Health care: Keep treatment costs down - Letters Unlimited - Cleveland.com

Posted by Janet Trautwein, Arlington, Va. May 31, 2009 04:29AM

Trautwein is executive vice president and CEO of the National Association of Health Underwriters.

Demonizing private health insurers with such tactics as antitrust investigations may make for good political theater, but it will do nothing about America's skyrocketing health care costs ("Activists seek Justice Dept. probe of insurers," May 20).

Health care isn't expensive because of insurance -- it's the other way around. Insurance has become so costly because the medical goods and services it pays for have become so costly.

Injecting more government into the health care system by creating a public insurance plan would only make things worse. Because of the systematic underpayment of hospitals and doctors by existing government health programs like Medicare and Medicaid, the average family of four is saddled with an extra $1,500 a year in premiums.

Policymakers can bring down health costs by expanding access to consumer-driven offerings like high-deductible individual policies.

Health care: Keep treatment costs down - Letters Unlimited - Cleveland.com

Newswise Law and Public Policy News | Education Campaign Needed on Social Security, Medicare Woes, Expert Says

Source: University of Illinois at Urbana-Champaign

Newswise — Painful but inevitable Social Security and Medicare reforms will be difficult to sell because years of partisan wrangling have clouded the public’s grasp of the programs’ dire financial problems, a former government economic adviser warns.

University of Illinois finance professor Jeffrey R. Brown hopes this week’s report that both programs will run out of money sooner than previously thought will help cut through confusion over the fiscal outlook of the federal retirement and health-care systems.

He blames years of political rancor, including a 2005 standoff during which Democrats sank reforms proposed by President Bush, arguing that his forecast of a funding crisis was fabricated and that both systems would be financially sound for decades. Many Republicans contributed, too, saying the problem was real but could be solved relatively painlessly by allowing people to invest their contributions in the stock market.

“So on one hand, the public hears all of these daunting reports about the need to reform these programs, but on the other hand they hear political leaders saying this is a phony crisis and everything will be fine, or that the problem is real but painless to fix,” said Brown, a former member of the bipartisan Social Security Advisory Board. “Neither of those positions is tenable.”

Brown warns that the challenge is real and worsening, and suggests the U.S. follow Britain’s lead by mounting an extensive public awareness campaign to clear up confusion and make a case for change.....

Newswise Law and Public Policy News | Education Campaign Needed on Social Security, Medicare Woes, Expert Says

Newswise Medical News | Overwhelming Medicare Plan Choices Spell Confusion

Source: Health Behavior News Service

Newswise — In a sign of the challenges facing seniors on Medicare, a new study finds that older Americans are more likely to make poor choices when faced with a wide array of drug-coverage plans. Making matters worse, many are confident they made the right decisions.

“There is information overload when there are too many drug plans for seniors to choose from,” said study co-author Thomas Rice, vice chancellor at the University of California at Los Angeles. “Congress needs to take this issue very seriously.”

The risk, he said, is that seniors will choose the wrong plans and end up needlessly spending hundreds of dollars a year.

Medicare, which mostly serves seniors, has offered coverage for prescription drugs since 2006. A typical senior chooses from a list of 50 drug plans, Rice said.

Advocates for the elderly have expressed concern that the choices are overwhelming. In the new study, published online in the journal Health Services Research, Rice and colleagues sought to understand how the number of choices affects decision-making.

The researchers created hypothetical drug plans and asked 180 adults in Claremont, Calif., to consider which one they would recommend that a friend choose. Half of the adults were age 65 or older. The researchers randomly divided the participants into groups and gave them information about three, 10 or 20 plans.

The researchers found that older people fared worse when asked to make a choice. People age 65 and older were only 41 percent as likely as younger people were to know which plan was the cheapest.....

Newswise Medical News | Overwhelming Medicare Plan Choices Spell Confusion

CQ Politics | Millions of Medicare Beneficiaries Face Reduced Social Security Benefits

By CQ Staff

New Social Security recipients and upper-income seniors could face a steep increase in their monthly Medicare premiums for the next two years, according to an analysis released Tuesday by a nonprofit health research group.

Millions more will see their finances squeezed if their premiums for Medicare Part D prescription drug coverage go up during that period.

Congress could intervene to soften the blow, but doing so would be costly at a time of ballooning deficits.

The study, by the Kaiser Family Foundation, points out that Social Security and Medicare trustees project no cost-of-living adjustment (COLA) to Social Security benefits in 2010 and 2011, and only a tiny one in 2012. The COLA is pegged to an inflation index, and the economic recession has erased increases in the relevant index.

This year, seniors received a 5.8 percent COLA, the largest in more than a quarter-century, but those days are gone for the near future.

Over the next two years, however, monthly premiums for Medicare Part B coverage will increase sharply under existing law, which requires premiums to cover 25 percent of program costs. Part B pays for doctor bills and other outpatient costs, and the monthly premiums that seniors pay are deducted from their Social Security benefits. The 2009 premium for most beneficiaries is $96.40 per month.

Medicare trustees project Part B premium increases to $104.20 per month in 2010 and $120.20 per month in 2011.....

CQ Politics | Millions of Medicare Beneficiaries Face Reduced Social Security Benefits

The Associated Press: States consider cutting drug help for seniors

By RAY HENRY – 4 days ago

PAWTUCKET, R.I. (AP) — Joanne Devlin needs about 20 prescription drugs to regulate her blood pressure, keep her arthritic joints limber and pain-free and control her asthma.

She counts on financial help from Rhode Island when her Medicare Part D insurance plan maxes out and no longer pays her drug bills, which can reach $3,000 every three months. But that state help may no longer be an option after Jan. 1.

The financial crisis has grown so severe that lawmakers in Rhode Island and five other states have debated whether to cut or reduce the state funding that helps seniors and disabled people like Devlin buy their drugs.

Devlin, 62, who lives off about $10,000 a year, worries she may need to stop taking her arthritis medication to make ends meet. She stocks shelves and helps distribute food as a volunteer at a Salvation Army food shelter.

