A project of the Galen Institute

Issue: "Medicare"

The Secret Committee Behind Our Soaring Health Care Costs

Katie Jennings
Politico
Thu, 2014-08-21
"It was late in the afternoon on a warm Friday in early fall and Doug Sumrell was mowing the lawn outside his suburban home in Evans, Georgia. As he pushed the mower across the yard, Sumrell began to feel faint — his chest tightened and the back of his neck started throbbing — so he went inside to take a break and drink a glass of water. But each time he went outside to finish the job, the feeling came back. He drove himself to the hospital as the sun was setting. On the way there, he left a message for his primary care doctor, Dr. Paul Fischer. At the hospital, a cardiac enzyme test showed Sumrell’s levels were extremely high, a strong indication that Sumrell had experienced a heart attack. The emergency room doctors said that they wanted to admit him, but it was already after midnight and Sumrell’s symptoms had subsided. His wife was out of town and their dog Buddy needed to be let out. Sumrell checked himself out of the hospital. He was jolted awake at 7:30 a.m. by the telephone.

Carondelet to pay $35 million in rehab overbilling case

Modern Healthcare
Wed, 2014-08-20
"Carondelet Health Network, a Tucson, Ariz.-based division of Ascension Health, has agreed to pay $35 million to settle allegations that two of its hospitals inappropriately billed Medicare and other federal health programs for inpatient rehabilitation care. The settlement is the highest amount paid in Arizona under the False Claims Act, according to the U.S. attorney's office in Phoenix. From 2004 to 2011, the Justice Department alleged, the Carondelet hospitals billed the government for inpatient rehab services for patients who didn't meet coverage criteria. The Roman Catholic hospital system “expressly denies” the allegations in the settlement agreement."

Analysis: California's Enrollment Success Is Its Greatest Challenge

Anna Gorman
Kaiser Health News
Thu, 2014-08-14
"California is coming face to face with the reality of one of its biggest Obamacare successes: the explosion in Medi-Cal enrollment. The numbers — 2.2 million enrollees since January — surprised health care experts and created unforeseen challenges for state officials. Altogether, there are now about 11 million Medi-Cal beneficiaries, constituting nearly 30 percent of the state's population. That has pushed the public insurance program into the spotlight, after nearly 50 years as a quiet mainstay of the state's health care system, and it has raised concerns about California's ability to meet the increased demand for health care. Even as sign-ups continue, state health officials are struggling to figure out how to serve a staggering number of Medi-Cal beneficiaries while also improving their health and keeping costs down. Many are chronically ill and have gone without insurance or regular care for years, and some new enrollees have higher expectations than in the past."

Special election will affect debate over Medicaid expansion

Allie Robinson Gibson, Bristol , Va. Herald-Courier
Mon, 2014-08-11
"Medicaid expansion continues to be a hot-button issue in the 38th District Virginia Senate race, as candidates try to define their positions on a subject that has divided the district — and the state — since the seat was vacated unexpectedly earlier this year. The June resignation of former Sen. Phillip Puckett, D-Russell County, threw the balanced Senate into Republican control and affected the Senate vote on whether to expand Medicaid. When he resigned, Puckett said it was because of family reasons — his daughter sought to be a judge and the Senate makes the appointments — but others said it was to accept a job with the Virginia Tobacco Commission, which did not happen. The resignation came just days before the General Assembly voted to pass the budget without Medicaid expansion.

Many Americans can't afford Obamacare: Aetna CEO

Matthew J. Belvedere, CNBC
Mon, 2014-08-11
"The Affordable Care Act—also known as Obamacare—is "not an affordable product" for many people and it does not fix the underlying problems causing high health-care costs, Aetna Chairman and CEO Mark Bertolini told CNBC on Wednesday. "If we're going to fix health care, we've got to get at the delivery of care and the cost of care," Bertolini said in a "Squawk Box" interview. "The ACA does none of that. The only person who's really going to drive that is the consumer and the decisions they make." "Getting everybody insured should probably be our goal, but you have to have a more affordable system," he added. "We have a 1950[-style] health care system in the Unites States." Aetna said Tuesday that its medical spending rose more than estimates in the second quarter, due in part to the higher costs of covering patients who bought insurance under Obamacare for the first time. But the third-largest U.S.

