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Re: POTUS changes ACA unilaterally again: New regs provide for ins. co. bailouts

Posted by Nilet on Thu May 22 16:36:57 2014, in response to POTUS changes ACA unilaterally again: New regs provide for ins. co. bailouts, posted by Olog-hai on Thu May 22 12:38:25 2014.

fiogf49gjkf0d
Gee, it's almost as if private companies are notoriously inefficient at actually providing health coverage.

So when are we getting that single-payer system that Obama allegedly supports?

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Re: POTUS changes ACA unilaterally again: New regs provide for ins. co. bailouts

Posted by SelkirkTMO on Thu May 22 18:56:59 2014, in response to Re: POTUS changes ACA unilaterally again: New regs provide for ins. co. bailouts, posted by Nilet on Thu May 22 16:36:57 2014.

fiogf49gjkf0d
Amen.

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(1186446)

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Re: POTUS changes ACA unilaterally again: New regs provide for ins. co. bailouts

Posted by AlM on Thu May 22 18:59:26 2014, in response to POTUS changes ACA unilaterally again: New regs provide for ins. co. bailouts, posted by Olog-hai on Thu May 22 12:38:25 2014.

fiogf49gjkf0d
Right, done unilaterally by Obama saying "Do it." No notice of proposed rulemaking, no hearings, etc. No vote by the empowered regulators. Just unilaterally by the President all on his own.

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Re: POTUS changes ACA unilaterally again: New regs provide for ins. co. bailouts

Posted by Nilet on Thu May 22 19:13:46 2014, in response to Re: POTUS changes ACA unilaterally again: New regs provide for ins. co. bailouts, posted by SelkirkTMO on Thu May 22 18:56:59 2014.

fiogf49gjkf0d
They never stop screaming that he's a socialist. Olog keeps calling me "far left" for saying he's not even a liberal. So obviously, we'll be getting single payer any day now, right?

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ACA piles on costs to states thanks to Medicaid requirements

Posted by Olog-hai on Tue May 27 07:12:07 2014, in response to Universal Health Care is HERE in these USA! Apply Now. www.healthcare.gov, posted by SMAZ on Tue Oct 1 13:19:06 2013.

fiogf49gjkf0d
TANSFTAFHC!

Associated Press

States face new cost concerns with Medicaid surge

By Ricardo Alonso-Zaldivar
May 27, 2014 3:11 AM EDT
From California to Rhode Island, states are confronting new concerns that their Medicaid costs will rise as a result of the federal health care law.

That's likely to revive the debate about how federal decisions can saddle states with unanticipated expenses.

Before President Barack Obama's law expanded Medicaid eligibility, millions of people who already were entitled to its safety-net coverage were not enrolled. Those same people are now signing up in unexpectedly high numbers, partly because of publicity about getting insured under the law.

For states red or blue, the catch is that they must use more of their own money to cover this particular group.

In California, Democratic Gov. Jerry Brown's recent budget projected an additional $1.2 billion spending on Medi-Cal, the state's version of Medicaid, due in part to surging numbers. State officials say about 300,000 more already-eligible Californians are expected to enroll than was estimated last fall.

"Our policy goal is to get people covered, so in that sense it's a success," said state legislator Richard Pan, a Democrat who heads the California State Assembly's health committee. "We are going to have to deal with how to support the success."

Online exchanges that offer subsidized private insurance are just one part of the health care law's push to expand coverage. The other part is Medicaid, and it has two components.

First, the law allows states to expand Medicaid eligibility to people with incomes up to 138 percent of the federal poverty line, about $16,100 for an individual. Washington pays the entire cost for that group through 2016, gradually phasing down to a 90 percent share. About half the states have accepted the offer to expand coverage in this way.

But whether or not a state expands Medicaid, all states are on the hook for a significantly bigger share of costs when it comes to people who were Medicaid-eligible under previous law. The federal government's share for this group averages about 60 percent nationally. In California, it's about a 50-50 split, so for each previously eligible resident who signs up, the state has to pony up half the cost.

There could be many reasons why people didn't sign up in the past.

They may have simply been unaware. Some may not have needed coverage. Others see a social stigma attached to the program for those with the lowest incomes. But now virtually everyone in the country is required to have coverage or risk fines. That's more motivation to come forward.

"It's not a bad thing that we are opening a door that should have been open before," said Judy Solomon of the Center for Budget and Policy Priorities, which advocates for the poor.

The budget consequences are real.

"Clearly we are going to need to do our best to make sure we are working within the budget we are given," said Deidre Gifford, Rhode Island's Medicaid director.

States always expected that some previously eligible people would sign up, but Gifford said her state enrolled 5,000 to 6,000 more than it had projected.

In Washington state, people who were previously eligible represent about one-third of new Medicaid enrollments, roughly 165,000 out of a total of nearly 483,000. But state officials say they are treating that as a preliminary number, and the true net increase may be lower once they factor in people who drop out of the program for a host of reasons, such as getting a job with coverage.

Governors in California, Rhode Island and Washington state all strongly supported the health care law. Their outreach campaigns to promote sign-ups overall probably contributed to drawing out uninsured residents who already were entitled to Medicaid.

But researchers also are seeing increased Medicaid enrollment in states that have resisted the health care law.

A recent report from the market research firm Avalere Health found Georgia enrollment increased by nearly 6 percent. Montana saw a 10 percent rise and South Carolina 5 percent. A big exception is Texas, which has barely seen any increase.

