Category Archives: Uncategorized

Uwe Reinhardt: Adverse risk selection crippling Obamacare

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http://www.healthcaredive.com/news/uwe-reinhardt-adverse-risk-selection-crippling-obamacare/425182/

  • The ACA has failed to attract enough younger, healthier people to the public insurance exchanges, causing Aetna and other private insurers to exit the market rather than shoulder the costs of sicker people, according to Princeton economist Uwe Reinhardt.
  • To deal with adverse risk selection — where sicker-than-average individuals buy insurance while younger, healthier ones don’t — some payers plan to raise premiums more than 25% in 2017.
  • That will lead even more young, healthy individuals to forego obtaining ACA coverage, creating even greater adverse risk selection, Reinhardt says.

CBO: Aging population, drugs driving federal healthcare spending

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http://www.healthcaredive.com/news/cbo-aging-population-drugs-driving-federal-healthcare-spending/425062/

The country’s aging population, which is using more Social Security and requiring more Medicare coverage, is driving most of the spending increases, according to the report. Compared to 50 years ago, the number of people who are 65 years old and older has more than doubled, CBO found. As a result, Medicare outlays will remain at about 3% of GDP until 2018 but then increase on an annual basis through 2026.

“Over the next decade, as members of the baby-boom generation age and as life expectancy continues to increase, that number is expected to rise by more than one-third, boosting the number of beneficiaries of those programs,” the report states, adding, “As a result, projected spending for people age 65 or older in three large programs — Social Security, Medicare, and Medicaid — increases from roughly one-third of all federal noninterest spending in 2016 to about 40% in 2026.”

Fatal Illness Contracted From Bagpipes

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http://www.medpagetoday.com/Pulmonology/Pneumonia/59807?xid=fb_o_

Image result for bagpipe lung

Musicians who play wind instruments are at risk for a potentially fatal inflammatory lung condition that is being called “bagpipe lung,” researchers suggested.

Writing in the journal Thorax, British researchers described the case of a 61-year-old bagpipe player who died of the interstitial lung disease hypersensitivity pneumonitis (HP), which appeared to be caused by regularly breathing in mold and fungi which thrived in the moist interior of his musical instruments.

https://tpc.googlesyndication.com/safeframe/1-0-4/js/ext.js

HP is triggered by repeated exposure to airborne bacteria, fungi or molds found in the environment. More than 300 airborne substances have been shown to cause the disease.

Farmers, bird and poultry handlers, veterinary workers, and grain processors have all been previously identified as having an increased risk for the interstitial lung disease. There have also been isolated reports of musicians developing the disorder, including saxophone and trombone players, which resolved when players began routinely cleaning their instruments.

But the case is the first to link specific fungal contamination in a musical instrument to fatal HP.

Fewer than one-third of ACOs qualify for Medicare bonuses

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http://www.fiercehealthcare.com/payer/cms-acos-generated-466m-savings-2015?mkt_tok=eyJpIjoiTXpNd1lqZGlNR0U1WkRJeCIsInQiOiJLOWhzWGhXZ2FrUHdBMEg5d1VNTnppNTR6TEh5XC9tQjI1bDgxcVlUUWNcL1wvSWt0SkRUck9vYm90K1VuSlZJUGFpQ3RubDhPdjFFTWZFUEF1S3RDTUlpZ0VQbmtJRmYyOVg5ZHk0T3RiUUZYRT0ifQ%3D%3D&mrkid=959610&utm_medium=nl&utm_source=internal

CMSCMS

Fewer than one-third of Accountable Care Organizations qualified for bonuses from Medicare in 2015.

And just 31 percent of ACOs generated savings of $466 million, according to a CMS announcement released Thursday.

CMS and Congress must “take swift and decisive action to solidify the foundation of the Medicare ACO program,” Clif Gaus, CEO of the National Association of ACOs, said in a response (.pdf) to the findings.

The savings were accumulated from 392 Medicare Shared Savings Program participants and 12 Pioneer ACO participants, according to CMS. Total savings grew 13 percent from 2014, when ACOs recognized $411 million in total savings.

