Survey Says - Healthcare Executives Don't Trust Payers

A survey designed to measure the level of trust that hospital executives have in health insurance companies finds several factors that contribute to low scores, including the length of time it takes for claims to be paid, and the rates hospitals and physicians are paid.

Payers scored poorly on all three of the new trust questions in the annual National Payor Surveyconducted by ReviveHealth, a Nashville, TN based strategic communications firm and Catalyst Healthcare Research. The results from the final question, which asked providers whether a particular payer "balances its interests with ours and doesn't routinely take advantage of us," were particularly dire. Read the article in HealthLeaders Media here.

Study Says When Hospitals Buy Physician Practices, Costs Go Up

A new study gives ammunition to what health economists and health insurers have argued for years: When hospitals buy physician practices, the result is usually higher hospital prices and increased spending by privately insured patients.

The study, published Monday in the journal Health Affairs, was based on an analysis of 2.1 million hospital claims from workers of self-insured employers between 2001 and 2007. The analysis by Stanford University researchers found prices were most likely to increase when hospitals bought physician practices, as opposed to hospitals forming looser contractual relationships with physicians.

Read the article in Kaiser Health News.

Community Tools Are Available to Combat the Higher Rates of Childhood Obesity In Rural Areas

The Altarum Institute, a nonprofit health-systems research and consulting organization, reported today that children living in rural areas are about 25 percent more likely to be overweight or obese than children in urban areas. Rural communities have come up with several strategies to battle childhood obesity. 

According to Sarah Lifsey and Karah Mantinan of the Altarum Institute, studies have found that there is little open public space in rural areas, often because of a lack of a strong government to provide and maintain such public spaces. They also cite research showing that rural children are also at increased risk of poverty compared to children in cities or suburbs, and face lower access to healthcare, lower levels of physical activity and lower-quality food.  Many rural families who lack access to fresh and healthy foods live in “food deserts,” Studies have found poverty and childhood obesity are more likely in rural food deserts.

Tools are available to help with this planning such as the Rural Active Living Assessment Tools, developed by the Robert Wood Johnson Foundation. Other resources include the Rural Assistance Center, funded by the U.S. Department of Health and Human Services Rural Initiative, which features a Rural Obesity Prevention Toolkit developed by the Nutrition Obesity Research Center’s Walsh Center for Rural Analysis, as well as a resource guide for rural areas developed by the University of North Carolina’s Active Living by Design.

Read the article in the Lane Report.

Rural Physicians More Likely to Participate in QI Efforts and Discuss Cost of Care with Patients

A new study in the National Rural Health Association’s Journal of Rural Health finds rural primary care physicians are more likely to participate in quality improvement activities than their urban counterparts. According to Alan Morgan, CEO of the National Rural Health Association, “Quality healthcare can be found in rural towns all across America. Rural primary care often faces significant challenges with equal or better patient outcomes. It’s time to start looking at what’s done right in rural.” 

A survey of 2,000 rural and urban family practitioners indicated that while rural communities may have fewer training options, rural primary care physicians are significantly more likely to participate in quality improvement activities. The study also found that rural physicians were more likely to agree that physicians should discuss the costs of care with their patients and to report having added Medicaid or uninsured patients during the preceding year.

The peer-reviewed article on the study can be found here (a subscription may be required).

 

Study Shows One in Four Families Struggle to Pay Medical Bills

According to a government survey published in the Bloomberg Personal Finance this week, one in four US families struggled to pay medical bills in 2012, and one in 10 said they had costs they couldn't pay at all.

The survey, released from the National Center for Health Statistics at the US Centers for Disease Control and Prevention, also found the lack of health insurance increased the burden of medical debt.

Major provisions of the Affordable Care Act take effect this year as the Obama administration seeks to extend healthcare coverage to most of the nation’s 48 million uninsured. The law may help lessen some of the financial burdens of medical care, said Karen Pollitz, a fellow at the Kaiser Family Foundation. "Unpaid medical bills is the number one reason why families declare personal bankruptcy,” Pollitz said in a telephone interview. “It causes people to lose equity in their homes, to endanger their retirement and their kid’s college education. It will destroy a family financially.” Read the rest of the article here.

