Do physicians provide more services to Medicare patients to make up for lower Medicare fees? With almost 42 million people enrolled in Medicare in the United States in 2008, it's a question that could have a very costly answer. Jack Hadley, professor and senior health services researcher in George Mason University's College of Health and Human Services, along with co-authors James Reschovsky of the Center for Studying Health System Change (HSC), Catherine Corey of the New York City Department of Health and Mental Hygiene, and Stephen Zuckerman of The Urban Institute, analyzed thousands of physicians and their Medicare insurance claims to investigate volume-offset behavior, the belief that physicians respond to lower Medicare fees by increasing service volume to make up for potential lost revenue. The results of the study, "Medicare Fees and the Volume of Physicians' Services, " were published online Feb. 10 in the health-policy journal Inquiry. "In recent years, Medicare fees have fallen after accounting for inflation, while overall physician costs and volume of physician services have grown.
New England Journal of Medicine : Increased Ambulatory Care Copayments And Hospitalizations Among The Elderly - This study examines the consequences of increasing copayments for outpatient care of Medicare enrollees in managed-care plans. "As compared with matched control plans in which copayments for ambulatory care were unchanged, Medicare plans that increased these copayments by an average of 95% for primary care and 74% for specialty care had a reduction in the number of outpatient visits but an increase in hospital admissions, in the number of days of hospital care, and in the proportion of enrollees who used hospital care, " the authors write. They estimate that "for every 100 elderly enrollees exposed to this level of increased cost sharing for ambulatory care, there would be 20 fewer outpatient visits during the first year after the increase but more than 2 additional admissions for acute care and approximately 13 additional inpatient days in the year after the increase. The effects of copayment increases on the subsequent use of inpatient care were magnified for enrollees living in areas with low income and low educational levels, for black enrollees, and for enrollees who had hypertension, diabetes, or a history of acute myocardial infarction as compared with the effects observed for the entire study cohort.
Mr. Obama's New Budget The New York Times Medicare and Medicaid alone will cost $788 billion; that should be another reminder of why the country needs health care reform (2/1). A Bipartisan Prescription For National Health Care Reform Atlanta Journal-Constitution [W]e need a rational, bipartisan approach to health reform that is truly person-centered. It's time to come together to craft a plan that puts patients first rather than political and special interests (Newt Gingrich and Andrew Von Eschenbach, 2/1). An Obama-Sized Government National Review [The president's health] plan would create another runaway entitlement program and partly 'pay for it' with Medicare cuts that will never stand the test of time. It's a recipe for more explosive spending growth, not less (2/1). Unpromising Newsweek [T]he only way for a president to start from a good bargaining position is by proposing something bolder (such as the public option) than what he ultimately thinks he can get. 'Breaking' those 'promises' may be disappointing, but it isn't a betrayal.
Democrats' health overhaul efforts are stalled in Congress, but President Obama's 2011 budget offers a "modest" back-up plan, the Associated Press reports. "The budget released Monday contains lots of respectable ideas to squeeze savings, expand coverage and improve quality, but no ambitious change that launches the nation on a path to health care for all." Those efforts include increased resources for health care fraud prevention, more help for state Medicaid programs, funding for community health centers, and pilot projects to improve care in the Medicare program. Including automatic spending on the Medicare, Medicaid and other mandatory programs, the budget totals more than $900 billion for health care (Alonso-Zaldivar, 2/1). The Wall Street Journal reports that, while in some ways, the president "did not assume fast passage of the health bill, " his budget "includes a line for 'health insurance reform' based on the average budget impact of the versions of the health bill the House and Senate passed last year.
The following summarizes selected women's health-related videos. O'Neill, Dannenfelser on CNN: On CNN's "Rick's List, " NOW President Terry O'Neill and Susan B. Anthony List President Marjorie Dannenfelser debated Focus on the Family's Super Bowl ad featuring Heisman Trophy winner Tim Tebow and his mother, Pam. While Dannenfelser called the Tebows' story "uplifting and beautiful, " O'Neill noted that Focus on the Family's underlying agenda is to overturn Roe v. Wade (Sanchez, "Rick's List, " CNN, 2/5). Rachel Maddow Talks Health Reform: In her "Ms. Information" segment on Monday, Maddow weighed in on "what happens if health reform doesn't pass?" According to Maddow, the result would be a major blow to the economy. She cited health care cost data from the Centers for Medicaid and Medicare Services that project dramatic increases in health spending in the coming decade (Maddow, "The Rachel Maddow Show, " MSNBC, 2/11). В Willie Geist on Super Bowl Ad: In a segment on MSNBC's "Way Too Early, " commentator Willie Geist parsed the Focus on the Family ad the morning after its Super Bowl debut.
