Sunday, June 25, 2017

What I’m Reading: The New York Times

Medicaid, targeted for deep cuts by the Republican health care bill, currently pays for most of the 1.4 million people in nursing homes.

Article: Medicaid Cuts May Force Retirees Out of Nursing Homes


Sunday, June 18, 2017

What I’m Reading:

In the US, the world's largest food exporter, there are 13.1 million households with children that often go without food. What would it take to feed everyone?

Article: Why does America have so many hungry kids?


Friday, June 16, 2017

Attack on RAC

In a letter to CMS Administrator Seema Verma sent Tuesday, the American Hospital Association urged CMS to "hold Medicare Recovery Audit Contractors accountable." The Medicare Recovery Audit Contractor program's mission is to correct improper Medicare payments by identifying and collecting over- and underpayments. The program's auditors are paid a contingency fee for denying hospital claims. They receive the financial reward even when denials are later found to be in error.

Healthcare providers have the option to appeal recovery auditors' findings, and HHS' Office of Medicare Hearings and Appeals administers hearings concerning denied Medicare claims. Claim denials that reach the third of five possible levels of the appeals process are brought before administrative law judges, who issue decisions regarding coverage determinations. In its letter to CMS, the AHA advocated for penalizing auditors who have high overturn rates at the administrative law judge level. "The AHA urges the administration to revise the RAC contracts to incorporate a financial penalty for poor performance by RACs, as measured by administrative law judge appeal overturn rates," the letter stated.

This isn't the first time the AHA has pressed for changes to the RAC program. In 2014, the AHA sued HHS over the Medicare appeals backlog and a federal judge granted the AHA's motion for summary judgment in the case last year. The judge ordered HHS to incrementally reduce the backlog of appeals pending before OMHA over the next four years, reducing the backlog by 30 percent by the end of 2017; 60 percent by the end of 2018; 90 percent by the end of 2019; and to completely eliminate the backlog by Dec. 31, 2020. In March, HHS said in a court filing that it will not be able to meet the deadlines imposed by the court for clearing the appeals backlog. HHS appealed the order to clear the backlog, and an appellate court heard oral arguments in the case in May.

Wednesday, June 14, 2017

What I’m Reading: Becker’s Hospital Review

I recently posted about the increased prevalence of high deductible health plans. Apparently, a HDHP, like beauty, is in the eye of the beholder. The writer below says that HDHPs are not taking over as quickly as they should. Also of note, we are back on the “healthcare costs are rising too fast to be sustainable” mantra. We had low healthcare inflation from 2009 to 2013 but it is hard for an alcoholic accustomed to drinking heavily for four decades to stay off the bottle. A single payor system would maintain sobriety.

Article: Why the ‘new normal’ for healthcare cost growth isn’t sustainable


Tuesday, June 13, 2017

What I’m Reading: Fox News

Someone drive to D.C. and explain Americare to President Trump -- he's clearly ready.

Apparently, Trump either didn't pay attention or, if he did, didn't understand the House bill he just got passed. He recently told Republican senators that the bill passed by the House to repeal and replace ObamaCare is "mean" and "harsh," multiple GOP and Senate sources have told Fox News.

Article: Trump tells senators House health care bill is ‘mean,’ sources say


Friday, June 9, 2017

What I’m Reading:

When then-Sen. Sam Brownback was elected governor of Kansas in 2010, he promised to turn the state into a fiscal conservative paradise. For residents of the Sunflower State, the intervening years have fallen well short of that dream. Brownback's struggles reached a climax earlier this week when the strongly Republican state legislature jettisoned the tax cuts that had been the centerpiece of his governing vision.

Article: How the grand conservative experiment failed in Kansas


Thursday, June 8, 2017

What I’m Reading: National Center for Health Statistics

Below is a recent report on the increase in high deductible health plans. The definition of high deductible may surprise you: it is $1,300 for single and $2,600 for family. Using that definition, 40% of commercial insurance coverage is now a high deductible plan.