Response to Study Finding CAHs Had a Slightly Worse Mortality Rate Than Major Medical Centers

A recent research report in the Journal of American Medicine stated that Critical Access Hospitals (CAHs) had a slightly worse mortality rate than major medical centers. Dr. Wayne Myers, a retired pediatrician and rural medical educator, responds in The Daily Yonder stating that the report gave the wrong reasons for the small difference in survival between the rural CAHs and larger regional hospitals. Read Dr. Myers's insightful response here.

Report Says Experience of CHIP Hints at Impact of Medicaid Expansion on Providers

Enrollment in public health insurance coverage will expand significantly beginning in 2014. At this time there is only a limited understanding of what happens when an influx of newly insured patients encounters a relatively fixed supply of providers. Will they choose to work longer hours to accommodate the increase in demand? The experience of the Children’s Health Insurance Program (CHIP) offers a preview of how providers might respond to the expansion.

According to a report in the Medicare & Medicaid Research Review, researchers from the Government Accountability Office and the Washington-based Center for Studying Health System Change found that the creation of the Children's Health Insurance Program in 1997 did not create a deluge of patients that the nation's pediatricians couldn't handle. Read more here.

Policy Options to Cut Emergency Department Costs

For nearly 50 years, emergency rooms have been fingered as a major source of excessive healthcare costs. And while some newer research has challenged the idea that a large proportion of patients visit the emergency room for routine problems, many payers and policy makers continue to focus on these patients as a major source of wasteful spending.

For a new study published in The Journal of the American Medical Association, researchers reviewed the records from almost 35,000 patient visits to emergency departments across the country. In just 6 percent of cases, the patient was discharged and could have been treated in a healthcare provider’s office. 

History has shown that limiting payments based on discharge diagnoses has been largely unsuccessful. However, other policy options are being tested around the country. Beginning last summer, emergency departments in Washington state established programs to educate patients on how to access care, as well as other measures designed to improve care, including statewide guidelines on prescribing narcotics, shared electronic health and prescription information, and regularly updated reports on how emergency department resources are utilized. The policy has already resulted in significant changes and a projected savings of over $31 million by the end of the fiscal year. Read more here.

Interim Report Says There is Little Support for Medicare Payments That Vary

An interim report recently issued by the Institute of Medicine concluded Medicare should not adjust payments on a broad regional basis to reward hospitals and doctors that spend less to achieve high-quality care. 

The study was conducted at the request of the secretary of Health and Human Services, Kathleen Sebelius, in response to a push by some members of Congress to revisit how Medicare pays hospitals and doctors. The report’s authors were responding to the argument that Medicare should pay higher levels of reimbursement to areas of the country that deliver measurably good care at low cost and less to regions where costs are high and outcomes are poor. Read more about the study in the New York Times.

Colorado Health Report Card Released

Each spring, the Colorado Health Foundation releases a health report card for the state, measuring things like teen pregnancy, smoking, obesity and mental health. This year, Colorado received three Bs, a C and a D.

The analysis divides Coloradans into five age groups, prenatal to old age. Overall, the report said adolescents, adults and the elderly are doing pretty well; they earned Bs and B pluses. However, the score for Colorado’s children, was a D plus. According to Anne Warhover, president and CEO of the Colorado Health Foundation, “[W]e’re not growing our own healthy children. Our child obesity rate remains in the middle of the pack. That’s where the foundation is really going to emphasize more and more of our work in trying to prevent childhood obesity. It leads to so much cost in our system.”

Read more about the report card in Katie Kerwin McCrimmon's post in the Colorado blog, Health Policy Solutions.

Study Says Medicaid Expansion for All States Would Pay Hospitals More By 2022

According to a study by the Urban Institute funded by the Robert Wood Johnson Foundation, states that expand Medicaid could see $2.59 gained in Medicaid revenue for every private insurance dollar lost. Under the Affordable Care Act (ACA), states have the option to raise the income eligibility mark for Medicaid to 133% of the federal poverty line starting in 2014 in exchange for full federal funding for the expansion for three years and not less than 90% of the added cost after that. Read about the study here, which examined current low-income patients who have private insurance but would be newly eligible for Medicaid coverage if the state expanded the program. In Colorado, Senate Bill 13-200 is making its way through the legislative process. If passed, Colorado will expand Medicaid eligibility to 133% beginning in 2014.

