All posts by Jason White

Release Of Hospital Quality Ratings Delayed By Medicare Amid Lawmaker, Lobbying Pressure


Kaiser Health News:
Medicare Delays Plans For New Star Ratings On Hospitals After Congressional Pressure


Bowing to pressure from the hospital industry and Congress, the Obama administration on Wednesday delayed releasing its new hospital quality rating measure just a day before its planned launch. The new “overall hospital quality” star rating aimed to combine the government’s disparate efforts to measure hospital care into one easy-to-grasp metric. The Centers for Medicare Medicaid Services now publishes more than 100 measures of aspects of hospital care, but many of these measures are technical and confusing since hospitals often do well on some and poorly on others. The new star rating boils 62 of the measures down into a unified rating of one to five stars, with five being the best. (Rau, 4/20)

Some Firms Save Money By Offering Employees Free Surgery

Lowe’s home improvement company, like a growing number of large companies nationwide, offers its employees an eye-catching benefit: certain major surgeries at prestigious hospitals at no cost to the employee.

How do these firms do it? With “bundled payments,” a way of paying that’s gaining steam across the health care industry, and that Medicare is now adopting for hip and knee replacements in 67 metropolitan areas, including New York, Miami and Denver.

Here’s how it works: Lowe’s and other employers pay one flat rate for a particular procedure from any of a number of hospitals they’ve selected for quality, even if they are a plane ride away. And, under the agreement, the hospital handles all the treatment within a certain time frame — the surgery, the physical therapy and any complications that arise — all for that one price.

It was Bob Ihrie, senior vice president for compensation and benefits at Lowe’s, who came up with the idea in 2010. When he told managers at other companies about it, he said, “The first question was always, ‘Oh, this is just for executives, right?’ And I said no, absolutely not, this is for any Lowe’s employee in the Lowe’s health care plans.”

The program is optional for employees. They can still use their local surgeon, if they prefer, and pay out-of-pocket whatever their insurance doesn’t cover. But more than 700 Lowe’s employees have taken the company up on its offer, Ihrie said.

It’s a great deal for patients, he said, and for his company.

“We were able to get a bundled price, which actually enables us to save money on every single operation,” Ihrie says.

The Pacific Business Group on Health negotiates that price for Lowe’s, Walmart and a number of other large employers. Associate Director Olivia Ross oversees these deals, and said her team is able to negotiate rates that are 20 to 30 percent below what the companies used to pay for the procedures.

“We’re seeing savings at the front end,” she said, because Lowe’s pays less for the surgery. And, because the hospital is responsible for all that care, the institution has a strong incentive to be careful and thorough, Ross added.

That means “huge savings on the back end,” she said, “from things like reduced re-admissions, reduced return to the O.R. and lower rates of blood clots. Those are hugely expensive, preventable complications.”

Lowe’s comes out ahead, even after paying for the patient’s travel, Ihrie confirmed.

Participating hospitals win, too, by attracting more patients, said Trisha Frick, who handles such negotiations on behalf of Johns Hopkins Medicine in Baltimore.

“It’s new business for us,” Frick said. “And, for the most part, the reimbursement is acceptable; we believe that we can provide that, within that amount of money.”

Medicare, the health insurance program for people 65 and older, started using bundled rates for hip and knee replacements this month. Medicare had some early evidence from pilot programs that “the model works well,” according to Rob Lazerow, a health care consultant with The Advisory Board Company.

“Medicare is saving something like $4,000 on orthopedic cases,” he said.

Medicare’s deal is somewhat different than Lowe’s. Patients may pay something out of pocket, depending on the type of Medicare policy that insures them. And while the few hospitals selected in Lowe’s program can bank on increasing their revenue and the number of surgeries they’ll get, the rates established by Medicare’s bundled payment system hold for every hospital in a participating area.

“Entire markets are selected for participating,” Lazerow explains. “If you’re in the San Francisco market or you’re in the New York market, all of the hospitals are actually participating in the program.”

But there are similarities, too, and Medicare may learn some lessons from Lowe’s experience. Lowe’s initially had trouble wrangling all a patient’s medical records from local doctors. And the company found that patients who had questions weeks or months after an operation sometimes had trouble following up with the out-of-town doctor who had performed the surgery.

