Tag Archives: Health System

It’s Easy for Obamacare Critics to Overlook the Merits of Medicaid Expansion

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At a national level, the expansion of Medicaid continues to yield benefits. Its coverage was increased, and its quality raised. Some states that have expanded Medicaid are even expecting net savings for the next few years. In states where Medicaid was expanded, hospitals had fewer uninsured visits.

Focusing on only the positives can be as misleading as focusing on only the negatives. Policy decisions, including those involving health, need to be considered in terms of trade-offs. It is true that providing Medicaid can cost the federal government, and even states, a lot of money, which can’t then be spent on other worthy pursuits. It is true that Medicaid reimburses physicians and hospitals less generously, and that it often leaves beneficiaries with fewer choices than private insurance might.

But when we look at the balance sheet for Medicaid — health benefits, financial security, societal improvements through education — it’s not hard to argue that money allocated to Medicaid is well spent.

 

Obamacare repeal plan stokes fears of market collapse

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http://www.politico.com/story/2016/11/obamacare-repeal-market-collapses-231653?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=37969677&_hsenc=p2ANqtz–Wv-16E4bE7iT4jhF2j2QKWBhCJZPBLuy-TBTKYxxVNSL8KAVSAyRmDFndXujD1e6r6JMx9BX3zcgMSf3biYBAMLyJug&_hsmi=37969677

161118-obamacare-repeal-getty_1160.jpg

Republicans warned for years that Obamacare would blow up the nation’s individual insurance market. Instead, their own rush to repeal the health care law may be what triggers that death spiral.

GOP lawmakers say they plan to repeal the Affordable Care Act as soon as President-elect Donald Trump takes office, including a transition period of a year or two before it takes effect. That way, they satisfy their base while giving notice to 20 million Obamacare customers that they must find other coverage options.

But repealing the law without a replacement is likely to spook health insurers, who might bolt from the markets prematurely to avoid losses as some people stop paying their premiums, while other people rush to have expensive medical procedures before losing coverage. Insurers would have little incentive to stick around without knowing what to expect at the end of the transition. And that could spell chaos for consumers.

“The discussion right now about repeal and replacement is making the market very, very nervous,” said Washington Insurance Commissioner Mike Kreidler, a Democrat. “I would not be surprised to see the potential for a stampede to exit the market.”

Even if Congress delays immediate action to kill the health care law, Obamacare insurers would have just a few months to decide whether to stay in the law’s marketplaces for 2018. Deep uncertainty about the Republicans’ Obamacare replacement could drive out those companies, cutting off insurance for, potentially, millions of customers.

“A repeal that kicks the can on replace would put the market in serious jeopardy, and the American people will hold them accountable for the results,” Topher Spiro, who heads health policy at the left-leaning Center for American Progress, said on a call with Obamacare supporters last week.

Uncertainty about Obamacare’s future is occurring against the backdrop of strong demand for coverage. More than 1 million people signed up through HealthCare.gov in the first two weeks of the current enrollment season, including 100,000 who enrolled the day after the election, according to the Department of Health and Human Services. The administration projects that 13.8 million people will participate this season, which ends about two weeks after Trump takes office. Millions more — including young adults on their parents’ policies and those in expanded Medicaid — will also get coverage this cycle.

Uncertain Fate Of Health Law Giving Health Industry Heartburn

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Uncertain Fate Of Health Law Giving Health Industry Heartburn

WASHINGTON, DC - NOVEMBER 10: President-elect Donald Trump (L) talks after a meeting with U.S. President Barack Obama (R) in the Oval Office November 10, 2016 in Washington, DC. Trump is scheduled to meet with members of the Republican leadership in Congress later today on Capitol Hill. (Photo by Win McNamee/Getty Images)

Six years into building its business around the Affordable Care Act, the nation’s $3 trillion health care industry may be losing that political playbook.

Industry leaders, like many voters, were stunned by the election of Donald Trump and unprepared for Republicans’ plans to “repeal and replace” Obamacare.

