For decades, reformers have sought to change how doctors and hospitals are paid to reward quality and efficiency ? efforts that accelerated as a result of the health care overhaul. But surprisingly little progress has been made to date, a consortium of large employers reported today. Only 10.9 percent of health care spending last year by employer-sponsored plans was based on "value," as opposed to "volume," or the number of services performed, according to the study by Catalyst for Payment Reform (CPR), a nonprofit group which represents 21 U.S. employers, including Verizon, Walmart, eBay and Boeing.
WASHINGTON — A new study finds that insurance companies will have to pay out an average of 32 percent more for medical claims under President Barack Obama's health care overhaul. What does that mean for you? It could increase premiums for at least some Americans. If you are uninsured, or you buy your policy directly from an insurance company, you should pay attention. But if you have an employer plan, like most workers and their families, odds are you don't have much to worry about. The estimates from the Society of Actuaries could turn into a political headache for the Obama administration at a time when much of the country remains skeptical of the Affordable Care Act.
The chief executive of Kaiser Permanente, which is often hailed as a model of health care reform and cost control, said in a Times article recently that "the future of health care is going to be rationing or re-engineering." Consumers tend to dislike the idea of rationing, but would it be better than the alternatives? If "re-engineering" means consolidation and vertical integration, is that a good thing for patients? For the industry?
Doctor-owned businesses that act as middlemen between medical device makers and hospitals are "inherently suspect" and some of their practices may violate U.S. anti-kickback laws, a government inspector general said. Daniel Levinson, the inspector general for the Health and Human Services Department, today issued an unusual "special fraud alert" about so-called physician-owned distributorships, or PODs. The companies sell medical devices that the doctor owners then use in surgical procedures on their own patients. The greatest concern is about implantable medical devices, an area in which doctors have wide latitude in selecting the type and brand of device that will be used in patients.
Fairview Health Services, the Twin Cities' second-largest hospital and clinic group, is weighing a merger with South Dakota-based Sanford Health in negotiations that have triggered concerns on the part of Minnesota Attorney General Lori Swanson. A merger could transfer control of the University of Minnesota Medical Center, a major research and teaching hospital, to a company with no history in Twin Cities health care, Swanson said. In addition, she said, Fairview is a Minnesota charitable trust with obligations to taxpayers and private donors who helped the business grow over the course of a century.
SACRAMENTO -- A series of bills to expand the roles of nurse practitioners and other healthcare professionals has set off a turf war with doctors over what non-physicians can and can't do in medical practices. Citing a doctor shortage in California, state Sen. Ed Hernandez (D-West Covina) has proposed legislation that would redefine professional boundaries for nurse practitioners, pharmacists and optometrists to help treat what is expected to be a crush of newly insured Californians seeking care next year under the federal healthcare law. But physicians are pushing back, arguing that the proposed "scope of practice" changes would radically alter longstanding medical standards and jeopardize patient safety.