“You have some setbacks, and things happen, and you just have questions,” Ihrie said. “So what we give every patient now is a little card with the doctor’s name and direct phone line and the nurse’s name and direct phone line. And all of a sudden, things were a lot better.”

Another lesson was startling, Ross said. In addition to cutting the cost of procedures, another chunk of savings to the companies came from avoiding surgeries that probably shouldn’t happen in the first place.

“We’re seeing up to 30 percent — close to 30 percent of cases — who should not be moving forward with the joint replacement,” Ross said.

What typically happens in these cases, she said, is that employees get a recommendation from a local doctor that they should have surgery, only to have physicians at the selected hospitals deem the operation inappropriate.

In some cases that may be because the employee hadn’t first tried less invasive treatments, such as physical therapy, Ross said. Or the employee may need to lose weight first, to make the surgery safer.

Ihrie said what heartens him most about his company’s program is that Lowe’s employees are now taking a more active role in decisions about their care.

“What treatment you receive is not always very black and white,” he said. “The mere fact that people now think about what they’re doing helps us control costs across the board.”

This story is part of a reporting partnership with WFAE, NPR and Kaiser Health News.

Categories: Cost and Quality, Health Industry, Insurance, Medicare, Public Radio Partnership, Syndicate

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Medicare Proposes Payment Increases For Skilled-Nursing And Inpatient Rehab Facilities, Hospice Care


Modern Healthcare:
CMS Proposes Raising Payment Rates For Hospice, Skilled Nursing And Rehab


The CMS has dropped three payment rules that propose increased payments to skilled-nursing facilities, inpatient rehabilitation facilities and hospice care, and implemented new quality measures. The agency Thursday proposed nearly doubling the increase skilled-nursing facilities received last year. This would amount to a $800 million bump. Last year they only received a 1.2% Medicare rate increase, leading to $430 million in higher payments from the previous year. Medicare would pay out $125 million a year more to rehabilitation facilities while those facilities would face about $5.2 million in costs related to new quality-reporting requirements. (Dickson, Meyer and Schencker, 4/21)

Research Roundup: Hospital Readmissions; Children’s Health; Medicare Overview


The Kaiser Family Foundation:
An Overview of Medicare


Medicare plays a key role in providing health and financial security to 55 million older people and younger people with disabilities. … Many people on Medicare live with health problems including multiple chronic conditions, cognitive impairments, and limitations in their activities of daily living, and many beneficiaries live on modest incomes. In 2011, two-thirds of beneficiaries (66%) had three or more chronic conditions, more than one quarter of all beneficiaries (27%) reported being in fair or poor health, and just over 3 in 10 (31%) had a cognitive or mental impairment. … Two million beneficiaries (5%) lived in a long-term care facility. In 2014, half of all people on Medicare had incomes below $24,150 per person and savings below $63,350. (4/1)

State Highlights: Pastoral Provider Licenses Stoke Concern In Texas; Pilot Medicare Program Helped Cut Costs In Arkansas

News outlets report on health issues in Texas, Arkansas, Wisconsin, Florida, Massachusetts, Texas, Washington, New Hampshire and Missouri.


NPR:
Pastoral Medicine Credentials Raise Questions In Texas


You’ve probably heard of the credentials M.D. and R.N., and maybe N.P. The people using those letters are doctors, registered nurses and nurse practitioners. But what about PSC.D or D.PSc? Those letters refer to someone who practices pastoral medicine – or “Bible-based” health care. It’s a relatively new title being used by some alternative health practitioners. The Texas-based Pastoral Medical Association gives out “pastoral provider licenses” in all 50 states and 30 countries. Some providers call themselves doctors of pastoral medicine. But these licenses are not medical degrees. That has watchdog organizations concerned that some patients may not understand what this certification really means. (Silverman, 4/25)


Arkansas Democrat-Gazette:
Savings Seen In New Care Program


Paying doctors to better coordinate care for Medicare beneficiaries in Arkansas and seven other states helped hold down the cost of patients’ medical care over a two-year period, although the savings didn’t fully offset the cost of the extra payments, a report found. Still, the authors of the report by Mathematica Policy Research said the Comprehensive Primary Care Initiative’s effect on medical expenses was bigger than they expected. (Davis, 4/24)


