In a new poll, most adults ages 50-80 expressed concerns about the quality of care that comes with remote provider visits.
Older adults and seniors are not exactly embracing telemedicine, but that doesn't mean they're unwilling to try it, a new survey shows.
A survey of 2,250 adults aged 50 to 80 conducted by the National Poll on Healthy Aging found that only 4% of respondents had had a video-based telehealth visit with a provider via smartphone or computer in the past year.
Their reviews were mixed.
More than 70% of the respondents voiced concerns that providers couldn't do a physical exam over a webcam or smartphone camera, and 68% suggested that remote care wouldn't be as good. With a small minority who had used telehealth, 58% said office visits offered better care quality, and 48% were concerned about privacy.
Meanwhile, more than half of all those polled didn't know if their health providers offer telehealth visits at all. More than 80% of older adults polled expressed at least one concern about seeing a doctor or other provider virtually rather than in person. And 47% worried about getting the technology to work.
But 64% said they'd be willing to try telehealth in some situations, for instance if they got sick while traveling and 58% said they'd be receptive to telemedicine if they needed follow-up on a previous office visit.
With that in mind, Preeti Malani, MD, the poll's director and a professor of internal medicine at Michigan Medicine, said targeting certain types of telehealth visits could help older adults get comfortable with the idea.
"Telehealth won't replace in-person medical examinations completely, but for situations where in-person visits aren't essential, they can save time and resources for patients and providers alike," Malani said.
"Providers shouldn't assume older adults aren't receptive to virtual visits, but they should understand and work to overcome some of the reasons for hesitation," she said.
Of the one-third of the respondents whose providers don't offer telemedicine, 48% said they'd be willing to try it for primary care, but fewer were willing to use it for specialty or mental health services.
Beginning in 2020, Medicare Advantage health maintenance organizations will reimburse providers for telemedicine. In addition the Veterans Administration has increased access to telemedicine, along with some Medicaid and commercial plans.
Alison Bryant, senior vice president of research for AARP, said the poll findings suggest that providers need to do a better job informing older patients that telemedicine is an option, explaining how it works, and how it could benefit them.
"Many older Americans can benefit from being able to get care through telehealth without long trips to their doctor's office," Bryant said. "Telehealth allows people to schedule health-related appointments, request prescription refills, and link to healthcare providers when time or distance is a barrier. It can also support family caregivers who are taking care of their loved ones."
Of the 548 ACOs that cared for 10.1 million beneficiaries, 66% saved money and 37% saved enough money to earn bonuses.
The Medicare Shared Savings Program generated $1.7 billion in total savings in 2018, the Centers for Medicare & Medicaid Services said this week.
Of that, Medicare netted $739 million, after paying out shared savings bonuses, and collecting shared savings loss payments from ACOs that participated in the Pathways to Success Shared Savings Program, CMS Administrator Seema Verma said in a commentary posted in Health Affairs.
"ACOs that received shared savings payments had decreases in inpatient, emergency room, and post-acute care spending and utilization, while ACOs that increased spending relative to their targets tended to show increases in these areas," Verma said.
ACOs in the shared savings and risk-based models saw reductions in per-enrollee spending. However, ACOs that took on downside risk generated more savings than ACOs that did not, with an average $96 reduction in spending per enrollee, compared with $68 per enrollee in ACOs that did not take on risk.
"This trend is one of the reasons that the greater accountability for ACOs included in Pathways to Success, along with greater flexibility for them to innovate, will lead to better, more efficient care for Medicare beneficiaries," Verma said.
Among the highlights singled out by Verma:
ACOs led by physicians, which are generally "low revenue", continued to outperform hospital-led ACOs, which tend to be "high-revenue" and which provide inpatient and outpatient services.
Low-revenue ACOs in 2018 saw an average reduction in spending relative to targets of $180 per beneficiary, compared to just $27 for high-revenue ACOs.
ACOs had an average quality score of almost 93%;
ACOs that joined the program in 2016 or 2017 improved their quality measure performance by an average of 27% in 2018;
ACOs that earned shared savings retained an average of 48% of their generated savings;
ACOs in their second contract period saved more than twice as much per beneficiary compared to ACOs in their initial contract period.
Clif Gaus, president and CEO of the National Association of ACOs, said CMS' findings "put to rest any notion that ACO savings are 'modest' and illustrate the strong performance of the leading Medicare alternative payment model."
"Given time, we know ACOs save money and provide benefit for patients and taxpayers," he said.
The robust savings generated by the program comes amid fears that enthusiasm is cooling with ACOs.
