DOCTOR PUNDIT » CMS

Poll: Negative Attitudes & Beliefs about Reform Trending Downward

Michael Douglas, MD, MBA — Fri, 30 Jul 2010 13:10:57 +0000

Republicans and Dems are waiting to see just exactly how public opinion continues to be shaped on the issue of healthcare reform in this country in the run-up to the 2010 mid terms. If the results of a new tracking poll [PDF] are any indication, there is comfort for the latter party.

The July Health Tracking Poll indicates overall public support for the health reform law is steady from June, while unfavorable views of the law have trended downward. Half the public (50%) now expresses a favorable view of the law, while 35 percent say they have an unfavorable opinion (down from 41% in June).

The results don’t exactly show that misconceptions do exist, however.

[L]arge shares of seniors mistakenly believe the law includes provisions that cut some previously universal Medicare benefits and creates “death panels.”

Results are over at the Kaiser (kff.org) website, a link from this blog in the Blogroll.

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Disaffected Physician Group Creates Political Stand on Healthcare Delivery, Criticizing Reform and Alleging Rationing

Michael Douglas, MD, MBA — Wed, 21 Jul 2010 11:54:45 +0000

During the preamble to the passage of the Patient Protection and Affordable Care Act, much was made of the disharmony among the political left and right, giving fodder to explosive townhalls — many of which became inescapable albatrosses around the necks of President Obama and other Democrat proponents of the now famously defunct “public option” in its purest form. In the healthcare debate’s final days, an increasing number of physicians joined in the fray to make their voices heard. Generally (if you don’t count the political institutionalism of the AMA) many physicians saw pending legislation as a positive step toward increasing healthcare access for patients who, at the very least, needed coverage.

However, not all doctors jumped on the reform bandwagon. In fact, a group which claims to speak for those providers disillusioned by the promises of the Obama administration to enact reform on the basis of responsible healthcare delivery done in an affordable manner free of increased government bureaucracy and oversight are trying to make themselves heard. It appears that the most recent action by Obama as part of reform — his recess appointment of Don Berwick, targeted by many pols on the right as a proponent of care rationing, to CMS head — was the last straw.

The org’s president warns of a familiar refrain of many who always opposed reform on its most basic level: the trend toward socialism in healthcare delivery.

As a doctor and someday as a patient, I have grave concerns about our healthcare system. I believe that Obamacare will very quickly lead us to the type of socialized medicine that exists in Canada and England,” stated Dr. Shessel. In fact, Docs4PatientCare recently exposed the nomination of Donald Berwick, M.D. to head Health and Human Services Center for Medicare & Medicaid Services (CMS) as dangerous to the nation’s health. Despite the denials of the President, and protests from legislators, this recess appointment proves that ObamaCare is indeed the road toward socialism…

There’s also a Tea Party affiliation event in the works.

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Obama Appoints New CMS Head

Michael Douglas, MD, MBA — Thu, 08 Jul 2010 14:46:23 +0000

The fact that President Obama is naming Don Berwick, MD, CMS head via recess appointment shows his commitment to quality in healthcare delivery. It’s welcome news given that his drive for cost and access were the other cornerstones of recently passed reform legislation. Via the WH blog:

There’s no question that Don Berwick is the right choice to be our next CMS administrator: he’s the founder of the Institute for Healthcare Improvement and has spent decades as a practicing physician and a Harvard professor. He’s dedicated his career to finding ways to make our health care system work better for patients and cost less for taxpayers.

The choice of Berwick to fill this post is the perfect fit for an administration in search of the holy grail in healthcare delivery: quality. | LINK

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Massachusetts Faces Uphill Battle with Legislative Efforts to Control Healthcare Spending

Michael Douglas, MD, MBA — Tue, 06 Jul 2010 11:35:14 +0000

Those who expected the state with the first-in-the-nation initiative to cover the health care of all of its citizenry will have to hold their collective breaths a little longer. The plans for an overhaul on how physicians and hospitals are paid for quality delivery are on hold as major parties cannot come to an agreement on how this metric should be implemented. Perhaps the thought of examining Massachusetts’ negotiated payment system as a relatively straightforward exercise in healthcare economics was a bit shortsighted.