"I wouldn't be able to move a lot," she said. "I probably wouldn't even be able to come here. I'd probably have to stay home and some days be bedridden, probably."

Devlin's predicament is shared by many of the nearly 27 million people enrolled nationally in Medicare Part D, the federal insurance plan that covers prescription drugs for seniors until the total bill reaches $2,700.

Seniors then hit what's commonly called the "doughnut hole," and must personally pay the drug bill until their out-of-pocket costs reach $4,350, at which point Medicare coverage resumes. When seniors fall into this gap, 16 states offer financial assistance, said Thomas McCormack, a consultant for the Community Access National Network and editor of the Medicaid Watch newsletter.

The Associated Press: States consider cutting drug help for seniors

Reimbursement Issues with Medicare / Medicaid: A Free Article from Clifford Law Offices, Personal Injury Attorneys in Chicago

The Chicago law office, Clifford Law Offices, is posting legal articles on their website (http://www.cliffordlaw.com) in an effort to educate the public about legal matters such as personal injury. An introduction is provided, with a link to the full article.

Chicago, IL (PRWEB) May 28, 2009 -- A new law is slated to take effect July 1 that impacts claims involving Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA). While Medicare has the right to reimbursement of money it paid for medical care rendered to injury victims since 1980, the MMSEA will require insurance companies to register on behalf of a Medicare claimant in an injury case. The aim is to insure that Medicare is compensated and parties that fail to repay will be subject to a $100 per day penalty.

Robert Clifford, nationally renowned personal injury attorney based out of Chicago, wrote about potential solutions to the anticipated issues arising from the new MMSEA requirements in a piece originally published in Chicago Lawyer entitled, 'Reimbursement Issues.' In the article, Clifford advocates for a course of action that is guided by protecting the client's due process that would otherwise be violated if an unusual length of time were to pass before settlement money was distributed to victims. Clifford goes on to describe a Medicare compliance process instituted by plaintiff's firms that would verify, negotiate, and resolve Medicare's reimbursement claims.

Read the full Medicare / Medicaid Reimbursement Issues article here.

"Clifford Law Offices offers these free articles to help educate people about subjects such as Reimbursement Issues for Medicare and Medicaid," says Robert A. Clifford, Founder.

###

Reimbursement Issues with Medicare / Medicaid: A Free Article from Clifford Law Offices, Personal Injury Attorneys in Chicago

Health insurer suggests ways to save government $500 billion - San Jose Mercury News

By Erica Werner

Associated Press

Posted: 05/27/2009 06:17:11 PM PDT

Updated: 05/28/2009 08:40:20 AM PDT

 

WASHINGTON — A major health insurer says the government can save more than $500 billion in Medicare spending by sending patients to less expensive, more efficient doctors, reducing hospital visits by the elderly and cutting unnecessary care.

Those are among 15 suggestions made Wednesday by UnitedHealth Group, a Minnesota-based health management company that is the biggest participant in the government's Medicare insurance program for the elderly. United said the proposals added up to $540 billion in savings over 10 years.....

Health insurer suggests ways to save government $500 billion - San Jose Mercury News

Healthcare Reform that Doesn't Address Long Term Care Would Be a Failure - John A. Farrell (usnews.com)

 

May 22, 2009 03:36 PM ET | John Aloysius Farrell

By John Aloysius Farrell, Thomas Jefferson Street blog

"It is absurd," writes Howard Gleckman, "to expect someone to clean feces from a dementia patient every day for nine dollars an hour for no benefits."

But, as anyone who has cared for an aging parent or terminally ill friend or disabled neighbor or relative knows, America's hodge-podge system of long-term care is packed with such assumptions. And some 54 million of us wrestle with them every day.

Here is one of my favorites: if you suffer a massive heart attack and need expensive medical care in your golden years, it is likely that Medicare will cover your bills.

But if you have the bad luck to contract Alzheimer's disease, it's sorry pal, you're on your own.....

Healthcare Reform that Doesn't Address Long Term Care Would Be a Failure - John A. Farrell (usnews.com)

AARP Ramps Up Effort To Close Medicare Doughnut Hole - KYPost.com

Web Produced: Jessica Noll
Email: Jessica.Noll@kypost.com
Last Update: 5/19 3:45 pm

(Getty Images)

LOUISVILLE, Ky – AARP’s Health Action Now campaign turns its attention this week to the growing problem of prescription drug costs and reducing the gap in prescription drug coverage for people in Medicare.

Closing the Part D doughnut hole could save people in the program thousands of dollars in drug costs and keep them healthier by ensuring they can afford their medications.

The Association is pressing lawmakers to lower individuals’ drug costs as a part of health reform, including closing the doughnut hole—[which forces more than 3 million people in Medicare to pay their full drug costs each year]—and increasing the availability of generic drugs, particularly generic versions of costly biologics.....

AARP Ramps Up Effort To Close Medicare Doughnut Hole - KYPost.com

AMNews: Editorial - May 18, 2009. Help for physicians on Medicare deadlines ... American Medical News

CMS is making it tougher for doctors to enroll or update Medicare information. An AMA resource lets members cut through red tape.

Editorial. Posted May 18, 2009.

---

Physicians re-enrolling in or reporting changes to Medicare lately understandably might feel that one inadvertent false move could have catastrophic results.

That's because the Centers for Medicare & Medicaid Services has put even stricter rules on how long physicians and others have to report on certain practice-related changes -- with failure to comply possibly resulting in a year or two of banishment from the program.....

AMNews: Editorial - May 18, 2009. Help for physicians on Medicare deadlines ... American Medical News

AMNews: May 18, 2009. 2010 HHS budget looks to use Medicare savings for reform ... American Medical News

The Obama administration also will look into removing physician-administered drugs from the calculation of the Medicare pay formula.

By Chris Silva, AMNews staff. Posted May 18, 2009.

---

Washington -- Preventing Medicare pay cuts for physicians and finding funding for additional rate updates could prove easier if Congress follows a health budget released May 7 by President Obama.

