Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.
The Department of Health and Human Services' new Office of Consumer Information and Insurance Oversight (OCIIO) began accepting applications on Tuesday for a program that gives financial relief for employers, unions, nonprofits, or state and local governments to provide coverage to early retirees—those age 55 or older who are not yet eligible for Medicare.
Under the Early Retiree Reinsurance Program (ERRP), which was created under the new healthcare reform law, $5 billion in financial assistance will be made available to help employers continue to provide health insurance to their younger retirees.
"Today, Americans who have retired but are not yet eligible for Medicare are often unable to find coverage that is affordable and meets their health needs on the individual market," said HHS Secretary Katherine Sebelius in a statement. "This program will help both retirees and employers facing spiraling healthcare costs, and ensure more Americans have access to the healthcare they need."
As healthcare costs have increased, it has become harder for employers to provide health insurance not only to their current employees but also their retirees, according to Sebelius. Recent surveys have found that over the past several decades, the percentage of firms offering retiree health insurance has dropped by more than half; by 2009, less than a third did so.
This program has been designed to provide employer-based health coverage until insurance plans are made available through health insurance exchanges in 2014.
The reinsurance program will reimburse employers for medical claims for younger retirees who are not eligible for Medicare, along with their spouses, surviving spouses, and dependents. The reimbursements will be available for 80% of medical claims costs for health benefits between $15,000 and $90,000. Those participating in the program will be able to submit claims for medical care beginning from June 1, 2010.
According to a new Hewitt Associates retiree benefits survey, many employers are likely to be looking to use "new cost management opportunities" in relation to pre-Medicare retiree benefits. Of the 242 employers Hewitt surveyed earlier this year that provide coverage to 1.3 million retirees and their families, 77% said they plan to apply for the temporary federal reinsurance program intended to help younger retirees.
However, nearly two-thirds of such companies are unsure on how they will use these proceeds to reduce employer and retiree costs and are waiting for guidance before reaching a decision. About half (54%) of respondents said they plan to make changes to their benefits strategy to leverage the health insurance exchanges that states are required to create in 2014.
Applications for ERRP, as well as fact sheets and application assistance, can be found at: www.hhs.gov/ociio.
Physicians who report quality measures to the Centers for Medicare and Medicaid Services (CMS) under the Physician Quality Reporting Initiative (PQRI) using electronic health records (EHRs) will soon be able to combine data with physicians who demonstrate "meaningful use" of those records under the HITECH Act. Under the new healthcare reform law, the deadline for combining the two programs is Jan. 1, 2012.
With PQRI, physicians participating in Medicare can receive incentives for reporting various quality measures -- a select number of which are being aimed at those who want to report using electronic health records. The PQRI first started in 2007.
Meaningful use measures that physicians could use for PQRI reporting through electronic health records include blood pressure measurement for hypertension, body mass index screening, and prevention care follow up, according to CMS.
As a result of healthcare reform, PQRI incentive payments are authorized through 2014. For 2011, the healthcare reform law states that providers may earn an incentive payment of 1% of the provider?s estimated total allowed charges for covered professional PFS services under Medicare Part B provided during the reporting period.
Meanwhile, providers who become "meaningful users" of EHRs, as laid down by the financial stimulus legislation in 2009, will be eligible for incentive payments as well.
In the proposed rule, CMS is soliciting comments on its approach to integrate measures of the two reporting programs. "Specifically, we encourage comments on how CMS plans to align the measures, and how the plan for integration will optimally improve quality of care for individuals and provide meaningful use of EHRs."
CMS also has proposed a number of key changes in 2011 for PQRI, including:
Adding 20 individual PQRI measures (including new measures for reporting through registries and electronic health records) and one new measures group on which individual providers may report;
Making 12 additional individual PQRI measures available for reporting through electronic health records systems (EHRs), in addition to the 10 measures already available for EHR reporting;
Reducing the reporting sample requirements for claims based reporting of individual measures from 80% to 50%, which could lessen the burden on providers to qualify for incentive payments; and
Creating a new group practice reporting option (GPRO) that would allow group practices with fewer than 200 providers to participate.
The proposed rule is expected to be published in the Federal Register on July 13. Comments will be accepted for 60 days after the date of filing.