CMS released the 267-page final rule for Pathways to Success under the Medicare Shared Savings Program in late December, and announced that applications to participate in the program would be due in February.
NAACOS and other stakeholders in January had asked CMS to extend by at least one month the application deadline..
CMS reported in July that only 518 ACOs are currently in the program, a decline from 2018 participation rates.
"Recent data from CMS indicate a potential drop in ACO participation. Today’s results prove the Shared Savings Program was doing very well before last year's changes by CMS," Gaus said.
NAACOS has also challenged the metric to measure ACO savings. Rather than relying on CMS-set benchmarks, NAACOS said Medicare should use "counterfactual" data "that compares Medicare spending to what spending would be like in the absence of ACOs."
"Researchers at Harvard University, the Medicare Payment Advisory Commission andNAACOs have all done such work. All showed ACOs are lowering Medicare spending by 1% to 2%, which translates into tens of billions of dollars of reduced Medicare spending when compounded annually," NAACOS said.
The researchers warned that these potentially lethal cardiac infections pose an increasing threat to hospital patients admitted for other diseases.
"In the past, infective endocarditis was associated with rheumatic heart disease and most often caused by bacteria in the mouth," study lead author Abel Moreyra, MD, a professor of medicine at Rutgers, said in comments accompanying the study.
"However, new risk factors, such as intravenous opiate abuse, compromised immune systems, hemodialysis and implanted heart devices have emerged," Moreyra said.
In 2007, the American Heart Association revised guidelines and recommended antibiotics only for patients at high risk for infection.
The researchers looked to find how the revised guidelines changed infection rates. They analyzed 21,443 records of people who were diagnosed with infective endocarditis in New Jersey hospitals from 1994 to 2015.
The researchers were surprised to find that, beginning in 2004, there was a significant decline in the number of patients hospitalized with infective endocarditis as the primary diagnosis for their reason for admission.
Coupled with that was a significant increase in the number of patients developing the infection in the hospital, or a secondary diagnosis.
In total, 9,191 people were hospitalized with infective endocarditis as the primary diagnosis and 12,252 with secondary diagnosis, the researchers found
The decline in primary diagnosis was attributed by researchers to improved dental care and the rarity of rheumatic heart disease, where streptococcus plays a key role in the infection.
"However, 60% of infective endocarditis that developed after admission were caused by a different microorganism, staphylococcus bacteria, which is abundant in hospitals and implicates health care as a possible source of infection," Moreyra said.
The researchers believe that, by identifying the different time trends of primary and secondary diagnosis of infective endocarditis, the findings can help hospitals tailor different strategies for the prevention of this potentially lethal infection.
The defendants allegedly schemed to improperly obtain a $164 million FHA-backed loan to build a for-profit hospital in Texas.
A Texas hospital, a Tennessee-based healthcare company, and three healthcare executives have been accused of improperly obtaining and misusing federal loans targeted for hospital construction in underserved areas, the Department of Justice said.
The alleged violations of the False Claims Act and the Financial Institutions Reform, Recovery, and Enforcement Act were leveled against Lakeway (TX) Regional Medical Center, LLC; Franklin, Tennessee-based Surgical Development Partners, LLC; Surgical Development Partners' CEO G. Edward Alexander; Frank Sossi; and John Prater, federal prosecutors said.
Lakeway Regional Medical Center suffered financial difficulties soon after the 106-bed, for-profit hospital opened in 2012, and defaulted on a $164 million HUD loan in August 2013, according to The Austin American Statesman.
In September 2016, HUD sold the hospital for $50 million to BaylorScott&White Health in 2016.
The federal complaint alleges that the defendants schemed to improperly obtain a Federal Housing Administration-backed loan to build the Lakeway hospital.
Prosecutors allege that the scheme delayed refunds to investors who had cancelled their investments to make it appear as if the project satisfied cash-on-hand covenants required to close the loan.
Prosecutors also allege that the defendants improperly doled out project funds.
"We will do what it takes to ensure that the American people are not left footing the bill when borrowers fail to comply with FHA program requirements intended to protect the public fisc," U.S. Attorney John Bash of the Western District of Texas said in prepared remarks.
BaylorScott&White issued a statement noting that "these allegations have nothing to do with Baylor Scott & White Health or the hospital it operates as Baylor Scott & White Medical Center – Lakeway. These allegations relate to matters that occurred long before we acquired the operations of this hospital."