Combine the complexities of fee-for-service government reimbursements with the intricacies of funding for coordinated care systems; the possibilities of funding an accountable care commission of sorts as a payment governing body; and the simple inertia that current levels of healthcare spending have created in a wasteful state system — and you’ve got a recipe for an overwhelming stalemate. There is a glimmer of hope that one faction’s action will get the legislative ball rolling on this issue: some hospital systems in the state plan to release details on the creation of governance to oversee spending in their ranks. | LINK

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HHS Unveils Temporary Pre-Existing Coverage Plan

Michael Douglas, MD, MBA — Thu, 01 Jul 2010 13:50:52 +0000

Have you been rejected for insurance coverage because of a pre-existing condition? Have you been without coverage for at least 6 months? Finally, are you a legal U.S. resident? If you hit the trifecta, you qualify for the HHS’s Pre-existing Condition Insurance Plan. Kathleen Sebelius makes the announcement today.

Today, the Pre-Existing Condition Insurance Plan gives them a new option — the same insurance coverage as a healthy individual if they’ve been uninsured for at least six months because of a medical condition. This program will provide people the help they need as the nation transitions to a more competitive and fair marketplace in 2014.

The plan covers primary and specialty care and begins today in states where HHS implements the program. States with their own programs will roll out the initiative later in the summer.^[1] One’s income is not a consideration. | LINK

In 21 states, the federal government will run the program. Twenty-nine states plus the District of Columbia will run their own plans. Premiums can run anywhere from $100 – $1000/month and vary by region.

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Senate Rejection of Unemployment Extension Means Fears of Near-Term Dropped Medicaid Funding for States

Michael Douglas, MD, MBA — Sat, 26 Jun 2010 14:47:29 +0000

The U.S. Senate is the target of criticism of budgetary concerns on the left and on the right, as the weekend before most states’ new fiscal years begin. At issue is the stalled bill on unemployment benefits and extensions, which was the outcome of hours of debate and an ultimate (mostly) party line vote to block future consideration. States’ Medicaid packages were to figure in heavily, as many government-run healthcare programs were in dire need of funding in the face of the alternative — severe budget cuts in not only the state level, but also the local and municipal levels. Governors on both sides of the ideological aisle decried the Senate’s rejection of aid to their states in the form of another six months of Medicaid assistance. (Here in Minnesota, our governor has already rejected the earmark of funds as part of the balanced budget for this biennium.)

Also,

Making the situation more difficult for states, the recent passage of the federal health care overhaul bars them from rolling back eligibility on Medicaid, so the cuts would have to come from elsewhere in their budgets — and would likely include layoffs from different parts of the state governments, many of which have already seen big cuts — or by slashing things like payments to Medicaid providers.

Will governors have to go to Washington to lobby for the inclusion of this provision in this latest legislative battle? Unless the bill is revived next week in the House in an effort to address this critical setback, the issue of Medicaid financing will suddenly become much more complicated than it usually is this time of year. After all, state budgets have to be balanced. | LINK

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Study: Rapid Growth in Healthcare Expense Due to Medicaid Unlikely to Moderate

Michael Douglas, MD, MBA — Wed, 23 Jun 2010 13:07:50 +0000

President Obama’s recent remarks surrounding the commitment to Americans the promise of lower insurance premiums for healthcare access are all over the news and healthcare blogosphere this morning. The interested reader and health policy wonk also can’t avoid the latest goings on with Medicare legislation. But what about Medicaid? Obscured by concerns of healthcare providers’ battles with looming cuts to Medicare and patients’ bills of rights in their tussles with Insurance; the fears many states have with changes to Medicaid policy in lieu of reform are just as newsworthy.