In a new proposed rule, the Centers for Medicare and Medicaid Services (CMS) has included a provision that could mean an additional reduction by 6.1% in physician service payment rates starting Jan. 1 2011, under the sustainable growth rate (SGR) formula adopted by Congress. This reduction would be added to a projected 23.5% cut that is scheduled to take effect Dec. 1 --unless Congress works to change or eliminate the current SGR formula.
The SGR formula has called for an across the board reduction in physician payment rates every year since 2002, and since 2003, through May 31, 2010, the cuts have been averted by legislative action. Last week, after a sustained battle, Congress finally approved -- and President Obama signed into law on June 25 -- a provision postponing the SGR through Nov. 30. The reduction called for the SGR (21.3%) -- plus an increase in physician rates approved by Congress (2.2%) -- would essentially create a 23.5% decrease in reimbursements if Congress fails to act after Dec. 1.
CMS, though, has expressed its reluctance about the proposed cuts to the Medicare physician fee schedule. "We are very concerned about the impact the continuing uncertainty about payment rates and cash flow disruptions may have on physician practices and on beneficiary access to physicians' services," said Jonathan Blum, deputy administrator and director of CMS's Center for Medicare.
He added that while 97% of physicians have chosen to participate in Medicare for 2010 -- and have agreed to accept Medicare's payment rates as payment in full for the services they provide to beneficiaries -- CMS is hearing more stories of physicians limiting the number of beneficiaries they will see. "We are also concerned about the diversion of scarce Medicare resources as we have to adjust our payment operations to the constantly changing legislative landscape."
The CMS proposed rule also calls for implementing provisions of the healthcare reform act that would eliminate out of pocket costs for beneficiaries for most preventive services--including the new annual wellness visit. This visit augments the benefits of the initial preventive physical examination (IPPE) -- or the "Welcome to Medicare Visit" -- with an annual wellness visit.
This provision is designed to allow physicians and patients to develop a personalized prevention plan. The law will require the annual wellness visit to include at least the following six elements:
Establish or update the individual's medical and family history.
List the individual's current medical providers and suppliers and all prescribed medications.
Record measurements of height, weight, body mass index, blood pressure, and other routine measurements.
Detect any cognitive impairment.
Establish a screening schedule for the next 5 to 10 years including screenings appropriate for the general population, and any additional screenings that may be appropriate because of the individual patient's risk factors.
Furnish personal health advice and coordinate appropriate referrals and health education.
In addition, the proposed rule calls for implementing other provisions in the new healthcare reform law:
Elimination of deductible and coinsurance for most preventive services: Effective Jan. 1, 2011, the Part B deductible and the 20% coinsurance that would otherwise apply to most preventive services would be waived.
Incentive payments to primary care practitioners for primary care services: Incentive payments equal to 10% of a primary care practitioner's allowed charges for primary care services would be made under Part B. The law also defines primary care services as limited to new and established patient office or other outpatient visits; nursing facility care visits; and domiciliary, rest home, or home care plan oversight services; and patient home visits.
Incentive payments for major surgical procedures in health professional shortage areas: The new healthcare reform act calls for a payment incentive program to improve access to major surgical procedures -- defined as those with a 10 day or 90 day global period under the Medicare physician fee schedule--in Health Professional Shortage Areas between Jan. 1, 2011 and Dec. 31, 2016. To be eligible for the incentive payment, the physician must be enrolled in Medicare as a general surgeon.
Permitting physician assistants to order post hospital extended care services: Physician assistants would be authorized to perform the level of care certification that is one of the requirements for coverage under Medicare's skilled nursing facility (SNF) benefit.
Physician self referral for certain imaging services: The healthcare reform law amends the in office ancillary services exception to the self referral law as applied to magnetic resonance imaging, computed tomography, and positron emission tomography. CMS is proposing to require that the referring physician provide a patient with a list of 10 alternative suppliers within a 25 mile radius of the physician's office who provide the same imaging services.
Misvalued codes under the physician fee schedule: CMS will be periodically reviewing and identifying potentially misvalued codes and make appropriate adjustments to the relative values of the services that may be misvalued. CMS will be looking for additional categories of services that may be misvalued, including codes with low work relative value units (RVUs) commonly billed in multiple units per single encounter and codes with high volume and low work RVUs.
