Tag Archives: Medicare

The Myth of a Cheap Obamacare Replacement

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , • Leave a comment

http://www.latimes.com/business/hiltzik/la-fi-hiltzik-trump-paul-20170117-story.html?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=41037755&_hsenc=p2ANqtz-8pBWi30RdOLslYQ89FMuSTb8hSonUKKpIqWGUR6-WRPjXZJxVIUiM49YQ6dDiBROgviwVLxtxSEKFVcIPLyvnTm-UpMQ&_hsmi=41037755

The 10 essential health benefits required of any qualifying Obamacare plan: Which would you want to do without?

News on the Obamacare-replacement front was dominated this past weekend by Donald Trump and Sen. Rand Paul (R-Ky.), who both touted their Obamacare replacement plans.

To be absolutely precise, they touted the claim that they had Obamacare replacement plans. They didn’t go into any great detail about what would be in those plans. (That didn’t stop CNN from captioning its interview with Paul, “Rand Paul Releases Obamacare Replacement Details.”)

The few details, or guideposts, or guidelines that they did disclose only underscored how difficult it will be for Trump, Paul and the the Republicans on Capitol Hill to fashion a replacement that meets all their stated goals. For Trump, according to an interview with the Washington Post published Sunday, this includes “insurance for everybody” that will encompass “great health care … in a much simplified form. Much less expensive and much better.” He promised “lower numbers, much lower deductibles.”

Paul, speaking on CNN’s Sunday morning “State of the Union” program, said his plan would “insure the most amount of people, give access to the most amount of people, at the least amount of cost.” That sounds like a set of concrete goals, but actually they’re ambiguous. “Most people” compared to what? “Least cost” compared to what?

Before we get into the details, such as they are, we should recognize that if one takes as the goal of healthcare policy to provide universal coverage in which everyone is “beautifully covered,” as Trump promised, then a few limitations immediately appear. Health coverage is the product of three factors: How many people are covered; the benefits provided; and the cost of those benefits. Since the 1940s, U.S. politicians and policymakers have tried to find a balance among these factors. Every effort has been confounded by the immutable facts that treating the sick costs money and treating more people costs more money. One can save money by treating fewer people, or giving the same number of people less treatment. So any politician who says he can do more for less money is almost certainly blowing smoke.

How do the Trump and Paul “details” stack up?

Rampaging goats and $10 million mansions: your guide to the weird world of Obamacare rhetoric

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , • Leave a comment

Rampaging goats and $10 million mansions: your guide to the weird world of Obamacare rhetoric

The Obamacare repeal effort is just getting underway and already the political wordplay is dizzying. On the GOP side, the rhetoric has gone from “repeal and replace” to “insurance for everybody” to “repair and rebuild.” Meanwhile, Democrats continually warn that the Republicans are trying to “rip apart our health care system.”

To help you keep pace with the debate, we’ve assembled this handy glossary of buzzwords and talking points. Enjoy.

From the Republicans:

Repair and rebuild

This is the GOP’s attempt to describe its legislative strategy for Obamacare, and an evolution of the phrase “repeal and replace.” As Politico reported Thursday, it is the mantra of Oregon Representative Greg Walden, who is leading the offensive against Obamacare in the House. It is meant to soften the GOP’s tone and suggest the replacement effort will be carefully staged and surgical. It also opens the door to delay tactics if things don’t quickly shape up in the GOP’s favor.

From the Democrats:

‘Make America Sick Again’

A play on Donald Trump’s campaign slogan, this phrase emerged in early January as Democrats held rallies to generate support for Obamacare. Judging by the nation’s $3.2 trillion tab for health care costs in 2015, a number expected to jump as high as $3.6 trillion this year, it seems clear a lot of us are pretty sick already. But you get the point.

