The wrangling back and forth in the US legislature concerning the upcoming vote on the payroll tax cut extension (which includes a provision giving providers a two-year break on Medicare payment cuts) continues to raise the ire of acute hospitals, which would shoulder part of the financing for such an action. The amount to be financed, at the literal expense of hospitals, approaches $17 billion. Essentially, the proposed offsets to direct provider payments would come from reduced payments to hospital administrative and evaluatory functions.

House GOP leaders are in the hospitals’ crosshairs, as the hospitals complain that, under the proposal, there is little incentive for them to continue to collect other payments (copays, deductibles) in the face of such financing, compromising care delivery in the process. Republicans are quick to point out, however, hospitals did agree to major cuts in Medicare as part of reform and that overall Medicare spending would fall by less than 1 percent over the next 10 years. | LINK

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Honestly, these “clock-ticking countdowns” are getting a little irksome. The eleventh hour negotiations surrounding the legislative extensions of the payroll tax cuts for the middle class just hit another roadblock, outlets have reported. Cue the Senate showdown between the GOP and Dems. Closely tied into the GOP plan for the extension of the tax cut is the inclusion of the Keystone XL oil pipeline — a controversial project which President Obama had originally hoped to decide upon by 2013 its potential for environmental sustainability.

The Keystone pipeline pawn would force Obama to make a decision on its contruction by the end of this year.

With respect to healthcare, the inclusion of provisions to forestall cuts to Medicare payments for 2 years, preventing incremental threats to physician reimbursements (no permanent overhaul), would be the political gambit. It’s a political mixed bag for some healthcare entities. Hospitals would be better served by more long-term solutions to the so-called doc-fix problem. Providers would be spared more frequently intermittent threats to reimbursement. If passed, this payroll tax cut extension would eliminate the possibility of approximately 27 percent in cuts to Medicare payments.  | LINK

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A physician advocacy group has released a report detailing the costs to Massachusetts in the wake of its healthcare reform. The goal is to shed light on the potential costs to the country as a whole once reform begins in earnest. The single-payer advocacy group mainly cites that cost shifting of taxpayer subsidies to fund the private insurance marketplace is creating an access burden for the state’s impoverished and lower middle class by pricing them out.

Most of the gains in coverage have come from expansions in publicly subsidized insurance. This largely represented a shift of patients from the state’s former Free Care Pool, which compensated hospitals and community health centers directly for care of the uninsured, to private insurance plans, which is a more costly way to provide care.

Read the PDF of the entire report. The report appears to yearn for a less-than-market-based approach to solving this financial crisis as a way in which access to care can remain intact amid long-term reform sustainability. This report was released jointly among this group and via the state chapter of Physicians For a National Health Program.

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The news Wednesday morning of a 3.6 percent increase in Social Security COLA payments for 2012 is somewhat of a mixed blessing for Medicare beneficiaries, many of whom have had to shoulder stagnant SS income over the last couple of years due to negligible inflation. The increase — set to take place in January — could be offset by higher Medicare B premiums, which are deducted from SS payments.

Typically, and unsurprisingly, Medicare B premiums increase at rates higher than inflation — but those increases cannot exceed COLA, by law. Dually eligible recipients over the last couple of years, as well as higher income senior beneficiaries, were not protected from rate increases over 2010 because of Medicaid payments incurred by the former and Part B surcharges paid by the latter group.

The majority of Medicare beneficiaries, however, paint a variable picture with respect to SS income and Part B liability; and the degree of variability has to due with the amount of the monthly SS benefit paid to seniors. All of this is a stark reminder of the degree of the increasing costs of healthcare delivery on Medicare and how it compares and impacts SS entitlements year-in and year-out.

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With all of the hubbub surrounding Herman Cain’s 9-9-9 taxation plan, it got me to thinking about what this really means for the financing of healthcare now that reform is upon us. Answer? I should just keep on wondering. The Soundbite Candidate really offers nothing substantial at this point — though, that could change if his polling continues to rise among GOP and Tea Party faithful.