"Anyone who didn't budget for this is going to be behind the eight ball," Avalere CEO Dan Mendelson said. "It's the kind of thing governors will want to discuss with the White House."

When the health care law was being debated in Congress, many states recognized they might face a problem if droves of already-eligible people joined Medicaid. States lobbied federal lawmakers — unsuccessfully — to get more money for that group, said Ray Scheppach, the former top staffer for the National Governors Association.

"States are concerned about this," he said. "It's something they had been worried about right along."

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Re: ACA piles on costs to states thanks to Medicaid requirements

Posted by bingbong on Tue May 27 11:08:24 2014, in response to ACA piles on costs to states thanks to Medicaid requirements, posted by Olog-hai on Tue May 27 07:12:07 2014.

fiogf49gjkf0d
Hmmmm.....could be there's TOO MANY POOR PEOPLE??? Maybe the solution to this lies in the private sector....like PAYING A LIVING WAGE???

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Re: ACA piles on costs to states thanks to Medicaid requirements

Posted by AEM-7AC #901 on Tue May 27 13:44:14 2014, in response to ACA piles on costs to states thanks to Medicaid requirements, posted by Olog-hai on Tue May 27 07:12:07 2014.

fiogf49gjkf0d
So in other words, some of the people signing up for Medicaid are people who were already eligible for it, and the states are responsible for their portion of the costs. For all intents and purposes, this isn't an Obamacare problem per se since states could have easily faced this issue in the long-run, but it's a problem with law that created the programme in the first place. For all intents and purposes, the states shouldn't be in the business of providing social welfare, nor should municipalities due to the fact that the decision to provide such services can put a state at a competitive disadvantage vis à vis other states that choose to skimp on such programmes, and states and municipal governments simply lack the funding flexibility that the federal government has during downturns to fund such programmes.

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Re: ACA piles on costs to states thanks to Medicaid requirements

Posted by SelkirkTMO on Tue May 27 16:47:14 2014, in response to ACA piles on costs to states thanks to Medicaid requirements, posted by Olog-hai on Tue May 27 07:12:07 2014.

fiogf49gjkf0d
Single payer is still an option. :)

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Re: ACA piles on costs to states thanks to Medicaid requirements

Posted by bingbong on Tue May 27 17:54:14 2014, in response to Re: ACA piles on costs to states thanks to Medicaid requirements, posted by SelkirkTMO on Tue May 27 16:47:14 2014.

fiogf49gjkf0d
Sounds good to me.

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Feds considering subsidizing "end-of-life planning" (death panel redux)

Posted by Olog-hai on Mon Jun 2 13:11:39 2014, in response to Universal Health Care is HERE in these USA! Apply Now. www.healthcare.gov, posted by SMAZ on Tue Oct 1 13:19:06 2013.

fiogf49gjkf0d
Pew Stateline

Feds to Consider Paying Doctors for End-of-Life Planning

By Michael Ollove, Staff Writer
June 2, 2014
The federal government may reimburse doctors for talking to Medicare patients and their families about “advance care planning,” including living wills and end-of-life treatment options — potentially rekindling one of the fiercest storms in the Affordable Care Act debate.

A similar provision was in an early draft of the federal health care law, but in 2009, former Republican vice-presidential candidate Sarah Palin took to Facebook to accuse President Barack Obama of proposing “death panels” to determine who deserved life-sustaining medical care. Amid an outcry on the right, the provision was stripped from the legislation.

Now, quietly, the proposal is headed toward reconsideration — this time through a regulatory procedure rather than legislation.

The American Medical Association soon will issue recommendations on what doctors should be paid for advance care planning, or conferring with patients about the care they would want if they were incapacitated. Every year, the AMA makes reimbursement recommendations on a broad range of procedures and services to the Centers for Medicare and Medicaid Services, the federal agency that administers the Medicare program and works with state governments to administer Medicaid. CMS and private insurers don’t have to follow AMA’s recommendations, but they typically do.

Medicare is the country’s largest health insurer. It has about 50 million beneficiaries, most of them over 65.

Geriatricians, oncologists and other medical specialists who see gravely ill patients say it’s crucial to elicit a patient’s wishes for treatment and other pastoral or psychological supports in a dire medical situation. Would a particular patient, for instance, want to pursue additional procedures that, while grueling, offer some slim possibility of success? Or would the patient want doctors to intervene only to alleviate pain?

If Medicare reimburses doctors for such discussions, as it pays them for examining patients and performing procedures, they are much more likely to happen.

Some private insurers, including Excellus Blue Cross Blue Shield of New York, already reimburse doctors who help patients with advance care planning. Under Medicaid, states largely determine what medical services are covered. At least two states, Oregon and Colorado, provide reimbursement for advance care planning. In Colorado, doctors can be compensated up to $80 for a 30-minute conversation to discuss advance care planning.

“We are doing this to incentivize providers to have these conversations with our clients,” said Judy Zerzan, chief medical officer of the Colorado Department of Health Policy.

Phillip Rodgers, a professor at the University of Michigan Medical School and a member of the AMA group that makes compensation recommendations, said a decision by Medicare to approve reimbursement for advance care conversations would allow patients to control decision-making as their medical options narrow. Compensating doctors for such discussions would be an acknowledgement that, “these conversations are a highly beneficial service that makes certain that the care we provide is the right care based on the patients’ wishes,” he said.