The president's fiscal 2010 budget for the Dept. of Health & Human Services totals $879 billion in outlays, an increase of $63 billion over fiscal 2009. Although it calls for additional spending in several areas, it also proposes saving hundreds of billions of dollars from Medicare so the money can be spent elsewhere, possibly on boosting physician pay or other reforms.....

AMNews: May 18, 2009. 2010 HHS budget looks to use Medicare savings for reform ... American Medical News

Medical News: Senators Disagree on Public Health Insurance Plan - in Washington-Watch, Washington Watch from MedPage Today

By Emily P. Walker, Washington Correspondent, MedPage Today
Published: May 15, 2009

WASHINGTON, May 15 -- With just a month to go until a bipartisan healthcare reform bill is to be unveiled, Democratic and GOP senators remain at an impasse over the public plan portion of reform.

After an eight-hour, closed-door meeting of the Senate Finance Committee on Thursday, Sen. Charles Grassley of Iowa, the committee's ranking Republican, said members are no closer to consensus on the most controversial part of reform: the inclusion of a government-run insurance plan that would be an alternative to private insurance.

"We haven't been able to reach an agreement," Grassley said during a postmeeting recap for reporters.....

Medical News: Senators Disagree on Public Health Insurance Plan - in Washington-Watch, Washington Watch from MedPage Today

Health Plans Would Add to Controls on Insurers - NYTimes.com

By ROBERT PEAR Published: May 15, 2009

WASHINGTON — The government could rein in aggressive marketing practices of health insurance companies, regulate their premiums and allow workers to drop out of group health plans to seek a better deal on their own under legislation being developed by leading Democratic senators.

The Senate proposals, which emerged this week, are broadly similar to ones being drafted by the chairmen of three House committees. Democrats in both houses would vastly expand federal regulation of insurance to guarantee that all Americans have access to affordable coverage, a top priority of President Obama.

Lawmakers have not figured out how to pay for their proposals, which could easily cost more than $1 trillion over a decade. And they have not resolved the politically explosive question of whether to create a public insurance program, to compete with private insurers.

But after a week of intense discussions, in which members of the House and the Senate immersed themselves in the details of health care, Democrats began to line up in favor of several basic ideas.....

Health Plans Would Add to Controls on Insurers - NYTimes.com

Extending Medicare: Medical and National Suicide -- Seeking Alpha

By Simon Smelt | May 15, 2009

Medicare and social welfare are heading for insolvency more rapidly than previously forecast. The $50 trillion plus of their unfunded liabilities (according to the government’s “Financial Report of the United States” is beginning to appear over the horizon. At the same time, the U.S. Congress is discussing extending Medicare to those not covered.

But maybe that’s OK because the industry has said it is going to get costs under control and save literally trillions.

Alas, closer inspection shows the idea of extending Medicare to be suicidal and the trillions in savings do not exist, based on the government’s own figures.....

Extending Medicare: Medical and National Suicide -- Seeking Alpha

Medical News: Pfizer Offers Year of Free Meds to Unemployed - in Product Alert, Prescriptions from MedPage Today

By John Gever, Senior Editor, MedPage Today
Published: May 14, 2009

WHEELING, W.Va., May 14 -- Drug giant Pfizer said unemployed people who have been taking its branded products could receive them free for up to a year in a new program -- with some exceptions.

The program, called MAINTAIN, will provide access to more than 70 Pfizer drugs including atorvastatin (Lipitor), celecoxib (Celebrex), pregabalin (Lyrica), and sildenafil (Viagra).

But the program excludes biologics, most cancer drugs, and other of Pfizer's most expensive products.

Individuals who became unemployed after Jan. 1 of this year are eligible for the program and may sign up through Dec. 31.

Other eligibility requirements include having taken the branded Pfizer drug for at least three months prior to losing a job, having no other prescription drug coverage, and being able to attest to financial hardship.

Income prior to becoming unemployed is not a factor, Pfizer said. But participants who regain employment or prescription drug coverage will have to start paying again.

A stock analyst quoted by the Associated Press pointed out that the program is likely to prevent some current Pfizer drug customers from switching to generic equivalents.

The company said it was taking signups today, although the program would not be fully operational until July 1.

Pfizer said signups and additional information on the MAINTAIN program would be available at Pfizer Helpful Answers or by calling 866-706-2400 toll-free.

Medical News: Pfizer Offers Year of Free Meds to Unemployed - in Product Alert, Prescriptions from MedPage Today

Higher Medicare Premiums in Store For Some Retirees - Planning to Retire (usnews.com)

May 14, 2009 05:40 PM ET | Emily Brandon

The recession is taking its toll on Social Security and especially Medicare. This year’s annual checkup found that the Social Security trust fund is predicted to be exhausted until 2037, 4 years sooner than last year, according to the Social Security Board of Trustees report. Medicare’s hospital insurance trust fund is expected to be emptied even sooner, in 2017.

Costs for Medicare Parts B and D, which cover doctors' bills and prescription drugs respectively, are predicted to increase an average of 6.4 annually over the long-term, according to the report. That means higher enrollee premiums and the need for more general revenue funding.

Most retirees won’t have to pay higher premiums in the near future because a current law doesn’t allow Medicare Part B premiums to be raised higher than Social Security increases for most retirees. The Congressional Budget Office predicts that there will be no cost-of-living increases for Social Security beneficiaries in 2010 through 2012, which also means no Medicare Part B premium hike for the majority of beneficiaries.

But about one quarter of Medicare Part B enrollees will be subject to unusually large premium increases in the next two years, according to the Trustees report.....

Higher Medicare Premiums in Store For Some Retirees - Planning to Retire (usnews.com)

Health Costs Are the Real Deficit Threat - WSJ.com

By PETER R. ORSZAG

This week confirmed two important facts -- that health-care costs are the key to our fiscal future, and that even doctors and hospitals agree that substantial efficiency improvements are possible in how medicine is practiced.

