A project of the Galen Institute

Issue: "Quality/Access"

Medicare Limbo: A Question Seniors Need To Ask If They're In The Hospital

Northwestern Mutual team
Forbes magazine
Wed, 2014-08-27
"Bill Jacobs spent four nights in a hospital in Florida battling pneumonia. His kids visited each day, fluffed his pillows, brought his favorite Sudoku puzzles and got regular updates from his nurses and doctors. Imagine their surprise when they found out that their 86-year-old father was never actually admitted; instead, he was treated as an outpatient under what Medicare refers to as “observation status.” What difference does that make? Actually, more than you might think. If your parents are on Medicare, the difference between being considered an inpatient or an observation patient could be thousands of dollars out of their pocket, if not more. First, Medicare Part A will cover all hospital services, less the deductible, but only if you’re admitted to the hospital as an inpatient. The one-time deductible covers all hospital services for the first 60 days in the hospital. Doctors’ charges are covered under Medicare Part B.

When Medical Care Is Futile, Other Patients Pay The Hidden Price

Richard Knox
WBUR
Wed, 2014-08-27
"Every day in intensive care units across the country, patients get aggressive, expensive treatment their caregivers know is not going to save their lives or make them better. California researchers now report this so-called “futile” care has a hidden price: It’s crowding out other patients who could otherwise survive, recover and get back to living their lives. Their study, in Critical Care Medicine, shows that patients who could benefit from intensive care in UCLA’s teaching hospital are having to wait hours and even days in the emergency room and in nearby community hospitals because ICU beds are occupied by patients receiving futile care.

Cover Oregon: At least 2,000 Oregonians need to change coverage due to health exchange errors

Nick Budnick, The Oregonian
Wed, 2014-08-27
"Cover Oregon will hold a special open enrollment period for 1,400 Oregonians who were incorrectly enrolled into the low-income Oregon Health Plan by the state's troubled health insurance exchange. Starting Aug. 31, the people affected will have no coverage through the OHP, the state's version of Medicaid. However, they will have the option to sign up for coverage from private insurers and to qualify for tax credits through Cover Oregon to bring down premiums. Meanwhile, Cover Oregon is contacting at least 700 people who should have been enrolled in the Oregon Health Plan, but were incorrectly enrolled in a commercial health plan instead. If they were receiving tax credits for private plans, those will go away immediately, though they can keep their plan. Cover Oregon is currently negotiating with the federal government over whether those people will have to refund to the IRS all the tax credits they received incorrectly, said Amy Fauver, Cover Oregon communications director.

Pharma tells the Federal Government: Transparency Works Both Ways

Peter Loftus
Wall Street Journal
Wed, 2014-08-27
"File this under ‘how ironic.’ Drug makers are asking for more transparency from the government agency that is requiring them to be more transparent about how much they pay doctors. The Pharmaceutical Research and Manufacturers of America, or PhRMA, is calling on the Centers for Medicare and Medicaid Services to further explain why the agency has removed one-third of the payment information from an online database that is due to be made public by Sept. 30. Earlier this month, CMS said it would withhold about one-third of the payment data from the so-called “Open Payments” system. The agency also said it would return the records to drug makers because they were “intermingled,” including the erroneous linking of payment information for some doctors to still other doctors with similar names.

Universities nationwide limit student employment to comply with Obamacare

Caleb Bonham, Campus Reform
Wed, 2014-08-27
"Middle Tennessee State University (MTSU) is restricting student work because of compliance issues associated with the Affordable Care Act (ACA), commonly known as Obamacare. In an email last week, MTSU President Sidney McPhee explained that “due to our interpretation of the reporting requirements of ACA,” graduate assistants, adjunct faculty members, and resident assistants are barred from working on-campus jobs that exceed 29 hours of work per week. "[E]ffective beginning with the fall semester, we will no longer allow part-time employees, or those receiving monthly stipends from the university, to accept multiple work assignments on campus." Tweet This Now, they cannot take on multiple campus jobs. “[E]ffective beginning with the fall semester, we will no longer allow part-time employees, or those receiving monthly stipends from the university, to accept multiple work assignments on campus," the email stated. McPhee noted that violations of the law “could add up as high as