Studies show that when given a choice, patients often forgo invasive procedures at the end of life. Such procedures can be costly while doing little to extend or improve the quality of the patient’s life.

But some people fear that end-of-life conversations could lead to rationing health care or withholding it entirely.

Burke Balch, director of the Powell Center for Medical Ethics at the National Right to Life Committee, said he wasn’t aware of the AMA’s proposal. But Balch expressed concern that the measure would result in the “denial of life-saving medical treatment.”

“It is one thing genuinely to determine what people’s treatment wishes are but the danger is very grave that efforts to pay for advance care planning sessions (under) Medicare will turn into subtle efforts to pressure some of the most vulnerable patients to surrender their right to live,” Balch said.

‘Death Panel’ Debate

Like the current proposal, the provision that sparked controversy in 2009 would have provided Medicare reimbursement to doctors who used office time to discuss living wills, advance care planning or other matters pertaining to patients’ end-of-life preferences. It did not require such conversations, but ensured that doctors or other practitioners would be compensated for these often difficult sessions.

Then Sarah Palin weighed in. “The America I know and love,” she wrote in a now infamous Facebook post, “is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's ‘death panel' so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,' whether they are worthy of health care.”

“Such a system is downright evil," she wrote.

Whether it was a willful misrepresentation of the actual proposal or a misreading of it (PolitiFact, a fact-checking operation run by the Tampa Bay Times, described Palin’s posting as the “Lie of the Year.”) Palin’s broadside ignited an outpouring of criticism on conservative media. Other Republicans, including then-House Republican leader John Boehner, picked up the refrain. "This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law," he said.

It wasn’t long before the provision was scrubbed from the bill. Two years later, the administration proposed a similar measure through regulation, but withdrew it out of fear of sparking another controversy.

Request from Illinois

The current effort began last year, when the Illinois State Medical Society recommended that the AMA adopt specific medical codes for the reimbursement of doctors for advance care conversations. Medical codes provide a uniform description of hundreds of medical procedures and services and are used by medical providers, hospitals and insurers across the country. In response to the Illinois request, an AMA panel approved a new code for advance planning.

In the absence of a code, doctors who want to have such conversations with their patients have had to squeeze them into medical appointments ostensibly held for another purpose. Many providers say that forces them to give short shrift to a discussion intended to help a patient — and often, family members — understand all the medical options and the risks associated with each one. Those sessions take time and delicacy, doctors say, and shouldn’t have to be fitted in among other medical procedures or exams.

“It may take up to two hours to bring everyone to an understanding of the situation and the various options,” said Thomas J. Smith, an oncologist and director of palliative care at Johns Hopkins Medicine.

Furthermore, there is no current reimbursement for phone consultations, for instance with relatives who don’t live in the area. It’s also not easy to get reimbursement for patients who are well but still want to discuss advance directives.

“You essentially have to be deceitful to get paid to do advance care planning for the patient who doesn’t have a medical illness,” said Christopher A. Jones, an assistant professor of palliative care at Duke University.

“The federal government places no value on this conversation. None,” said U.S. Rep. Earl Blumenauer of Oregon, a Democrat who is sponsoring a bill that would require reimbursement for advance care planning.

“If reimbursement occurs at all in the federal program, it’s incidental to the primary treatment or somebody miscodes, and that’s not the way it should be,” Blumenauer said. “Under the best of circumstances, this is a difficult conversation for both doctors and families alike that takes time and focused attention.”

The lack of compensation for advance care discussions is part of a broader pattern: Doctors who perform procedures, such as surgeons, generally are paid more than those who examine and counsel, such a geriatricians and internists. Studies consistently show that the compensation for “proceduralists“ is three times or more higher than that of primary care doctors and others whose practices usually involve diagnosis and noninvasive treatment.

In Congress, Blumenauer is hopeful his bill will get a hearing free of any death panel outcry. It helps, he said, that among his 30 co-sponsors are a number of Republicans, all of whom oppose the ACA.

“They know this is not about the ACA at all,” Blumenauer said by phone from Oregon. “I don’t care if you’re for the ACA or against it or don’t care one way or the other. This is legislation that is supported by 90 percent of the public.”

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Re: Feds considering subsidizing ''end-of-life planning'' (death panel redux)

Posted by bingbong on Mon Jun 2 13:27:03 2014, in response to Feds considering subsidizing "end-of-life planning" (death panel redux), posted by Olog-hai on Mon Jun 2 13:11:39 2014.

fiogf49gjkf0d
The only problem I see in this is an irrational belief in the words uttered by Sarah Palin.

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Re: Feds considering subsidizing ''end-of-life planning'' (death panel redux)

Posted by RIPTA42HopeTunnel on Mon Jun 2 13:52:30 2014, in response to Feds considering subsidizing "end-of-life planning" (death panel redux), posted by Olog-hai on Mon Jun 2 13:11:39 2014.

fiogf49gjkf0d
Good.

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Re: Feds considering subsidizing "end-of-life planning."

Posted by Nilet on Mon Jun 2 16:09:59 2014, in response to Feds considering subsidizing "end-of-life planning" (death panel redux), posted by Olog-hai on Mon Jun 2 13:11:39 2014.

fiogf49gjkf0d
Kindly explain how "we'll help you make a living will" constitutes a "death panel." Are you under the impression that people are immortal as long as they don't make advance preparations for their end-of-life affairs?

