Latest News | Health Care Delivery

From: Center for Economic and Policy Research

Article Excerpt:

The U.S. health care system is possibly the most inefficient in the world: We spend twice as much per person on health care as other advanced countries, but we have worse health outcomes, including a lower life expectancy. The government, through programs like Medicare and Medicaid, pays for approximately half of the country’s health care, almost all of which is actually provided by the private
sector. Thus, the bulk of our projected rising budget deficits are due to skyrocketing private health care costs.

The CEPR Health Care Budget Deficit Calculator shows that if the U.S. can get health care costs under control, our budget deficits will not rise uncontrollably in the future. But if we fail to contain health care costs, then it will be almost impossible to prevent exploding future budget deficits.

The Calculator lets you see what projected U.S. budget debts would be if we had the same per person health care costs as any of the countries listed below, all of which enjoy longer life expectancies than the U.S. (Life expectancies are listed in parentheses.)

Read more… Healthcare Budget Deficit Calculator

Gov. Jerry Brown’s administration wants health care change, with or without federal law

From: The Sacramento Bee – 3/30/12

Aricle Excerpt:

Gov. Jerry Brown’s administration vowed Thursday to continue pushing forward elements of the federal health care overhaul in California, even if the U.S. Supreme Court strikes it down.

If the court does rule the federal law unconstitutional, state Health and Human Services Secretary Diana Dooley said California should at least consider enacting its own universal health care legislation, including requiring every Californian to buy insurance.

“I think that we should be committed to making this system more rational than it is today, and improving the health of the people of California,” Dooley said in an interview. “If we ask the insurance plans to take everybody and insure everybody with no screens or pre-existing conditions, then we have to have everybody buying some level of health insurance to meet their responsibility to the system.”

She said whether the administration sponsors such legislation would depend on “where we are and what the conditions are at that particular time.”

Dooley’s remarks came a day after the Supreme Court finished three days of oral arguments over President Barack Obama’s signature health care law.

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Supreme Court has a wide range of options in ruling on Obama’s health care overhaul law

From: Chicago Tribune – 3/30/12

Article Excerpt:

WASHINGTON (AP) — The arguments are done and the case has been submitted, as Chief Justice John Roberts says at the end of every Supreme Court argument. Now the justices will wrestle with what to do with President Barack Obama’s health care overhaul. They have a range of options, from upholding the law to striking it down in its entirety. The court also could avoid deciding the law’s constitutionality at all, although that prospect seems remote after this week’s arguments.

A look at six potential outcomes, from the simplest to the most complicated possible rulings:

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Legal Challenges to the Affordable Care Act

From: HFMA – March 2012

Publication Excerpt:

The Supreme Court has granted review of four issues from challenges to the Affordable Care Act that have been pursued in the federal courts since passage of the act in March 2010. The court originally set aside 5 1/2 hours for oral argument (arguments at the court are typically restricted to one hour, with each side granted a half-hour of argument), but has expanded the total argument time to 6 hours, spread over three days (March 26, 27, and 28, 2012). The four issues on which the court has granted review are:

• Whether the Anti-Injunction Act prevents challenges to the Affordable Care Act at this time (90 minutes of argument on March 26)
• The constitutionality of the individual mandate, requiring most Americans to purchase health insurance by 2014 (2 hours of argument on March 27)
• Whether the individual mandate is severable if it is found to be unconstitutional, or whether the entire Act would have to fail (90 minutes of argument on March 28)
• Whether the Affordable Care Act’s expansion of the Medicaid program is constitutional (1 hour of argument on March 28)

The issues of the constitutionality and severability of the individual mandate have attracted the most attention in the federal district and appellate courts. The possibility that the Anti-Injunction Act might bar challenges to the Affordable Care Act has also emerged as a significant issue, hinging on the question of whether the penalty for failure to observe the individual mandate functions as a tax.

The argument that the act’s expansion of Medicaid is unconstitutional has not been successful in lower court challenges. This argument asserts that the act violates the Constitution’s Spending Clause (Article I, Sec. 8, Clause 1), based largely on speculation in preexisting Supreme Court case law that financial inducements offered by Congress to encourage state action could at some point pass a threshold and become coercive.

The discussion below summarizes district court rulings on the challenges to the Affordable Care Act, followed by a summary of reviews of the district courts’ rulings in the federal appellate courts.

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Could the health-care law work without the individual mandate?

From: Washington Post – 3/27/12

Article Excerpt:

If the Supreme Court were to invalidate the 2010 health-care law’s requirement that virtually all Americans obtain insurance, would the rest of the law become unworkable?

Even among supporters of the statute, opinions vary widely about the practical impact of a decision to strike down the mandate but leave everything else intact — one of several options available to the court.

“It’s probably the biggest area of uncertainty around all estimates about the law,” said Larry Levitt, a health insurance expert with the Kaiser Family Foundation.   The Obama administration argues that requiring individuals to get coverage is essential to the success of two of the most important — and popular — regulations that the law will impose starting in 2014: a rule that insurers can’t discriminate against people with preexisting conditions, and limitations on how much they can vary rates among customers.