David Gothard

The numbers speak for themselves. The Medicare and Social Security trustees' reports released this week show that health-care costs drive our long-term entitlement problem. An example illustrates the point: If costs per enrollee in Medicare and Medicaid grow at the same rate over the next four decades as they have over the past four, those two programs will increase from 5% of GDP today to 20% by 2050. Despite the attention often paid to Social Security, spending on that program rises much more modestly -- from 5% to 6% of GDP -- over the same time period. Over the long run, the deficit impact of every other fiscal policy variable is swamped by the impact of health-care costs.

Spiraling health-care costs are not just some future abstraction, however. Right now, families across America who have health insurance are seeing their take-home pay reduced and their household budgets strained by high costs and spiraling premiums. State and local governments also are feeling this pinch. And the growing weight of health costs on state budgets translates into an inability to make investments in areas such as education, hindering our overall economic growth.

The good news is that there appear to be significant opportunities to reduce health-care costs over time without impairing the quality of care or outcomes. In health care, unlike in other sectors, higher quality currently seems to be associated with lower cost -- not the opposite.....

Health Costs Are the Real Deficit Threat - WSJ.com

Medical News: Medicare Finalizes Denial of Virtual Colonoscopy Coverage - in Public Health & Policy, Medicare from MedPage Today

By John Gever, Senior Editor, MedPage Today
Published: May 13, 2009

BALTIMORE, May 13 -- CT colonography for colorectal cancer screening will not be covered under Medicare, the Centers for Medicare and Medicaid Services has confirmed.

The agency issued a final decision memo yesterday that reiterates the coverage denial proposed in February in draft form. (See Medicare to Deny Coverage of CT Colonography Screening)

"The evidence is inadequate to conclude that CT colonography is an appropriate colorectal cancer screening test under § 1861(pp)(1) of the Social Security Act," according to the final CMS memo.

Although the 30-day comment period following publication of the draft memo brought many requests to allow at least some coverage for the procedure, CMS stuck to its conclusion that there is not enough evidence to support the procedure in the Medicare population.

Agency analysts cited evidence from numerous studies that found CT colonography less sensitive for smaller lesions.

Medical News: Medicare Finalizes Denial of Virtual Colonoscopy Coverage - in Public Health & Policy, Medicare from MedPage Today

Health Care Reform Outlook Clear? Don't Count on It | 44 | washingtonpost.com

 

By Dan Balz
The gathering of industry leaders standing with President Obama in the White House pledging to cut up to $2 trillion in health care costs over the next decade suggests a gathering of momentum behind one of the president's signature domestic initiatives. The train is leaving the station. All aboard!

Perhaps. While 2009 may not be 1993-94, the truth is that it still may be too early to declare that the constellation of forces in favor of reform is cohesive and strong enough to weather the battle that will surely come. Whatever goodwill Obama can create now he will need later this year to persuade the House and Senate -- and the array of special interests involved in health care -- to enact a comprehensive reform package.

The story line is developing that the political climate is dramatically different today than it was during the Clinton administration, when health care reform ultimately crashed and burned without ever coming to a vote on the floor of the House or Senate. There is some truth to that, but not so much as people might assume......

Health Care Reform Outlook Clear? Don't Count on It | 44 | washingtonpost.com

Report: Medicare faces cash crunch - UPI.com

Do you worry about Social Security and Medicare?

WASHINGTON, May 12 (UPI) -- A U.S. government report by the trustees who monitor Medicare and Social Security predicts the Medicare trust fund will run out of money by 2016.

The U.S. Department of Health and Human Services said in a statement Tuesday that last year 45.2 million people were covered by Medicare. About 22 percent of beneficiaries have enrolled in private health plans that contract with Medicare to provide healthcare services.

The report said the Medicare hospital insurance fund "does not meet the short-range test of financial adequacy," noting that the fund has not been considered satisfactory since 2003. The report said the fund's financial health has dipped amid the nation's current recession.

"The HI trust fund is not adequately financed over the next 10 years," the report said. "At the beginning of 2009 the assets of the HI trust fund were $321 billion and are projected to be exhausted during 2017, under the intermediate assumptions."

As for Medicare Part B and Part D accounts in the Supplemental Medical Insurance trust fund, the report said they are "adequately financed" since premium and general revenue income are reset each year to match expected costs.

The report said total Medicare expenditures were $468 billion in 2008, and were expected to increase faster than workers' earnings or the overall economy in the coming years.

"This isn't just another government report. It's a wake up call for everyone who is concerned about Medicare and the health of our economy," said Health and Human Services Secretary Kathleen Sebelius said. "And it's yet another sign that we can't wait for real, comprehensive health reform."

Report: Medicare faces cash crunch - UPI.com

Recession puts Social Security in spotlight - May. 11, 2009

The forgotten fiscal problem

The recession has put the debate over Social Security's fiscal health in the shadows. A report Tuesday could revive it - at least for awhile.

By Jeanne Sahadi, CNNMoney.com senior writer

Last Updated: May 12, 2009: 9:24 AM ET

NEW YORK (CNNMoney.com) -- The financial crisis has cast a shadow over a perennial debate in Washington: How to ensure the long-term financial health of Social Security.

While President Obama has taken on more major issues in his first few months than most presidents, the entitlement program for retirees hasn't made the list.

But on Tuesday, the reform debate is likely to be revived, if only temporarily, with the release of the annual report from the trustees who oversee Social Security and Medicare.

Experts expect the trustees' short-run projections for both programs to be worse than they were a year ago.....

Recession puts Social Security in spotlight - May. 11, 2009

» WH Release: “Coming Together to Bring Down the Cost of Health Care” Row 2, Seat 4 « FOXNews.com

Daniela Sicuranza
Contributing Editor

White House Press Release:   "Coming Together to Bring Down the Cost of Health Care Fact Sheet "

RISING HEALTH CARE COSTS ARE BURDENING FAMILIES, BUSINESSES, GOVERNMENTS, AND THE ECONOMY: For years, rising health care costs have been a burden on families, businesses, and the entire economy. Since 2000, health insurance premiums have almost doubled and health care premiums have grown three times faster than wages. These rising costs have eroded the financial stability of all Americans as families have had to pay more for insurance coverage; have been exposed to a greater risk of personal bankruptcy as deductibles and co-payments increase; and have seen their actual benefits decrease as employers search for ways to rein in escalating health care costs. As families and businesses have struggled with these rising costs, states have also been forced to cut back on investments in areas that are critical to long-term prosperity such as higher education and infrastructure. Overall, health care is consuming an ever-increasing amount of our nation's resources: at the current rate, health care will eat up more than 20 percent of GDP in 2018. Reforming health care is the key to restoring financial stability for American families and businesses and for securing our fiscal future.....