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Re: Feds considering subsidizing ''end-of-life planning'' (death panel redux)

Posted by Olog-hai on Mon Jun 2 16:27:48 2014, in response to Re: Feds considering subsidizing ''end-of-life planning'' (death panel redux), posted by RIPTA42HopeTunnel on Mon Jun 2 13:52:30 2014.

fiogf49gjkf0d
You like death panels? Do elaborate.

Subsidy ain't going to last. And federal control of the health system = You Die Quickly, to paraphrase Alan Grayson.

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Re: Feds considering subsidizing "end-of-life planning"

Posted by Nilet on Mon Jun 2 16:34:34 2014, in response to Re: Feds considering subsidizing ''end-of-life planning'' (death panel redux), posted by Olog-hai on Mon Jun 2 16:27:48 2014.

fiogf49gjkf0d
FAIL.

Also double fail because you apparently don't know how to type double quotes. Seriously, just hold shift while pressing the apostrophe key.

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Re: Feds considering subsidizing ''end-of-life planning'' (death panel redux)

Posted by SelkirkTMO on Mon Jun 2 17:10:49 2014, in response to Re: Feds considering subsidizing ''end-of-life planning'' (death panel redux), posted by Olog-hai on Mon Jun 2 16:27:48 2014.

fiogf49gjkf0d
So you plan to stick your relatives with the bill for your funeral as well as your local government because you didn't make plans? Do you want to be kept alive after you've gone brain dead (clinically proven finally) and run up the bills for the taxpayers because you failed to choose a DNR for the appropriate conditions?

Do you have ANY idea of what this is about? Or is Sarah Palin your mentor?

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Re: Feds considering subsidizing ''end-of-life planning'' (death panel redux)

Posted by Fred G on Mon Jun 2 20:04:57 2014, in response to Feds considering subsidizing "end-of-life planning" (death panel redux), posted by Olog-hai on Mon Jun 2 13:11:39 2014.

fiogf49gjkf0d
Good news.

your pal,
Fred

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Re: Feds considering subsidizing ''end-of-life planning'' (death panel redux)

Posted by Fred G on Mon Jun 2 20:51:56 2014, in response to Re: Feds considering subsidizing ''end-of-life planning'' (death panel redux), posted by Olog-hai on Mon Jun 2 16:27:48 2014.

fiogf49gjkf0d
My doctor hands me living will pamphlet every physical. What's the big deal? You specify your last wishes and opt for being kept alive or not being kept alive through a terminal hopeless condition. Or perhaps you think that we should act like it's a Disney film with a guaranteed happy ending.

your pal,
Fred

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Re: Feds considering subsidizing ''end-of-life planning'' (death panel redux)

Posted by bingbong on Mon Jun 2 21:28:25 2014, in response to Re: Feds considering subsidizing ''end-of-life planning'' (death panel redux), posted by Fred G on Mon Jun 2 20:51:56 2014.

fiogf49gjkf0d
Last I looked nobody gets out alive.

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Re: Feds considering subsidizing ''end-of-life planning'' (death panel redux)

Posted by Fred G on Mon Jun 2 21:49:02 2014, in response to Re: Feds considering subsidizing ''end-of-life planning'' (death panel redux), posted by bingbong on Mon Jun 2 21:28:25 2014.

fiogf49gjkf0d
Olog and his gang will lace up the Nike's and cruise out on the DaDa ship :)

your pal,
Fred

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Re: Feds considering subsidizing ''end-of-life planning'' (death panel redux)

Posted by Nilet on Mon Jun 2 21:58:05 2014, in response to Re: Feds considering subsidizing ''end-of-life planning'' (death panel redux), posted by bingbong on Mon Jun 2 21:28:25 2014.

fiogf49gjkf0d
Life has a 100% mortality rate.

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Hospital charges going up for common ailments (Medicare/ACA)

Posted by Olog-hai on Tue Jun 3 00:52:33 2014, in response to Universal Health Care is HERE in these USA! Apply Now. www.healthcare.gov, posted by SMAZ on Tue Oct 1 13:19:06 2013.

fiogf49gjkf0d
NY Times

Hospital Charges Surge for Common Ailments, Data Shows

By Julie Creswell, Sheri Fink and Sarah Cohen
June 2, 2014
Charges for some of the most common inpatient procedures surged at hospitals across the country in 2012 from a year earlier, some at more than four times the national rate of inflation, according to data released by Medicare officials on Monday.

While it has long been known that hospitals bill Medicare widely varying amounts — sometimes many multiples of what Medicare typically reimburses — for the same procedure, an analysis of the data by The New York Times shows how much the price of some procedures rose in just one year’s time.

Experts in the health care world differ over the meaning of hospital charges.

While hospitals say they are unimportant — Medicare beneficiaries and those covered by commercial insurance pay significantly less through negotiated payments for treatments — others say the list prices are meaningful to the uninsured, to private insurers that have to negotiate reimbursements with hospitals or to consumers with high-deductible plans.

“You’re seeing a lot more benefit packages out there with co-insurance amounts that require the holders to pay 20 percent of a lab test or 20 percent of an X-ray. Well, 20 percent of which price?” asked Glenn Melnick, a professor who holds a Blue Cross of California endowed chair at the University of Southern California. “Some hospitals will charge 20 percent of what Blue Cross Blue Shield will pay; others will play games.”

