Americans who get health insurance for their families through their jobs have seen their premiums increase 10 times faster than their income in recent years, according to a new analysis of government data. The study, released April 29 by the Robert Wood Johnson Foundation (RWJF), shows that a growing share of workers’ earnings is being absorbed by the increasing cost of health insurance. Nationwide, the amount employees pay for family coverage increased 30 percent from 2001 to 2005, while family policyholders’ incomes increased just 3 percent over the same period. The analysis was conducted by researchers at the University of Minnesota.
The researchers found that the average cost of family coverage increased from $8,281 in 2001 to $10,728 in 2005. The percentage of family premiums that employees pay held steady at about 24 percent. The amount that workers pay for family premiums, on average, increased from $1,921 in 2001 to $2,585 in 2005. Meanwhile, the median income of people who hold family health insurance policies increased just $1,250 during the same period. The average cost that employers pay for their share of family coverage increased 28 percent during the period.
The report is being released during Cover the Uninsured Week, a nonpartisan campaign organized by RWJF to advocate for health coverage for all Americans. Read the report.
The United States faces an impending shortage of generalist physicians to provide primary care for adults, according to a study published April 29 as a Health Affairs web exclusive.
By 2025, the nation will be short 35,000 to 44,000 adult care generalists practicing family medicine and general internal medicine, say researchers from the University of Missouri-Columbia and the Department of Health and Human Services. However, the researchers project an adequate supply of generalist care for children provided by physicians practicing family medicine and general pediatrics.
The researchers make several recommendations to address the impending shortage of adult generalist care that they document. Most important, they say, is modifying reimbursement to foster development of the medical home models put forward in various forms by the generalist physician specialties. The authors also note that shortages could be alleviated if interventions produced four additional generalist graduates in each family medicine and internal medicine residency program annually. Read the abstract.
The Centers for Medicare and Medicaid Services’ (CMS) had added significant information to its Nursing Home Compare web site; for the first time, information about nursing homes on the web site will list whether a home is or has been on CMS’s special focus facility (SFF) list. The agency’s SFF initiative gives heightened scrutiny to nursing homes that have a history of poor performance or repeated violations of state and federal health and safety rules.
The SFF initiative was created because a number of facilities were consistently providing poor quality of care, yet were periodically instituting enough improvement that they would pass one survey only to fail the next (for many of the same problems as before). Such facilities with a “yo-yo” compliance history rarely addressed underlying systemic problems that were giving rise to repeated cycles of serious deficiencies. As of this month, there are 134 SFFs, out of about 16,000 active nursing homes.
Nursing homes that have the SFF designation, including information about that designation, will now be noted on Nursing Home Compare. The web site will be updated with new information quarterly. Read the background information.
The Deloitte Forensic Center reports that complying with federal statutes and regulations continues to get more complex for hospitals. Regulations intended to address perceived abuse of Medicare and Medicaid spending keep growing in scope and in disclosure requirements as public officials strive to address different varieties of healthcare fraud. Regulatory agencies estimate that fraud and self-dealing could be costing Medicare and Medicaid as much as $200 billion per year.
Additionally, last September regulators announced a new information-collection program requiring about 500 hospitals to file comprehensive reports on their contractual relationships with physicians. The program imposes stiff penalties ($10,000 per day) for late filings. Also, there will be much more scrutiny of the contractual relationships that physicians have with hospitals, other health systems, imaging centers, durable medical equipment suppliers, and other health professionals--which will take more careful effort on the part of hospitals and their senior management. The timing of this requirement is still unknown.
To help clarify the issue, the Deloitte Forensic Center prepared a summary of the federal anti-kickback and physician self-referral statutes that have generated a number of government investigations. Read the article.
With its recently released 2008 Leapfrog Hospital Survey, the Leapfrog Group has added a way for hospitals to be certain that their computerized provider order entry (CPOE) prescribing systems are actually catching errors. Developed in partnership with First Consulting Group and the Institute for Safe Medication Practices, Leapfrog’s CPOE evaluation tool enables hospitals to determine how well their system alerts users to common, serious prescribing errors. The 2008 survey requires hospitals to test their CPOE system in order to obtain the survey’s highest CPOE rating.
Risk-adjusted efficiency measures also have been added to the survey to evaluate how efficiently hospitals use resources for coronary artery bypass graft, percutaneous coronary interventions such as angioplasty, acute myocardial infarction, and pneumonia. Among other changes to the 2008 survey, the number of safe practices evaluated was reduced from 30 to 13 to focus on those that have the strongest evidence, are auditable, and are not measured in another way in a different section of the survey.
Hospitals complete the self-administered survey beginning in April; individual results begin to be posted on The Leapfrog Group web site in July. Aggregated and analyzed results are published in the fall, along with the annual Leapfrog Top Hospitals list. Read the summary.
The Robert Wood Johnson Foundation (RWJF) and the American Association of Colleges of Nursing (AACN) announced on April 22 the creation of the RWJF New Careers in Nursing Scholarship Program, designed to alleviate the nation’s nursing shortage by dramatically expanding the pipeline of students in accelerated nursing programs. Scholarships in the amount of $10,000 each will be awarded to 1,500 entry-level nursing students over the next three years. Preference will be given to students from groups underrepresented in nursing or from a disadvantaged background.
