The Pioneer ACO pilot plan has mixed reviews. It supposedly improved the quality of care by having more of the required measures fulfilled. It failed in lowering costs and in keeping the ACOs happy campers. All the participants did do the quality work required. These pioneer entities were chosen since they had the most experience with doing this type work. However only slightly more than half will be paid for their effort. Some will have to pay money to Medicare and nine of the 32 have dropped out of the three year program of shared gains and losses after this first year. Most ACOs opted for the second tier of only sharing gains and not losses. The poll is still out on the entire concept since the ACO only includes physicians and hospitals and not patients.
The Republicans in the House will vote separately on two bills. The first one is to approve Obama's plan to delay the large employer Obamacare rollout for one year. The second bill will be to delay the individual mandate for the same length of time. The Democratic vote on both measures should be interesting.
A study by professors from Columbia, University of Chicago and Northwestern University have made public a study that showed people may quit their jobs to get unemployment and government paid health insurance instead of working and having to pay something for Obamacare. They used as a model Tennessee where when they discontinued the expansion of their Medicaid system people went back to work.
The new television commercials plugging enrollment are on the way. They will not mention Obamacare or the law by any name nor the requirement to buy insurance nor Congress nor Washington DC. They will only talk about the state's program and how to enroll. The early ads will only run in the states that will run their own exchange. Those 35 states that the fed will run the exchanges will not get commercials until later in the year.
As all know by now, Obamacare is delayed for one year for big business but not for anyone else. This is a catch 22 as it can not be done legally since the IRS needs to know who is in big business insurance and who is not so they can bill for the money. The CBO has said that this one year delay by Obama will cost the program about $16 Billion dollars.
HHS has put out it's own video but has changed the expectations to much lower according to the Washington Post. There is no mention of the one year delay but only says that on October 1 there will be exchanges available for people to sign up.
The Morning Call has a story on a little know excise tax that takes is to be paid by August 1. Businesses will be charged a tax of $1 per employee on all self insured people. This tax goes up 100% to $2 next year and then it is unknown how much it will be until 2019. The tax is to pay for something known as the Patient-Centered Outcomes Research Study. This is to see what treatments and systems work to keep people healthy. Only those businesses described above pay it to the IRS. All other businesses will pay it as a premium increase as the tax will be paid by an insurer and passed on. Those that don't file will pay a penalty but that penalty is unknown as of now.
CMS is banning new home health applications in eight counties in the Chicago and Miami areas and all ambulance providers in the Houston area. These areas are high fraud areas. The ban is for six months. CMS could have started doing this three years ago but chose not to. This cost the taxpayers many millions of dollars due to the delay.
The National Academy of Sciences reported that Medicare payments that reward payments to physicians in regions that provide high quality (whatever that is) at low cost would be a bad idea. This would reward inefficient providers in low cost regions and punish more efficient providers in high cost regions. The Academy took Obama and Congress to task by proving that low cost areas such as Iowa and Minnesota have large variations in cost as do those in urban areas.
New Hampshire has made it complete. Now all the northeast states have legal medical marijuana. This is the 19th state to legalize the drug al least for medical uses in the face of federal prosecution. Top
Some of the hospitals in the Las Vegas areas have been inappropriately transferring patients to the public hospital in Las Vegas. The reason for this and the state investigation is because the hospitals state they don't have the specialists to take call. They do but not on a 24/7/365 basis and so far have not been willing to compensate for the call. This may change in the near future as the hospitals are now working out a deal on possibly paying the public hospital for their transfers. Top
The unions of San Francisco are rearing their usual ugly head. After much delay due to union pressure the committee has forwarded to the full board of Stupes a proposal from Kaiser Health Plan to raise premiums 5.25% for next year. If they hadn't put this to the Board of Stupes many thousands of city workers would have lost their physicians. The employees have it good. The new Kaiser rates are about $550 per month and Blue Shield about $650 per month. The employee pays $4 per month for Kaiser and $60 per month for Blue Shield. We wonder why cities go broke. Top
The House Energy and Commerce Health Committee has passed a permanent fix for the SGR. The bill would have payment increases of 0.5% per year for five years. Then the formula would switch to how one performs against one's peers on certain measures. These would include coordination, clinical care, patient experience, patient population and safety. I have no idea what some of these things are but I do know what patient population is. This means taking Medicare and Medicaid patients as well as the exchanges. Physicians could opt out of the above and opt in for ACO, Bundling or Patient Centered medical homes. Some of this would be paid for by money from the Part B trust fund most of which goes to physicians in any case. The Dems are saying they want to make sure beneficiaries do not pay anything for this and the medical associations are for the proposal but with questions. The SGR is presently to take away about 25% of the Medicare pay in January. This, as in past years, will never happen.
The physicians in the People's Republic of Massachusetts are waiting with bated breath for 2015 when they will be required in order to be licensed to prove IT meaningful use. This should hopefully cost the Republic a significant number of physicians that are unaffiliated with hospital who do all for them. The Medical Society is trying to get the law changed as they see the handwriting on the wall. The state Senator believes that if physicians and other practitioners are not proficient in IT then they are not practicing safe medicine. He will find that they will not be practicing any medicine in his Republic. Top
DISCLAIMER: Although this
article is updated periodically, it reflects the author's point of view at the
time of publication. Nothing in this article constitutes legal advice. Readers
should consult with their own legal counsel before acting on any of the