In addition, Trump’s vague and sometimes conflicting statements on health policy have left industry officials guessing as to the details of any substitute for the federal health law.

“It will be repealed and replaced,” Trump said Sunday in an interview on CBS’ “60 Minutes.” At the same time, he vowed to preserve popular provisions of the law like ensuring that people with preexisting conditions can get insurance and allowing young adults to stay on their parents’ health plans.

Charles (Chip) Kahn, chief executive of the Federation of American Hospitals, said that before the election, health groups had not been meeting with Republicans about a rewrite of the law “because the working assumption was we had a program that wasn’t going anywhere. That working assumption is now no longer operative.”

Upending the health law plays havoc with a health industry that had invested heavily in strategies geared to the ACA’s financial incentives. The flipped script initially left some industry groups speechless. Others issued bland statements pledging cooperation with the next administration as they awaited greater clarity from the next president.

Said Donald Crane, who heads CAPG, a national trade group for physician organizations: “Nobody was ready for this. We didn’t have a Plan B.”

The results appear to have rattled the fragile industry coalition that the Obama administration carefully crafted to support the law. Looking ahead, some health sectors might have even more reason to worry.

The hospital industry may be the most vulnerable to proposed changes, which could result in millions of Americans losing health coverage, both through the insurance exchanges and expansion in the Medicaid program for those with lower incomes.

Not Just Obamacare: Medicaid, Medicare Also On GOP’s Chopping Block

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http://www.huffingtonpost.com/entry/obamacare-medicaid-medicare-gop-chopping-block_us_582a19b8e4b060adb56fbae7?jn7jtocg8bzqia4i

rious about repealing Obamacare, and doing so quickly. But don’t assume their dismantling of government health insurance programs will stop there.

For about two decades now, Republicans have been talking about radically changing the government’s two largest health insurance programs, Medicaid and Medicare.

The goal with Medicaid is to turn the program almost entirely over to the states, but with less money to run it. The goal with Medicare is to convert it from a government-run insurance program into a voucher system ― while, once again, reducing the money that goes into the program.

House Speaker Paul Ryan (R-Wis.) has championed these ideas for years. Trump has not. In fact, in a 2015 interview his campaign website highlighted, he vowed that “I’m not going to cut Medicare or Medicaid.” But the health care agenda on Trump’s transition website, which went live Thursday, vows to “modernize Medicare” and allow more “flexibility” for Medicaid.

In Washington, those are euphemisms for precisely the kind of Medicare and Medicaid plans Ryan has long envisioned. And while it’s never clear what Trump really thinks or how he’ll act, it sure looks like both he and congressional Republicans are out to undo Lyndon Johnson’s health care legacy, not just Barack Obama’s.

f course, whenever Trump or Republicans talk about dismantling existing government programs, they insist they will replace them with something better ― implying that the people who depend on those programs now won’t be worse off.

But Republicans are not trying to replicate what Medicaid, Medicare and the Affordable Care Act do now. Nor are they trying to maintain the current, historically high level of health coverage nationwide that these programs have produced. Their goal is to slash government spending on health care and to peel back regulations on parts of the health care industry, particularly insurers.

This would mean lower taxes, and an insurance market that operates with less government interference. It would also reduce how many people get help paying for health coverage, and make it so that those who continue to receive government-sponsored health benefits will get less help than they do now.

It’s difficult to be precise about the real-world effects, because the Republican plans for replacing existing government insurance programs remain so undefined. Ryan’s“A Better Way” proposal is a broad, 37-page outline without dollar figures, and Senate Republican leaders have never produced an actual Obamacare “replacement” plan.

But the Republican plans in circulation, along with the vague ― and shifting ― health care principles Trump endorsed during the campaign, have common themes. And from those it’s possible to glean a big-picture idea of what a fully realized version of the Republican health care agenda would mean.

