Category: Medicare

A Look at Types of Universal Healthcare

Posted on by ecma

Americans all around the nation are giving their support for Medicare for all. On March 29 of this year, we wrote a blog called “Is Medicare For All the Solution?” In case you don’t know what Medicare For All is,

“Medicare For All is a universal health care plan that was developed by Vermont Senator, Bernie Sanders. This would be built off what former President Barack Obama had with the Affordable Care Act (ACA), also known as Obamacare. Medicare For All is a solution that would help give health insurance at affordable rates, covering primary and specialty healthcare, vision, hearing, dental, mental health, addiction services, and many other essential health care solutions.”

Niran S. Al-Agba, MD, explains universal health care through the following four points:
1. Most universal health care systems are not highly centralized,
2. Most universal coverage systems offer narrow benefit packages and incorporate cost-sharing for patients.
3. Private health insurance plays a significant role in most developed countries with universal coverage.
4. Countries with universal coverage have strict immigration policies to control health care expenditures.

The Commonwealth Fund recently compared universal health care systems around the globe with the United States single-payer bills proposed in Congress. The country that most resembles the US proposal (where decision making is centralized) is France. In France, the government is responsible for 77 percent of total health expenditures. However, there is an out-of-pocket cost share for patients that is around 7 percent, annually. A few other countries that also use a highly centralized system are the Netherlands, Singapore, and Taiwan. However, these countries have populations that are more similar to that of only one state in the US.

Another type of Universal Healthcare is a “hybrid” system, where decision making and financing are shared at the federal, regional, and local government levels. This form of government is the most cost-effective system to deliver universal health care coverage to a larger population. In Australia, Denmark, the United Kingdom, and Norway, policy making and resource allocation decisions remain centralized. However, there is flexibility within a region to distribute funds in a more individualized way that is best for local needs.

There is also a “decentralized” universal health coverage system, where decision making and resource allocation is regulated at the regional or provincial level. Canada, Germany, Sweden, and Switzerland use this system. For example, in Canada, each province receives (per capita) block grants from the federal government. A block grant is a fixed amount of money the government allocates to a province in advance. Regions are usually held accountable through the establishment of broad national guidelines to ensure fairness and service uniformity.

Now that we’ve gone over a few different universal health care systems which do you think is the best? Using our comment section is a safe place to share your opinions and see what others think about the article or things we’ve talked about in the blog.

Is Medicare For All the Solution?

Posted on by ecma

Medicare For All is a universal health care plan that was developed by Vermont Senator, Bernie Sanders. This would be built off what former President Barack Obama had with the Affordable Care Act (ACA), also known as Obamacare. Medicare For All is a solution that would help give health insurance at affordable rates, covering primary and specialty healthcare, vision, hearing, dental, mental health,addiction services, and many other essential health care solutions.

Not much is known on where funding would come from for this new health care solution. However, it is sure to be discussed soon with the 2020 elections coming up.

The first thing that needs to be viewed is how this will pass through Congress. The current House of Representatives may be inclined to pass this Medicare For All plan, whereas, the Senate would be completely opposed. This could change come 2020, but there will still be many opposers, including Republicans and moderates, the insurance lobby, and other special interests. This new plan would require a total reboot of our current healthcare, which would cause a reworking of the tax code, rearranging of national priorities, and either cause reconstruction or abolishment of the health insurance industry.

With our current healthcare system, some like it, and some hate it. However, more people are without health care than individuals who have health care. Most people will agree that, as a nation, we need to improve health insurance coverage and make it more affordable. President Obama attempted to do so, but unfortunately, due to some flaws in the ACA, it wasn’t all that people hoped for. However, people are becoming hopeful for this Medicare For All plan because they want an expansion of Medicare. Some also support a single payer system, backed by the government, but it doesn’t have to be Medicare.

With the Medicare For All plan possibly destroying the health insurance industry we have now, some citizens are becoming irate. This would mean the abolishment of health insurance plans through employers and private health insurances that users currently have in place.

There is also the giant question in the air of, “who pays for it?” Medicare is not free, and it isn’t all that cheap depending on the individual’s circumstances, needs, and preferences. There are also still costs that Medicare doesn’t cover for some patients, creating even more issues for Medicare For All. Big-ticket items that aren’t covered by Medicare could begin to overwhelm the patient. There is also the government’s single-payer plan, which would cost somewhere in the 30 trillion dollar range over a decade, which would make US citizens pay more in taxes.

This new Medicare For All plan could be very overwhelming and could cause many issues. It could also bring in a new affordable health insurance policy that is easier to acquire.

One thing that isn’t overwhelming is how Emerald Coast Medical Association takes care of its physicians at all government levels. Our Board of Governors routinely take their time to advocate for patients and physicians at the local, state, and federal level. What’s your stance on this issue? Voice your opinion in the comments section below.