Healthcare Leaders Split on Incoming Trump Administration

Posted on by • Posted in Uncategorized • Tagged , , , , , , , • Leave a comment

http://www.healthleadersmedia.com/leadership/healthcare-leaders-split-incoming-trump-administration?spMailingID=10260830&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1081571803&spReportId=MTA4MTU3MTgwMwS2#

Trump logoTrump logo

While 41% of executives are generally positive about the potential impact of a Trump administration, nearly as many (37%) are generally negative about the prospects. The figures regarding Tom Price at HHS and Seema Verma at CMS are similar in a HealthLeaders Media survey.

Health Spending Projections: 2015-2025

Posted on by • Posted in Uncategorized • Tagged , , • Leave a comment

http://www.chcf.org/publications/2016/12/health-spending-projections?utm_source=CHL&utm_content=From%20The%20Foundation&utm_campaign=Footer

California Health Care Foundation - Health Care That Works for All Californians

National health spending will reach $5.6 trillion by 2025. Get the data on payers, per enrollee costs, payment sources, and spending on types of services.

Gut check: Change is coming, and healthcare executives don’t necessarily think it’s a bad thing

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , , , , • Leave a comment

http://www.healthcarefinancenews.com/news/gut-check-change-coming-and-healthcare-executives-dont-necessarily-think-its-bad-thing

Self-Discovery

The future of healthcare policy is a bit murky these days. President-elect Donald Trump has pledged to repeal the Affordable Care Act, and the Republican-run U.S. Congress is already fast at work to make that happen.

What’s not known, however, is what will change for the thousands of U.S. healthcare businesses that have not only adapted to the ACA but also made millions in investments in areas such as electronic health records, value-based reimbursement and reporting to align with the policies of the outgoing administration.

Healthcare Finance spoke with several executives at healthcare businesses to get their perspectives on not only the changes they expect but also their thoughts on what the healthcare sector actually needs to do to provide the best care while still safeguarding the health of its business model.

 

Private vs. public prices

Posted on by • Posted in Uncategorized • Tagged , , , , , , , • Leave a comment

http://www.academyhealth.org/blog/2017-01/private-vs-public-prices

selden-fig 1

You probably knew that the prices private health insurers pay hospitals are higher than those of Medicare and Medicaid. But you may not have known that the gap between private and public payers used to be a lot smaller and has grown tremendously in recent years.

Using Medical Expenditure Panel Survey (MEPS) data, by payer (private health insurance, Medicare, and Medicaid) and over time (1996-2012), the chart shows average hospital payment rates (in constant dollars), adjusted for age, sex, race/ethnicity, geography, income, health conditions, charges, length-of-stay, and whether or not a surgical procedure was performed. To produce figures for the chart, the authors used this model to predict hospital payment per stay for each MEPS observation, as if they were covered by private insurance, Medicare, or Medicaid, in turn.

As is clear from the chart, adjusted, average private pay rates have always been above public rates, but were closest in 1996-2000. Back then, private rates were no more than 10% above Medicare rates. Perhaps this was the effect of managed care, which kept growth in private rates down. Those rates began to grow during the managed care backlash, until 2005. From 2005-2009, adjusted, average private hospital rates—while considerably above Medicare and Medicaid rates—held steady. Then, in 2009, they took off again. In 2012, adjusted, average private rates were about 75% higher than Medicare rates.*

Medicaid payments were about 90% of Medicare’s in most study years.

Top 10 challenges facing physicians in 2017

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , , , , , , • Leave a comment

http://medicaleconomics.modernmedicine.com/medical-economics/news/top-10-challenges-2017

2016 was a challenging year on many fronts for healthcare providers.

Physicians have just started to digest the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its changes to physician reimbursement. A long presidential election finally reached its conclusion, but the consequences of a Republican Congress and President-elect Donald J. Trump for U.S. doctors and patients remain unclear. And running a private practice did not get any easier. Balancing the need to deal with patients who won’t listen or won’t pay while also seeking positive patient satisfaction scores remains a daily struggle for many. 

These were just some of the challenges physician readers told Medical Economics they experienced this year and anticipate continuing for the foreseeable future. 

For the fourth consecutive year, Medical Economics reveals its list of obstacles physicians will face in the coming year and, more importantly, how to overcome them. For this latest presentation, we asked readers to tell us what challenges they face each day and where they needed solutions.