True value-based care is a trillion-dollar unicorn for the health care industry

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True value-based care is a trillion-dollar unicorn for the health care industry

In Silicon Valley, Kendall Square, and points in between, unicorns are more than mythical creatures that adorn software engineers’ ironic T-shirts. They’re disruptive technology behemoths with billion-dollar-plus valuations. These beasts have largely shied away from the health technology sphere over the last decade, despite many promising upstarts. Maybe we’ve been hunting for the wrong kind.

Get ready for the uber-unicorn. It won’t be a single, enormous company with a trillion-dollar valuation. Instead, it’s a movement called value-based care.

Value-based care isn’t a new concept. But it’s been used a bit bashfully, traditionally referring to carrot-and-stick-based incentive payments and penalties for physicians. Today these pale in comparison to the fee-for-service care that rewards reactive, episodic, paternalistic care — and lots of it.

Here’s what I mean by true value-based care: fully capitated payment contracts in which a lump sum of money is available to treat a patient over the course of a year. No penalties or incentives, simply ownership of the total cost of care and the total cost of outcomes. The better the care, the more money the organization bearing the risk receives. This is how to best reward exceedingly efficient, effective health care.

 

 

What Would Block Grants or Limits on Per Capita Spending Mean for Medicaid?

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http://www.commonwealthfund.org/publications/issue-briefs/2016/nov/medicaid-block-grants

ABSTRACT

Issue: President-elect Trump and some in Congress have called for establishing absolute limits on the federal government’s spending on Medicaid, not only for the population covered through the Affordable Care Act’s eligibility expansion but for the program overall. Such a change would effectively reverse a 50-year trend of expanding Medicaid in order to protect the most vulnerable Americans.

Goal: To explore the two most common proposals for reengineering federal funding of Medicaid: block grants that set limits on total annual spending regardless of enrollment, and caps that limit average spending per enrollee.

Methods: Review of existing policy proposals and other documents.

Key findings and conclusions: Current proposals for dramatically reducing federal spending on Medicaid would achieve this goal by creating fixed-funding formulas divorced from the actual costs of providing care. As such, they would create funding gaps for states to either absorb or, more likely, offset through new limits placed on their programs. As a result, block-granting Medicaid or instituting “per capita caps” would most likely reduce the number of Americans eligible for Medicaid and narrow coverage for remaining enrollees. The latter approach would, however, allow for population growth, though its desirability to the new president and Congress is unclear. The full extent of funding and benefit reductions is as yet unknown.

9 ways hospitals can reduce debt

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http://www.healthcaredive.com/news/9-ways-hospitals-can-reduce-debt/430488/

Healthcare reform has had a dramatic impact on hospital reimbursement. While millions of Americans are now insured under the Affordable Care Act, high-deductible health plans can leave patients cash-strapped after expensive episodes of care. Sometimes, patients can’t pay for the services they receive, pushing up bad debt at hospitals. At the same time, hospitals are dealing with lower reimbursements and a shift from inpatient to outpatient care, leaving some with property and beds that are no longer financially productive.

Take Community Health Systems for example. Burdened with $15 billion in debt , the Franklin, TN-based hospital chain sold a four-hospital joint venture and spun off 38 hospitals into a separate entity, Quorum Health Corp., earlier this year. Recently, the system inked deals to sell an additional 17 hospitals.

According to Patrick Pilch, head of BDO Consulting’s healthcare advisory practice, many hospitals and health systems don’t have a complete handle on what their costs of care are and they’re losing money as a result. “Understanding your costs of care as well as your cost of capital is imperative,” he tells Healthcare Dive. “Then align that to a future strategy. That’s where you’re going to pull your way out of debt.”

Hospitals should look at their assets, business plan, market and supply chain and then see how those align with their capital strategy, Pilch says. With interest rates expected to rise, non-investment grade hospitals will have a harder time getting capital. “If you have a lot of capital that’s not performing well, you’re in a bit of a state right now,” he adds.

Here are nine ways hospitals can work on debt:

MultiCare plans to acquire Spokane health system

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http://www.bizjournals.com/seattle/blog/health-care-inc/2016/11/multicare-plans-to-acquire-spokane-health-system.html

MultiCare Health System is acquiring Spokane's Rockwood Health System. This is the fifth partnership/merger/acquisition announced this month the health care industry in Washington continues to consolidate.