Cain, who should employ the KISS mnemonic to all of his policy decisions, doesn’t stray from this credo with respect to healthcare. In fact, he cites a late-1960s era promo campaign to healthcare delivery and its skyrocketing costs: creating an ad campaign in order to change peoples’ behaviors and attitudes toward healthcare in this country. Via MOJO:

Cain got a chance to lay out what he would have done if he’d been in charge of the country and needed to deal with health care. His alternative? Lady Bird Johnson’s “Keep America Beautiful” campaign. Cain writes in his [1997 book, "Leadership Is Common Sense"] that the main problem the United States has with health care is one of attitude, and the former first lady’s anti-littering campaign was a stellar example of how an advertising campaign to change national attitudes can have a significant impact on behavior.

Who needs robust policy on healthcare when a potential president says it all comes down to simply not getting sick in the first place? Certainly, not Mr. Cain, whose recent cancer scare would have been much moreso had he not had his wealth to rely on for timely access to appropriate care. | LINK

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While California struggles to make some headway in reconciling its budgetary woes amidst an outcry from patients, hospitals, and physicians with respect to Medicaid funding, the funding of Medicare — specifically via auterity measures to ensure its short term viability within reform — is a top concern among the same factions. Only this time, the ire is directed towards the commission charged with implementing payment scales.

The [sustainable growth rate] calls for annual, automatic cuts in Medicare payments to doctors, which Congress always delays, allowing the cuts to accumulate. MedPAC is considering a 10-year replacement that would be offset by cuts to most medical specialties. But the American Hospital Association said health care providers shouldn’t have to foot the bill for a new formula.

MedPAC knows that this is an issue which legislators are echoing, as well. It is becoming a rather common — and exasperating — rite of passage: automatic SGR cuts in Medicare reimbursements which are usually stalled by Congress; the inevitable revisiting of definitive methods to decrease healthcare costs due to Medicare next on the agenda. Most parties agree on that point, just as long as that agenda does not include massive industry cuts (read: providers) within healthcare delivery. | LINK

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Alzheimer dementia continues to be among the most heavily researched and funded chronic diseases in medical science today. The increased awareness, brought into the spotlight and “modernized” more than 20 years ago following the high profile revelations of celebrites and politicians afflicted with the disorder, has led to increased patient education, public policy initiatives, and, of course, greater research monies in the effort to not only treat symptoms, but also to find a cure.

An international advocacy group is now asking municipalities to take awareness a notch higher with the commitment to even greater awareness of the disorder — addressing what it calls a “treatment gap”, hampering any gains on detection of the disorder at its earlier stages. Here in the U.S., the Obama admin is apparently hard at work in developing the country’s first-ever national anti-Alzheimer strategy aimed at sharply cutting the enormous healthcare costs associated with ancillary treatment .

The National Alzheimer’s Project: From Act to Action is an effort to support a committed and effective implementation of the National Alzheimer’s Project Act (NAPA). Information collected from individuals living with the disease, caregivers, providers and other stakeholders will be shared with the U.S. Department of Health and Human Services, which is responsible for creating a national strategy to address the crisis and coordinate across government agencies. This project is facilitated and supported by the Alzheimer’s Association.

Consider this effort an amalgam of citizen awareness and discussion (townhalls) and legislation (congressional passage of the National Alzheimer Project Act) garnering bipartisan^[1] support to fight a scourge that can leave heavy financial tolls on caregivers, families, and the healthcare delivery system itself.^[2] A daunting task, to be sure — but one that is sorely needed. Here’s looking forward to December — the date when the president makes his plans for these initiatives very public. | LINK

1. Just how bipartisan? In 2007, Newt Gingrich co-authored an article in Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association, making the case for the creation of a federal Alzheimer strategy.
2. Alzheimer’s Association advocates sent more than 15,000 email messages to the White House asking the President to sign the National Alzheimer’s Project Act into law; on 1/4/11, he did — making this action the most significant legislative action with respect to Alzheimer funding intiatives up to this point.