New Hampshire Public Radio:
State Issues Update On PFOA-Contaminated Wells


The New Hampshire Department of Environmental Services has announced updated drinking water well test results for the water contaminant PFOA in Southern New Hampshire. So far, the state has tested over 350 wells, mostly within a 1.5 mile radius of the Saint-Gobain performance plastics plant. Of those, 52 private wells have tested above the state’s threshold of concern: which is 100 parts per trillion of the contaminant. The well with the highest concentration came in at 1600 parts per trillion. So far, these wells are located in Merrimack and Litchfield, with one Manchester well testing above the threshold. (Corwin, 4/22)


St. Louis Public Radio:
What’s Next, After Defeat Of Medical Marijuana Bill?


Supporters of legalizing marijuana for medical use in Missouri now have only one option this year – the ballot box. That comes after the state House last week defeated House Bill 2213. In its original form, the measure would have allowed for medical cannabis centers in Missouri, which would have sold medical cannabis to patients with a “debilitating medical condition.” (Griffin, 4/24)


This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

At risk for Diabetes? Take this quick test.

Diabetes affects 22 million people in the U.S.—are you one of them? Tuesday, March 22 is American Diabetes Association Alert Day, and it’s a great time to take the Diabetes Risk Test to find out if you’re at risk for developing type 2 diabetes, a disease where blood glucose levels are higher than normal. Type 2 diabetes develops most often in middle-aged and older adults.

Many people with diabetes don’t know that they have it, but Medicare covers screening tests so you can find out if you do.

If you have diabetes, Medicare covers many of your supplies, including insulintest stripsmonitors, lancets and control solutions. In some cases, Medicare also covers therapeutic shoes if you have diabetic foot problems. You pay 20% of the Medicare-approved amount for these supplies.

Medicare also covers diabetes self-management training to help you learn how to better manage your diabetes. You can learn how to monitor your blood sugar, control your diet, exercise, and manage your prescriptions. Talk to your doctor about how this training can help you stay healthy and avoid serious complications.

Take control of your health—talk to your doctor today about screening tests and what supplies and training may help you stay healthy.

Rethink the Drink

There are a lot of changes that happen with age, and some of them, like physical pain, loss of mobility, and loneliness can lead to alcohol misuse. As people age, they become more sensitive to the effects of alcohol. Over time, someone’s drinking habits may become a problem.

Older adults who drink may be at a higher risk for falls or other injuries. And alcohol can make some health problems worse, including diabetes, high blood pressure, and heart problems. It can also cause bad interactions when mixed with prescription or over-the-counter medications. The National Institute on Alcohol Abuse and Alcoholism recommends adults 65 and over who are healthy and don’t take medications have no more than 3 drinks on a given day or 7 drinks in a week.

If you think you or a loved one could be misusing alcohol, don’t be ashamed to ask for help. April is Alcohol Awareness Month, and it’s the perfect time to remember that Medicare covers alcohol misuse screening counseling to provide counseling for people who misuse alcohol.

Celebrate Earth Day—Go Paperless!

Nearly 200 countries celebrate Earth Day – a day for encouraging awareness and action for the environment on April 22nd. How can you make your voice heard this year? One great way is to sign up to get your “Medicare You” handbook electronically.

If you have an eReader (like an iPad, Kindle Fire, Surface, or Galaxy Tab) you can download a free digital version of the Medicare You handbook to your eReader and take it with you anywhere you go.

Don’t have an eReader? You can still sign up to get a paperless version in a few simple steps. We’ll send you an email in September when the new eHandbook is available. The email will explain that instead of getting a paper copy in your mailbox each October, you’ll get an email linking you to the online version of “Medicare You.” This online version of the handbook contains all the same information as the printed version.

Even better, the handbook information on Medicare.gov is updated regularly, so you can be confident that you have the most up-to-date Medicare information!

Sign up today to get your Medicare You information electronically, and you’ll be making a difference for the environment. What a great way to make your voice heard and celebrate Earth Day.