MultiCare Health System plans to purchase the assets of Rockwood Health System in Spokane from subsidiaries of a Tennessee-based health system.

Financial details of the agreement were not disclosed. The deal, which was announced Thursday, is expected to close in the first quarter of 2017.

This is the fifth partnership/merger/acquisition announced this month as the health care industry in Washington state continues to consolidate.

Rockwood Health System includes Deaconess and Valley Hospitals as well as Rockwood Clinic. Those facilities will become part of the MultiCare system, which includes five hospitals, 15 urgent care centers in the Puget Sound region as well as 11 RediClinics located inside select Rite Aid stores. MultiCare is also in the process of opening seven new urgent care clinics it announced in June. It calls these higher-end clinics Indigo Urgent Care.

Community hospitals: What’s your long-term game plan?

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http://www.beckershospitalreview.com/facilities-management/community-hospitals-what-s-your-long-term-game-plan.html

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The volume of hospital M&A deals has doubled over the past six years, with fewer and fewer community hospitals still going it alone. For the remaining holdouts, they are at an important juncture: Should they continue fighting for independence or join a larger system?

This heavily-debated question is at the core of many board meetings. While the answer is unique to each institution, in either scenario, the community hospital that proactively controls its own destiny — instead of losing that control to market forces — can come out ahead.

Whether the future holds independence or acquisition, here is what leadership needs to know to position their hospitals for future growth.

What does it take to stay independent?
For efficient facilities with ample cash on hand, there’s an understandable allure to remaining independent. After all, the board of directors at a community hospital is typically made up of individuals from the local area who can continue to focus exclusively on addressing the needs of the local community rather than answer to a distant corporate team.

But a lean and high-volume operation today just isn’t a strong enough indicator to choose independence for the long term. Leadership must consider broader questions that take into account a host of internal and external factors:

‘Somewhere in between’: Finding the balance between quality and the bottom line

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http://www.beckershospitalreview.com/finance/somewhere-in-between-finding-the-balance-between-quality-and-the-bottom-line.html

Values-GeneralLeadership

As healthcare continues its shift from fee-for-service to value-based care, hospitals and health systems are working steadily to try and improve quality while reducing costs. However, striking a balance between the two can be challenging.

At the Becker’s Hospital Review 5th Annual CEO + CFO Roundtable on Nov. 8 in Chicago, healthcare experts discussed how their entities balance rewarding physicians for quality and clinical activity in what is still primarily a fee-for-service environment.

“We’re not totally in a fee-for-service environment. We’re not totally in a value-based care environment. We’re kind of somewhere in between,” said Patrice M. Weiss, MD, executive vice president and CMO of Roanoke, Va.-headquartered Carilion Clinic. “In the past, the two were felt to be mutually exclusive, but recent models of care have demonstrated that quality of care can be delivered in a low-cost model.”

While the shift from fee-for-service to value-based care is slightly slower in coming to her organization’s region, they are preparing, according to Dr. Weiss.

Carilion is a nonprofit organization with a network of hospitals, primary and specialty physician practices and other complementary services. The health system offers physicians a base salary, as well as a Tier 1 bonus and a Tier 2 bonus. The Tier 1 bonus is based on scorecard measures, which include quality metrics, patient experience metrics and operating margin.

“We have found we’ve been able to reduce the cost by using evidence-based medicine, standardization of care and appropriateness of testing and imaging,” Dr. Weiss said. “This reduced utilization has not reduced the quality of care or outcomes but has reduced the cost of care, thereby positively affecting our operating margin. So improving quality care and reducing the cost of care are not mutually exclusive.”

Physician-led, cost-reducing initiatives and physician engagement have been primary drivers in achieving reduced costs and improved quality, according to Dr. Weiss. For instance, Carilion has a significant physician-led initiative on early elective inductions or deliveries. This initiative, which was based on national guidelines, resulted in less utilization of obstetrical resources at an earlier gestational age.