Healthcare Newsmakers from Modern Healthcare
The people making healthcare business news headlines
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So far largely unseen and unfelt, the effects of making provider pricing data public are about to impact hospitals and health systems in a big way. I'm not going to lie to you—it's going to hurt.
Inpatient care is still a bedrock of almost all health systems, but its role in the care continuum is changing dramatically.
Paul Haidet, MD, applies lessons gleaned from his lifelong love of jazz to teach physicians how to better communicate with patients.
The Senate confirmed Sylvia Mathews Burwell, the White House's budget director for the past year, on Thursday as the 22nd secretary of the Department of Health and Human Services. On a bipartisan vote of 78 to 17, senators approved Burwell to lead the government's largest domestic department, ending a quick confirmation process that was devoid of the bitter partisanship surrounding the 2010 Affordable Care Act and the changes it is bringing to the U.S. health-care system. Senate Finance Committee Chairman Ron Wyden (D-Ore.), whose committee had recommended Burwell to the full Senate, said that she attracted what he called "a choir of bipartisan support" because "she is really that good, she is really that capable, and she is really that qualified."
The Obama administration is revamping HealthCare.gov and scrapping significant parts of the federal health-insurance marketplace in an effort to avoid the problems that plagued the site's launch last fall, according to presentations to health insurers and interviews with government officials and contractors. But the makeover—and the tight timeline to accomplish it—are raising concerns that consumers could face another rocky rollout this fall when they return to the site to choose health plans. Some key back-end functions, including a system to automate payments to insurers, are running behind schedule, according to a presentation federal officials made to health insurers. [Subscription Required]
Congressional budget scorekeepers estimated Thursday that only a fraction of the people without health insurance in 2016 will actually pay a penalty under ObamaCare's individual mandate. In a new analysis, the Congressional Budget Office (CBO) said only 4 million of the 30 million who are expected to be uninsured in 2016 will pay a fine. The number is a lower estimate than in 2012, before the administration added exemptions to the mandate. The CBO previously estimated that 6 million people would pay a fine. All told, the government is projected to collect $4 billion from individual mandate penalties in 2016, followed by $5 billion every year through 2024, according to the CBO.
Accountable Care Organizations have given little attention to surgery in the early years of the Medicare program, choosing to focus instead on managing chronic conditions and reducing hospital readmissions. That's according to a case study and survey published this week in the journal Health Affairs. The authors conducted case studies at four ACOs in 2012 and sent a survey to all 59 Medicare ACOs in the first year of the program, with 30 responding. "I'm a surgeon, so I was really curious as this model probably continues to gain steam, what's this going to mean for me?" said lead author James M. Dupree, a urologist at Baylor College of Medicine.
Key senators announced a bipartisan agreement Thursday on draft legislation designed to improve Veterans Affairs medical care that includes a two-year pilot program to allow veterans to obtain private care if they have to wait more than 30 days for an appointment or live more than 40 miles from a VA health facility. The bill also calls for the VA to spend $500 million in unobligated funds to hire more doctors and health care providers and authorizes construction of 26 new health clinics, including one each in Lafayette and Lake Charles.
In April 2014, the Centers for Medicare and Medicaid Services (CMS) released data for payments Medicare made to doctors and outpatient providers nationally in 2012. The release touched off a series of discussions that focused on outlier physicians, have led to investigations of care patterns and calls for caution in using such data, all prompting CMS officials to defend their release. It is unclear what the impact of such a release will be, but much of the public doesn't understand that the unprecedented data release excludes the payment data for three in 10 Medicare beneficiaries — those enrolled in Medicare's private insurance option, Medicare Advantage (MA).
As the purchaser representative on the federal Health IT Policy Committee, David Lansky, PhD., is the voice of employers, insurers, and other organizations responsible for healthcare compensation. It's a role he's handled for five years, one that complements his full-time position as CEO and president of Pacific Business Group on Health, a nonprofit business coalition that helps its 60 purchaser members provide coverage to more than 3 million employees by improving the quality and affordability of healthcare. In both positions, Lansky focuses on improving the nation's healthcare delivery system by curtailing unnecessary spending and enhancing visibility by measuring outcomes and value.