NCHS Study: High-deductible Health Plans and Financial Barriers to Medical Care: Early Release of Estimates From the National Health Interview Survey



The Kansas legislature continues to push back against the “living experiment” in ultra conservative economics touted by Brownback (who is part of the same cabal advising Trump). They recently overrode his veto of legislation repealing many of his extreme tax cuts which Brownback “guaranteed” would stimulate the Kansas economy so much that the increased revenue would offset the tax cuts only to have Kansas tie Louisiana (which underwent a similar “living experiment” fostered by Bobby Jindal, a rising star who crashed and burned when reality got in the way) for the worst performing economy in all 50 states. Unfortunately, the Kansas legislature could not override Brownback’s veto of a Medicaid expansion—something the new Louisiana governor was able to accomplish. Now, the Kansas legislature has found a source of funds to help restore Brownback cuts to Medicaid: commercial insurance companies who Brownback allowed to operate in Kansas while paying lower fees than most states impose.

The Kansas legislature approved a bill aimed at offsetting about $56 million in cuts to the state's Medicaid program ordered by Republican Gov. Sam Brownback in May 2016. The Senate substitute for House Bill 2079 proposes increasing the fee health maintenance organizations pay to operate in Kansas to replace the funds. The bill calls for a 5.77 percent fee, up from 3.31 percent. State lawmakers anticipate the change, set to take place January 2018, would garner $108.6 million for Medicaid next year, and $144.6 million in fiscal year 2019. Brownback has threatened to veto the bill in order to protect his friends and lobbyists in the insurance industry.

I want to say, “At long last sir, have you no shame?”

What I’m Reading: Missouri Hospital Association

New research from MHA finds that the American Health Care Act would disadvantage the 19 Medicaid nonexpansion states, including Missouri, by more than $680 billion throughout 10 years. The significant disparity is evident even after the bill’s restored disproportionate share hospital payments and $10 billion safety-net fund are included in the analysis. The research projects that federal per capita Medicaid spending disparity between states will be 67 percent with $1,936 in spending per capita in expansion states and $1,158 in nonexpansion states in 2025. The U.S. Senate is expected to outline its replacement for the Affordable Care Act this week.

MHA STUDY: The American Health Care Act Fails to Restore Parity in Medicaid Spending for Nonexpansion States


Wednesday, June 7, 2017

MAP Fraud

The DOJ is suing UnitedHealth, accusing the nation’s largest MAP of exploiting the program by providing inaccurate information about the health of its enrollees. DOJ alleges the practices have led to damages of more than $1.14 billion from 2011-2014.

In separate news, two Florida MAPs, Freedom Health and Optimum HealthCare, recently agreed to pay nearly $32 million to settle a whistleblower lawsuit that alleged they exaggerated how sick patients were and took other steps to overbill the government health plan for the elderly.

Politicians have made a living by promoting the idea that Medicare and Medicaid programs are rife with fraud. No politician in recent history has focused on the track record of MAPs (Care or Caid) in either perpetrating or uncovering fraud. The truth is commercial insurers do not bother auditing for fraud (perhaps because they know they live in extremely fragile glass houses) but instead simply rely on their age old tactic of denying claims to “save” money. It is a fascinating illustration of how politicians control the narrative by creating myths people accept as gospel.

I seriously doubt these recent stories about fraud in the MAP sector will become part of the political narrative.

Thursday, June 1, 2017

What I’m Reading: Bloomberg

Something for everyone. Americans, in general, support government-provided universal health care. A Pew Research Center survey taken in January found that 60 percent say that it’s the responsibility of the federal government to make sure that all Americans have health coverage. A Morning Consult/Politico poll in April found that support for a single-payer health system outweighs opposition, by 44 percent to 36 percent (with 19 percent unsure). A Gallup poll turned up similar results.

Americans Sure Seem to Like Universal Health Care