HealthLeadersMedia.com - Health Plan News & Analysis

CMS Seeks to 'Rapidly Reduce' Medicare Spending with $1B in Grants

Fri, 17 May 2013 12:16:00 GMT

The second round of federal Health Care Innovation Awards specifically seeks clinical models that will quickly shrink Medicare costs and improve care for populations with special needs as well as population health.

Case Study: Advance Care Conversations

Fri, 17 May 2013 11:57:00 GMT

Not knowing a patient's wishes for end-of-life care can lead to expensive and sometimes unwanted medical interventions. Gundersen Health System is trying to change that, by embracing a conversation around end-of-life care that is not about dying.

Obamacare isn't getting repealed. But not because it's popular.

Fri, 17 May 2013 11:12:00 GMT

The GOP-controlled House will try for the 37th time later Thursday to repeal Obamacare. Like the first 36 times, the effort will gain no traction beyond the lower chamber. Is that because of a Democratic Senate and White House? Absolutely. Is it because the law is popular? No, because it's not. As House Republican renew their assault, it's worth bearing in mind that President Obama's health care law continues to divide the public. An April Kaiser Health Tracking Poll showed that Americans were split over the law, with a narrow plurality saying they held an unfavorable view of it:

Boehner: No ACA replacement timetable

Fri, 17 May 2013 11:10:00 GMT

House Speaker John Boehner was noncommittal on when — or even if — Republicans would put a bill on the floor to replace President Barack Obama's health care law. "I expect our conference in the coming weeks to have a discussion about Obamacare and how we're going to deal with it, and what the replacement legislation would look like," Boehner said. Republicans offered replacements to the Affordable Care Act when they were in the minority. And the Pledge to America — their promises to voters when they took the majority in 2011 — clearly stated that they would "repeal and replace the government takeover of health care." They've passed some bills that would do that.

Sebelius limited her fundraising for health law to two companies

Fri, 17 May 2013 11:08:00 GMT

The U.S. health secretary's solicitation of money from companies to promote the Affordable Care Act ended after two phone calls, to H&R Block Inc. (HRB) and the Robert Wood Johnson Foundation, according to her spokesman. Enroll America, a nonprofit promoting the 2010 health law had asked Health and Human Services Secretary Kathleen Sebelius to help raise money from a longer list of companies. Sebelius solicited two for money, and only asked the others for technical advice and nonfinancial support because they were regulated by her department, said Jason Young a spokesman for the agency.

Obamacare: 3 years in, it faces steep challenges

Fri, 17 May 2013 11:04:00 GMT

WASHINGTON -- The Affordable Care Act is sure to survive the latest vote by the House of Representatives Thursday to repeal it — since the Senate doesn't plan to take it up and President Obama would veto a repeal bill if it somehow reached his desk — but the administration's signature legislative achievement still faces serious perils ahead. Americans have a dimmer view of the health care law now than they did when Obama triumphantly signed it three years ago, according to monthly tracking polls by the Kaiser Family Foundation.

NC state officials pitch Medicaid managed care to doctors

Fri, 17 May 2013 11:03:00 GMT

DURHAM — The McCrory administration's plan to convert the $13 billion Medicaid program to managed care remains an outline as two top health officials travel the state pitching it to doctors and other health care providers. Dr. Aldona Wos, head of the state Department of Health and Human Services, told a crowd of doctors and other health care providers that she wanted them to help figure out the next steps. The aim is to integrate physical, mental and dental health and make costs predictable for the state.

Hospital charges and the need for a maximum price obligation rule

Fri, 17 May 2013 10:56:00 GMT

The release of average charges for common procedures in more than 3,000 U. S. hospitals last week by the Centers for Medicare and Medicaid Services (CMS) elicited divergent reactions ? not surprisingly. On one hand, it was front-page news for most of the major newspapers: "Hospital Billing Varies Wildly, Government Billing Data Shows," was the headline in the New York Times. The article went on to speculate that these new data would likely "intensify a long debate over the methods that hospitals use to determine their charges." On the other hand the data were "old hat" to most health policy analysts.

Tavenner Confirmed as CMS Administrator

Thu, 16 May 2013 12:06:00 GMT

Marilyn Tavenner, a former nurse, hospital executive, and state health official, is the first Centers for Medicare & Medicaid Services head to gain congressional approval since 2004. The full Senate confirmed her nomination with a 91-7 vote Wednesday.

Medicare spending projections are plummeting

Thu, 16 May 2013 11:16:00 GMT

Here's the story budget wonks will tell from today's Congressional Budget Office report: The deficit is poised to shrink to its lowest level since 2008. Good news? Yes, if you're a deficit hawk. Bad news? Yes, if you think (as I do) the deficit is falling too quickly, especially at a time of high unemployment and declining household debt. Here's the story I wish more people would talk about: Our incredible shrinking Medicare projections. Since August, CBO has now revised down its projections of mandatory health care spending by nearly $500 billion, as Michael Linden pointed out. Since the 2010 CBO report, projected Medicare spending between 2013 and 2020 has fallen by just over $1 trillion ... or 16%.