Charges for chest pain, for instance, rose 10 percent to an average of $18,505 in 2012, from $16,815 in 2011. Average hospital charges for digestive disorders climbed 8.5 percent to nearly $22,000, from $20,278 in 2011.

In 2012, hospitals charged more for every one of 98 common ailments that could be compared to the previous year. For all but seven, the increase in charges exceeded the nation’s 2 percent inflation rate for that year, according to The Times’s analysis.

Experts say the increase in the price of some of the most common procedures may be offsetting rising technology or drug costs, declines in the number of patients being admitted to hospitals and a leveling out of reimbursements from Medicare. Between 2011 and 2012, Medicare increased payment rates by only 1 percent for most inpatient stays.

The number of patients admitted for chest pain under Medicare’s fee-for-service plans plummeted more than 28,000, to 107,224 in 2012, and inpatients with digestive disorders decreased more than 29,000, to 217,514.

Over all, the number of Medicare patients discharged from hospitals for the comparable 98 most common diagnoses dropped from 7.45 million to 7.2 million. The total amount Medicare paid for their care also declined somewhat between 2011 and 2012, from $62.8 billion to $61.9 billion.

In an effort to reduce overall health care costs, hospitals have been encouraged to admit fewer patients for conditions like asthma, for example, in favor of less expensive outpatient care.

Still, hospital charges make up nearly a third of the nation’s $2.7 trillion health care bill.

The data for 3,317 hospitals, released for the first time last year by the Centers for Medicare and Medicaid Services, again shows broad variations in what hospitals charge for the same procedure. While experts debate why one hospital charges significantly more than another for the same procedure, Medicare does pay slightly higher treatment rates to certain hospitals — like teaching facilities and hospitals in areas with high labor costs.

Reasons for other discrepancies are less clear.

In 2011, the Wuesthoff Medical Center in Rockledge, Fla., a hospital with 300 beds near Cape Canaveral, charged patients admitted for a severe irregular heartbeat an average of $25,361. A year later, the average charge more than doubled to $53,597.

In Muncie, Ind., the price of treating a kidney or urinary tract infection at Indiana University Health Ball Memorial Hospital jumped 70 percent to $38,873 in a year. And at Baptist Medical Center in San Antonio, the charge for esophagitis and other digestive disorders rose 34 percent to more than $46,000. A call and emails to Ball Memorial were not returned, and a spokeswoman for Baptist said the hospital didn’t have the time to analyze the data itself.

The new hospital charge data follows the release in April of Medicare’s physician billing records for 2012. To some, the data is bringing increased transparency and fueling the ongoing national dialogue about financially debilitating health care bills faced all too often by consumers.

“We think this is a big deal. We think it’s very important that people can have conversations about prevailing charges and variation in charges among hospitals,” said Niall Brennan, acting director of the Offices of Enterprise Management at the Centers for Medicare and Medicaid Services. Mr. Brennan made his comments in Washington at Health Datapalooza, a conference focused on digital innovation in health care. The administration also announced a platform called openFDA, which includes data on millions of drug-related adverse events and errors reported to the Food and Drug Administration by doctors and members of the public from 2004 to 2013.

But the charge data may also, in part, reflect a huge shift among hospitals.

The industry has been caught up the biggest wave of mergers since the 1990s, a reaction, in part, to President Obama’s signature health care law, the Affordable Care Act. That law, experts say, is transforming the economics of health care and pushing a growing number of hospitals into mergers.

On top of that, hospitals are spending enormous amounts of money buying up physicians’ practices and groups while investing billions of dollars to upgrade to digital health records.

While those and other moves have caused hospital spending on administrative costs to soar, they still do not explain the continued surge in charges, experts say.

“It just isn’t clear what has gone into the increase in hospital charges for the past decade,” said Dr. Hamilton Moses III, chairman of the consulting firm Alerion Advisors and an adjunct professor of neurology at Johns Hopkins University. “But if you look at the Veterans Administration and the amount of administrative costs that are eating up the moneys that should go to direct health care, that’s a pattern that is repeated everywhere.”

And while there is still broad debate over whether the investment that hospitals are making in information technology will ultimately lower costs by, for instance, reducing unnecessary tests, there are growing concerns that the wave of consolidation may be increasing prices. Bigger hospital systems are viewed by some as having increased leverage in negotiating prices with commercial insurers.

Nowhere may the impact of hospital mergers be more visible than with Wuesthoff Medical Center. A nonprofit system that traces its roots back to 1941 when it opened a 10-bed community hospital, Wuesthoff was acquired in 2010 by the for-profit hospital giant Health Management Associates, recently bought by Community Health Systems.

Over all, the prices charged at Wuesthoff went from 12 percent below the national average to 32 percent above it, based on its case mix.

Between 2011 and 2012, prices for 77 out of the 98 most common ailments for which patients were admitted to the hospital increased. Treatment for a simple case of pneumonia rose by about 25 percent from $39,217 to $49,284. The average hospital charged $38,384 in 2012.

But Wuesthoff’s charges for a major a small- or large-intestine procedure rocketed 168 percent to $152,047 in 2012 from $56,704 in 2011. The average hospital charged $68,982 in 2012.

In an email, Sara Virgin, a spokeswoman for Wuesthoff Health System, said, “Although the hospital’s charges increased, the amount the hospital is actually reimbursed for these services has not significantly changed.” She added that Medicare determines what it will pay for services, commercial payers negotiate rates, and the hospital offers discounts to the uninsured.