The National Association of ACOS “was disappointed not to find stronger financial results that reflect the extensive financial and personal contributions invested by ACOs,” Clif Gaus told FierceHealthcare via email, adding, “the ACO program has strong, bipartisan support and is considered a model for the transition from fee-for-service to value-based payment.”

Obamacare CEO Kevin Counihan counterstrikes after Aetna’s ACA exit

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http://www.fiercehealthcare.com/payer/obamacare-ceo-kevin-counihan-counterstrikes-aetna-s-aca-exit

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In the aftermath of Aetna’s ACA exchange exit, which leaves places like Pinal County, Arizona, with no insurers scheduled to offer plans in 2017, Obamacare CEO Kevin Counihan says HHS has already revved up its efforts to recruit insurers to fill in the gaps, according to an interview with Politico.

Insurers, including most recently the Dallas-based insurer Scott & White Health Plan, say sicker, more expensive populations mean they’re losing money on government-created marketplaces. Aetna, Scott & White, UnitedHealth and Humana have all said they can’t afford to keep offering the plans.

This week, Aetna dropped out of 68 percent of the exchanges in which it was operating.

But the insurance market–a market based in risk, after all–will always be dynamic. That was the case even before healthcare reform. “This is the nature of the industry,” Counihan toldPolitico.

According to University of Chicago economist Robert Kaestner, these exits are entirely normal.

“I don’t think it’s a particularly unusual situation where the firms are leaving the market,” Kaestner told Salon. “The fact that firms can leave and enter markets means the markets are, in fact, quite competitive.”

Hospitals more likely to admit children with private insurance

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http://www.fiercehealthcare.com/payer/hospitals-more-likely-to-admit-children-private-insurance?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTXpNd1lqZGlNR0U1WkRJeCIsInQiOiJLOWhzWGhXZ2FrUHdBMEg5d1VNTnppNTR6TEh5XC9tQjI1bDgxcVlUUWNcL1wvSWt0SkRUck9vYm90K1VuSlZJUGFpQ3RubDhPdjFFTWZFUEF1S3RDTUlpZ0VQbmtJRmYyOVg5ZHk0T3RiUUZYRT0ifQ%3D%3D

Medicaid on paper and a stethoscope Medicaid on paper and a stethoscope

New research shows hospitals are more likely to admit children with private insurance over those with publicly funded plans, particularly during times when there are limited inpatient beds, an indication that reimbursement rates play a role in how hospitals manage pediatric patients in the emergency room.

Researchers from the National Bureau of Economic Research studied billing patterns for children in New Jersey that visited an emergency room between 2006 and 2012. The economists found that children with Medicaid or Children’s Health Insurance Program that presented to the ER with flu symptoms were 10 percent less likely to be hospitalized than those with private plans, according to the Washington Post.  During peak flu season, when there was a shortage of inpatient beds, children between 2 and 10 years old on Medicaid and CHIP were 20 percent less likely to be admitted.

Prices soar for some popular drugs despite insurer discounts

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http://www.fiercehealthcare.com/payer/price-hikes-for-popular-drugs-soar-above-inflation-despite-insurer-discounts

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Three out of four medicines with $1 billion or more of yearly global sales increased prices by more than double the rate of inflation between 2009 and 2015, even when insurer- and pharmacy benefit manager-negotiated discounts were factored in, a Bloomberg analysis shows.

Insurers can easily require patients to switch to alternatives, the analysis notes, giving them leverage to negotiate lower prices.

But drug costs are still putting significant pressure on payers’ margins, rising from less than 10 percent of care-cost expenditures years ago to 13 percent in 2010 and 17 percent in 2015. Insurers and state lawmakers have tried pushing back, with Virginia among severalstates trying to legislate better price transparency. Insurers also are experimenting with negotiating deals with drug manufacturers that link prices to how well the drugs work.

Bloomberg looked at 39 drugs for its analysis. Only six increased in price at the rate of inflation or below, the news agency found. Discounted prices rose significantly as well. The discounted prices for 27 of the 39 drugs rose by 25 percent or more over six years; the consumer price index rose just 9.5 percent during the same period, according to the article. Prices doubled or more for seven drugs.