A think tank’s new study sheds some light on this potentially incendiary issue: Medicaid is the prime payer of long term care (LTC) healthcare delivery in this country. Many states are concerned that Medicaid costs as a percentage of state budgets will nearly double by 2030, from the current 20 percent to 35 percent in some states. In some cases, costs can triple. LTC accounts for about a quarter of that expense. All the talk about the disappearance of patients from physicians’ Medicare rolls may be just the iceberg’s tip. Companies could be forced to jettison Medicaid beneficiaries; proposals to tax some healthcare and health plans to curb Medicaid cost increases are even on the table. As states’ problems with unemployment grow (here in MN, it’s at a ‘moderate’ 7 percent), Medicaid-related healthcare expense continues to increase in tandem. Not a rosy outlook at all. | PDF LINK

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Tuesday Newswire: MN Nurses Overwhelmingly Approve Move to Strike & More

Michael Douglas, MD, MBA — Tue, 22 Jun 2010 13:17:45 +0000

It’s on. The mega union only needed 66%. They got over 80% ‘yea’. [LINK]
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Hospital executives who have worked with Dr. Berwick describe him as a visionary, inspiring leader. [..] Republicans are using the nomination to revive their arguments against the new health care law, which they see as a potent issue in this fall’s elections, and Dr. Berwick has given them plenty of ammunition. In two decades as a professor of health policy and as a prolific writer, he has spoken of the need to ration health care and cap spending and has confessed to a love affair with the British health care system.

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Physicians’ Concerns Raise Awareness of Need for Revamped Medicare Legislation

Michael Douglas, MD, MBA — Mon, 21 Jun 2010 16:52:08 +0000

Yep, November 2010 is shaping up to be a very interesting month. The perfect storm surrounding the complexities of providing care to the aging uninsured is about to become a tsunami. The addition of millions of patients to the rolls of Medicare, the end of the six month reprieve on the implementation of enormous cuts, and the eye-opening intention of many medical providers to shorten their Medicare beneficiary bases will all combine to create healthcare’s version of the BP oil catastrophe.

Okay, that sentiment could be a little hyperbolic, but don’t discount the lingering animosity many physicians have for the lack of any government action on the way Medicare reimbursements are generated. Sure, there may be a six-month break before the inevitable occurs, but some providers have just had enough.

“I’m making a statement,” says Leah McCormack, a New York City dermatologist. “Many physicians are really being forced out of private practice.”

While hardly representative of the entire universe of physicians who see Medicare patients (some 97 percent according to CMS), it does encapsulate the sentiment being felt as many states’ medical societies as they report significant numbers of physician opt-outs. On the flip side, realistically, how many physicians can actually afford to leave Medicare — either via a moral stance or one out of necessity? Hopefully, patients will not have to find out. Healthcare access is an important part of President Obama’s reform agenda. The little-known (until now) inner workings of Medicare legislation will be taking front-and-center positions, as this latest wrinkle in healthcare reform gains more momentum for definitive action. And this time, the physicians are taking notice. | LINK

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Senate Reverses Course on Inaction in Preventing Steep Cuts to Medicare Physician Payments

Michael Douglas, MD, MBA — Sun, 20 Jun 2010 19:07:29 +0000

No sooner had the Senate’s stonewalling led to the expectation of the approval of deep cuts to Medicare reimbursements to physicians, a reversal of fortunes now has both Dems and the GOP agreeing on the so-called “doc-fix” compromise for which Finance chair Max Baucus has been advocating.

The $6.4 billion measure would reverse a 21 percent cut in physician payments that was to kick in Friday, raising the possibility that some doctors might begin to turn away those covered by Medicare.

To the GOP, this action means implementing yet another interim budget-neutral respite on the road toward Medicare payment . To the Democrats, it means saving face among healthcare reform advocates for another six months — just in time for the midterms. | LINK

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