Through the program, funding will be available to schools of nursing with entry-level accelerated programs at the baccalaureate and/or master’s degree level(s). By bringing more nurses into the profession at those levels, the new scholarship program also hopes to address the nation’s nurse faculty shortage. Data from the U.S. Health Resources and Services Administration show that nurses entering the profession at the baccalaureate level are four times more likely than other nurses to pursue a graduate degree in nursing, which is the required credential to teach.
AACN will serve as the national program office for this RWJF-funded initiative and will oversee the grant application submission and review processes. Read the press release.
Despite a veto threat from the White House, the House on April 23 voted 349-62 to block the Bush administration from cutting federal spending on Medicaid by $13 billion over the next five years. The vote approves legislation that would delay implementation of seven new Medicaid regulations that the administration said were needed to curb waste and abuse in Medicaid. The legislation would delay those regulations until April 1, 2009. Under the regulations, states could not use federal Medicaid funds to help pay for physician training. The regulations also would place new limits on Medicaid reimbursements to hospitals and nursing homes operated by state and local governments and limit coverage of rehabilitation services for individuals with disabilities and mental illnesses. In addition, the bill would provide $25 million annually for efforts to fight Medicaid fraud, according to The New York Times.
Although the House vote margin was well above the two-thirds needed to override a veto, the legislation must now go to the Senate for a vote.
To achieve significant gains in quality and efficiency, the healthcare delivery system will need fundamental and systemic changes, say healthcare and health policy leaders. Nearly nine of 10 (89 percent) respondents to the latest Commonwealth Fund/Modern Healthcare Healthcare Opinion Leaders Survey agree on the need for fundamental change; only 8 percent said modest changes to the delivery system would be sufficient.
When polled about specific strategies for improving the organization of the system, a large majority of healthcare leaders said that strengthening primary care (90 percent), encouraging care coordination and the management of care transitions (90 percent), and promoting care management of complex patients (88 percent) were very important or important to improving health system performance.
Opinion leaders also voiced strong support for payment reform: 84 percent support providing supplemental payments to primary care providers for delivering comprehensive, coordinated, and accessible care. In addition, 84 percent support incentives for avoiding unnecessary hospitalizations and re-hospitalizations. Download the data brief.
Responding to public requests, the Department of Health and Human Services (HHS) and the Health Resources and Services Administration (HRSA) have extended until May 29, 2008, the comment period on the proposed rule “Designation of Medically Underserved Populations (MUP) and Health Professional Shortage Areas (HPSA).” HRSA extended the comment period in response to concerns that publication of the proposed rule has created misapprehension among health center grantees regarding their ability to meet the proposed MUP/HPSA designation criteria--in particular, their eligibility for current or expanded health center funding opportunities.
The proposed rule is intended to improve the way underserved areas are designated by simplifying and consolidating two processes of determining underserved areas into one, improving the identification of areas of need, and reducing the data reporting burden for obtaining designations. Read the proposed rule.
The Centers for Medicare and Medicaid Services (CMS) on April 17 announced steps it is taking to encourage physicians and other eligible professionals to take part in the Physician Quality Reporting Initiative (PQRI), a program designed to improve the quality of care provided to Medicare beneficiaries. These steps, including a variety of new reporting options, are intended to make it easier for eligible professionals to participate and receive feedback on their performance.
In late 2007, Congress authorized PQRI transitional bonus incentive payments in 2008. Also, in addition to submitting PQRI measure data as part of their Medicare claims submissions, eligible professionals may report data on quality measures to a medical registry, and these registries will then report that data to CMS.
Besides providing new flexibility for submitting data, registry-based reporting will provide more ways for eligible professionals to qualify for an incentive payment. Another change will be new PQRI reporting periods for eligible professionals who report using measures groups. Read the overview.
Providers that order, refer, or supply certain medical equipment and supplies, such as oxygen or power wheelchairs, need to know about a new Medicare program that may change the suppliers their patients will need to use.
The new program will begin July 1, 2008, in 10 geographic areas around the country, including Charlotte-Gastonia-Concord, N.C.-S.C.; Cincinnati-Middletown, Ohio-Ky.-Ind.; Cleveland-Elyria-Mentor, Ohio; Dallas-Fort Worth-Arlington, Texas; Kansas City, Mo.-Kan.; Miami-Fort Lauderdale-Miami Beach, Fla.; Orlando-Kissimmee, Fla.; Pittsburgh; Riverside-San Bernardino-Ontario, Calif.; and San Juan-Caguas-Guaynabo, P.R. The program will expand to 70 additional areas in 2009 and to additional areas thereafter.
Patients who live in or travel to one of these 10 designated areas must now get equipment or supplies that fall within 10 product categories from a Medicare-contracted supplier. Providers are highly encouraged to provide their patients with the Medicare fact sheet entitled “What You Should Know if You Need Medicare-Covered Equipment or Supplies.”
Primary care physicians treating a disproportionate share of black and Latino patients typically earn less, see more patients, provide more charity care, treat more Medicaid patients, and receive lower private insurance payments than their counterparts who treat fewer such patients, according to a national study funded by the Commonwealth Fund and published April 22 as a web exclusive in Health Affairs.