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Ever wonder how the preparations for healthcare exchanges are proceeding? The Kaiser foundation has constructed a brief [PDF] which allows one to reasearch states’ plans in progress. To review, the establishment of healthcare exchanges by the feds under reform is meant to enable consumers to compare a selection of qualified health insurance options in order to find the plan that best meets their needs and budget — with a significant amount in taxpayer subsidies devoted to this purpose.

Among the highlights in the brief report: (1) discussion of governance of exchanges, with some states granting significant control over governance matters at the hands of the excutive branch; (2) plans by states to address conflict-of-interest issues regarding insurance plan representation within governing boards of exchanges; (3) the total amounts paid to states so far in the funding of exchange formations in their individual healthcare marketplaces; and (4) the effect of legal challenges brought forth in some states regarding the constitutionality of the insurance mandate provision of the ACA (most recently, the striking down of the state of Virginia’s challenge filed by its atty. gen.) on the formation of exchanges.

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If one assumes that news of cuts in reimbursements of the two major healthcare entitlements (which probably will not happen) is never really good news for providers when accompanied by news of overall decreases in government spending on Medicare and Medicaid — then news of OMB-projected reductions in entitlement spending over the next decade essentially confirms this postulate. Under current fiscal policy, the government is expected to spend about $4 billion less this year on Medicare, matched with another $4 billion reduction over the next decade compared to the administration’s previous estimates, according to those revised projections.

When coupled with a virtually stagnant U.S. economy, a subsequent decline in payroll tax means finding alternatives to fund not only Medicare, but also Social Security. FY 2012 mandatory spending (which now includes funds spent on TARP funding) on Medicare will top north of $450 billion. If more than half of the budget goes toward entitlement spending, it’s difficult to realize other options when it comes to managing discretionary expenses — even with President Obama’s push for healthcare reform. Choosing between raising taxes, decreasing SS payouts to retirees, or inflating the budget as a percentage of GDP — just to maintain fiscal gov’t solvency — is enough to give any healthcare policy wonk a massive headache.

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The initial spin on the recently squared away budget deal preventing a national default relates a necessary evil that not only carries the partisan rift seen in advance of the legislation, but also becomes a harbinger for a financial outlook that, in some ways, looks as bleak as the presumptive default did. Still retaining its triple-A rating, the credit outlook for the United States will be reflected in a “negative” forecast — likely resulting in a downgraded credit status within the next couple of years. Of course, all of this big-picture wrangling really doesn’t mean much to the millions of people whose salaries are paid — in part — by the federal government. A harsh reality at the forefront of this thinking, given the current jobless rate and achingly persistent unemployment levels is the specter of the loss of unemployment insurance for those currently receiving benefits. Minnesota is just one of many states bracing for such an apocalypse which appears to be sparing future cuts in another enormous federal subsidy — Medicaid.

Department of Human Services Commissioner Lucinda Jesson said she was relieved that Medicaid, known as Medical Assistance in Minnesota, is exempted from the initial cut. That doesn’t mean the new bipartisan commission charged with driving down the deficit won’t come after it once the panel breaks out the budget knife. “We are going to track it very closely,” Jesson said Tuesday. She said her department will also keep a close watch on child protection, food support and other assistance for seniors.

What about cuts to the service side of the equation? Since Social Security and Medicaid are specifically exempted from the ravages of the debt ceiling bill, physicians could see an additional 2 percent pay cut on top of double-digit Medicare reductions already slated for 2012 under the debt ceiling deal. Perhaps more concerning is the strong likelihood for major Medicare cuts and overhauls in long term care payments as a by product of a commission^[1] created as part of the deal agreed to on Sunday. Nursing homes would be hit extremely hard in this scenario — potentially affecting care delivery to the most medically complex beneficiaries in the LTC sector. Understandably, the deal reached by a less than jubilant Hill on Sunday has many folks extremely wary about the nation’s prospects on an already shaky economy. Its effects on federally subsidized healthcare delivery ups the ante for lobbyists, providers, and most importantly — patients. | LINK

1. The deal to raise the debt ceiling would task a 12-member bipartisan committee to come up with $1.5 trillion in deficit reduction and would require a significant swath of cuts starting in 2013 if those efforts at reducing the deficit should fail.

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