Comments on the proposed rule are due Aug. 24, with a final rule to be issued by Nov. 1.
After several days of waiting and seeing what would happen with the Senate's jobs bill, the House decided in a lopsided 417-1 vote on Thursday evening to approve the measure (HR 3962) that would postpone (until Nov. 30) a 21% cut in Medicare and TRICARE reimbursements to physicians. The approved bill was then sent to the White House for President Obama's signature.
The Senate had approved the $6.4 billion bill last Friday, but House Speaker Nancy Pelosi (D-CA) held back any vote earlier in the week in anticipation of the Senate approving the long-delayed jobs bill (HR 4213). The Senate doc fix amendment was carved out the jobs bill last week and scheduled for the separate vote by Finance Committee Chairman Max Baucus (D-MT) and Ranking Minority Member Charles Grassley (R-IA).
Hours before the Thursday House vote, Pelosi indicated at her weekly press conference she wanted to see a more complete bill from the Senate—which included extensions to COBRA unemployment benefits through the end of November and funding through June 2011 for the Federal Medical Assistance Percentages (FMAP) funding—before voting just on the doc fix.
The House had passed its jobs bill prior to the Memorial Day weekend. However, it appeared this week that the votes were not there yet in the Senate. "I'm hard pressed to pass any more initiatives here unless there's some reasonable prospect of success on the Senate side," Pelosi said.
The Centers for Medicare and Medicaid Services (CMS) began implementing the 21% cut last Friday in processing claims. However, the new bill restores the cuts back to June 1 and provides an additional 2.2% raise for physician reimbursements through Nov. 30.
After the bill was approved by the House, President Obama said in a statement that he was "pleased that Congress has acted to ensure the security of our seniors’ health care. A 21% pay cut to physicians’ payments would have forced some doctors to step seeing Medicare patients—an outcome we can all agree is unacceptable."
He also restated that a permanent fix to the Medicare formula was needed that "attacks our fiscal problems without punishing our hard working doctors or endangering the benefits on which so many of our seniors rely."
New American Medical Association President Cecil Wilson, MD, said in a statement that seniors already are experiencing access problems "as a result of the complete congressional mismanagement of Medicare over the years."
"About one in four Medicare patients looking for a new primary care physician are having trouble finding one. About one in five physicians are already limiting the number of Medicare patients they treat because of the instability and uncertainty of Medicare payment," Wilson said.
Wilson said that in December, the Medicare physician payment cut will be 23%—increasing to nearly 30% in January. "Congress is playing a dangerous game of Russian roulette with seniors’ healthcare," Wilson said. "Sick patients can’t wait. Congress must replace the broken payment system before the damage is done and cannot be reversed."
William Jessee, MD, president and CEO of the Medical Group Management Association, said that the "short term relief provided by passage" of the bill to avert the 21% Medicare payment cut to physicians "belies the fact that Congress continues to act irresponsibly in addressing the flawed sustainable growth rate formula."
He added that extending the latest payment to November will be disruptive to many medical groups. In particular, the current doc fix period expires in November—just one month before the start of the next fiscal year for most medical groups.
"It throws responsible business planning for 2011 into complete disarray and occurs exactly when physicians will make the difficult decision to participate in Medicare for the coming year," Jessee said.
In a statement, bill authors Baucus and Grassley said: "Our House colleagues deserve praise for standing with us today to help fulfill our responsibility to seniors and military families."
Department of Health and Human Services Secretary Kathleen Sebelius asked the leaders of the major hospital organizations this week to urge their members to not wait for the conclusion of the formal rulemaking process before implementing new rules that would broaden the visitation rights of their patients.
In April, the White House asked HHS to initiate rulemaking to lift restrictions on unrelated visitors who act as surrogate decision makers and visit hospitalized patients. The Centers for Medicare and Medicaid Services (CMS) on Tuesday issued a proposed rule that will revise the Medicare conditions of participation for hospitals and critical access hospitals to ensure the visitation rights of all patients.
Under the proposed rule, hospitals will be required to inform patients of their visitation rights, any clinical restrictions on those rights, and their right to receive any visitors they designate. Hospitals would not be permitted to restrict or deny visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability. They also must ensure that all visitors designated by the patient have visitation privileges that are no more restrictive than those for immediate family members.
