conditions_in_multiple_ways_110599.html?utm_source=RC+Health+Morning+Scan&utm_campaign=38995c8cb7-EMAIL_CAMPAIGN_2017_05_19&utm_medium=email&utm_term=0_b4baf6b587-38995c8cb7-84752421

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For those with pre-existing medical conditions, the House-passed health bill became notorious for a last-minute addition that would let insurers once again charge them higher premiums in the individual market based on their health status. But the focus on this single provision distracts from a troubling fact: even without it, the bill would threaten health care for those with pre-existing conditions in four broader ways.

#1: The bill would cap and cut federal funding for virtually all of Medicaid by imposing a per capita cap or letting states convert Medicaid into a block grant.

A per capita cap would set annual limits on federal funding per beneficiary that would grow more slowly than actual health care costs. A block grant would cap the amount of overall federal Medicaid funding the state could receive. Either way, states would receive significantly less federal funding compared to current law, under which the federal government pays a fixed share of state Medicaid costs, and the funding cuts would grow deeper each year.

Faced with large cuts in federal funding, states would have no choice but to sharply cut their programs. Consequently, tens of millions of people with pre-existing conditions – including millions of children with disabilities and special health care needs – would face the threat of Medicaid cuts.  They could lose coverage entirely or go without needed care as states scaled back covered benefits and payments to medical providers.

Home- and community-based services, an optional Medicaid benefit that most states already limit based on available funds, would be at particular risk. These services, which include nursing and home health care and help with chores, meals, transportation, and other services, let seniors and other low-income people with serious health problems remain in their homes instead of having to go to a nursing home.

#2: The federal government wouldn’t provide any more enhanced funding after 2019 for Medicaid enrollees who were enrolled because their states took the option, under the Affordable Care Act (ACA), to expand their Medicaid programs.

That would force states to pay three to five times more for the ACA’s Medicaid expansion.  Most or all of the 31 states and Washington, D.C. that have adopted it would have no choice but to drop it because they could no longer afford it.

The Medicaid expansion now covers 11 million people, including many who have pre-existing conditions. For example, almost 30 percent of those benefitting from the Medicaid expansion have a mental illness or substance use disorder. By effectively ending the Medicaid expansion starting in 2020, the House bill would leave millions of low-income people with pre-existing conditions without coverage.

#3: The bill would let insurers charge older people — many of whom have pre-existing conditions —at least five times more to buy coverage compared to younger consumers, while also slashing the subsidies that help them afford insurance. 

For example, a 60-year-old woman with $22,000 of annual income who faced the national average benchmark premium would pay $8,200 more in premiums after accounting for federal tax credits than she does now. The Congressional Budget Office projects that uninsured rates for people age 50-64 would double due to the House bill.  Some 84 percent of people age 55-64 have pre-existing health conditions.

#4: The bill would eliminate a broad range of consumer protections that the ACA established in the individual market, threatening access to health care and coverage for those with pre-existing conditions.

Plans would no longer need to offer a comprehensive set of benefits and could exclude even core benefits such as maternity services and mental health care. Nor would they have to limit the amount that people with expensive health care must pay out-of-pocket for deductibles and other cost-sharing each year.  Insurers could again place annual and lifetime limits not only on individual and small-group plans but also on coverage that people get from large employers, leaving millions with costly pre-existing conditions to once again worry about exhausting their benefits.

All told, then, the House bill would bring back the highly-flawed, pre-ACA individual insurance market that made it impossible for millions with pre-existing conditions to get adequate, affordable health coverage.  Additionally, it would threaten the coverage of millions of Medicaid recipients with pre-existing conditions.

That’s not a health care system that should make us proud.

THE PEOPLE WHO LEAD THE BEST TRY THE LEAST

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The People Who Lead the Best Try the Least

Genuine leadership:

Real leaders change us effortlessly. Who they are influences us more than what they do. Comfort with themselves and their belief in us gives us courage to open our hearts to their influence.

Authentic leaders give us courage to see strength in ourselves because they don’t need us to affirm their worth. Phony leaders fear power in others and work to control rather than release.

Jim Parker, former CEO of Southwest Airlines said his favorite word of advice to leaders is, “Be yourself.” Warren Bennis said, “Becoming a leader is synonymous with becoming yourself.”

The leader on a white horse is a myth propagated by our own fears and neediness.

Finding genuine leadership:

Jot down memories of people and events. Who comes to mind when you think of your past? How are they living in you today?

Authenticity consists of your responses to influential individuals and formative circumstances combined with your genetic code. You can’t change genetics. You can interpret and assimilate circumstances and relationships.

Say what you really think. “Candor says, ‘Here’s what I think. What do you think?’” Kim Scott, author of, Radical Candor. The courage to say what you think is formative. Our words impact who we become.