These same physicians also reported more problems providing high-quality care, ranging from inadequate time with their patients to difficulty obtaining specialty care. The study found that 35 percent of physicians in high-minority practices reported that patients’ inability to pay was a major barrier to providing high-quality care, compared with 23 percent of physicians in low-minority practices.
Conducted by researchers at the Center for Studying Health System Change, the study sheds new light on the pervasive racial and ethnic health disparities in the United States by looking beyond individual patient characteristics to community and physician practice resources. The study also examined how higher Medicaid payments might help physicians treating mostly minority patients provide high-quality care and reduce racial and ethnic disparities. Read the abstract.
The Centers for Medicare and Medicaid Services (CMS) on April 21 proposed a rule that will improve the accuracy of payment for services furnished to people with Medicare who need the intensive rehabilitation services provided by inpatient rehabilitation facilities (IRFs). CMS is proposing to apply a zero percent increase factor for IRF payment rates for FY09. As a result, CMS expects to spend roughly $5.6 billion in FY09 and approximately $30 billion in the next five years for IRF services.
The proposals are intended to improve the accuracy of Medicare payments for these services by recalculating the rates using more recent information from rehabilitation hospitals about the costs they have incurred in treating patients. The proposal would implement policies for FY09 requiring that 60 percent of a facility’s patient population have one of 13 specified qualifying conditions and allowing facilities to count patients whose principal reason for needing inpatient rehabilitation services is not one of the specified conditions, but whose treatment is complicated by the presence of one of the 13 conditions as a secondary diagnosis.
Comments on the proposed rule are due by June 20, 2008; the final rule will be published on or before Aug. 1, 2008. Download the proposed rule.
Sens. John D. (Jay) Rockefeller IV (D-W.V.) and Olympia Snowe (R-Maine) on April 18 released legal opinions from the nonpartisan Government Accountability Office (GAO) and Congressional Research Service (CRS), both of which indicate that the Aug. 17 State Children’s Health Insurance Program (SCHIP) “directive” is in fact a rule for purposes of the Congressional Review Act and, therefore, in violation of the statutory requirements for congressional notice and review.
At the request of the two senators, GAO and CRS were asked to provide their independent legal analyses of the directive issued last year by the Centers for Medicare and Medicaid Services (CMS). The directive mandates that states achieve 95 percent enrollment of children in families earning less than 200 percent of the poverty level before they can seek to enroll additional low-income children in families earning more than 250 percent of the poverty level.
“Rather than working with Congress and the governors in an open, cooperative, and transparent manner, CMS chose to circumvent the rules and go their own way,” said Snowe. “As we can see from the opinions released today, this is clearly the wrong approach.” Read the hearing testimony. Read the GAO legal opinion. Read the CRS legal opinion.
Citing the fact that the Centers for Medicare and Medicaid Systems (CMS) is “flying in the face” of the original intent of the National Provider Identifier (NPI) final rule, the National Uniform Billing Committee (NUBC) wrote to Health and Human Services Secretary Michael Leavitt on April 16 to ask for a six-month extension of the May 23, 2008, NPI enforcement deadline.
As of that date, healthcare providers can no longer use legacy identifiers when submitting claims; instead they must use only the NPI. However, the NUBC points out that CMS made a significant change to its requirements only last week. Rather than being allowed to use a single NPI for their primary facility and its subparts (psychiatric unit, rehab unit, etc.), providers are now being “strongly encouraged” to obtain distinct NPIs for each of their facility subparts.
The NUBC believes that six extra months are needed to allow providers to complete the work necessary to ensure accurate mapping of these additional NPIs to legacy numbers. Read the letter.
Emergency department (ED) visits by the uninsured in Oregon underwent an “abrupt and sustained” increase after the state’s Medicaid program made substantial cuts of more than 50,000 beneficiaries in 2003, report researchers in the April issue of Annals of Emergency Medicine.
The researchers studied hospital billing data on more than 2.5 million visits to 26 Oregon EDs, sampled up to two years before and two years after the cutbacks. They found that, after the policy changes, ED visits by the uninsured increased from 6,682 per month in 2002 to 9,058 per month in 2004. However, Medicaid and commercially insured visits decreased, resulting in a slight decrease in overall ED visits. Read the article.
CMS on April 17 announced grants of $50 million to 20 states to help improve access to primary medical care so that Medicaid beneficiaries could avoid improper use of costly hospital emergency departments. Created by the Deficit Reduction Act of 2005 (DRA), the grants will help Medicaid programs fund local and rural initiatives to provide alternative healthcare settings for individuals with nonemergency medical needs.
The DRA provided $50 million to be distributed over four years (2006-09) for primary healthcare programs, primarily in rural and/or other underserved areas as well as programs that work closely with community hospitals.
Grantees will use the funds to establish new community health centers, extend the hours of operation at existing clinics, educate beneficiaries about new services, and provide for electronic health information exchange between facilities for better coordination of care. Read the CMS overview.