» WH Release: “Coming Together to Bring Down the Cost of Health Care” Row 2, Seat 4 « FOXNews.com

New Report: Home Health Care Saves Billions for Medicare

 Avalere Health Finds Home Health Use Saved $1.71 Billion for Medicare in 2005-2006

AHHQI Believes Medicare Could Realize More Than $30 Billion in Savings for Chronic Disease Patients in Next Ten Years By Expanding Access to Home Health

 

Early use of home health care services following a hospital stay by patients with at least one chronic disease saved Medicare $1.71 billion in the two-year 2005-2006 period, according to a study released today by Avalere Health LLC. The study, sponsored by the Alliance for Home Health Quality and Innovation (AHHQI), also found that an additional $1.77 billion would have been saved in the same period if all Medicare beneficiaries with similar chronic diseases had accessed home health care services. Approximately 12.7% of the savings is attributable to reductions in hospital readmissions, and it is presumed that the remaining savings accrue from avoiding more costly institutional settings. AHHQI believes that the unrealized savings identified in this study could allow Medicare to save $31.1 billion over the next ten years by expanding access to home health for chronic disease patients.....

New Report: Home Health Care Saves Billions for Medicare

The Associated Press: Obama wants $58 billion in taxes to offset errors

By STEPHEN OHLEMACHER – May 11, 2009

WASHINGTON (AP) — The Obama administration on Monday proposed $58 billion in additional taxes to offset budgeting errors that overstated revenues in the president's plan to finance health care reform.

The tax measures target a host of activities, including people who for tax purposes aggressively reduce the value of property received as gifts or in estates. To reduce fraud, other provisions would require investors, contractors and taxpayers to provide more information about certain transactions to the Internal Revenue Service.

The largest budgeting error overstated the amount of money that would be raised by limiting charitable and other deductions for high-income taxpayers. The limits would generate $267 billion over the next 10 years — $51 billion less than the administration projected in February.....

If I made an error like that, I would get fired!!!

The Associated Press: Obama wants $58 billion in taxes to offset errors

It's time to heal our health care system

May 11, 2009

BY BOBBY L. RUSH

One of the most profound questions Jesus asked during his ministry was put before a sick man who had spent 38 years waiting near the base of the Bethesda well for his turn at treatment. ''Do you want to get well?'' Jesus queried, as the man lay surrounded by other broken, paralyzed, blind, mentally and spiritually infirmed people waiting for his turn to be healed.

Today, the man from this story could be any one of America's poor or uninsured who lay in wait within the nation's many overburdened hospital emergency rooms. It is only because of faith and perseverance that I am not one of them. As a recovering cancer patient, I have experienced firsthand the lifesaving work of physicians, nurses and other health care workers who are able to focus on restoring a person's health rather than being saddled by administrative policy and financial restrictions.

Recently, a hospital in my district has come under fire for reportedly engaging in a deplorable practice known as "patient dumping," the inhumane exercise of turning away poor, uninsured and elderly patients to other facilities, refusing to administer care due to overcrowding and other obstacles. It should be no surprise that a majority of the patients being turned away are poor, and often people of color. This practice is even more startling when you consider that six hospitals have closed on Chicago's South Side, placing an enormous burden on any hospital whose doors are still open, with thousands of people depending on fewer hospitals, atop the over restrictive nature of an already-broken health care system.

Nearly 47 million Americans are without health insurance. Since the beginning of the recession, an estimated 4 million more Americans have lost their health insurance. On average, 14,000 Americans lose their coverage every day. Where, then, do these citizens go and to whom do they turn when they need to get well? Are they condemned to suffer silently, waiting for 38 years like the man at the foot of the Bethesda well?

Health care reform is the single most important domestic issue facing our nation. In 2007, we spent $2.2 trillion on health care. This is why expanding coverage and making insurance affordable has been one of my top priorities since taking office in 1993. We are increasingly becoming a nation of the "have-mores" vs. the "have-nots" -- the invisible people who linger on the margins of society as they seek the American Dream.

This is why I have co-sponsored the "Access to Emergency Medical Services Act of 2009" (H.R.1188/S.468) and am an original co-sponsor to H.R. 1678, both of which will improve access, quality and efficiency of emergency care.

I also sponsored pioneering health legislation called the Melanie Blocker Stokes Postpartum Depression Research and Care Act (H.R.20/S.324). This bill will provide immediate attention and resources toward one of the most underdiagnosed conditions after childbirth. It has passed the House and is on its way to becoming law.

There is growing support for my Medicare bill (H.R. 444), which will expand the federal discount drug program to make it easier for the underinsured and low-income patients to access the medication they need. These efforts are just a small piece of the health care reform puzzle that must be put together. And I urge all of you to call on your elected officials to get engaged in these issues, as well.

President Obama and Congress have made it a top priority to pass comprehensive health care reform legislation this year that lowers costs, improves quality, increases coverage and preserves patient choice of plan and doctors. Left alone, our broken health care system will cost the American people another $2.2 trillion. We need reform now. Families cannot wait. America cannot wait.

When it comes to U.S. health care reform, lawmakers can no longer act like Sisyphus, a man condemned to forever roll a ball up a never-ending hill, moving forward but never making progress. It is time for America's health care system to answer the question, "Do we want to get well?"

U.S. Rep. Bobby L. Rush represents the 1st Congressional District of Illinois.

Thyatiria Towns

Office of Congressman Bobby L. Rush

700 East 79th Street

Chicago, Illinois 60619

773-224-6500 (office)

773-224-9624 (fax)

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Sign up for Congressman Bobby L. Rush's Issue Alerts and our E-Newsletter at: http://www.house.gov/rush/

AMNews: May 11, 2009. Senate panel suggests delay in long-term reform of Medicare pay ... American Medical News

The proposal would put off changing the formula for a few years until reform demonstrations proved effective.