If you can’t say what you think, you can’t become who you were meant to be.

Abandon yourself to a grand idea and live it in small ways everyday. Don’t dabble on the edges of purposeful work. There is no authority except in submission to something meaningful that lies outside ourselves – a calling that finds expression in a cause.

I mentioned that our responses to circumstances and people combined with genetics constitutes authenticity. What other components of authenticity do you see?

How might leaders become themselves?

AHCA Would Affect Medicare, Too

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http://www.commonwealthfund.org/publications/blog/2017/may/ahca-would-affect-medicare?omnicid=EALERT1211869&mid=henrykotula@yahoo.com

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“Don’t touch my Medicare” has been a rallying cry in recent years, first as Congress considered health reform and now as it debates the fate of the Affordable Care Act (ACA). While the bill that would repeal and replace the ACA—the American Health Care Act (AHCA)—does not include explicit changes to Medicare, the legislation could have a profound impact on the 11 million Medicare beneficiaries who also rely on Medicaid for key components of their care. Here’s a look at how the ACHA’s major changes in federal funding for Medicaid would affect low-income older adults and the Medicare program.

One-Third of All Medicaid Spending Is for People Covered by Medicare

Low-income Medicare beneficiaries who also are enrolled in Medicaid—often referred to as “dual eligibles”—could be disproportionately affected by congressional efforts to cut and cap federal Medicaid financing. Not only do these older adults account for one-third of all Medicaid spending, much of the Medicaid spending for low-income Medicare beneficiaries is “optional” for states.1

The nearly three-quarters (72%) of dual eligibles who receive full Medicaid benefits are most at risk under the AHCA’s funding caps.2  They tend to be in poorer health than other Medicare (and Medicaid) beneficiaries, and rely on Medicaid for high-cost services.3  While Medicare covers physician, hospital, and most other acute care, Medicaid covers some of dual eligibles’ behavioral health services as well as most of their long-term services and supports, such as nursing home and home and community-based services. Under federal law, many of these services are optional. Similarly, many low-income Medicare beneficiaries who qualify for Medicaid are “optional” beneficiaries who qualify only when they incur health and long-term care costs that are well in excess of their incomes. States can drop optional services and optional enrollees even without any new federal flexibility.

Economists propose paying physicians salary over fee-for-service method to avoid conflicts of interest

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http://www.healthcarefinancenews.com/news/conflicting-jama-reports-highlight-debate-over-reality-pending-physician-shortage

In a Journal of the American Medical Association Viewpoint article, a pair of behavioral economists contend that doctors should be paid by salary, rather than the fee-for-service arrangements under which most of them now operate.

While most conflict of interest research and debate in medicine tends to focus on physicians interacting with pharmaceutical and device companies, how doctors are paid is one important source of conflict that’s largely ignored in medical literature, they said.

Fee-for-service compensation arrangements, they propose, create incentives for physicians to order more, and different, services than are best for patients.

“Paying doctors to do more leads to over-provision of tests and procedures, which cause harms that go beyond the monetary and time costs of getting them,” said George Loewenstein, the Herbert A. Simon University professor of economics and psychology at Carnegie Mellon University, in a statement. “Many if not most tests and procedures cause pain and discomfort, especially when they go wrong.”

He and Ian Larkin, an assistant professor of strategy at UCLA’s Anderson School of Management, said that a commonly proposed solution to the problem involves requiring physicians to disclose their financial interest for a given procedure. But disclosure of conflicts has been found to have limited, or even negative, effects on patients.

Loewenstein and Larkin argue that the simplest and most effective way to deal with conflicts caused by fee-for-service arrangements is to pay physicians on a straight salary basis. Several health systems well-known for high quality of care, such as the Mayo Clinic, the Cleveland Clinic and the Kaiser group in California, pay physicians salaries without incentives for volume of services performed.

Moving more physicians to straight salary-based compensation might have benefits not only for patients, but also for physicians themselves, they said.

“The high levels of job dissatisfaction reported by many physicians may result, in part, from the need to navigate the complexities of the fee-for-service arrangements,” said Larkin. “Instead of focusing on providing patients with the best possible medical care, physicians are forced to consider the ramifications of their decisions for their own paychecks.”

58% of Physicians ‘Strongly Negative’ on AHCA

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http://www.healthleadersmedia.com/physician-leaders/58-physicians-strongly-negative-ahca?spMailingID=11059722&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1161579213&spReportId=MTE2MTU3OTIxMwS2

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Survey data suggests that physicians dislike the GOP’s American Health Care Act even more than they disliked the Affordable Care Act.

Two-thirds of physicians do not like the American Health Care Act, the Republican House bill to unwind Obamacare, while only about a quarter support it, a new survey indicates.