The April White House memo noted that gay and lesbian Americans are often "barred from the bedsides of the partners with whom they may have spent decades of their lives, unable to be there for the person they love, and unable to act as a legal surrogate if their partner is incapacitated."
Others affected include widows or widowers with no children who are "denied the support and comfort of a good friend," and members of religious orders are "sometimes unable to choose someone other than an immediate family member to visit them and make medical decisions on their behalf."
A sample letter was composed by HHS and sent to leaders of the American Hospital Association, Federation of American Hospitals, Association of American Medical Colleges, National Association of Children's Hospitals and Related Institutions, National Association of Public Hospitals & Health Systems, and Catholic Health Association of the United States to send to their members.
"Every patient deserves the basic right to designate whom they wish to see while in the hospital," Sebelius said in a statement. "Today's proposed rules would ensure that all patients have equal access to the visitors of their choosing—whether or not those visitors are, or are perceived to be, members of a patient's family."
"This proposed rule is an important step forward in the rights of all Americans to expect equal rights and privileges from the health care system, regardless of their personal and familial situations," said Marilyn Tavenner, CMS acting administrator. "In the environment of inclusion that this rule promotes, patients and providers can expect improved patient experiences of care."
The proposed rules are available for public comment for 60 days and will be finalized after CMS has read and considered the comments.
Earlier this month, the Agency for Healthcare Research and Quality (AHRQ) announced it would be spending over $23 million to find potential solutions to the medical liability issue. It became the largest investment in malpractice reform by the federal government in at least 20 years. But is the U.S. ready to consider more ways to use quality-related methods—rather than legal briefs or court dates—to handle medical liability reform?
Eric Thomas, MD, a professor of medicine at the University of Texas (UT) Houston and director of the UT Houston Memorial Hermann Center for Healthcare Quality and Safety, says now is the time to look at alternative liability reforms. "The malpractice system...is pretty worthless in that it does not compensate most patients. The majority of patients who have been injured by negligent care never sue—let alone get compensation for their injury," he says.
When many physicians are sued, it's not because their care was negligent, Thomas adds. "[The current malpractice system] is not designed to make things better. It's not designed to let us learn about what went wrong and to make improvements."
So what can change? Thomas, one of the AHRQ grantees, proposed a three-year project that will review the use of a "disclosure and compensation" model, which aims to inform injured patients and families promptly and make efforts to provide quick compensation.
"What [we're] doing with this project is to not only serve the needs of individual patients through disclosure but to try to take advantage of a patient's experience," he says. The goal will be to see if the patient's observations of what went wrong can be incorporated into the efforts by the hospital to learn what went wrong—and make improvements.
Including the injured party in the entire process of "analyzing and learning" is something that, to his knowledge, hasn't been done before, he says.
Over a three-year period, the project also will work to identify best practices for using disclosure to improve patient safety, and disseminate those best practices to others. "That's something the malpractice system has no intention of doing," he adds.
Tom Gallagher, MD, an associate professor of medicine at the University of Washington, Seattle, has been working for about a decade on issues of communicating with patients when there are problems with the quality of care, he says.
"It's an interesting area because for a long time people assumed that the way we communicate with patients when there are problems in care is primarily a risk management or service recovery issue," says Gallagher, another AHRQ grantee. "But we're learning that the link between disclosure of errors to patients and the quality of care is a much stronger one than people recognize."
One of the new developments in this field is that people are realizing that disclosure and transparency are fundamental aspects of the way high quality patient care is delivered, he says. His AHRQ project will build on this idea—expanding on the notion of communication.
It includes training for healthcare workers across Washington State to not just communicate with patients after an adverse event or error, but also communicate with other workers to prevent adverse events and errors, he says.
The statewide initiative will look at how a large malpractice insurer, physicians, and private hospitals can work together when there has been a medical injury to provide patients with fast and fair compensation, Gallagher says.
It will be a real breakthrough, he adds, to try to extend the work on disclosure and compensation that has been done in some of the large self-insured settings—such as academic medical centers—to the private hospital environment.
