Lowering healthcare costs is tougher than improving the quality of care, according to first-year results from a key pilot program under the federal health law. All of the 32 health systems in the so-called Pioneer Accountable Care Organization program improved patient care on quality measures such as cancer screenings and controlling blood pressure, according to data to be released Tuesday by the Centers for Medicare and Medicaid Services. But only 18 of the 32 managed to lower costs for the Medicare patients they treated?a major goal of the effort. Two hospitals lost money on the program in the first year. Seven have notified CMS that they intend to move to another program where they will face less financial risk. Two others have indicated they intend to leave the program, CMS says, but it declined to identify them. [Subscription required.]
Most primary care doctors are still waiting for that Medicaid pay raise that was scheduled to begin in January under the Affordable Care Act, but a federal official says the government has now approved applications from 48 states to begin paying the higher rates. A spokeswoman for the Centers for Medicare & Medicaid Services says with those approvals in hand, every state but California and Alaska is expected to implement the pay raise this summer. Under the law, Medicaid fees for primary care would be increased for two years to the same amount paid under Medicare. The change means an average 73 percent pay increase nationally, according to a 2012 study by the Kaiser Family Foundation.
(Reuters) - Community health centers expect to sign up millions of newly insured patients under President Barack Obama's health reform law, but U.S. budget cuts just as they need to beef up services may make it hard to keep the newcomers. The federally funded centers have been a safety net in the nation's poorest areas since 1965, offering primary care and mental health services to 22 million people, more than a third of them without insurance. When the Affordable Care Act, popularly known as Obamacare, takes full effect on Jan. 1, the 1,200 clinics plan to help enroll many of the newly insured. That campaign is expected to bring 10 million new patients within a year.
Freeing companies from a U.S.- government mandate to offer employees health care is setting off a chain of events that may enlarge the pool of uninsured Americans. That may be good for President Barack Obama's health-care overhaul. The success of the 2010 Affordable Care Act is largely dependent on how many people are willing to buy subsidized health plans through government exchanges. Most of the people affected by Obama's decision this month to delay the employer mandate to provide health care will now be eligible to use the exchanges when they open Oct. 1. The law's creation of state-by-state marketplaces had targeted about 26 million of the more than 50 million uninsured Americans for coverage.
Stand-alone EDs, which are often located near high-end shopping centers and target consumers with private insurance, bill like regular emergency deparments. Insured patients have little incentive to drive past more expensive, freestanding EDs because their co-payment is only $50 or $100, modestly more than what it might cost for a visit to an urgent-care center or doctor's office. Their insurers pay the balance. Insurers have little power to stop patients from using the facilities because by state law, they must pay for ED coverage any time a patient perceives they have an emergency, regardless of whether that turns out to be the case. For that reason, the freestanding EDs have no need to contract with insurers and offer discounts.
Your doctor hands you a prescription for a blood pressure drug. But is it the right one for you? You're searching for a new primary-care physician or a specialist. Is there a way you can know whether the doctor is more partial to expensive, brand-name drugs than his peers? Or say you've got to find a nursing home for a loved one. Wouldn't you want to know whether the staff doctor regularly prescribes drugs known to be risky for seniors or overuses psychiatric drugs to sedate residents? For most of us, evaluating a doctor's prescribing habits is just about impossible.