Calif. Budget Cuts Will Hit Adult Day Care Centers, Prison Health Care; Texas And Kansas Weigh Medicaid Cuts
The Los Angeles Times, on adult day care centers in California: "Under the most recent cost-saving budget proposals, 327 adult day healthcare centers throughout California would be eliminated. Cuts could save the state $135 million in fiscal 2011, state projections show. But advocates and center operators said care for many of the 37, 000 low-income participants -- who suffer from diabetes, brain injuries, dementia and other chronic conditions -- would cost the state even more money if the centers close. More than 40% of participants would end up in nursing homes, said Lydia Missaelides, executive director of the California Assn. for Adult Day Services. Others would be hospitalized" (Gorman, 2/11). The Los Angeles Times, in a separate story: "Democratic state senators pushed the first budget cuts of 2010 through a key committee Wednesday, slicing government payroll costs by 5% and cutting $811 million from the prisons' healthcare budget. ... It remains to be seen how much of what the lawmakers cut from prisons will materialize;
"Lawsuits, state inspections and federal statistics paint a troubling picture of the care offered at some hospitals, " writes The New York Times in an investigation of long-term care hospitals that dominates the front page. The Times focuses on the Select Medical Corporation, "a publicly traded Pennsylvania company that runs 89 long-term hospitals, more than any other company, " but also points out that "more than 400 similar facilities ... have opened nationally in the last 25 years. Few of them have doctors on staff, and most are owned by for-profit companies." "In 2007 and 2008, Select's hospitals were cited at a rate almost four times that of regular hospitals for serious violations of Medicare rules, according to an analysis by The New York Times. Other long-term care hospitals were cited at a rate about twice that of regular hospitals." The rapid growth in the number of these facilities is "driven by Medicare rules that offer high payments for hospitals that treat patients for an average of 25 days or more.
Health care providers with employees who committed Medicare fraud also face consequences. The Memphis Daily News reports that the Eye Specialty Group "can't help but question their decision to turn in a colleague for Medicare fraud. Doing the right thing, they said, has been a costly business decision." The practice has to pay back hundreds of thousands of dollars to the government for the actions of Dr. Seth Yoser who pled guilty to diluting "dosages of eye injection medicine, falsely billed Medicare for the amount of medicine used, then removed the medicine from the practice and sold it elsewhere. In total, false billings of about $1.6 million were submitted to Medicare, prosecutors said." Yoder continues to practice medicine, and his partners are suing him while trying to pay back Medicare for the false billings (Wilemon, 2/10). Los Angeles Times : "A former top executive with Tustin Hospital and Medical Center has agreed to plead guilty to paying illegal kickbacks for patients recruited from L.
States tackle several health care policy issues focused on health insurance coverage mandates and requirements. Idaho Reporter explores efforts to mandate that insurers cover prosthetics in the state with the nation's fewest health insurance mandates. "The Idaho Senate is looking at requiring health insurance to cover replacing and repairing prosthetic limbs and devices." Legislation proposed by Rexburg Republican Sen. Brent Hill "would mandate all state-regulated health care plans to cover repairs at the same level that Medicare dictates. That would mean replacing or fixing prosthetics due to physical changes, like a child growing up, or when a doctor says it's medically necessary" (Iverson-Long, 2/10). Kansas Health Institute : "Insurance lobbyists today testified against a bill that would require health insurers to cover oral chemotherapies the same way they do intravenous chemotherapies. The bill would add to the companies' costs, raise customer premiums, be difficult to administer, and open the door to other mandates, the industry spokesmen said.
The Wall Street Journal reports that "an examination of one of the best-known examples of a comparative-effectiveness analysis shows how complicated such a seemingly straightforward idea can get" as officials look for savings in the health care system." One study, called Courage, "found that the most common heart surgery -- a $15, 000 procedure that unclogs arteries using a small scaffold or stent -- usually yields no additional benefit when used with a cocktail of generic drugs in patients suffering from chronic chest pain." Stent implants dropped 13 percent in the month after the study was released, but they soon began to rise again and are now at pre-study levels of one million per year. "Without a way to keep insurers from covering procedures that studies find ineffective, projects like Courage face an uphill climb. The health-care bills passed by the House and Senate have provisions to disseminate study results, but wouldn't require private insurers or Medicare to adjust coverage or payments to doctors in response to findings" (Winstein, 2/11).