“When considering the cost of health care, what matters most to consumers is the actual amount paid for their care, not the hospital’s charges,” she said.

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Re: Hospital charges going up for common ailments (Medicare/ACA)

Posted by SelkirkTMO on Tue Jun 3 01:06:27 2014, in response to Hospital charges going up for common ailments (Medicare/ACA), posted by Olog-hai on Tue Jun 3 00:52:33 2014.

fiogf49gjkf0d
Hospitals are corporations too, my friend. Are you going commie on us? They're entitled to whatever the taxpayer market will bear, right?

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Re: Hospital charges going up for common ailments (Medicare/ACA)

Posted by Fred G on Tue Jun 3 07:48:18 2014, in response to Hospital charges going up for common ailments (Medicare/ACA), posted by Olog-hai on Tue Jun 3 00:52:33 2014.

fiogf49gjkf0d
Wow that's never happened before! :-/

your pal,
Fred

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Re: Hospital charges going up for common ailments (Medicare/ACA)

Posted by SelkirkTMO on Tue Jun 3 16:26:47 2014, in response to Re: Hospital charges going up for common ailments (Medicare/ACA), posted by Fred G on Tue Jun 3 07:48:18 2014.

fiogf49gjkf0d
Damn you, Obama! :)

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Re: Hospital charges going up for common ailments (Medicare/ACA)

Posted by gp38/r42 chris on Tue Jun 3 16:33:09 2014, in response to Re: Hospital charges going up for common ailments (Medicare/ACA), posted by Fred G on Tue Jun 3 07:48:18 2014.

fiogf49gjkf0d
No....but after spending all this money wasn't the opposite supposed to happen?

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Re: Hospital charges going up for common ailments (Medicare/ACA)

Posted by Olog-hai on Tue Jun 3 16:52:48 2014, in response to Re: Hospital charges going up for common ailments (Medicare/ACA), posted by gp38/r42 chris on Tue Jun 3 16:33:09 2014.

fiogf49gjkf0d
pwnt.

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Re: Hospital charges going up for common ailments (Medicare/ACA)

Posted by Fred G on Tue Jun 3 20:07:28 2014, in response to Re: Hospital charges going up for common ailments (Medicare/ACA), posted by gp38/r42 chris on Tue Jun 3 16:33:09 2014.

fiogf49gjkf0d
Spending what money?

Your pal,
Fred

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Re: Hospital charges going up for common ailments (Medicare/ACA)

Posted by bingbong on Tue Jun 3 21:04:53 2014, in response to Re: Hospital charges going up for common ailments (Medicare/ACA), posted by gp38/r42 chris on Tue Jun 3 16:33:09 2014.

fiogf49gjkf0d
Last I looked, nobody spent "all this money".

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Re: Hospital charges going up for common ailments (Medicare/ACA)

Posted by train dude on Tue Jun 3 21:48:36 2014, in response to Re: Hospital charges going up for common ailments (Medicare/ACA), posted by Fred G on Tue Jun 3 07:48:18 2014.

fiogf49gjkf0d
According to our President, healthcare costs were supposed to go down.

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Re: Hospital charges going up for common ailments (Medicare/ACA)

Posted by train dude on Tue Jun 3 21:48:36 2014, in response to Re: Hospital charges going up for common ailments (Medicare/ACA), posted by Fred G on Tue Jun 3 07:48:18 2014.

fiogf49gjkf0d
According to our President, healthcare costs were supposed to go down.

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Re: Hospital charges going up for common ailments (Medicare/ACA)

Posted by Olog-hai on Tue Jun 3 21:55:26 2014, in response to Re: Hospital charges going up for common ailments (Medicare/ACA), posted by train dude on Tue Jun 3 21:48:36 2014.

fiogf49gjkf0d
That's what they told us over and over again.

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Re: Hospital charges going up for common ailments (Medicare/ACA)

Posted by Nilet on Tue Jun 3 21:57:00 2014, in response to Re: Hospital charges going up for common ailments (Medicare/ACA), posted by train dude on Tue Jun 3 21:48:36 2014.

fiogf49gjkf0d
And if you believe anything he says, I have a bridge you might be interested in buying.

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Re: Hospital charges going up for common ailments (Medicare/ACA)

Posted by Fred G on Tue Jun 3 21:59:04 2014, in response to Re: Hospital charges going up for common ailments (Medicare/ACA), posted by train dude on Tue Jun 3 21:48:36 2014.

fiogf49gjkf0d
Mine did :)

your pal,
Fred

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Re: Hospital charges going up for common ailments (Medicare/ACA)

Posted by Nilet on Tue Jun 3 22:00:44 2014, in response to Re: Hospital charges going up for common ailments (Medicare/ACA), posted by Fred G on Tue Jun 3 21:59:04 2014.

fiogf49gjkf0d
Lucky for you.