Commission on Doc Pay Urges End to FFS, SGR

The National Commission on Physician Payment Reform released a dozen recommendations to ultimately change how physicians are paid by public and private payers, starting with the premise that physician salary and expenses account for 20% of healthcare spending, but the decisions doctors make influence another 60% of that spending.

The Society of General Internal Medicine convened the commission a year ago to suggest new ways to pay the nation's physicians that could improve patient outcomes and lower healthcare costs.  In the report released Monday, the commission concluded that the problems of physician payment are based on systemic issues, such as the traditional fee-for-service payment model, and problems pertaining specifically to Medicare, including the sustainable growth-rate formula to pay physicians and the operation of the Relative Value Scale Update Committee (RUC), which makes recommendations to the CMS. Read more here (may need free subscription).

New Analysis of Colorado Children and Health Insurance

The Colorado Health Institute recently released its annual analysis of the number of eligible children in the state who are not enrolled in the Medicaid or Child Health Plan Plus (CHP+) public insurance programs.

According to the analysis, about 125,000 Colorado children, or 9.7 percent of all children, did not have health insurance in 2011. This was a decrease from the 132,000 uninsured children in 2010.

View the 2011 estimates from the Colorado Health Institute here in three new publications:

• A fact sheet that summarizes the high-level findings and maps county-level estimates. 
• A data supplement that includes detailed tables of county-level data. 
• A methodology document that outlines the assumptions and processes used to create the estimates.

Report Says Medicaid Expansion Will Boost Colorado's Economy

A new study of Medicaid expansion commissioned by the Colorado Health Foundation, and conducted by legislative budget analyst Charlie Brown and a team of economists, says expanding Medicaid to an estimated 275,000 additional people will cost Colorado less than the price of not adding them.  Brown and his team found that expanding Medicaid would be similar to a stimulus program for Colorado because millions of federal dollars will flow into the state to pay for the new patients’ care (federal taxes will pay 100 percent of the costs of Medicaid expansion from 2014 to 2016, then taper to 90 percent by 2020).

Key findings from the report include:

• In FY 2025-26, the last year of the study period, a comparison of the "no expansion" and "full expansion" options shows that the following economic impacts will occur as a result of the decision to fully expand Medicaid:
• The economy, as measured by state gross domestic product (GDP), will be 0.74 percent larger than if Colorado does not expand its Medicaid program. Expansion will result in just less than $4.4 billion in additional state economic activity in 2025.
• Average annual household earnings will be $608 more with full Medicaid expansion compared to no expansion.
• Colorado will have 22,388 more jobs in 2025 if the state fully expands Medicaid.
• While Medicaid expansion is not free, the combination of federal support for expansion populations and state savings in programs makes full expansion less costly to the General Fund than no expansion until FY 2020-21.
• By FY 2025-2026, state General Fund appropriations would be a cumulative $133.8 million less for full Medicaid expansion than if the state chose not to expand.
• The larger economy that would result from Medicaid expansion will generate more state tax revenue without an increase in tax rates. In FY 2025-26, tax revenue is projected to be $128 million higher due to a decision to expand Medicaid. In each year, the combination of the additional revenue generated from the larger economy and savings in other General Fund programs is sufficient to fund the state's share of the cost of Medicaid expansion.
• Compared to no expansion, Medicaid expansion will add an additional 275,000 Coloradans to Medicaid enrollment by FY 2025-26. Those added to Medicaid insurance include 209,000 newly eligible adults without dependent children, 44,000 newly eligible parents and an additional 22,000 currently eligible but not enrolled children and parents.
• Medicaid expansion will reduce the number of uninsured non-elderly Coloradans by 189,000 by FY 2025-26 and reduce the percentage of uninsured in the non-elderly population from 11.1 percent to 7.7 percent compared with non-expansion.

Read the press release from the Colorado Health Foundation and link to the full report here.