In June, four development companies and their executives involved in the Lakeway project agreed to pay the federal government $1.1 million to settle allegations that they improperly obtained and distributed money from the FHA loan.
Average deductibles now at $1,655, double the average of a decade ago.
Even in a strong economy, cost growth for employer-sponsored health insurance continues to easily outstrip wage growth and inflation in the overall economy, survey results released today show.
Employers' and workers' costs for premiums continue to rise faster than wages (3.4%) and was more than double the rate of inflation (2%) in the overall economy over the same period, the survey of more than 2,000 small and large businesses found.
"The single biggest issue in health care for most Americans is that their health costs are growing much faster than their wages are," KFF President and CEO Drew Altman said in a media release.
"Costs are prohibitive when workers making $25,000 a year have to shell out $7,000 a year just for their share of family premiums," Altman said.
On average, workers are contributing $6,015 toward the cost of family coverage for the 153 million Americans who receive health insurance through an employer-based plan. Employers paid the bulk of the costs, KFF found.
Since 2009, average family premiums have increased 54% and workers’ contribution have increased 71%, several times faster than wages (26%) and inflation (20%), KFF reported.
The survey also found that:
82% of covered workers have a deductible in their plan, similar to last year and up from 63% a decade ago.
The average single deductible now stands at $1,655 for workers who have one, similar to last year’s $1,573 average but up sharply from the $826 average of a decade ago.
These two trends result in a 162% total increase in the burden of deductibles across all covered workers over the past decade.
28% of all covered workers, including 45% of those at small employers with fewer than 200 employees, are now in plans with a deductible of at least $2,000, almost four times the share who faced such deductibles in 2009.
13% of workers now face deductibles of at least $3,000.
Workers at lower-wage employers are nearly half as likely as other workers to be covered by their employer.
HHS says MA plan options, benefits, and enrollment are expected in increase in the coming year.
With Medicare's open enrollment period looming on October 15, the Centers for Medicare & Medicaid Services announced this week that Medicare Advantage premiums for 2020 will drop by an average of 23% when compared with premiums in 2018.
Since 2017, the average monthly Medicare Advantage premium has fallen by 27.9%, and the 2020 estimates represent the lowest average monthly premium for a Medicare Advantage plan has been since 2007, CMS said.
In addition, Health and Human Services Secretary Alex Azar said the 24 million people who are projected to enroll in Medicare advantage will have more plans and benefits to choose from.
"That is what CMS has been delivering with its improvements to Medicare Advantage: lower costs, more options, and benefits tailored to patients' needs," Azar said in a media release.
"This proven record of success—decreasing premiums in both Medicare Advantage and Medicare Part D—contrasts with proposals for a total government takeover of healthcare, which would destroy options such as Medicare Advantage that seniors increasingly choose," he said.
Medicare Advantage enrollment has increased by more than 30% since 2017. CMS projects that Medicare Advantage enrollment, currently at 22.2 million, will increase to 24.4 million in 2020, representing about one third of the 60 million people in the Medicare program.
CMS Administrator Seema Verma used the announcement to take a swipe at Medicare For All proposals touted by some Democratic presidential candidates.
"On the contrast, proposals for more government through Medicare for All or a public option, would only harm the progress we have made to protect and strengthen the Medicare program for future generations," Verma said.
Along with a previously announced 13.5% declinein the average monthly basic Part D premium, Verma said beneficiaries have saved about $2.65 billion in Medicare Advantage and Part D premium costs since 2017.
Critics of MA say it actually costs the federal government more money because MA enrollees generally are healthier, use fewer healthcare services, and would accrue lower costs for the program if they were enrolled in traditional Medicare.'
Katherine Holt, associate director of the Center for Medicare Advocacy, says that MA plans have been able to lower premiums by narrowing provider networks, and "aggressively managing care through difficult prior authorization requirements."
Holt says the Trump administration is "engaged in a concerted effort to steer beneficiaries to Medicare Advantage, whether or not a private plan is the right choice for their coverage needs."
"More choices are not necessarily better choices," Holt says. "Beneficiaries should carefully weigh the value of Medicare Advantage plan extra benefits against the need for significant access to medical services as available in Original Medicare."
The projected average monthly basic Part D premium of $30 in 2020 is the lowest the Part D basic premium has been since 2013.
According to CMS:
MA average monthly premiums are expected to drop 14% to $23 in 2020, down from $26.87 in 2019.
Beneficiaries will have about 1,200 new MA plans operating in 2020 than in 2018.
The average number of MA plan choices per county will increase from about 33 plans in 2019 to 39 plans in 2020. This represents an increase of 49% since 2017.
