Wednesday, May 6, 2009

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

By TOM MURPHY , 05.05.09, 04:34 PM EDT

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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

Tuesday, May 5, 2009

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

Monday, May 4, 2009

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

Saturday, May 2, 2009

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

Friday, May 1, 2009

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