By Doug Trapp, AMNews staff. Posted May 11, 2009.

---

Washington -- Senate Finance Committee leaders on April 28 offered a list of ideas for the first third of a national health reform bill, but a private discussion between senators and their staffs the next day did not produce significant agreements on the proposed solutions.

 

Nevertheless, the 48-page draft, which addressed improving patient care and reducing costs, provided more detail on the direction Senate Finance Committee Chair Max Baucus (D, Mont.) and highest-ranking Republican Charles Grassley (Iowa) would like to take health system reform. The draft was released after the first of three Finance public roundtable discussions. More policy option papers and private discussions were to follow the two remaining roundtable meetings, scheduled for May 5 and May 12.....

AMNews: May 11, 2009. Senate panel suggests delay in long-term reform of Medicare pay ... American Medical News

AMNews: May 11, 2009. Congressional budget short on answers for Medicare pay formula ... American Medical News

The blueprint provides physicians some exemption from deficit spending rules in the House, but the bulk of any payment changes will require budgetary offsets.

By Chris Silva, AMNews staff. Posted May 11, 2009.

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Washington -- Congress on April 29 adopted a fiscal 2010 budget resolution that leaves some room for Medicare physician payment reform, but not nearly as much as doctors would have liked.

 

The $3.56 trillion budget allows the House to pass reform legislation costing up to $38 billion without the need to find offsets in the form of new revenue or cuts from other parts of Medicare. That would cover the expected cost of freezing Medicare rates at current levels in 2010, 2011 and part of 2012 instead of implementing the reductions required by current law. The Senate, however, still would need to find full offsets for any bill that prevents the cuts or boosts Medicare pay.....

AMNews: May 11, 2009. Congressional budget short on answers for Medicare pay formula ... American Medical News

Funds in 2010 Budget Could Increase Access to Care for Medicare Beneficiaries

ALEXANDRIA, Va., May 6 /PRNewswire-USNewswire/ -- Funds in the FY 2010 budget aimed at transforming the nation's health care system may be used to improve access to outpatient physical therapy services for Medicare beneficiaries by repealing the therapy caps, says the American Physical Therapy Association (APTA).

S.Con.Res.13, which recommends budgetary levels and amounts for FY 2009-FY 2014, was passed April 29 by the House of Representatives by a 233 to 193 vote and by a 53 to 43 Senate vote. An amendment by Senators Ben Cardin (D-MD) and John Ensign (R-NV) to the budget's existing deficit neutral reserve fund relating to health care reforms allows for improvements to the Medicare program for beneficiaries and protects access to outpatient therapy services, including physical therapy, through measures such as repealing the current outpatient caps while protecting beneficiaries from associated premium increases.

"APTA applauds Congress for recognizing the critical need to repeal the caps on physical therapy services so that Medicare beneficiaries can receive the care they require," said APTA President R Scott Ward, PT, PhD. "By including this provision in the budget, our nation's aging adults are one step closer to having increased access to the rehabilitative and health services provided by physical therapists that are necessary for many conditions, such as stroke, diabetes, Parkinson disease, and cardiovascular disease, that lead to pain and some level of loss of function."

Earlier this year, Senators John Ensign (R-NV), Blanche Lincoln (D-AR), Susan Collins (R-ME), and Ben Cardin (D-MD), and Representatives Xavier Becerra (D-CA), Mike Ross (D-AR), and Roy Blunt (R-MO) introduced the Medicare Access to Rehabilitation Services Act (S 46/HR 43), which calls for the repeal of the Medicare therapy caps that limit coverage of outpatient rehabilitation services to $1,840 for physical therapy and speech language pathology combined and $1,840 for occupational therapy services.

Physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility - in many cases without expensive surgery or the side effects of prescription medications. APTA represents more than 72,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Its purpose is to improve the health and quality of life of individuals through the advancement of physical therapist practice, education, and research. In most states, patients can make an appointment directly with a physical therapist, without a physician referral. Learn more about conditions physical therapists can treat and find a physical therapist in your area at www.moveforwardpt.com.

SOURCE American Physical Therapy Association

Funds in 2010 Budget Could Increase Access to Care for Medicare Beneficiaries

Coventry joins WellCare in ending plans next year - Forbes.com

By TOM MURPHY , 05.05.09, 04:34 PM EDT

Coventry Health Care Inc. on Tuesday became the second health insurer this week to announce that it will leave a fast-growing segment of the Medicare Advantage market next year, forcing more than 300,000 people to find new coverage.

The Bethesda, Md.-based insurer said in a statement it will not renew its private fee-for-service product. The company cited profitability "in light of federal reimbursement rates and medical cost trends."

Coventry has 318,000 people enrolled in that Medicare Advantage product, a total that has grown 65 percent over the past year.

Private fee-for-service plans do not have networks, allowing patients to see any health care provider they wish as long as the provider accepts the plan.

WellCare Health Plans ( WCG - news - people ) Inc. said Monday it would not renew its Medicare Advantage private fee-for-service contracts for next year. The Tampa, Fla.-based insurer has about 110,000 members receiving that coverage.

Medicare Advantage plans allow the elderly and disabled to receive benefits through private health insurers. The plans receive a government subsidy and generally offer more benefits than traditional Medicare, but they've drawn criticism for their cost.

Many analysts who follow the insurance industry expect government reimbursement rates for the plans to fall as much as 5 percent next year.

The private fee-for-service plans also will be required to develop networks starting in 2011. Analysts have said that could force many insurers to drop the products. WellCare cited that as a reason for ending its contracts.

"Investing to build the provider networks ... would be unwise given the geographic dispersion of our membership and the uncertainty of Medicare rates in rural markets," a company spokeswoman said in an e-mail.

A lack of networks allows insurers to increase membership quickly because they don't have to negotiate contracts with doctors and hospitals, Wachovia analyst Matt Perry said in an interview.