As the post-9/11 spotlight on shoring up the nation’s public health system fades, local health departments face a mounting workforce crisis as they struggle to recruit, train, and retain qualified workers ranging from nurses to epidemiologists, according to a research brief released April 16 by the Center for Studying Health System Change. Factors influencing the workforce shortage include inadequate funding, uncompetitive salaries and benefits, an exodus of retiring workers, insufficient supply of trained workers, and lack of enthusiasm for public health as a career choice, according to the brief, Public Health Workforce Shortages Imperil the Nation’s Health.
Shortages of critical personnel and deficits in key skill areas ranged from significant to severe across public health agencies in each of the six communities, with general agreement that public health nurses are the most difficult personnel to recruit and retain, according to the study. Read the research brief.
Former U.S. Senate majority leaders Howard Baker, Tom Daschle, Bob Dole, and George Mitchell announced on April 16 the launch of the Bipartisan Policy Center’s Leaders’ Project on the State of American Health Care. The project is an effort to produce politically viable policy recommendations to address the delivery, cost, coverage, and financing challenges facing the nation’s healthcare system. “All four of us have seen many legislative battles over health care in our careers. The time has come to put aside partisanship and put forward solutions,” said Dole.
The project is centered on a series of forums that will take place throughout 2008, each hosted by one of the four leaders. The first phase of the project will culminate with the release of a report to the public, Congress, and the administration that will include recommendations for reforming healthcare coverage and delivery. The second phase of the project will involve the leaders advocating their recommendations to key decision makers.
The first of the policy forums will be held on April 24, 2008, in Washington, D.C. The event will be chaired by Daschle and will focus on improving the quality and value of health care. Access the web site.
Inspector General Daniel R. Levinson issued an open letter to healthcare providers on April 15 announcing that the Office of Inspector General (OIG) for the Department of Health and Human Services has refined the requirements of the OIG provider self-disclosure protocol, under which healthcare providers can voluntarily report fraudulent conduct affecting Medicare, Medicaid, and other federal healthcare programs. According to the letter, providers who disclose in good faith, fully cooperate with OIG, and provide requested information in a timely manner will generally not be required to enter into corporate integrity or certification of compliance agreements with OIG.
The letter also sets forth four additional self-disclosure submission requirements and emphasizes OIG’s commitment to streamline its internal process for self-disclosure case resolution. Read the letter.
A new web resource that allows users to learn, share, and adopt innovations in the delivery of health services was launched April 14 by the Agency for Healthcare Research and Quality. The resource, called the Health Care Innovations Exchange, is the federal government’s repository for successful healthcare innovations. It also includes useful descriptions of attempts at innovation that failed.
The web site is being launched with 100 examples of innovations in the delivery of healthcare services and attempts at innovation; that number will increase as the site is updated every two weeks. Profile examples include an initiative by geriatricians, nurse practitioners, and social workers to help seniors avoid institutional care by visiting seniors at home, and a patient/physician e-mail communication system that overcomes the inconvenience of automated phone systems and accommodates the difficult schedules of both the physician and the patient. Access the web page.
Relatively few uninsured households have enough financial assets to cover the cost sharing in consumer-directed health plans tied to health savings accounts (HSAs), according to a new study by Kaiser Family Foundation researchers published April 15 as a Health Affairs web exclusive.
The new study analyzes the asset levels of households with two or more uninsured members in 2004 and compares it with the range of cost-sharing features in HSA-qualified health plans in that year. The results show that most uninsured households do not have overall financial assets great enough to cover the HSA deductible if they get sick. For example, about 33 percent of households with at least two uninsured members had gross financial assets of at least $2,000, the minimum deductible for an HSA-qualified family plan in 2004, and only 9 percent had enough of these assets to cover the out-of-pocket maximum ($10,000).
The analysis is based on the 2004 Survey of Consumer Finances, a nationally representative household survey conducted by the Federal Reserve Board every three years. Read the abstract.
In the face of sobering reports of highly variable healthcare delivery across the nation, as reported in the Commonwealth Fund Commission on a High Performance Health System’s State Scorecard, nine states have been selected to participate in the State Quality Improvement Institute--an intensive effort to help states plan and implement concrete action plans to improve performance across targeted quality indicators. The institute is a collaboration of AcademyHealth and The Commonwealth Fund.
Colorado, Kansas, Massachusetts, Minnesota, New Mexico, Ohio, Oregon, Vermont, and Washington were selected for the institute through a competitive process designed to identify states with the commitment, leadership, and resources necessary. The institute kicks off in April 2008 and concludes in spring 2009.
“Our State Scorecard on Health System Performance found that we could save thousands of lives and billions of dollars if all states could achieve the level of the top performers on key indicators of health outcomes, quality, access, efficiency, and equity,” said Commonwealth Fund President Karen Davis. “The State Quality Institute will allow states to learn best practices to improve healthcare quality, and is an important step toward achieving a high-performing healthcare system in the U.S.” Read the press release.
Medicare payment rates for inpatient hospitals for FY09 are estimated to increase by nearly $4 billion, according to a proposed rule issued by the Centers for Medicare and Medicaid Services (CMS) on April 14. Based on current data (the actual adjustment will use the most recent data available when the final rule is published), the market basket update will be 3.0 percent for hospitals meeting quality measure submission requirements (the few not submitting quality measures will have that update reduced to 1.0 percent). The outlier threshold (which also could be affected by data changes between now and when the rule is finalized) proposed is $21,025, down from the current $22,185.