The continued decline in Medicare Advantage and Part D premiums over the past three years is estimated to save taxpayers nearly $6 billion in the form of lower Medicare premium subsidies.
America's Health Insurance Plans said beneficiaries are flocking to MA "because it delivers better services, better care and better value than traditional Medicare."
"Medicare Advantage continues to outperform and offer better coverage and care than traditional Medicare, even though the average payment to MA plans is equivalent to costs for traditional Medicare, AHIP said.
Children with two subtypes of cardiomyopathy — hypertrophic or restrictive — are now dying on the waitlist at a rate 4-6 times higher than before the new criteria went into effect in 2016.
Recent attempts to improve waiting times and lower mortality rates for children needing heart transplants may have made the problem worse, new research suggests.
In fact, mortality increased for some types of heart disease.
"Changes were made to prioritize sicker children with fewer treatment options — for instance, kids with congenital heart defects — but the reality we’re showing is that since the criteria change, transplant centers are using more listing status exceptions, essentially short-circuiting the intended benefit," said senior author Brian Feingold, MD, medical director of pediatric heart failure and heart transplantation at UPMC Children’s Hospital of Pittsburgh, in comments accompanying the study.
The new policy de-prioritizes children with cardiomyopathies. Because of that, the UPMC researchers found, clinicians are getting more exceptions to the policy for their cardiomyopathy patients, especially a subtype called dilated cardiomyopathy, so that patients will retain the highest listing status.
Since the revamped criteria was established, exceptions for dilated cardiomyopathy rose by more than 13-fold, yet the study shows high priority status makes no difference in the survival rates of these patients, the researchers found.
However, children with two other subtypes of cardiomyopathy — hypertrophic or restrictive — without an exception, are now dying on the waitlist at a rate 4-6 times higher than before the new criteria went into effect, the researchers found.
"We can't prove causality here, but it would seem that restrictive and hypertrophic cardiomyopathy patients have been disadvantaged by the criteria change," Feingold said.
"They're prioritized downward under the umbrella of cardiomyopathy, likely inadvertently, while children with congenital heart defects have not been able to benefit due to increased exception use," he said.
Feingold said the reason why patients with different subtypes of cardiomyopathy are faring so differently under the new guidelines is that children with dilated cardiomyopathy tend to be better candidates for implanted blood pumps called ventricular assist devices (VADs).
Considered a type of life support, VADs place patients higher on the waitlist. They also allow patients to rehabilitate, even leave the hospital, while waiting for a transplant.
Feingold said he hopes the findings will prompt discussions about improving waitlist criteria for children awaiting heart transplants.
"The chronic shortage of organ donors means that we must strive to optimize organ allocation as much as possible," he said. "It's very difficult to know all of the downstream effects of policy decisions like these, so we should continue to tweak and observe until we get it right."
Starsky Bomer, 46, the former CFO/COO at Atrium Medical Center Pristine Healthcare, was also ordered to pay more than $6.2 million in restitution.
A Houston-area hospital executive has been sentenced to 10 years in prison for his role in a $16 million Medicare fraud scheme involving partial hospitalization programs, the Department of Justice said.
Starsky Bomer, 46, the former chief financial officer and chief operating officer at Atrium Medical Center in Stafford, Texas, and Pristine Healthcare in Pasadena, Texas received the sentence this month, 11 months after a jury convicted him of one count of conspiracy to receive healthcare kickbacks, two counts of violating the Anti-Kickback Statute, and one count of conspiracy to commit healthcare fraud.
At trial, prosecutors showed that from 2011 until February 2013, Bomer and his co-conspirtors submitted to Medicare about $16 million in false claims for partial hospitalization program services.
Bomer ran a scheme that paid bribes and kickbacks to group home owners and patient recruiters in exchange for sending Medicare patients to Atrium and Pristine's PHPs, and disguised the bribes and kickbacks as salaries and transportation payments to group home owners, DOJ said.
Bomer knew that many of the patients admitted to Atrium and Pristine's PHPs did not qualify for and were never provided legitimate partial hospital servicea.
A federal judge this month also ordered Bomer to pay $6.2 million in restitution and to forfeit another $158,260 in money generated by the scheme.
Healthcare-related professions were the top four earners on Glassdoor's annual highest-paying jobs list.
For the third straight year, physicians sit atop Glassdoor's 25 Highest Paying Jobs in America, with a median base salary of $193,415.