In the self-insured setting, the physicians and a hospital have the same malpractice insurer. But, in the case of a private hospital—where the physicians and hospital have different insurers—both bodies can be at odds with one another, Gallagher adds. "It makes it much more difficult to figure out how can we together make a fast, fair offer of compensation to the patient."
While it's important to avoid injuries in healthcare whenever possible, "it really adds insult to injury when we can't provide the patient with a good explanation and an apology," he says. "And then things get even worse if the patient has financial needs as a results of the injuries that we can't meet."
"I think the stakes are really high to get this right," he says.
Another aspect of this process is to realize that communication with the patient can be an important part of improving quality, he adds. If something goes wrong and "you have an open and honest conversation with the patient about what took place, oftentimes the patient will have observed things about the injury that is really helpful information," he says.
Without talking with a patient, important information that could be lost that might be used for preventing other error or adverse events, he says. But they also are learning that when they encourage openness around injuries with patients, it has a spillover effect in the institutions and promotes transparencies in other areas—such as adverse event reporting.
"I think people will start to learn that the link between disclosure and improving the quality is a strong and important one," he says. "It's definitely the right direction we're headed."
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While the U.S. healthcare system was shown to be the most expensive when compared with six other industrialized nations—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—it failed to achieve better health outcomes when compared to those countries, according to a new Commonwealth Fund updated report, Mirror Mirror On The Wall: How the Performance of the U.S. Health Care System Compares Internationally.
Overall, the U.S. stood out for not getting good value for its healthcare dollars—ranking last despite spending $7,290 per capita on healthcare in 2007 compared to the $3,837 spent per capita in the Netherlands, which ranked first. The U.S. had ranked last in value as well in the previous three Commonwealth Fund studies that compared it with the other countries.
"These findings are clearly disappointing for U.S. patients and their families. We're simply not getting commensurate return for a much higher investment in healthcare," said Commonwealth Fund President Karen Davis, PhD, in a telebriefing.
However, the new healthcare reform legislation may hold "substantial promise" for changing some of these results, Davis said. The Fund's analysis shows that investments in improved coverage, expanded health information technology, a stronger primary care foundation, and expanded quality and safety initiatives "could bear fruit in the upcoming decade," she said.
In response to questions that the American population may face different challenges because of higher rates of obesity, Davis said the other countries face other health issues such as higher rates of smoking. "Certainly those factors come into play," Davis said. "However, dimensions of care—such as, do you wind up in an emergency room for something that a doctor could have taken care of—are universal issues and quite independent of the specific disease profile."
Other countries may be challenged by an older population, said Cathy Schoen, a senior vice president with the Commonwealth Fund. For instance, Germany has a percentage of the population over age 65 that the U.S. has not yet experienced. "They're grappling with growing rates of chronic disease and frail elderly. But each country can claim a growing area of need."
But indicators that are being observed in the U.S., such as hearing about hospital readmissions or not getting care afterhours, is a "reflection of a healthcare system that is not organized . . . or well-coordinated around a patient, irrespective of what condition they have," Schoen said.
On quality, the U.S. stood out "particularly with symptoms of more fragmented, poorly coordinated care," Schoen said. In 2008, for instance, 14% of American adults with a chronic condition reported receiving the wrong medicine or the wrong drug dose in the past two years. "This was twice the rate of the lowest rate countries, Germany and the Netherlands," she said.
Also, 14% adults in the U.S. reported delays in being notified about abnormal test results or given the wrong results during the past two years. These rates were more than twice the rates as those countries with the lowest rates, Germany (7%) and the Netherlands (6%). "As a result, we rank last on safety, and do poorly on several dimensions of quality," Schoen said.
The U.S. scored the highest regarding cost-associated access problems. Over half (54%) of chronically ill surveyed in 2008 reported going without care because of costs in the past two years, compared with 7% in the Netherlands and 13% in the U.K. These problems included not filling a prescription or skipping doses; not getting recommended tests, treatments, or recommended follow-up; or not visiting a doctor when sick, Schoen said.
But looking at the insured in the surveys, "we also see very high rates of going without care because of costs and very high rates of spending $1,000 or more," Schoen said. "Our insurance benefits have been declining as premiums have gone up, exposing more to being underinsured."