The agency is also proposing additional steps to strengthen the tie between the quality of care provided to Medicare beneficiaries and payment for the services provided when they are in the hospital.
CMS is proposing to expand the list of conditions that are reasonably preventable through proper care and for which Medicare will no longer pay at a higher rate if the patient acquires them during a hospital stay. In addition, CMS is adding 43 new quality measures for which hospitals will have to report data to receive the full annual payment update for their services. The proposed rule would apply to services provided to patients who are discharged from the hospital during FY09, which begins on Oct. 1, 2008.
Also included in the CMS physician-related proposals are revisions to the self-referral rules, which would modify the physician self-referral “stand in the shoes” provisions in the definition of indirect compensation arrangements to:
The rule would apply to more than 3,500 acute care hospitals paid under the inpatient prospective payment system. Comments on the proposed rule are due by June 13. Read the press release.
As the first of the nation’s 78 million baby boomers begin reaching age 65 in 2011, they will face a healthcare work force that is too small and woefully unprepared to meet their specific health needs, says a new report from the Institute of Medicine. The report, Retooling for an Aging America: Building the Health Care Workforce, calls for new initiatives, including training all healthcare providers in the basics of geriatric care and preparing family members and other informal caregivers, who currently receive little or no training in how to tend to their aging loved ones. Medicare, Medicaid, and other health plans should pay higher rates to boost recruitment and retention of geriatric specialists and care aides, said the committee that wrote the report.
The committee set a target date of 2030--the year by which all baby boomers will have turned 65 or older--for the necessary reforms to take place.
Healthcare workers should be required to demonstrate competence in basic geriatric care to maintain their licenses and certifications, recommends the report. Also, it calls on the healthcare professions and regulators to consider expanding the roles and responsibilities of healthcare providers at various levels of training, and recommends that the federally required minimum number of hours of training for direct-care workers be raised from 75 to at least 120. Read the report.
Between 1996 and 2006, the number of uninsured children in families with income between 100 percent and 200 percent of the poverty level fell 25 percent, according to testimony by Peter Orszag, director of the Congressional Budget Office. Orszag attributes the drop to the State Children’s Health Insurance Program (SCHIP).
The states’ outreach efforts and simplified enrollment processes for SCHIP appear to have also increased the share of eligible children who participate in Medicaid--and contributed to a decline in the percentage of children below the poverty level who are uninsured, said Orszag, in testimony before the Subcommittee on Health Care of the Senate Finance Committee on April 9.
Orszag admitted there has been some displacement, or “crowd out,” of private coverage. The enrollment of children in public coverage as a result of SCHIP has not led to a one-for-one reduction in the number of low-income children who are uninsured, however; on the basis of a review of the research literature, CBO has concluded that for every 100 children who gain public coverage as a result of SCHIP, there is a corresponding reduction in private coverage of between 25 and 50 children. Read the testimony.
Medicare pays many hospitals and their physicians more than the most efficient and effective healthcare institutions to treat chronically ill people, yet gets worse results, according to a new report from the Dartmouth Institute for Health Policy and Clinical Practice. This problem is particularly serious because caring for people with chronic disease now accounts for more than 75 percent of all healthcare spending.
The new edition of the Dartmouth Atlas of Health Care, Tracking the Care of Patients with Severe Chronic Illness, shows that institutions that give better care can do it at a lower cost because they don’t overtreat patients. Getting usage under control is the most critical factor in controlling costs, says the report. The researchers, for instance, discovered great variations in the number of services that patients with severe chronic disease receive at the end of life, depending on the hospital, region, or state--and not on how sick they are.
For example, an elderly person spent an average 10.6 days in the hospital during the last two years of life in Bend, Ore., but 34.9 days in Manhattan. The variation is even more striking in the last six months of life, when chronically ill patients visited physicians an average of 14.5 times in Ogden, Utah, compared with 59.2 times in Los Angeles.
That creates wide variations in how much Medicare spends on these patients. The U.S. average was $46,412. The highest spending was in New Jersey at $59,379 per patient, or a quarter more than the average. The lowest was in North Dakota at $32,523 per patient, or a quarter less than the average. Download the report.
In 2002, a study by the Institute of Medicine of the National Academy of Sciences demonstrated the direct link between a lack of health coverage and deaths from health-related causes. Drawing on that study, Families USA, a national organization for healthcare consumers, on April 8 made available reports for all 50 states that show how many people are expected to die in each state each week because they don’t have health coverage. A separate report is also available for the District of Columbia.
Among the figures cited is the fact that more than seven working-age Texans die each day due to a lack of health insurance. Other reports reveal that, on average, approximately 960 people in Illinios died in 2006 because they had no health coverage, and nearly 9,900 uninsured New Yorkers between the ages of 25 and 64 died in the years 2000 to 2006.
In its 2002 report, the Institute of Medicine estimated that 18,000 adults nationwide died in 2000 because they did not have health insurance. That estimate was later updated by the Urban Institute, which reported that at least 22,000 adults died in 2006 due to a lack of health insurance.
“The conclusions are sadly clear,” said Ron Pollack, executive director of Families USA, “that a lack of health coverage is a matter of life and death for many people.” Access the state reports.