Hospitals squeezed as revenue growth slows to all-time low

Beth Kutscher, Modern Healthcare
Wed, 2014-08-27
"Revenue at not-for-profit hospitals grew at an all-time low of 3.9% last year with sluggish gains in both inpatient and outpatient activity, according to a report on 2013 medians from Moody's Investors Service. In comparison, hospital revenue increased 5.1% in 2012 and historically has grown about 7% per year. Moody's pegged the increased popularity of high-deductible health plans for leading people to postpone care or seek out lower cost retail clinics. “Patients have more skin in the game,” said Jennifer Ewing, an analyst at Moody's. The volume decline also is coming amid a number of Medicare reimbursement cuts, including the ones known as sequestration triggered by the 2012 Budget Control Act and reductions in disproportionate-share hospital payments under the Patient Protection and Affordable Care Act.

With Coverage Through Obamacare, Transgender Woman Opts For Surgery

Anna Gorman, Kaiser Health News
Tue, 2014-08-26
"Devin Payne had gone years without health insurance – having little need and not much money to pay for it. Then Payne, who had a wife and four children, realized she could no longer live as a man. In her early 40s, she changed her name, began wearing long skirts and grew out her sandy blond hair. And she started taking female hormones, which caused her breasts to develop and the muscle mass on her 6-foot one-inch frame to shrink. The next step was gender reassignment surgery. For that, Payne, who is now 44, said she needed health coverage. “It is not a simple, easy, magical surgery,” said Payne, a photographer who lives in Palm Springs. “Trying to do this without insurance is a big risk. Things can go wrong … not having the money to pay for it would be awful.” Payne learned in the fall that she might qualify for subsidies through the state’s new insurance marketplace, Covered California, because her income fell under the limit of $46,000 a year.

Hospitals reassess charitable programs with Affordable Care Act in mind

Julie Appleby
Kaiser Health News
Mon, 2014-08-25
"As more Americans gain insurance under the federal health law, hospitals are rethinking their charity programs, with some scaling back help for those who could have signed up for coverage but didn’t. The move is prompted by concerns that offering free or discounted care to low-income, uninsured patients might dissuade them from getting government-subsidized coverage. It also reflects hospitals’ strong financial interest in having more patients covered by insurance as the federal government makes big cuts in funding for uncompensated care. If a patient is eligible to purchase subsidized coverage through the law’s online marketplaces but doesn’t sign up, should hospitals “provide charity care on the same level of generosity as they were previously?” asks Peter Cunningham, a health policy expert at Virginia Commonwealth University. Most hospitals are still wrestling with that question, but a few have changed their programs, Cunningham says."

Top Health Stories of the Summer

Jonathan Easley
Morning Consult
Mon, 2014-08-25
"From Halbig to Sovaldi, this summer was a busy one for health policy and politics. We’ve made it easy to catch up, collecting all of the top stories you clicked on over the past few months. Together, they tell a story about the state of healthcare in the U.S., and offer clues as to where things may be headed when Congress returns in the fall. Among them: The political battle over Obmacare has become more complicated for Republicans since the government cleaned up the Healthcare.gov mess, and with midterm elections around the corner, the focus will be on how much either party continues to attack or ignore the law. There are policy, legal and business matters to be settled as well – the employer mandate is under attack from the left and the right, the courts have been a wildcard for the health law to this point and could continue to be so, and employers and employees are finding themselves wading through the on-the-ground impacts of the law.

California: Insurers must cover elective abortions

The Associated Press
Mon, 2014-08-25
"Health insurance companies in California may not refuse to cover the cost of abortions, state insurance officials have ruled in a reversal of policy stemming from the decision by two Catholic universities to drop elective abortions from their employee health plans. Although the federal Affordable Care Act does not compel employers to provide workers with health insurance that includes abortion coverage, the director of California's Department of Managed Health Care said in a letter to seven insurance companies on Friday that the state Constitution and a 1975 state law prohibits them from selling group plans that exclude the procedure. The law in question requires such plans to encompass all "medically necessary" care. "Abortion is a basic health care service," department director Michelle Rouillard wrote in the letter.

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