Other findings are:
Chronically ill patients in the U.S. were the least likely to report having a regular physician (82%) while those in the Netherlands are most likely to have this connection (99%).
For patient centeredness, or "care delivered with the patient’s needs and preferences in mind," the U.S. was in the middle of the pack, ranking fourth.
For effective care overall, the U.S. was fourth, performing well on prevention but average on quality chronic care management. The U.K. and Australia scored first and second place, respectively.
For continuity and feedback, the U.S. scored in the midrange. Only slightly more than half (53%) of U.S. respondents said they had been with the same doctor for five years or more, compared with more than three quarters (79%) of respondents in the Netherlands.
The U.S. was third among the seven countries in terms of physicians routinely receiving data on patient satisfaction and experiences with care: 55% of American physicians receive such data. However, in the U.K., 96% of physicians received patient satisfaction data.
After meeting with top insurance industry officials and several state insurance commissioners on Tuesday, President Barack Obama unveiled a package of interim final rules that make up what the administration calls a Patients' Bill of Rights. The rules will implement various insurance reforms mandated by the new law and will take effect 60 days after publication in the June 28 Federal Register.
The overall tone of the meeting with health insurance executives at the White House seemed at times conciliatory: "The point is that there are genuine cost drivers that are not caused by insurance companies," Obama said.
However, "we've got to make sure that this new law is not being used as an excuse to simply drive up costs," Obama added. "The [insurance] CEOs here today need to know that they're going to be required to publicly justify unreasonable premium increases."
Obama introduced the proposed safeguards at a White House ceremony three months after healthcare reform was signed into law. "While it will take a few years to fully implement this law, we can already see it taking effect," Obama said.
The proposed Bill of Rights will apply to most healthcare plans renewing on or after Sept. 23 of this year. They include:
No pre existing condition exclusions for children. The new regulations will prohibit insurers from denying coverage to children [under age 19] based on pre existing conditions. The ban will include both benefit limitations and coverage denials. These provisions will apply to all types of insurance except for policies that are "grandfathered"—as specified in a White House memo sent out last week—and will be extended to all consumers starting in 2014.
No arbitrary rescissions of insurance coverage. Under the regulations, insurers and health plans would be prohibited from rescinding coverage for individuals or groups except in instances involving fraud or "intentional misrepresentation of material facts." Insurers and plans seeking to rescind coverage must provide at least 30 days' notice to give people time to appeal.
No lifetime limits on coverage. The new regulations prohibit the use of lifetime limits in all health plans and insurance policies issued or renewed on or after Sept. 23, 2010.
Restricted dollar limits on coverage. The rules will phase out the use of annual dollar limits over the next three years. Plans issued or renewed beginning Sept. 23, 2010, will be allowed to set annual limits no lower than $750,000; this minimum limit will be raised to $1.25 million beginning Sept. 23, 2011, and to $2 million beginning on Sept. 23, 2012. These limits apply to all employer plans and all new individual market plans.
Promoting choice of physicians. The new rules specify that health plan members are free to designate available participating primary care provider as their providers. The rules permit parents to choose available participating pediatrician to be their children's primary care provider. And, they prohibit insurers and employer plans from requiring a referral for obstetrical or gynecological care.
Removing insurance company barriers to emergency department services. Health plans and insurers would not be able to charge higher cost sharing (copayments or coinsurance) for emergency services that are obtained out of a plan's network. The rules also set requirements on how health plans should reimburse out of network providers.
Just as the debate on healthcare reform was coming to a close on Capitol Hill this spring, individuals who purchase their own health insurance were finding that most recent requests for premium increases from their insurers were averaging 20% nationwide, according to a new survey released Monday by the nonprofit Kaiser Family Foundation.
While individual or non group healthcare insurance covers 14 million individuals—or less than 10% of the individuals covered by employer-sponsored insurance (157 million) nationwide—this market has garnered its share of media attention in recent months as insurers sought higher premiums. The most visible example was a request for a 39% increase this spring in California by Anthem Blue Cross, which was later withdrawn.
The survey—conducted in March and April—shows that the sharp price increases for non-group health insurance that have been publicized over the last several months—are "not just extreme cases," said Drew Altman, the foundation’s president and CEO, at a briefing releasing the study.