The rise in emergency department (ED) visits between 1996 and 2003 cannot be primarily attributed to the uninsured, according to a study report published in the April issue of Annals of Emergency Medicine. Instead, major contributors to increasing ED utilization appeared to be a rise in use by nonpoor patients and by patients whose usual source of care is a physician’s office.
Those were among the surprising findings of a study by University of California, San Francisco, researchers who examined national Community Tracking Study Household Surveys. Their analysis revealed that, while the proportion of adult ED visits by the uninsured was stable across that period of time, the proportion of visits by patients whose family income was greater than 400 percent of the federal poverty level increased from 21.9 percent to 29.0 percent. Also, the proportion of ED visits by those whose usual source of care was a physician’s office increased from 52.4 percent in 1996-97 to 59.0 percent in 2003-04.
“Together, these findings suggest that the rise in ED use is disproportionately due to nonpoor individuals who have a usual source of health care,” write the researchers. “These findings have significant implications for current policy discussions because they suggest that the provision of health insurance will not, in and of itself, address issues of ED crowding or the more general issues of access to, and appropriateness of, healthcare services.” Read the article.
Patient safety incidents cost the federal Medicare program $8.8 billion and resulted in 238,337 potentially preventable deaths during 2004 through 2006, according to HealthGrades’ Fifth Annual Patient Safety in American Hospitals Study.
HealthGrades’ analysis of 41 million Medicare patient records found that patients treated at top-performing hospitals had, on average, a 43 percent lower chance of experiencing one or more medical errors compared to the poorest-performing hospitals.
The overall incident rate was approximately 3 percent of all Medicare admissions evaluated, accounting for 1.1 million patient safety incidents during the three years studied. With the Centers for Medicare and Medicaid Services scheduled to stop reimbursing hospitals for the treatment of eight major preventable errors, including objects left in the body after surgery and certain post-surgical infections, starting Oct. 1, the financial implications for hospitals are substantial. Download the report.
The Centers for Medicare and Medicaid has announced the annual Medicare Advantage (MA) capitation rate and MA and Part D payment policies for each MA payment area for CY09, and the risk and other factors to be used in adjusting such rates.
The final estimate of the increase in the national per capita MA growth percentage for combined aged and disabled beneficiaries is 4.24 percent. These growth rates will be used as the minimum update percentage in calculating the 2009 rates, except for the end-stage renal disease state rates, which are subject to a 2 percent minimum increase.
Also, the county fee-for-service (FFS) rates for 2009 were rebased. MA capitation rates in 2009 will be based on the higher of the county FFS per capita amount or a minimum percentage increase over the 2008 rate. Access the MA web page.
The IRS is seeking public comments on its draft instructions for the redesigned Form 990 that organizations will file for their 2008 tax year (returns filed in 2009), which was released in final form in December 2007.
The IRS is seeking comments in an effort to ensure that the final instructions address the needs of the tax-exempt community. The comment period is open until June 1, 2008.
HFMA has joined with the American Health Lawyers Association, VHA, and the Catholic Health Association to establish a web site that will provide resources to hospitals and their staff responsible for the submission of the form, as well as legal and accounting professionals providing advisory services related to its completion. The web site link will be announced in the coming days. Key among the resources will be annotated versions of the form and the draft instructions. Those preparing comments to the IRS should find the annotations very helpful; they will also be a “must read” for those initiating processes and procedures to ensure proper completion of the form with its new Schedule H for hospitals. Read the press release.
As the United States debates health reform, the Dutch and German health systems have been increasingly put forward as potential models. These nations have achieved universal coverage through competition among nongovernmental insurers within a governing regulatory framework, along with government subsidies for those with low incomes.
In interviews conducted in November and published April 8 on the Health Affairs web site, the health ministers from the Netherlands and Germany discuss their systems with three respected U.S. health policy analysts. Dutch minister of public health, well-being, and sport Ab Klink talks with Alain Enthoven, the Marriner S. Eccles Professor of Public and Private Management Emeritus at the Stanford University Graduate School of Business. German minister of health Ulla Schmidt speaks with Tsung-Mei Cheng, the host and executive editor of the International Forum at Princeton’s International Center, and Uwe Reinhardt, the James Madison Professor of Political Economy at Princeton’s Woodrow Wilson School of Public and International Affairs.
Both Klink and Schmidt highlight efforts their countries are making to increase competition in their health systems. For example, Klink tells Enthoven: “Competition now is especially at the level of the insurance companies. Still, many of the prices for care are fixed by the Dutch government. What we are trying to do in the coming years is to free prices, on the one hand, and to make insurance polices transparent, so that these two issues form pillars of the competition that we want to achieve.”
The Centers for Medicare and Medicaid Services (CMS) announced April 7 that nearly $36 million will be distributed to State Health Insurance Assistance Programs (SHIPs) to help Medicare beneficiaries get more information about their healthcare choices.
The nearly $36 million being distributed to the SHIPs is the first installment of more than $50 million that will be provided to them in 2008. This $20 million increase in funding over FY07 reflects more than $39 million in regular SHIP grants, performance-based grants to be awarded in September, and SHIP support, as well as an additional $15 million in supplemental funding that will be distributed on June 1.