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Big Hospitals Sue HHS

Posted on by ecma

Hospitals are beginning to follow in the footsteps of the American Hospital Association and are suing the Trump Administration for its decision to institute site-neutral payments.

The change, which is part of the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System rule-making for 2019, would lower reimbursements for hospital outpatient department services to match rates set by the physician fee schedule for clinic visits. This would mean lower costs for a patient’s insurance. However, hospitals would lose about $380 million in 2019 alone and possibly up to $760 million in 2020.  The colossal loss of money is causing an uproar with (as of right now) 38 hospitals signing the lawsuit.

This isn’t even helping the patient from what CMS Administrator Seema Verma says, “It doesn’t make sense for taxpayers, and it certainly doesn’t make sense for patients because they end up having to pay more depending on the site of service.”

However, this can be looked at as taking down the money hungry hospitals. University of Michigan health law professor Nicholas Bagley was among the observers who praised the Trump administration for the proposal, saying CMS is “picking a fight with powerful hospitals because it’s the right thing to do.” The site-neutral payments would mean, hospitals would have to offer the same care at lower prices.

The previous system had Medicare paying higher rates for services provided at the hospitals outpatient facilities. The Centers for Medicare & Medicaid Services projects the policy change will save the beneficiaries $150 million in co-payments annually; dropping the average copay from $23 to $9.

“The different payment rates also pushed hospitals to purchase independent practices to increase their reach and take advantage of the higher reimbursement rates,” Verma said. “Neutralizing payments would increase provider competition.” Competition could potentially turn into one hospital bettering the others, just because they have more resources and more funding.

However, Farzad Mostashari, MD, co-founder, and CEO of Aledade, said in a series of tweets that hospitals will fight the OPPS rule “bitterly” but that there could be a long-term benefit for them in it.

“The truth is that this proposal could help hospitals be more competitive in value-based contracts/ alternative payment models, and they should embrace the changes,” Mostashari wrote. “If rural hospitals or AMCs need subsidies, then we should do it directly, not through distorting payment policies.”

Here at Emerald Coast Medical Association, we care about your health too. Since 1981, over 50 local physicians banded together to create a Physician’s Security and Benefit plan.

The primary goals are:

  • Provide affordable health insurance to employees, physicians, and their families
  • Upon the death of a physician, provide insurance for the spouse and children of the physician
  • Use each others’ premium dollars to pay claims for those physicians and their family members who had serious medical conditions
  • To provide a premium-rating schedule that did not discriminate against those physicians and their employees who had incurred large medical claims
  • Avoid implementing “gatekeeper” type “managed care” features
  • Promote access to virtually all providers in and out of the state
  • Establish a stable alternative to those carriers who often abandon the insurance marketplace

You can get all this and more for being an Emerald Coast Medical Association Member.

No reason to wait, sign up today. We want to help you and your practice stay healthy and up to date on relevant information.

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Government Shutdown & Healthcare

Posted on by ecma

The government shutdown between President Trump’s administration and congressional Democrats regarding funding of the “border wall” leaves many with questions regarding its immediate impact on changing current healthcare systems. While the ongoing partial government shutdown leaves the majority of the federal government’s public health programs unaffected, the lack of funding to specific departments has the potential to alter some important health-related initiatives.

Due to the passing of five major appropriation bills by Congress, the funding of the Department of Health and Human Services and the Department of Veterans Affairs has remained. This funding dampens immediate large-scale negative impacts because many government healthcare programs such as Obamacare, Medicare, and Medicaid are insulated and funded through September. Additionally, two other critical unaffected departments are the Center for Disease Control and Prevention and the National Institutes of Health, allowing for the continuation of public health surveillance and significant biomedical research respectively. Unfortunately, other government agencies such as the Food and Drug Administration are greatly affected. Due to the Department of Agriculture being completely shut down, the FDA is currently only operating at 60% of regular employees leading to potential problems regarding regulations and mandatory recalls of possible harmful goods.

Another detrimental effect of the government shutdown is an impact on the Indian Health Service (IHS). The IHS receives all of its funding from the recently shut down Department of the Interior, which has had widespread consequences to Native American tribes. The only services that can continue in these areas are “immediate needs of the patients, medical staff and medical facilities” and this lack of funding has been extended to suspending grants and other IHS health programs.

Well-known departments and agencies such as the Department of Homeland Security’s Office of Health Affairs and the Environmental Protection Agency have already been displaying negative aftermath of the government shutdown with all signs pointing to large detrimental effects if this continues for an extended period. Health inspectors at the United States borders and the Countering Weapons of Mass Destruction Office have already faced setbacks causing increased concern regarding possible decreased safety of US citizens. Furthermore, even the National Park Service has ceased all restroom maintenance and trash service due to funding leading to closures of popular parks such as Yosemite and Joshua Tree National Park due to unsanitary conditions.