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Re: Hospital charges going up for common ailments (Medicare/ACA)

Posted by Nilet on Tue Jun 3 22:08:02 2014, in response to Re: Hospital charges going up for common ailments (Medicare/ACA), posted by Nilet on Tue Jun 3 22:00:44 2014.

fiogf49gjkf0d
My health care costs went up. :(

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UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs

Posted by Olog-hai on Sun Jun 8 14:04:03 2014, in response to Universal Health Care is HERE in these USA! Apply Now. www.healthcare.gov, posted by SMAZ on Tue Oct 1 13:19:06 2013.

fiogf49gjkf0d
Boston Globe

UnitedHealthcare to cut doctors for Mass. seniors

By Tracy Jan | Globe Staff
June 07, 2014
National insurance giant UnitedHealthcare plans to cut up to 700 Massachusetts doctors from its physician network for seniors enrolled in its private Medicare plan as a way to control costs, according to company officials.

For elderly patients enrolled in the plan, the cuts mean they will have to find a new doctor or eventually switch to a new health plan that covers their current doctor.

The move, effective Sept. 1, follows similar cuts made by the insurer to its Medicare Advantage provider networks in 11 other states, including in Rhode Island and Connecticut, where the reductions drew outrage from patients, doctors, and lawmakers earlier this year.

UnitedHealthcare is the country’s largest provider of privately managed Medicare Advantage plans, and the ongoing cuts have prompted lawsuits by doctors, state investigations, and recent federal policy changes to better protect consumers. There is also pending legislation in Congress to prevent health plans from cutting physicians mid-year.

“This phenomenon is nationwide and needs to be addressed,” Senator Richard Blumenthal, a Connecticut Democrat, said in an interview. “I’m reviewing possible legislation that would prevent this kind of draconian discharge of providers from networks serving Medicare Advantage patients.”

UnitedHealthcare officials said the Massachusetts cuts, which will trim 2 to 4 percent of its 18,600 Bay State physicians, will most affect patients receiving care from doctors in the Boston metropolitan area of Middlesex and Suffolk counties. They would not specify where the cuts would occur.

The insurer said it would not be dropping any hospitals from its Massachusetts coverage, as it has done — to much controversy — in other states, including Yale-New Haven Hospital in Connecticut and Moffitt Cancer Center in Tampa.

The changes come amid a gradual reduction of reimbursements to private insurers that offer Medicare Advantage plans as a way to offset costs associated with President Obama’s health reform law.

Medicare Advantage provides coverage for 30 percent of Americans on Medicare through private insurers. Consumers often prefer the program over traditional Medicare because it is a one-stop shop for hospital and doctor coverage, and often includes prescription drugs, eyeglasses, and gym memberships.

For years the federal government has paid the private plans up to 14 percent more than traditional Medicare for identical services, a benefit to the insurance industry that cost taxpayers an extra $1,000 per beneficiary, according to the National Committee to Preserve Social Security & Medicare, a Washington-based advocacy group. The 2010 federal health law was supposed to close the gap, as well as provide new bonus payments to plans with the highest quality ratings.

UnitedHealthcare officials say they hope that streamlining the pool of doctors will not just save money but ultimately improve the quality of patient care — and thus improve its chances of receiving bonus payments under a new federal rating system.

Cost savings could translate into more affordable care for patients, the insurer said, with the potential for lower out-of-pocket costs for prescription and office visit co-pays.

“Network restructuring is the new normal. It’s not just UnitedHealthcare, but that’s the way health plans will be operating in the future,” said Dr. Sam Ho, UnitedHealthcare’s chief medical officer, in an interview. “Healthcare is going through so many significant changes that it’s no longer a matter of doctors providing services and health plans paying claims, but a focus on the quality and cost effectiveness of those services.”

The insurer notified Massachusetts doctors last week that they would no longer be included in the network and began alerting members this week, Ho said. UnitedHealthcare would not say how many of its 55,000 Massachusetts consumers will be affected. Nationwide, the network’s changes affect more than 300,000 seniors.

Consumer and senior advocates, as well as physician groups, expressed concern about the impact of the cuts on patients.

“We’re really opposed to their actions because it’s going to limit access to care,” said Dr. Richard Pieters, president of the Massachusetts Medical Society. “We think the decisions on how they are eliminating physicians may well be arbitrary and not based on quality. It’s very unsettling. Potentially, this is just another domino starting to fall.”

The medical society plans to meet with UnitedHealthcare to discuss the changes.

In total, UnitedHealthcare will have cut about 35,000 doctors across the country over the past six months, the insurer said; that represents roughly 10 percent of the insurer’s national provider network.

The insurer said consumers are barred from changing insurers until October when the next open enrollment period begins. Patients may appeal to UnitedHealthcare to continue covering their current doctors for a finite time in special medical circumstances, such as if they are undergoing chemotherapy, post-operative rehabilitation, or physical therapy.

Only about 3,000 seniors, or 1 percent of members affected by the cuts, have requested such permission, Ho said. Fewer than 50 percent of the requests have been approved as medically appropriate.

New guidance issued by the federal Centers for Medicare & Medicaid Services in April said the agency is in the midst of establishing a policy to allow members to switch plans if their doctors have been cut out of their insurer’s network mid-year without cause. The policy would not be effective until 2015.

Representative Rosa DeLauro, another Connecticut Democrat, said she plans to introduce in the coming weeks the Medicare Advantage Participant Bill of Rights Act that would prohibit Medicare Advantage plans from dropping doctors at any time during the year without cause.

In Connecticut, about 32,000 seniors were affected when UnitedHealthcare dropped 2,200 doctors from its network last fall, DeLauro said. Two doctors groups filed lawsuits against the insurer in US District Court accusing UnitedHealthcare of violating the terms of their contracts.