CMS expects the SHIPs to use the increased 2008 funding to conduct targeted community-based outreach to an increasing number of beneficiaries who may be unable to access other sources of information. Read the press release.
As more Americans worry about a slowing economy, a new study highlights the important role hospitals play in supporting a strong and stable economy. Hospitals employ more than 5 million people and rank second as a source of private sector jobs, according to a TrendWatch report released April 7 at the American Hospital Association’s (AHA) annual meeting in Washington.
The new report, Beyond Health Care: The Economic Contribution of Hospitals, found that hospitals:
Also included is a detailed state-by-state analysis of the economic contributions hospitals make to the communities they serve. Read the report.
Both very small firms (fewer than 25 employees) and very large firms (more than 100 employees) have greater health insurance burdens than do medium-sized firms (25 to 99 employees).
That unexpected finding was revealed in a study of trends in the economic burden associated with health insurance provision for small and large businesses during 2000-05, conducted by researchers from the Kauffman-RAND Institute for Entrepreneurship Public Policy. Their research brief--Is the Economic Burden of Providing Health Insurance Greater for Small Firms Than for Large Firms?--was published on the RAND web site April 3.
Firms with fewer than 25 employees spent 11 percent of payroll on health insurance, and firms with 100 or more employees spent 10 percent. On the other hand, firms with 25-49 employees spent only 7 percent. The researchers found no evidence that either small or large firms dropped coverage during the period studied. The analysis did reveal that smaller firms offer health coverage of slightly lower quality than that offered by larger firms. Read the research brief.
A growing body of research is supporting what has long been a concern in health care: that physician ownership of hospitals may influence their referral decisions. That is the conclusion of a new American Hospital Association TrendWatch report, Physician Ownership and Self-referral in Hospitals: Research on Negative Effects Grows, released April 2.
According to the report, other negative impacts of physician hospital ownership include the fact that specialty hospitals focus on more profitable services, are associated with higher utilization, and serve fewer high-acuity, low-income, and uninsured patients--resulting in lost revenue to community hospitals. Citing the fact that 57 percent of physician-owned hospitals had margins at or above 10 percent in FY06 (as opposed to just 17 percent of other acute care hospitals with such margins), the report points out that these gains contribute to increasing systemwide health costs. Read the report.
Trust for America’s Health (TFAH) released a new study April 2 that finds Midwestern states receive less funding from the U.S. Centers for Disease Control and Prevention (CDC) than other states, at an average of $16.24 per person. Southern states receive the most CDC funding, with an average of $29.40 per person.
The new analysis, Shortchanging America’s Health: A State-by-State Look at How Federal Public Health Dollars Are Spent--2008, reviews key health statistics and federal funding for public health on a state-by-state level.
Federal funding for disease and injury prevention programs in states averages out to be $17.23 per person for FY07. However, CDC funding for individual states can vary by more than $56 per person, according to the analysis. Alaska receives more than any other state from the CDC at $69.76 per person. Kansas receives the least, at $13.61 per person. Download the report.
A study report released last week by the Center for Studying Health System Change (HSC).suggest that although consumer-directed health plans (CDHPs)--typically a high-deductible health plan accompanied by either a health reimbursement arrangement (HRA) or health savings account (HSA)--are being offered by a growing number of employers, enrollment in these products constituted just 5 percent of total enrollment in employer-sponsored health plans in 2007.
“There’s a lot of window shopping going on with consumer-directed health plans, and there’s a lot of watchful waiting to see how early adopters fare,” said Paul B. Ginsburg, PhD, president of HSC.
The study’s findings are detailed in a new HSC issue brief, Consumer-Directed Health Plans: Mixed Employer Signals, Complex Market Dynamics. Among the issues that might be contributing to the low enrollment in CDHPs, said the report, is the fact that some employers believe that CDHPs, especially tied to HSAs, are difficult for some employees to understand and require extensive employee education when offered. Also, some employers perceive the portability of HSAs as a negative feature, especially in industries with high employee turnover. These employers respond by contributing little or nothing to the account or by offering an HRA instead. Read the issue brief.
A new regulation issued April 2 by the Centers for Medicare and Medicaid Services (CMS) establishes Part D e-prescribing standards for four types of information: formulary and benefits, medication history, fill status notification, and identification of individual healthcare providers.
Prescribers, dispensers, and other providers are not required to implement e-prescribing, but those who do must comply with the new Medicare standards when using e-prescribing to send prescriptions and prescription-related information for covered drugs prescribed for Part D eligible individuals.
The rule will (1) allow physicians and other prescribers to communicate with Part D sponsors about which drugs are covered by a Medicare-eligible individual’s prescription drug benefit plan and which generic prescription drugs might offer lower-cost options for the individual; (2) allow physicians and other providers, as well as dispensers and Part D sponsors, to communicate among themselves about a beneficiary’s prescription history, which should help reduce the number of adverse drug events; (3) allow physicians and other providers to receive e-mail fill status notifications; and (4) require providers, dispensers, and Part D sponsors to use the National Provider Identifier (NPI) to identify individual healthcare providers in Part D e-prescribing transactions.
The new e-prescribing standards will be effective on April 1, 2009. Read the overview.