"They just blanketed markets with private fee-for-service plans, and it didn't take any investment for them," he said.

Oppenheimer analyst Carl McDonald said in a research note that seniors will see increases in premiums and a reduction in benefits next year, which will force them to spend more out of pocket.

"But seniors who are forced to pick a new plan are going to be even more displeased, particularly if it means that a favored physician or specialist is no longer accessible," he wrote.

Coventry joins WellCare in ending plans next year - Forbes.com

Patient Advocacy Groups Support Legislation To Eliminate Two-Year Medicare Waiti by Adviatech.com

The Coalition to End the Two-Year Wait for Medicare enthusiastically supports the introduction of the Ending the Medicare Disability Waiting Period Act of 2009. The Act would eliminate the current two-year delay in coverage for people with severe disabilities who are waiting to become eligible for Medicare coverage.

(1888PressRelease) May 04, 2009 - Among the advocacy groups in support of this bill, are the Special Needs Alliance (SNA) and the National Academy of Elder Law Attorneys (NAELA). Bernard A. Krooks, a founding partner of Littman Krooks LLP, is current President of the SNA and past President of the NAELA.

The Coalition consists of over 115 organizations that work to ensure access to health care for people with disabilities. The Coalition is urging Congress to make coverage for people with disabilities a priority while addressing the issue of national health care reform.

The 24 month waiting period has been in effect since 1972 when Congress stipulated that people with disabilities must first receive Social Security Disability Insurance (SSDI) for 24 months before gaining Medicare eligibility. The legislation to address this issue, introduced by Senator Jeff Bingaman and Representative Gene Green, will phase-out the waiting period for all people with disabilities over ten years, while immediately eliminating the waiting period for people with life-threatening conditions.

The 24 month waiting period has resulted in many individuals with disabilities going without health insurance during their wait. Nearly 40 percent of people with disabilities are without health insurance coverage at some point during their wait for Medicare; 24 percent have no health insurance during this entire period. The waiting period forces people with severe disabilities to endure two years during which treatment and care of their conditions are put at risk. Many forgo medical treatment and/or stop taking medications, compromising their already fragile health and resulting ultimately in conditions that are often more costly to treat when Medicare coverage finally begins.

The Special Needs Alliance (SNA) is a national, not-for-profit organization of attorneys dedicated to the practice of disability and public benefits law. Individuals with disabilities, their families and their advisors rely on the SNA to connect them with nearby attorneys who focus their practices in the disability law arena. SNA membership is based on a combination of relevant legal experience in the disability and special needs planning fields, direct family experience with disability, active participation with national, state and local disability advocacy organizations, and professional reputation. SNA members average 20 years of experience in special needs planning and disability law.

Patient Advocacy Groups Support Legislation To Eliminate Two-Year Medicare Waiti by Adviatech.com

Nursing home operators howl as government proposes slashing Medicare payments by $1 billion - McKnight's Long Term Care News

 

The Centers for Medicare & Medicaid Services set off a backlash from nursing home operators late Friday afternoon when it proposed “adjustments” that would cut Medicare payments by $1.05 billion in fiscal 2010. The 3.3% reduction will “largely” be offset by a 2.1% market basket increase, officials said.

Regulators stressed they would be simply closing a four-year window in which providers were paid far more than originally forecasted after a 2006 payment adjustment for certain therapy groupings. Providers, however, claimed the cut would be working against the spirit of the recently passed economic stimulus bill, endangering resident care and causing thousands of caregiver job losses.....

Nursing home operators howl as government proposes slashing Medicare payments by $1 billion - McKnight's Long Term Care News

Baucus on health care: 'Crisis' not too strong a word - Sen. Max Baucus - POLITICO.com

By SEN. MAX BAUCUS | 5/3/09 10:32 PM EDT

Our health care system is in crisis. This isn’t being dramatic or hyperbolic. There is no better, or more accurate, term to describe our current situation than “crisis.” 

It isn’t just a crisis for those who can’t receive care, and it isn’t just a crisis that affects people’s health. It’s a crisis that affects our economy and affects each of us. More important, it is not just me, or doctors, or economists, or executives, or health care experts, or the 46 million uninsured people saying this. The numbers say it all.
In 2007, our economy lost more than $200 billion as a result of the poor health and the shorter life span of the uninsured. ... That’s a crisis. 

Every day, 14,000 people lose their health care coverage on account of our economic downturn. ... That’s a crisis.
Uncompensated care forces the average family with insurance to pay approximately $1,100 a year in additional premiums. ... That’s a crisis. 

Between 2000 and 2008, health care premiums rose more than 78 percent, while wages rose only 15 percent. ... That’s a crisis.

During this same time, in my home state of Montana, health care premiums rose 88 percent, while earnings rose only 16 percent. ... That’s a crisis.

One-and-a-half million families lose their homes each year to foreclosure because of unaffordable medical costs. ... That’s a crisis.

It’s estimated that if we don’t act now, in just seven years, most Americans will spend nearly half their income on health insurance. ... That’s a crisis.

The cost of covering people insured by Medicare and Medicaid is projected to increase by 114 percent in 10 years, while our economy will grow only 64 percent. ... That’s a crisis.

And these numbers don’t even begin to touch on the hundreds of small businesses across the country that can’t afford health care for their employees or the corporations that can’t compete in the global marketplace because health care costs are so high.....

Baucus on health care: 'Crisis' not too strong a word - Sen. Max Baucus - POLITICO.com

AHCA/Alliance: New Medicare Regulation Will Hurt Seniors, Cost Jobs, Perpetuate Inefficiency

Turning Back Clock to Implement Bush Administration Proposal at Odds With Intent of Economic Stimulus, Broader Health Reform Goals

WASHINGTON, May 1 /PRNewswire-USNewswire/ -- Reaching back in time to propose implementing a Medicare regulation first proposed by the Bush Administration to cut seniors' Medicare funding by $1.05 billion in FY 2010 (estimated to be $5.6 billion over five years) is completely at odds with the intent of the American Recovery and Reinvestment Act (ARRA) in terms of creating jobs and spurring economic growth, and will hinder ongoing efforts to modernize Medicare for the benefit of seniors and taxpayers, according to two national long term care leaders.