Social Determinants of Health Influence in 2018

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Social determinants of health (SDOH) started becoming more mainstream of a concern for the greater healthcare system in 2018. An individual’s socioeconomic status can put their health at risk. Locally, this has become even more apparent since Hurricane Michael hit the panhandle last October. SDOH is defined by the Centers for Disease Control and Prevention as “conditions in the places where people live, learn, work, and play affect a wide range of health risks and outcomes.” These conditions can determine the health of people.

People have been living in unimaginable conditions since Hurricane Michael hit on October 10th, 2018. We are now in 2019, and many are still unable to live in their homes. Without proper housing and the many hazardous conditions around the panhandle that extend farther than just at home, there has been an increased rate of injury and illness. This hurricane has provided us with a prime example of social determinants impacting health.

The healthcare system has avoided addressing the issue of social determinants for a long time. In 2018, newly launched initiatives, as well as studies showing the need for these initiatives, have caused the healthcare system to take a new look at social determinants and how to address them.

Factors such as housing, transportation, food assistance, and personal finances have been taken into account to begin the process of reassessing healthcare’s take on social determinants. People with limited access to transportation and housing are at a higher risk of injury or illness, especially when they have limited ways to get to a physician. Medicaid plans on helping to offer affordable housing to those who need it. Patients without transportation often forego making an appointment or miss them when they do have them. Uber recently launched a “health dashboard” to provide free rides for those unable to get to a doctor when they need to.

In addition to this, Geisinger Health System started “Fresh Food Farmacy,” which cut costs among diabetic patients from anywhere between $48,000 to $240,000 per member. This caused the risk of serious complications or death for people with diabetes to drop to 40%, a great win for those working with diabetics. Cigna is also planning on offering financial planning services for their group members, as announced in December 2018. Financial stress can take a significant toll on a person’s physical and mental health.

With many physicians claiming social determinants “aren’t their problem,” there is still a long way to go with maintaining equity among Americans. However, now that the panhandle is experiencing even more of these social determinants than usual, we have been provided a new chance to tackle these determinants and make the panhandle a healthier place for everyone. These social determinants will continue to play a significant role in local health for everyone involved with the hurricane, but choosing to see the positive side of this great opportunity is best for our county’s health.

CMS Proposal Aims to Improve Doctor-Patient Relationships

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In May, Health and Human Services Secretary Alex Azar told us that he planned to use his pen to make significant and hopefully positive changes to the healthcare industry in the United States. Staying true to his word, the HHS Centers for Medicare & Medicaid Services (CMS) has issued a proposal that could have a drastic, positive impact on doctor-patient relationships in the U.S.

The proposed rule would update the Medicare fee schedule for physicians and routines sweeping changes for the third year of the payment program implemented by MACRA. CMS higher-ups say they have been attentive to physicians and responded with these rules in order to allow practitioners more time with their patients.

The proposal was announced on July 12th. CMS Administrator Seema Verma stated in a press call, “Today’s proposals deliver on the pledge to put patients over paperwork by enabling doctors to spend more time with their patients. Physicians tell us they continue to struggle with excessive regulatory requirements and unnecessary paperwork that steal time from patient care.”

These proposals, which are part of the Physician Fee Schedule and Quality Payment Program, also serve to update Medicare to allow payments for virtual care, which would save money for beneficiaries while allowing them better access to quality treatment regardless of their location. Patients could connect with their care providers remotely, and the practitioners would have the opportunity to determine if the patient needs to come to the office or not. The clinician can be paid under this new proposal for both these “virtual visits” and for time spent evaluating photos or videos sent in electronically by the patient. Medicare coverage of “telehealth” benefits would also be expanded to include preventative services over the long-term.

Additionally, the reform would make broad changes to the reporting requirements in order to effectively put the focus on the most important measures, the ones that have the most impact on health outcomes. The shift in reporting would also encourage electronic information sharing between providers, so patients can be more effectively “followed” through the system by their entire care record.

If the new proposals are adopted and finalized, clinicians should see a boost in their productivity levels, which in turn is likely to lead to a better quality of care for their patients. CMS estimates that upwards of 50 work hours per year would be saved by the paperwork this proposal would eliminate from the workload of a doctor with 40% of their patients covered by Medicare.

This proposal also aims to advance President Trump’s efforts to lower prescription drug costs, by suggesting a change in the payment amounts for new drugs under Part B, so the payment amount is commensurate with the actual drug cost. This could significantly reduce the amount that seniors are asked to pay out of pocket, especially when it comes to newer drugs with high launch prices.

The proposal can be viewed at this link: https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf  and HHS is asking for public comments and input to be submitted by September 10th 2018.

Emerald Coast Medical Association works to keep our members informed about changes that impact us as medical practitioners, at the federal as well as the state level. These changes, if they go into effect, will be significant to all of us, and we pledge to help our members understand and implement them. Together, we are stronger, and our shared knowledge improves the lives of all of us as well as our patients.

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