Researchers investigating outcomes at accredited and non-accredited cancer hospitals arrive at "murky" conclusions, which may indicate problems with the way the quality of care is measured.
As Medicare officials mull new rules and a second round of participant recruitment for the Pioneer ACO program, healthcare providers are quick to point out how the gainsharing model can be improved.
About 2.2 million people, or more than one in every four Americans who signed up for private health coverage under President Barack Obama's healthcare reform law, have inconsistent data in their applications that could lead to them losing coverage in isolated cases, officials said on Wednesday. Republicans, who have made the law known as Obamacare a top issue for November's midterm congressional elections, pounced on the disclosure as fresh evidence that it poses an unworkable burden for Americans. But officials denied that the data issues rise to the level of problem enrollments, saying consumers in many cases included data on income, citizenship and immigration that is more up to date than federal records show.
The U.S. Senate on Wednesday cleared the way for lawmakers to decide on Thursday whether to confirm Sylvia Mathews Burwell as President Barack Obama's new health secretary. Senators voted 67-28 to approve a procedural measure limiting debate on Burwell's nomination to no more than 30 hours, allowing a final confirmation vote to move forward sometime on Thursday. Senate approval is widely expected. A confirmation vote allowing Burwell to take over implementation of Obamacare from departing U.S. Health and Human Services Secretary Kathleen Sebelius could help open a new chapter for Obama's healthcare law just five months before November's midterm congressional elections.
Congressional budget scorekeepers said they can no longer measure the fiscal impact of many provisions of ObamaCare because the task is impossible. In a little-noticed footnote from April, the Congressional Budget Office (CBO) said it will continue to assess the effects of the law's exchange subsidies and the Medicaid expansion, while not tracking others. "The provisions that expand insurance coverage established entirely new programs or components of programs that can be isolated and reassessed," the office wrote. "In contrast, other provisions of the Affordable Care Act significantly modified existing federal programs and made changes to the Internal Revenue Code.
Individual health insurance premiums in the years before President Barack Obama signed the Affordable Care Act into law had large average increases and a high variability in rate hikes across different states and insurers, a study released Thursday found. Nonpartisan foundation The Commonwealth Fund said its findings provide the most comprehensive data assembled to date for use as a benchmark comparison with Affordable Care Act-era price increases, which have begun being released for the 2015 plan year. The study, which examined the years 2008 to 2010, found that health insurance premiums for people buying coverage on their own—not as part of an employer-provided plan—grew more than 10 percent on average.
UnitedHealth is once again hiking the quarterly dividend it gives shareholders by more than 30 percent, with the latest increase tripling the initial value of a payout the nation's largest health insurer debuted in 2010. The insurer said Wednesday it will pay a cash dividend of 37.5 cents per share on June 25 to stockholders of record as of June 16. That's up nearly 10 cents from the Minnetonka, Minnesota, company's current payout of 28 cents per share. UnitedHealth Group Inc. became the first health insurer to offer more than a token payout to shareholders in 2010 when it started providing a quarterly dividend of 12.5 cents per share.
Removing the consumer pinch from narrow provider networks in individual insurance exchanges is a matter of striking a "delicate balance" between payers and the insured, suggests a Robert Wood Johnson Foundation report.
New models of collaboration (even among competitors) are producing shorter boarding times and fewer instances of aggressive behavior in the emergency department.
The federal government wrongfully paid Medicare Advantage programs almost $70 billion, mostly through overbilling between 2008 and 2013, according to a new report. The Center for Public Integrity released the first of its four part investigative series Wednesday on Medicare Advantage payments that examines the use of risk scores used by providers to charge the government more for sicker patients. CPI found between 2007 and 2011, scores for Medicare Advantage patients grew twice as fast when compared to ordinary Medicare patients in more than 500 counties. The report cites government audits of six Medicare Advantage plans in 2007 alone with nearly $650 million in overpayments.