Last summer, forty Democratic and Republican Senators joined together to actively oppose the rule, and noted in one letter to the Administration that the proposed cuts "will jeopardize the significant quality improvements made by the Skilled Nursing Facility (SNF) community in recent years as well as the ability of SNFs to continue caring for high-acuity patients. Because SNFs rely on Medicare to make up for chronic underfunding by the Medicaid program. We believe that if CMS were to finalize its proposed rule, the ability of providers to care for our nation's most vulnerable population - the frail elderly and disabled - would be severely threatened."

Bruce Yarwood, President and CEO of the American Health Care Association (AHCA), said, "Implementing this old Bush Administration Medicare regulation will undermine seniors' future access to quality care in the setting of their choice, sidetrack our sector's ongoing ability to create good-paying health jobs, and place at risk the delivery system reforms now successfully underway to make this vital program more efficient for patients and more accountable to taxpayers. With Congress and the Obama Administration so effectively focused on job creation in the face of poor national and state economic conditions, this CMS proposal is at fundamental odds with our broader economic and health policy objectives, not complementary to them."

Alan Rosenbloom, President of the Alliance for Quality Nursing Home Care, said the Bush CMS rule, and the damaging impact of its sharp funding cuts, would slow the flow of post-acute patients into the lowest cost setting most appropriate to their care needs. "Backtracking in the manner CMS proposes will undermine the very core principles of the Administration's health policy goals, and is antithetical to the health system delivery reforms America needs and seniors deserve," he said. "As the nature of America's nursing home patient population continues to change and evolve, it should logically be the policy of CMS to help facilitate the ability of nursing homes to care for higher-acuity, post-acute Medicare beneficiaries."

Yarwood and Rosenbloom said one of the many flaws associated with the proposal is that because approximately 70 percent of facility operating costs are directly related to staff, the proposed rule's deep cuts will result in thousands of lost jobs in the very sector well positioned to create them.

This comes at a time when the long term care industry is already facing major challenges due to the economic recession. A recent study of proprietary nursing homes by Dobson DaVanzo & Associates LLC found that "while there may be vacant positions that could be filled, one third of our respondents spoke of having to freeze jobs in their facilities and forgo filling these positions." Wages for current employees were also not increasing as a result of the economy, the study found.

On a health policy level, many Medicare beneficiaries have sought and received quality care in skilled nursing facilities (SNFs) rather than a higher cost setting. Yarwood and Rosenbloom observed that SNFs have invested heavily in recent years to increase capabilities to admit, treat and return to home a growing number of patients requiring intensive rehabilitative care, and care for patients with multiple chronic illnesses. Implementing the proposed funding cuts, the long term care leaders said, would inhibit continued investments in cost effective care - contrary to the Obama Administration's stated health policy objectives.

The AHCA and Alliance leaders also expressed concern the CMS action to cut Medicare-financed nursing home care will be especially damaging to seniors in the many states across the nation who have already endured or soon face substantial Medicaid funding cuts as a result of recent state legislative actions.

"Medicare and Medicaid funding are inextricably linked, and the combination of cuts to both programs squeezes facilities in a manner harmful to Medicare beneficiaries' rising care needs, as well as to our local economy and caregiver jobs base," Yarwood said. "As this is our initial analysis of the CMS rule, and we will continue to evaluate and comment, we urge the Administration and Congress to avoid adopting short-term, budget-driven policies that are inconsistent with the goal of improving post-acute care coordination and payment efficiency," concluded Rosenbloom.

SOURCE American Health Care Association

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AHCA/Alliance: New Medicare Regulation Will Hurt Seniors, Cost Jobs, Perpetuate Inefficiency

Medicare System Overhaul Proposed by Two Senators - NYTimes.com

By ROBERT PEAR

Published: April 30, 2009

WASHINGTON — Leading senators from both parties said Wednesday that they would make sweeping changes in Medicare to reward or penalize doctors, hospitals and nursing homes according to the quality of care they provided.

The proposals, the opening salvo in a broad effort to overhaul the health care system at the urging of President Obama, would also create strong financial incentives for doctors and hospitals to coordinate the care they now provide in a fragmented way.

The White House and Congressional Democrats have stacked the deck for Mr. Obama’s health plan by making sure it is filibuster-proof. Despite their objections to such expedited procedures, Republicans continue working with Democrats in the Senate Finance Committee.....

Medicare System Overhaul Proposed by Two Senators - NYTimes.com

Medicare Part D shows market-based solutions work | ajc.com

By Gary E. Applebaum

Wednesday, April 29, 2009

Before President Obama and his team overhaul the American health care system, they should note what currently works.

Consider Medicare Part D. This prescription drug benefit for seniors has a huge price tag, but by allowing the market to set prices, Part D has actually reduced costs and improved services for seniors.

Under Part D, seniors select a prescription drug plan offered by a private insurer. The federal government subsidizes these plans, and insurers compete to offer seniors the best deal. Competition among insurers drives down costs to enrollees and provides them with multiple choices so that they can pick a plan that suits their medical needs and budget.

Medicare Part D stands out as a rare success among the scores of bloated, inefficient government programs we encounter on a daily basis. It has managed to deliver great service to its beneficiaries — at a fraction of the projected cost to taxpayers.

The Congressional Budget Office put the original 10-year price tag of the program at a whopping $634 billion. Premiums for a standard plan were projected to be $44 by 2009.

CBO recently revised its 10-year estimate of Part D’s cost down to $395 billion. And today, standard plan premiums are $28 — 37 percent less than anticipated.

Seniors have also been tremendously satisfied. Of the more than 25 million seniors enrolled in Medicare Part D in 2008, 87 percent expressed satisfaction with their plans, according to a Harris Interactive Poll. In fact, three-quarters of seniors said that their plan saves them money.

Part D is also lowering health care costs nationally.....

Medicare Part D shows market-based solutions work | ajc.com