What the IRS scandal means for healthcare reform

Thu, 16 May 2013 11:14:00 GMT

The revelation that the Internal Revenue Service targeted conservative groups for extra scrutiny has given fuel to Republican complaints of government overreach. It's also given them more ammunition in their fight against the implementation of President Obama's health care law. Half of the billion dollars allocated to cover implementation of the Affordable Care Act went to the IRS. Starting in 2014, the agency will distribute subsidies for health-care coverage through state exchanges and issue penalties against individuals who do not get or businesses that do nor provide insurance.

UnitedHealth, Humana may see surge in Medicare Advantage

Thu, 16 May 2013 11:08:00 GMT

Enrollment in the U.S.-funded Medicare plans run by UnitedHealth Group Inc. (UNH), Humana Inc. and other insurers may rise 50 percent in the next decade rather than declining as predicted earlier, U.S. budget analysts said. Medicare Advantage plans for the elderly and disabled will swell to 21 million participants by fiscal 2023 from 14 million this year, the Congressional Budget Office said yesterday in its annual review of the federal budget. The CBO didn't explain the revision from its previous estimate that enrollment would fall to 11 million and a spokeswoman didn't respond to an e-mail.

Why 'Medicare-for-all' is not the answer

Thu, 16 May 2013 10:55:00 GMT

The Affordable Care Act survived the Supreme Court and a presidential election, so why does it face such an uncertain future? One reason is that it was essentially silent on how to control costs. This has led many pundits — including the likes of Paul Krugman and Robert Reich — to argue that the best approach would be to extend Medicare to everyone. A January National Research Council report on the relative disadvantage of America in global health outcomes, especially compared to countries with national health insurance, added further fuel to the fire. But is a larger government role in health insurance the best approach?

House GOP knocks healthcare reform in 'Arrested Development' spoof

Thu, 16 May 2013 10:46:00 GMT

House Republicans are jumping on the recent woes of the Internal Revenue Service (IRS) and tying the agency's credibility to its forthcoming role in implementing President Obama's healthcare reform. Spoofing the opening credits of the popular TV show "Arrested Development," the House Republican Conference blasts ObamaCare's impact on small businesses saying the legislation would have a devastating impact on insurance premiums for business owners.

MA Data Supports Retailers Fighting Enrollment Mandate

Wed, 15 May 2013 16:43:00 GMT

Small businesses pay higher premiums for buying coverage on health insurance exchanges because employers subsidized too many unhealthy individuals, research on employer-sponsored health plans in Massachusetts shows.

How Medical Debt Forgiveness Benefits Hospitals

Wed, 15 May 2013 12:07:00 GMT

A tax expert describes how forgiving medical debts that a healthcare provider will more than likely never collect has an "incredibly low cost, generating very high return" for hospitals.

Senate Finance Committee Hears More 'Doc Fix' Testimony

Wed, 15 May 2013 11:46:00 GMT

The sustainable growth rate formula's days may be numbered, but the SGR won't be repealed until an alternative system for making Medicare payments to physicians is found.

$223M Medicare fraud bust nabs 89 in 8 cities

Wed, 15 May 2013 11:16:00 GMT

WASHINGTON — Nearly 100 people, including 14 doctors and nurses, were charged for their roles in separate Medicare scams that collectively billed the taxpayer-funded program for roughly $223 million in bogus charges in a massive bust spanning eight cities, federal authorities said Tuesday. It was the latest in a string of similar announcements by Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder as federal authorities crack down on fraud that's believed to cost the program between $60 billion and $90 billion each year. Stopping Medicare's budget from hemorrhaging that money will be key to paying for President Barack Obama's health care overhaul.

House to vote yet again on repealing healthcare law

Wed, 15 May 2013 11:13:00 GMT

WASHINGTON — The 37th time won't be the charm. But House Republicans are charging forward anyway this week on a vote to repeal President Obama's signature health care overhaul, which will put the number of times they have tried to eliminate, defund or curtail the law past the three-dozen mark. "This is what, the 40th time they're going to do it?" scoffed Representative Nancy Pelosi of California, the Democratic leader, confessing that she had lost count. "Thirty-eight? 39? 40? 41?" She eventually settled on "high 30s" as her best guess.

2 million fewer US uninsured to gain health coverage

Wed, 15 May 2013 11:11:00 GMT

President Barack Obama's landmark healthcare reform law will extend coverage to 2 million fewer uninsured Americans than expected only a few months ago, congressional researchers said on Tuesday. A new report from the nonpartisan Congressional Budget Office said 25 million people who currently lack insurance will obtain coverage through subsidized marketplaces or an expanded Medicaid program over the coming decade, down from a February CBO estimate of 27 million people. The office attributed the drop to a change in administration policy that will exempt 500,000 to 1 million more people from the law's individual mandate, which levies a fine on those who fail to obtain health coverage beginning in 2014.