Here are their responses, starting with the biggest challenge of the coming year.

Survey: 70% of medical groups worried about MACRA implementation

Posted on by • Posted in Uncategorized • Tagged , , , , , , • Leave a comment

http://www.beckershospitalreview.com/finance/survey-70-of-medical-groups-worried-about-macra-implementation.html

Image result for macra implementation

Almost three-quarters of employed medical groups are concerned about implementation of the final Medicare Access and CHIP Reauthorization Act rule, according to The Advisory Board’s survey of the Medical Group Strategy Council.

The Advisory Board said it recently surveyed a group of 30 employed medical groups to determine their concern about MACRA and see how they’re adjusting to the changes MACRA will cause.

Here are five survey findings.

1. Seventy percent of respondents are “concerned” or “totally freaked out” by MACRA. Of the remaining respondents, 20 percent are “confident,” while 10 percent are “ambivalent,” the survey found.

2. The MACRA final rule, a landmark payment system for Medicare physician fees that replaces the sustainable growth rate formula, includes two pathways for provider participation: the Merit-Based Incentive Payment System and the Advanced Alternative Payment Model. According to the survey, 70 percent of respondents anticipate participating in MIPS, while the remaining 25 percent predict they will fall into the APM category.

3. Only half of the medical groups that believe they will participate in MIPS expect to be prepared to report data for the entirety of 2017, according to the survey. Another 21 percent anticipate choosing the partial-year option to be eligible for the smaller positive payment adjustment, and 29 percent of respondents planning to “test the program” by reporting nominal data to avoid the negative payment adjustment.

4. The Advisory Board said 58 percent of survey respondents identified MACRA as the driving force for consolidation efforts in their markets.

5. However, the other 42 percent of respondents have not observed MACRA affecting consolidation decisions in their markets, The Advisory Board said. “This could be a result of the additional support for small practices CMS included in the final rule. But we’re still in the early stages of MACRA implementation, so this may change during the coming year,” The Advisory Board added.

7 things you need to know about the future of Obamacare

Posted on by • Posted in Uncategorized • Tagged , , , , , , , , , • Leave a comment

http://www.latimes.com/politics/la-na-pol-obamacare-explainer-20170105-story.html?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=40201659&_hsenc=p2ANqtz-9Uem4u-88vm0uSaKSUtpimygRZcnoFsTKnFjgSMV_-DO2M1uADZ2botlQqf2or2w1gLrjuw6jxaztyZOpFjfhhh2nvKQ&_hsmi=40201659

You’ve seen the headlines and you’ve heard the slogans: Obamacare is on the chopping block and President-elect Donald Trump is going to replace it with “something terrific.”

But what are the new president and Congress really going to do? How much of the current law will really go away? And what could “Trumpcare” look like?

In case it’s been a while since you read about the Affordable Care Act and the GOP replacement plans, here’s a refresher on the biggest Obamacare issues.

Beyond ‘Repeal and Replace,’ Further Health Reforms Loom

Posted on by • Posted in Uncategorized • Tagged , , , , , , • Leave a comment

http://www.healthleadersmedia.com/leadership/beyond-repeal-and-replace-further-health-reforms-loom?spMailingID=10175220&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1080402683&spReportId=MTA4MDQwMjY4MwS2#

Image result for Health Reforms

The old saying, “May you live in interesting times,” may sound like a blessing.

U.S. healthcare leaders know it is a curse.

All they’ve been working toward and preparing for since the Patient Protection and Affordable Care Act was enacted almost seven years ago has been turned upside down in the wake of the Republican election sweep.

Yet, for all their campaign promises to repeal the ACA, most congressional Republicans and President-elect Donald Trump must know that healthcare costs are too much for many Americans, and abolishing Obamacare with no replacement could be politically dangerous.

A report from consulting firm KPMG and an opinion piece published on LinkedIn by a Navigant executive predict that the Republican Congress and the executive branch will change the healthcare reform efforts initiated through the ACA, but the concept of value-based care will stay.