In June 2009, Atul Gawande wrote an influential New Yorker article, about the community of McAllen, Texas, which has some of the highest per-capita Medicare costs in the nation. At the time, “The Cost Conundrum” had a significant impact on the national debate over the legislation that would become the Affordable Care Act – not so much on the health insurance coverage aspects but about wasteful spending and flawed incentives built into our payment system.
McAllen was awash in waste, fraud and abuse, with millions spent on care of little to no value to the patient. The spending could not be blamed on socio-economic factors because nearby El Paso was a very similar community, but with half the per capita Medicare costs, and same or better outcomes. Gawande wrote this about McAllen: Continue reading
Earlier this month many of us received a news release from the American College of Emergency Physicians about a survey that indicates emergency department visits are rising along with coverage expansion under the Affordable Care Act. This was happening even though one important goal of the health law is to connect people with primary care physicians so they wouldn’t feel compelled to go to the ED for primary care.
While many of us ignored the release or, at most, wrote a brief; some large news outlets did give the survey big play, even linking the increase to expanded Medicaid coverage. The tone of that coverage, at least in a few pieces I saw, was that this was a negative development. Continue reading
Photo: Carla K. JohnsonBruce Japsen, Dan Yunker, Marilyn Serafini and Stephani Becker (l to r) discussed the possibility of 8 million people losing health insurance, during an AHCJ Chicago chapter event.
Will fretting over King v. Burwell be remembered in the same breath as worries over Y2K?
Or will the calamity of 8 million people losing health insurance come true if the plaintiffs win their case at the U.S. Supreme Court? A ruling is expected in June.
With Alliance for Health Reform’s Marilyn Serafini acting as moderator, the Chicago chapter of AHCJ gathered on May 13 for a panel discussion on “The outlook for health insurance subsidies.” Continue reading
The ACA made many changes to Medicare. One of them involves linking part of hospital pay to patient satisfaction.
In an Atlantic magazine essay adapted from her new book, “The Nurses: A Year of Secrets, Drama, and Miracles With the Heroes of the Hospital,” Alexandra Robbins argues that hospitals are missing the point: the way hospitals are defining, measuring and achieving patient “satisfaction” is not advancing the quality of care.
Robbins overstates that the amount of Medicare payments tied to patient satisfaction and understates the role of outcomes (more on Medicare’s Hospital Value-Based Purchasing later). But her essay is provocative and worth thinking about for those of you who cover the hospital industry or your local hospitals, and how they are changing under the Affordable Care Act. Continue reading
Anyone who is moderating a session at an AHCJ conference is lucky to have AHCJ board member, Associated Press medical writer, and Twitter extraordinaire Carla K. Johnson (@CarlaKJohnson) in the audience. Here, she’s Storified her Twitter stream from the session “Politics, Policy and People: ACA report card.”
Our speakers were David Blumenthal, M.D., president of The Commonwealth Fund; Mollyann Brodie, Ph.D., senior vice president for executive operations, Kaiser Family Foundation (she oversees its polling); and Lanhee Chen, Ph.D., David and Diane Steffy research fellow, Hoover Institution. On Twitter, they are @DavidBlumenthal, @mollybrodie and @lanheechen. Continue reading
The first day of Health Journalism 2015 featured a session “The ACA: Will it survive? And how to cover it now” with Kaiser Health News’s Julie Appleby and Vox’s Sarah Kliff. Their major themes included:
Julie Appleby & Sarah Kliff
- The King v. Burwell Supreme Court case over federal subsidies
- What’s next in Congress?
- And – the topic that got by far the most attention from the crowd – narrow networks.
Here are some of their highlights and story suggestions, with an emphasis on stories that state and local reporters can tackle. (Here are Kliff’s slides.) Continue reading
Medicaid pay rates for doctors in many states traditionally have been extremely low – so low that most physicians didn’t want to participate in the program, or take on more Medicaid patients than they already had.
According to the Kaiser Family Foundation, Medicaid had paid only 59 percent of what Medicare did for primary care before that.
The Affordable Care Act raised the rates for primary care providers to be equal to Medicare pay. Medicaid had paid only 59 percent of what Medicare did for primary care before that, according to the Kaiser Family Foundation. The snag: the Medicaid “bump” lasted for only two years, until the end of 2014. And Congress has not renewed it, although there has been a bit of preliminary talk about it. Continue reading
A key issue in King v. Burwell, the health care reform case argued before the Supreme Court in early March, is whether Congress intended to make certain subsidies available to eligible people across the country or only to those living in states that created their own health insurance exchange.
Sam Stein and colleagues at the Huffington Post filed public record requests with several key states, including some in which prominent GOP governors did not establish exchanges. The reporters also reviewed records from the U.S. Department of Health and Human Services and more than 50,000 previously released emails from the Oklahoma governor’s office. The requests covered a period between the March 2010 passage of the Patient Protection and Affordable Care Act and August 2011, when the IRS ruled that the subsidies should be available in all states.
How much discussion did Stein find about the risk of losing subsidies? Continue reading
We tend to focus on the Affordable Care Act as a law that simply gives more people health insurance – and it has.
But as we’ve noted before, the health reform law also contains all sorts of programs and provisions that aim to change how health care is delivered: how we pay, what we pay for, and how we shift from a hospital-centric acute care system to one that stresses prevention, wellness and care and management of chronic diseases. Examples can be found across the country.
At a recent AHCJ webinar, Patrick Conway, M.D., deputy administrator of the Center for Medicare and Medicaid Services, gave an overview of some of the changes underway. Conway, whose job includes oversight of the Center for Medicare and Medicaid Innovation, also announced the next big thing in Accountable Care Organizations. More on that below. Continue reading
It’s not often that we can tell you something about health care prices and also make you laugh … but we spotted a link to this on Twitter the other day and it’s priceless (no pun intended).
You all know by now that hospital bills make little sense, and that fee for service has its … shall we say … absurdities. Continue reading