Healthcare-related professions own the top four spots on the annual list, put out by the online job listing and recruiting site, including: pharmacy manager, with a median base salary of $144,768; dentist, $142,478; and pharmacist, $126,438. Physician assistant is No. 8, at $113,855, and nurse practitioner is No. 11, at $109,481.
Glassdoor's estimate for physician compensation is more than three-and-a-half times higher than the median U.S. base salary of $53,950.
In 2018and 2017, physicians also topped Glassdoor's list, with median base salaries of $195,842, and $187,876, respectively. No explanation was given for why the median base salary for physicians dropped by $2,427 over the past year.
The relatively high salaries in the healthcare sector could be attributed to demand. Glassdoor reported that there 3,729 job openings on its site for physicians on its site as of late August. Physician assistants and nurse practitioners also were in high demand, with 11,008, and 17,572 job openings, respectively.
To make Glassdoor's Top 25 list, job titles must get at least 100 salary reports shared by U.S.-based employees over the past year. Glassdoor also uses a proprietary statistical algorithm to estimate annual median base pay, which controls for location, seniority and other factors.
The number of job openings per job title represents active job listings on Glassdoor. The report takes groups similar job titles, and C-suite jobs are excluded.
For example, an American Medical Group Association survey in August identified the top mean compensation among physician specialists, led by orthopedic surgeons, $591,245; gastroenterologists, $527,998; general cardiologist, $519,964; diagnostic radiologists (MD non-interventional) $482,599; and urologist, $469,755.
The five lowest-paying specialties for AMGA's mean compensation were urgent care, $283,787; internal medicine hospitalists, $293,252; neurology, $310,518; general obstetrics/gynecology, $340,388; and emergency medicine, $363,201.
State officials say TennCare could collect as much as $1 billion in savings under the proposal.
Tennessee this week made public its $7.9 billion block grant proposal for its Medicaid program, which would be the first of its kind if it passes muster with federal regulators.
The proposal, four months in the making, is expected to be submitted to the Centers for Medicare & Medicaid Services in November.
Republicans have since the 1980s attempted to transition state Medicaid funding into block grants, which they say would allow for more flexibility and cost savings. Those attempts have been rebuffed at the federal level.
The federal government pays for about $7.9 billion of TennCare's $12.1 billion overall budget, which is roughly 65% of the cost.
Tennessee officials say TennCare, the state's Medicaid plan for 1.4 million Tennesseans, could collect as much as $1 billion in savings under the proposal, even as Medicaid services are expanded. The state based that estimate on claims that the program's spending has come in under CMS projections in recent years, saving the federal government billions of dollars.
Tennessee Gov. Bill Lee told reporters that the state deserves to be rewarded for its good stewardship of federal dollars.
"Over the last 10 years, we've saved the federal government a significant amount of money because of the efficiencies that we've operated our plan under, which is why they're looking to us as potentially being the first state," Tennessee Gov. Bill Lee told reporters this week, according to The Tennessean.
TennCare Director Gabe Roberts told the Associated Press that the plan was a "hybrid" approach to block grants because the state has designed its proposal to allow Tennessee to keep 50% of any unspent block grant funds.
State officials have also stressed that the proposal will undergo what is expected to be vigorous negitions with CMS in the coming months.
Reaction to the proposal was mixed.
Craig Becker, president and CEO of the Tennessee Hospital Association, said he was "encouraged that the Medicaid block grant proposal for the TennCare program will not reduce benefits, remove individuals from the rolls and has the potential for shared savings."
"THA is working now to understand the potential impact of the proposal on TennCare members, hospitals and the state," he said. "Ensuring adequate funding for the program in the future is critical to continuing to care for some of Tennessee’s most vulnerable residents and is a strength of the proposal."
"The potential for shared savings in recognition of TennCare's historic fiscal responsibility also presents a great new opportunity for enhanced coverage for TennCare enrollees, Becker said, adding that THA will review the proposal and submit formal comments in the coming weeks.
Michele Johnson, executive director of the Tennessee Justice Center, an advocacy group for TennCare enrollees, said the state wants to make children in the program "guinea pigs in a risky experiment that no other state has been reckless enough to try."
"Half of Tennessee children, including those who are most vulnerable, rely on TennCare for essential healthcare. We were just in the news for cutting off over 200,000 kids, and the state still doesn’t know whether they were eligible or not," Johnson said.
"What is most distressing is that this proposal is all about the state using kids' healthcare as a piggy bank. State officials should listen to the many respected national patient advocacy groups that warn that such proposals put patients' health and safety at risk," she said.