The survey of 1,112 physicians by the Dallas-based physician search firm Merritt Hawkins found that 66% of doctors have a negative impression of the AHCA, 26% have a positive impression, and 7% are neutral.

“Physicians have consistently expressed dissatisfaction with government-sponsored healthcare legislation in the past, and the AHCA does not reverse this trend,” Mark Smith, president of Merritt Hawkins, said in a media release. “So far, the bill rates a strongly negative diagnosis from physicians.”

In a 2016 survey of 17,236 physicians that Merritt Hawkins conducted for The Physicians Foundation, 23% of physicians gave the Affordable Care Act a grade of A or B, 28% gave it an average grade of C, while 48% gave it a D or F.

The AHCA, now being considered by the Senate, gets an even higher negative rating in the new Merritt Hawkins survey. Fifty-eight percent of those surveyed have a strongly negative impression of the bill, 8% have a somewhat negative impression, while 7% are neutral.

At the other end, 27% of physicians favor full repeal and replacement, while only 7% of respondents say keep it as it is, indicating the extent of dissatisfaction with the ACA, the HealthLeaders Media survey showed.

The Merritt Hawkins survey findings are in line with a HealthLeaders Media survey published in January, which showed that healthcare industry leaders support changes to the ACA rather than replacing it. Two-thirds of respondents (66%) said the best option for the healthcare industry regarding the ACA would be to make some changes but otherwise retain it.

Physicians Groups Denounce AHCA

Opposition to the AHCA among practicing physicians is reflected by the nation’s major physicians associations, all of which have come out against the repeal and replace proposal.

The American Medical Association, the nation’s largest physicians’ association, made clear its strong opposition to the ACHA in a March 7 letter to Congress, and again on April 27. Of course, the AMA has a long history of railing against government-sponsored healthcare.

The Merritt Hawkins survey was sent by email to about 80,000 physicians randomly selected from Merritt Hawkins’ database and has an error rate of +/- 2.87% as determined by experts in statistical response at the University of Tennessee.

Physician Age Linked to Clinically Significant Patient Mortality Risk

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http://www.healthleadersmedia.com/physician-leaders/physician-age-linked-clinically-significant-patient-mortality-risk?spMailingID=11059722&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1161579213&spReportId=MTE2MTU3OTIxMwS2#

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The difference in mortality rates translates into one additional patient death for every 77 patients treated by physicians 60 and older, compared with those treated by doctors 40 and younger.

Patients treated by older hospitalists are somewhat more likely to die within a month of admission than patients treated by younger physicians, suggests research published this week in the BJM.

Researchers at Harvard note that the difference in mortality rates was modest yet clinically significant—10.8% among patients treated by physicians 40 and younger, compared with 12.1% among those treated by physicians 60 and older.

That translates into one additional patient death for every 77 patients treated by physicians 60 and older, compared with those treated by doctors 40 and younger.

Study lead author Anupam B. Jena, MD, a hospitalist, and associate professor of medicine at Harvard Medical School, spoke with HealthLeaders about the findings. The following is a lightly edited transcript.

Broward Health fires another auditor

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http://www.beckershospitalreview.com/finance/broward-health-fires-another-auditor.html

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Fort Lauderdale, Fla.-based Broward Health will terminate a contract with its outside CPA at the end of this month after a 29-year working relationship. The fired audit director sees the break-up as the health system’s attempt to curb independent examination of the public system, according to the Sun Sentinel.

Joel Mutnick, audit director for Plantation, Fla.-based Fiske & Co., abstained from a vote to approve a draft of the firm’s audit since the documentation did not disclose several key events, including the suicide of late CEO Nabil El Sanadi, MD, in January 2016, the governor’s suspension of two board members and the lawsuit filed against the board by Pauline Grant, interim CEO who was fired in December 2016.

The audit covered the year ending June 30, 2016. Mr. Mutnick served on the committee of Broward board members and executives that supervised a third-party annual audit of the five-hospital system.

“They didn’t like not having control of me,” Mr. Mutnick told the Sun Sentinel. “Clearly they didn’t like the idea of me turning down the financial statements because of their inadequate disclosure. I don’t think they liked an outside auditor telling them or questioning the financial statement results.”

The chairman of Broward Health’s audit committee, Chris Ure, refused accounts that Mr. Mutnick’s departure involved his voting record or his independence. Mr. Ure said the committee is operating under new bylaws that impose term limits on members to strengthen independence and fresh perspectives, according to the Sun Sentinel. Under those new bylaws, Mr. Ure said outside members will no longer be paid.

Last September, Broward Health cut ties with KPMG after the accounting firm refused a contract addendum that would have extensively restricted its inquiry powers into Broward’s activities. Broward officials said they added the addendum over concerns KPMG would be unable to certify the system’s financial statements by the end of the year, due to the length of KPMG’s possible investigation into corruption allegations against the system.