Medicaid beneficiaries who were previously limited to receiving care in an institutional setting may now be given the option to receive that care in their homes and communities, under a proposed rule announced April 1 by the Centers for Medicare and Medicaid Services (CMS).
Previously, to qualify for assistance with personal care, home health care, or other services in the home or community setting, beneficiaries were required to be at imminent risk of institutionalization. A Deficit Reduction Act provision eliminates this requirement and allows states to cover Medicaid recipients who have incomes no greater than 150 percent of the federal poverty level, or $15,600 per individual in 2008, and who satisfy the needs-based criteria.
The proposed rule will be published in the Federal Register tomorrow, and will have a public comment period through June 3, 2008. Download the proposed rule.
Consumer, employer, and labor organizations on April 1 announced a comprehensive national agreement with leading physician groups and health insurers on principles to guide how health plans measure physician performance and report the information to consumers.
The “Patient Charter for Physician Performance Measurement, Reporting, and Tiering Programs” creates a national set of principles to guide measuring and reporting to consumers about physician performance. The accord is a step toward patient-centered health reform that gives patients reliable information that will help them make informed choices.
The health plans that adopt the Patient Charter are agreeing to a standard set of principles for performance measurement and reporting and to have their consumer reports assessed by an independent review organization. The agreement was spearheaded by the Consumer-Purchaser Disclosure Project, a group of consumer, labor, and employer organizations that works to ensure that all Americans have access to publicly reported healthcare performance information. Read the press release.
Reflecting a shift in thinking over the past five years among U.S. physicians, a new study shows that over half of them--59 percent--now support national health insurance. The findings reflect an increase of 10 percentage points in physician support for national health insurance (NHI) since 2002, when a similar survey was conducted.
According to a study report published in the April 1 issue of Annals of Internal Medicine, an Indiana University survey conducted last year of 2,193 physicians across the United States showed 59 percent of them “support government legislation to establish national health insurance,” while 32 percent oppose it and 9 percent are neutral.
Support for NHI is particularly strong among psychiatrists (83 percent), pediatric subspecialists (71 percent), emergency medicine physicians (69 percent), general pediatricians (65 percent), general internists (64 percent) and family physicians (60 percent). Fifty-five percent of general surgeons support NHI, roughly doubling their level of support since 2002. Read the report (subscription required).
Health Management Associates, Inc. (HMA) announced it has sold a 27 percent minority interest in its seven hospitals located in North and South Carolina to Novant Health for $300 million. The parties completed the transaction on March 31, 2008.
HMA and Novant will share governance of the joint venture through a partnership board; HMA will continue to manage the hospitals on behalf of the joint venture. Over a four-month transition period, Novant will assume ownership and operation of the hospitals’ employed physician practices, which HMA will subsidize partially for the first three years if necessary.
Novant Health is a not-for-profit group of hospitals and physician clinics that includes nine hospitals, an 830-physician medical group, two nursing homes, and 130 outpatient facilities. For-profit HMA owns and operates 58 hospitals, with approximately 8,300 licensed beds, in non-urban communities located throughout the United States. Read the press release.
Schizophrenia patients in Maine’s Medicaid program were subjected to more frequent interruptions in treatment when the state began requiring physicians to seek prior authorization (PA) or follow a step-therapy algorithm before prescribing certain schizophrenia medications not on the program’s preferred drug list, researchers report in a Health Affairs web exclusive published April 1.
Maine’s PA policy, which was in effect for eight months in 2003 and 2004 and covered patients newly receiving one of a class of drugs known as atypical antipsychotics (AAs), increased the number of patients starting on preferred drugs within this class. However, many patients experienced treatment gaps or other treatment disruptions, which suggests that they responded poorly to the preferred drug they were initially prescribed. In the end, the PA policy appeared to do a poor job of lowering Maine’s cost of treating patients with schizophrenia, report the researchers.
The researchers say their results raise concerns about the burgeoning number of PA programs for antipsychotic medications. All told, 40 percent of state Medicaid programs, as well as one-third of Medicare Part D prescription drug plans, restrict the prescription of AAs through PA requirements. Read the abstract.
According to Moody’s Investors Services most recent special comment on the company’s preliminary FY07 median ratios for not-for-profit hospitals, the medians indicate that financial measures for hospitals remain sound, although key volume measures and revenue growth continue to moderate.
This could be suggesting that operating pressures may result in more stressed bottom-line results in the near future. Consequently, the service expects the full year FY07 medians to be weaker than the preliminary medians data presented in the March 2008 special comment. The service also suggests that the multi-year improvement in liquidity could end or taper off this year due to weaknesses in both equity and fixed income markets.
For more information, call (212) 553-4431.
The Centers for Medicare and Medicaid Services (CMS) announced on March 28 that it has posted new survey information at the Hospital Compare consumer web site.
In addition to adding the new information from Medicare patients about their hospital stays, CMS is adding information about the number of certain elective hospital procedures provided to those patients and what Medicare pays for those services. The Hospital Compare web site currently provides information on 26 quality measures, which include process of care and outcome measures. The addition of the 10 new patient experience of care topics is intended to give consumers a better picture of the quality of care delivered at their local hospitals. Access the web site.
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