But the survey results also show what challenges the individual market will encounter in the next several years—since many of the changes in the new healthcare reform law will not go into effect until 2014.
Overall, three-fourths (77%) of those individuals with non group coverage reported facing premium increases with a current or previous insurer. While most said they paid the increase, 16% said they switched plans—either purchasing a less expensive policy from the current insurer or switching companies, according to survey. Following these "buy downs," people still faced premium increases, paying 13% more than before.
Preexisting conditions played major roles in the non-group market's decision to purchase or switch insurance, said Mollyann Brodie, a foundation vice president and director of Kaiser’s Public Opinion and Survey Research. "So certainly there's some sense of being stuck in the plan that they are in."
"When we looked at the people in the non-group market who have a preexisting condition in their households, they were much more likely to express worry ... than people who were in this market without those health challenges," Brodie said.
In the survey, 81% of the non-group plan with preexisting conditions were worried that insurance companies would "raise premiums so much" that they wouldn't be able to afford coverage. Another 49% said they found it difficult to find a policy that served their needs.
More than half (57%) of those with non group coverage said they were the only ones covered by their policy. That specific group reported average annual premiums of $3,606—or less than the average $4,824 premium reported in 2009 for employer sponsored coverage, which often provides more comprehensive insurance.
For those with their own policies that cover them and also other family members, the average annual premiums were $7,102. With insurers often varying premiums by age in the non group market, older people reported paying larger premiums than younger people, both for individual policies and for family policies.
Among other report highlights:
Of individuals in plans with high deductibles, one in four (26%) had an annual deductible of $5,000 or more and 6% had a deductible of $10,000 or more.
Six in ten (61%) said it was very or somewhat difficult for them to afford the cost of healthcare and insurance. Nearly twice as many as the 33% of those with employer sponsored coverage said it was difficult for them to afford the cost of care at the end.
Overall, the average deductible reported for single coverage was $2,498, almost four times the $634 deductible reported on average for employer sponsored PPO coverage.
After weeks of debate, the Senate finally agreed in a unanimous voice vote Friday to postpone a 21% decrease in Medicare and TRICARE physician reimbursements through a six-month period ending Nov. 30. But the vote comes with an unpleasant tradeoff for hospitals.
The Senate approval to extend a $6.4 billion temporary "doc fix" deadline goes onto the House this week for reconciliation. The House had passed its bill with an amendment calling for a 19-month postponement through 2011 of the sustainable growth rate (SGR) before the Memorial Day recess.
Like the House bill, the Senate measure calls for reducing hospital payments by preventing hospitals from submitting separate claims for inpatient and outpatient therapeutic care provided within 72 hours of an admission.
This means that all outpatient services provided within those three days before an inpatient admission—and related to the inpatient admission—would be included in a bundled payment for that admission. According to the Congressional Budget Office, this provision is expected to save $4.2 billion over 10 years and reduce excess spending.
In its description of the legislation, the Senate Finance Committee said the provision closes a "loophole." However, the hospitals are disagreeing—saying these provisions "would take away the option for hospitals to bill retrospectively for these services, unless they had already done so by the date of enactment."
In a letter sent Friday to the Senate, five healthcare groups—the American Hospital Association, the Association of American Medical Colleges, Catholic Health Association of the United States, Federation of American Hospitals, and the National Association of Public Hospitals and Health Systems—said that the Centers for Medicare & Medicaid Service and the Recovery Audit Contractors (RACs) directed hospitals to re file in this manner.
"But now refiling for underpayments would be retrospectively prohibited," the groups said. "This is unfair on its face." While supporting the doc fix provision, the groups called for removal of "the offset to finance the short term physician payment patch partially paid for" by "changing the so called Medicare '72 Hour Rule.'"
When adding $155 billion from the healthcare reform bill—plus an additional reduction of $3.7 billion being proposed by CMS for fiscal 2011, "we believe such additional savings from hospitals are unfair and unwarranted," they said. "We, therefore, ask that you modify this proposal and opt for a more responsible solution" that "fairly addresses the needs of the physicians."
The hospital groups also called for increasing Medicaid funding to the states through June 2011 for Medicaid's Federal Medical Assistance Percentage, as proposed in an earlier version of jobs bill legislation.