Strong Voter Support Emerges for Patient Choice of Pharmacy in Medicare

B. Douglas Hoey, Morning Consult
Thu, 2014-08-07
"As the backlash over narrow physician networks continues to make headlines and lawmakers start the August recess, a new nationwide survey found 76 percent of likely voters support a bipartisan proposal to give Medicare patients better medication access and more choice of pharmacy. Bait-and-switch. That’s the common refrain expressed by patients in recent articles about the narrow network trend, from Morning Consult to The New York Times to USA TODAY. Patients report either not knowing or being misinformed about restrictions on their access to the doctor of their choice. As a result some are racking up significant, unanticipated out-of-pocket costs. Now both regulators and insurance plans alike are reassessing the situation and contemplating adjustments for 2015. It’s not just doctors, however. Patient access to medication and consultations on its proper use with the pharmacist they know and trust are also suffering.

First Look At Medicare Quality Incentive Program Finds Little Benefit

Jordan Rau, Kaiser Health News
Thu, 2014-08-07
"One of Medicare’s attempts to improve medical quality –by rewarding or penalizing hospitals — did not lead to improvements in the first nine months of the program, a study has found. The quality program, known as Hospital Value-Based Purchasing, is a pillar of the federal health law’s campaign to use the government’s financial muscle to improve patient care. Since late 2012, Medicare has been giving small increases or decreases in payments to nearly 3,000 hospitals based on how patients rated their experiences and how faithfully hospitals followed a dozen basic standards of care, such as taking blood cultures of pneumonia patients before administering antibiotics. As much as 1 percent of their Medicare payments were at stake in the first year and 1.25 percent this year, though most hospitals gained or lost a fraction of that.

What Vox Forgot To Tell You About Medicare: The Future Is Not Nearly As Rosy As Reported

Chris Conover, Forbes
Mon, 2014-08-04
"Did you hear the great news? According to the latest Medicare Trustees report, “Medicare isn’t going bankrupt,” and Vox has a chart to prove it! Not only that, “slow health cost growth has improved Medicare’s financial outlook, extending the program’s trust fund to last until 2030.” That’s four years longer than last year’s forecast! It all sounds great until you hear what Vox unaccountably elected not to tell its readers.

Report Touches Off Fight Over Future Of Doctor Training Program

Julie Rovner, Kaiser Health News
Thu, 2014-07-31
"A high-level report recommending sweeping changes in how the government distributes $15 billion annually to subsidize the training of doctors has brought out the sharp scalpels of those who would be most immediately affected. The reaction also raises questions about the sensitive politics involved in redistributing a large pot of money that now goes disproportionately to teaching hospitals in the Northeast U.S. All of the changes recommended would have to be made by Congress. Released Tuesday, the report for the Institute of Medicine called for more accountability for the funds, two-thirds of which are provided by Medicare. It also called for an end to providing the money directly to the teaching hospitals and to dramatically alter the way the funds are paid. The funding in question is for graduate medical education (GME), the post-medical school training of interns and residents required before doctors can be licensed to practice in any state."

The Medicare Funding Problem Threatening Medicare’s Future

Bob Moffit, The Heritage Foundation
Thu, 2014-07-31
"Medicare’s true cost is the biggest problem in Washington and the one most ignored. The long-awaited 2014 Medicare Trustees report is out, and the “spinning “ is well underway. But the media is not yet reporting another big finding – this one by the Medicare Actuary and revealed on the same day: Taxpayers face a Medicare unfunded liability ranging from $28 trillion to $35 trillion, depending on the most realistic assumptions about the future. In other words, Washington politicians have promised seniors that over the next 75 years (the so-called long-term “actuarial window”) they will receive tens of trillions of dollars of Medicare benefits that are not paid for. It is Washington’s biggest, most expensive and most difficult federal entitlement problem. And it is one most politicians—with a few noble exceptions—continue to ignore."

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