Lessons Learned from Early Adopters of Remote Patient Monitoring Technologies

Remote patient monitoring such as home teleheath and telemonitoring can help improve coordination, improve patients’ experience of care, and reduce hospital admissions and costs. These technologies remotely collect, track, and transmit health data from a patient’s home to a healthcare provider and can facilitate communication and help engage patients in the management of their own care. A new brief from The Commonwealth Fund offers findings from case studies of three early remote patient monitoring adopters: the Veterans Health Administration, Partners HealthCare, and Centura Health at Home. Read the case studies and lessons from early adopters here.

Infographic on Healthcare Access in Rural Colorado Released

Joe Sammen, Community Partnership Coordinator for the Colorado Coalition for the Medically Underserved (CCMU), blogged this week about policy options to improve access for rural Coloradans. His opinion piece accompanied CCMU's lastest brief in their infographic series, a series that explores health from the perspectives of different populations. Developed using health survey data, the series demonstrates Coloradans’ varying experiences of health and healthcare. Read Joe's opinion piece here on rural healthcare reform and opportunities for coverage, and view CCMU's rural health infographic with data on access and coverage for rural Coloradans here.

Roughly 12,000 Jobs to be Added Statewide with Expansion of Medicaid

A proposal to expand Medicaid to cover 160,000 more Coloradans will add roughly 12,000 jobs statewide, according to a rough estimate by economic development leader Tom Clark.  Legislators will be debating whether to accept the federal offer this session, which as part of the Affordable Care Act, offers states the option to expand Medicaid to persons living below 133% of the federal poverty level. Gov. Hickenlooper recently gave the expansion his support and estimated it would bring $12.28 billion in federal funds back to Colorado taxpayers over 10 years. Read more here.

Health Cost Growth Slow But Showing Signs of Acceleration

A report recently released by the U.S. Centers for Medicare and Medicaid Services and published in Health Affairs, says U.S. healthcare spending rose at a historically low rate of 3.9 percent for the third consecutive year in 2011. But despite relatively low growth over the last few years, the figures showed signs of acceleration as the economy recovered from recession. Read the full article here.

New Issue Brief Says Coloradans Facing More Barriers to Accessing Oral Healthcare

According to a new Colorado Health Access Survey (CHAS) report, the number of Coloradans without dental insurance grew to 2.1 million in 2011 from 1.8 million in 2009 – a 17 percent increase from the 2008-2009 baseline survey. Over 2.5 times as many Coloradans were without dental insurance than were without health insurance in 2011 (829,000 uninsured Coloradans). The problem is even more pronounced among Hispanic Coloradans, the majority of whom (52.8%) reported that they lack dental insurance, an increase from 47.6% in 2008-2009.

The brief, A Growing Problem: Oral Health Coverage, Access and Usage in Colorado, is based on CHAS data from the 2011 CHAS. It shows that all Coloradans are facing more barriers to accessing oral health care, compared to 2008-2009 when the survey was last done. The brief also shows:

• Having dental insurance makes a significant difference in whether Coloradans seek dental care. Of Coloradans who had dental insurance, 76.9% visited a dental professional. Of those with no dental insurance, 44.5% visited a dental professional. 
• Hispanic Coloradans lack dental insurance at a higher rate (52.8%) than white (39.1%) and black (29.9%) Coloradans.
• Lower-income Coloradans lack dental insurance at a higher rate than those with higher incomes. In addition, uninsured Coloradans with low incomes did not seek dental care as often as uninsured Coloradans with higher incomes.
• Cost is the reason nearly one in four Coloradans (22.9%) did not get the dental care they needed, according to the 2011 CHAS. Even those with dental insurance do not always seek care because of cost. More than a third (36.6%) of Coloradans who did not get needed dental due to cost had dental insurance.

 

SHADAC Report Finds Safety Net Programs Working for Kids

The State Health Access Data Assistance Center (SHADAC) released a report which analyzes recent trends in health insurance coverage for children at the state level between 2008 and 2010. The report found the percentage of children with public coverage through Medicaid or the Children’s Health Insurance Program (CHIP) increased substantially, while rates of private coverage and uninsurance declined. Read more here.