Many of the law’s supporters insist that without the mandate, these rules would impose an unsustainable burden on insurers, ultimately causing the market to implode.

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Health Exchanges – Policies give states more flexibility to establish Affordable Insurance Exchanges

From: HHS News Room – 3/12/12

Text of Release:

Health and Human Services Secretary Kathleen Sebelius today announced policies to assist states in building Affordable Insurance Exchanges.  Starting in 2014, these one-stop marketplaces will allow consumers and small businesses to choose a private health insurance plan and offer the public the same kinds of insurance choices as members of Congress.

The policies released today will help states in designing their Exchanges to best meet the needs of their consumers.  They offer states substantial flexibility as they design a marketplace that works for their residents.

“These policies give states the flexibility they need to design an Exchange that works for them,” said HHS Secretary Kathleen Sebelius. “These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business. More competition will drive down costs and Exchanges will give individuals and small businesses the same purchasing power big businesses have today.”

Today’s policies provide states with the guidance and certainty they need as they continue to work to build these marketplaces for their residents for operation in 2014. The policies offer guidance about the options on how to structure Exchanges in two key areas:

• Setting standards for establishing Exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an Exchange, and certifying health plans for participation in the Exchange;
• Establishing a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs.

The final rule builds on the flexibility and resources provided by HHS already to build state-based Exchanges.  A majority of states have taken significant steps in building Exchanges. Previously, HHS awarded 49 states and the District of Columbia $50 million to begin planning their Exchanges, and as announced recently, 33 states and the District of Columbia have received over $667 million in Establishment Grants to begin building their Exchanges.

Today’s announcement builds on over two years’ worth of work with states, small businesses, consumers, and health insurance plans. The administration examined models of Exchanges; convened numerous meetings and regional listening sessions across the country with stakeholders; and consulted closely with state leaders, consumer advocates, employers and insurers. To finalize the rules announced today, HHS accepted public comment over 75 days to learn from states, consumers, and other stakeholders on how the rules could be improved, and HHS modified the proposals based on feedback from the American people.

Click here to view HHS Fact Sheet

Obama opposes repeal of healthcare program suspended last week

From: THE HILL’S Healthcare Blog – 10/17/11

Excerpt from Article:

President Obama is against repealing the health law’s long-term-care CLASS Act and might veto Republican efforts to do so, an administration official tells The Hill, despite the government’s announcement Friday that the program was dead in the water.

“We do not support repeal,” the official said Monday. “Repealing the CLASS Act isn’t necessary or productive. What we should be doing is working together to address the long-term care challenges we face in this country.”

Over the weekend, The Hill has learned, an administration official called advocates of the Community Living Assistance Services and Supports (CLASS) Act to reassure them that Obama is still committed to making the program work. That official also told advocates that widespread media reports on the program’s demise were wrong, leaving advocates scratching their heads.

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FYI: This provision of ACA was projected to account for $86 Billion of the savings from healthcare reform which reflects about 40% of the overall savings from the law.

A Couple of Humorous Videos Related to ACOs

On the lighter side, I just returned from the HFMA Fall Conference that was held earlier this week.  In a presentation from Ralph Lawson, EVP and CFO of Baptist Health South Florida he included a you tube video clip related to a CEOs wanting to create an ACO.  I did a search an found a couple videos you may enjoy.  Please, don’t take them too seriously:

• ·         In Search of an Accountable Care Organization (ACO)
• ·         Setting Up An Accountable Care Organization

Records of 4.9 mln stolen from car in Texas data breach

From: Reuters – 9/29/11

Backup tapes from a contractor transported from one federal facility to another were stolen from the car losing 4.9 million patient records.  This reflects about half of all Military beneficiaries covered under the TRICARE program.  It would appear that these back-up tapes were not encrypted.  If they were encrypted, then this event would not need to be reported.  This is simply my take in review of the article.  The moral of this story, all data needs to be encrypted when being transported whether electronically or otherwise.  The cure of this breach will cost millions of dollars.

Article Excerpt:

A massive data breach, in which the personal and medical records of millions of military patients and their families were compromised, happened when the records were stolen out of a data contractor’s car in San Antonio, officials told Reuters on Thursday.

The information for some 4.6 million active and retired military personnel, as well as their families, was on back up-tapes from an electronic health care record used to capture and preserve patient data from 1992 through September 7 of this year, according to Science Applications International Corp (SAIC).

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Report: Hospitals across the country failing patients after discharge

From: The Hill.com Healthcare Blog – 9/28/11 

Article Excerpt:

Hospitals across the country are doing a dismal job making sure their patients stay healthy after they have been discharged, according to a new report released Wednesday. 

Readmission rates have actually increased nationally for some conditions over the past five years, according to the Dartmouth Atlas Project, which tracks regional variations in care. The new data come as hospitals with high readmission rates will start seeing Medicare reimbursement cuts under the healthcare reform law, starting in October 2012.

“The report highlights widespread and systematic failures in coordinating care for patients after they leave the hospital,” lead author David Goodman said in a statement accompanying the report. “Irrespective of the cause, unnecessary hospital readmissions lead to more tests and treatments, more time away from home and family, and higher health care costs.”