In addition to UnitedHealthcare, the Medicare Advantage market in Massachusetts is dominated by Tufts Health Plan and Blue Cross Blue Shield, both of which said they have no plans to trim their doctor networks.

In fact, Blue Cross Blue Shield of Massachusetts has expanded its network by 750 physicians when it added Mount Auburn Hospital and Cambridge Health Alliance in March and South Shore Physician Hospital Association in January.

“We are competing to grow our Medicare Advantage network, not make it smaller,” said Ken Arruda, executive director of Medicare markets for Blue Cross Blue Shield of Massachusetts. “We see this as an opportunity for our company.”

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Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs

Posted by AlM on Sun Jun 8 14:11:47 2014, in response to UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs, posted by Olog-hai on Sun Jun 8 14:04:03 2014.

fiogf49gjkf0d
Your title is not reflected in the contents of the article.

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Re: UnitedHealthcare to cuts Medicare Advantage network, BC/BS expands theirs in MA

Posted by bingbong on Sun Jun 8 14:21:13 2014, in response to UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs, posted by Olog-hai on Sun Jun 8 14:04:03 2014.

fiogf49gjkf0d
Looks like the competition is heating up.

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Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs

Posted by Olog-hai on Sun Jun 8 14:26:25 2014, in response to Re: UnitedHealthcare to cuts Medicare Advantage network, BC/BS expands theirs in MA, posted by bingbong on Sun Jun 8 14:21:13 2014.

fiogf49gjkf0d
Cronyism is not competition. And notice that neither BC/BS nor Tufts are saying how many doctors they're "expanding" by.

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Re: UnitedHealthcare to cut Medicare Advantage networks, BC\BS expands theirs

Posted by bingbong on Sun Jun 8 14:41:47 2014, in response to Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs, posted by Olog-hai on Sun Jun 8 14:26:25 2014.

fiogf49gjkf0d
In fact, Blue Cross Blue Shield of Massachusetts has expanded its network by 750 physicians when it added Mount Auburn Hospital and Cambridge Health Alliance in March and South Shore Physician Hospital Association in January

You didn't read what you posted again Olog.

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Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs

Posted by Dave on Sun Jun 8 14:49:29 2014, in response to UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs, posted by Olog-hai on Sun Jun 8 14:04:03 2014.

fiogf49gjkf0d
In total, UnitedHealthcare will have cut about 35,000 doctors across the country over the past six months, the insurer said; that represents roughly 10 percent of the insurer’s national provider network.

Obviously this story is untrue because bingbong informed us that no one has lost their doctor under Obamacare.

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Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs

Posted by AlM on Sun Jun 8 14:51:38 2014, in response to Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs, posted by Dave on Sun Jun 8 14:49:29 2014.

fiogf49gjkf0d
???

This story is not about Obamacare; it's about Medicare Advantage. Did you even read it?

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Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs

Posted by Dave on Sun Jun 8 14:55:23 2014, in response to Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs, posted by AlM on Sun Jun 8 14:51:38 2014.

fiogf49gjkf0d
Cause and effect relationship. If not for Obamacare, Medicare Advantage would not have needed to cut these doctors from their plan.

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Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs

Posted by AlM on Sun Jun 8 15:00:56 2014, in response to Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs, posted by Dave on Sun Jun 8 14:55:23 2014.

fiogf49gjkf0d
If not for Obamacare, Medicare Advantage would not have needed to cut these doctors from their plan.

Proof? There's no such claim in the article. And another insurer is expanding its network according to the article. The inference is that United Healthcare is simply losing market share.

And even if you are correct, your original comment is unwarranted. You made it seem like an obvious conclusion. It certainly is not.

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Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs

Posted by bingbong on Sun Jun 8 15:02:23 2014, in response to Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs, posted by Dave on Sun Jun 8 14:49:29 2014.

fiogf49gjkf0d
Never said such a thing. Did say that it's likely most will see that change as the coverage networks expand. There's bound to be reshuffling when such a major change is made. The OP shows a perfect example of that.

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Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs

Posted by Dave on Sun Jun 8 15:45:49 2014, in response to Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs, posted by AlM on Sun Jun 8 15:00:56 2014.

fiogf49gjkf0d
UnitedHealth CEO Stephen J. Hemsley is expecting cuts in Medicare payments tied to the Affordable Care Act.

"That's what's driving our actions," said Austin Pittman, president of UnitedHealth's networks. He also said, "It's no secret that we are under substantial funding pressure from the federal government."

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Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs

Posted by AlM on Sun Jun 8 16:05:59 2014, in response to Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs, posted by Dave on Sun Jun 8 15:45:49 2014.

fiogf49gjkf0d
OK, fine, but not a quote from the source you cited. So my original point stands.

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Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs

Posted by AlM on Sun Jun 8 16:06:47 2014, in response to Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs, posted by AlM on Sun Jun 8 16:05:59 2014.

fiogf49gjkf0d
Sorry, not the source you cited, but the source that this thread is about.

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Re: UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs

Posted by SelkirkTMO on Sun Jun 8 17:12:29 2014, in response to UnitedHealthcare to cut around 700 docs for MA seniors on Medicare Advantage—to offset ACA costs, posted by Olog-hai on Sun Jun 8 14:04:03 2014.

fiogf49gjkf0d
No surprise here ... our experience with UHC goes back a LONG way and they are THE shittiest "HMO" style insurer there is. :(

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