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Pulse Magazine

Pulse Magazine

News & Notes

Minnesota Nurses Association Buys Past-Due Debts

In June, the Minnesota Nurses Association purchased the past-due accounts of 1,800 families with medical debt as a way to give back for the support they received during strikes against Allina Health. The debt totaled $2.6 million secured for $28,000 between the MNA and New York-based nonprofit RIP Medical Debt. The credit reporting bureaus received notification that the consumers’ debts were paid.  http://ow.ly/YvcE30cOGRj

CMS Issues Long-Term Data on Health Spending by State

The recession had a “sustained impact” on health spending and insurance coverage, according to a Centers for Medicare and Medicaid Services report on spending. “Every state experienced slower growth in per capita personal healthcare spending from 2010-2013 than experienced during the period 2004-2009,” according to the report.  http://ow.ly/cIHL30cOKxZ

Pace of Healthcare Sector Expansion Slows

The healthcare industry added 24,300 new jobs in May and overall monthly job growth this year is lagging behind 2015 and 2016.  Job growth through the first five months of this year averages less than 22,000 jobs each month, compared to 32,000 monthly in 2015 and 2016, according to the Altarum Center for Sustainable Health Spending. http://ow.ly/HUR930cQhRP

CMS Proposes Updates to Reduce Burdens Under Quality Payment Program in 2018

The Centers for Medicare and Medicaid Services has proposed changes to the Quality Payment Program instituted by the Medicare Access and CHIP Reauthorization Act of 2015 that aim to simplify the program.  The proposed changes would occur in the second year of the Quality Payment Program and would especially help streamline the requirements for small, independent and rural healthcare practices, “while ensuring fiscal sustainability and high-quality care within Medicare,” CMS reports (http://ow.ly/U9rN30cQpuA.)

Under the program, healthcare providers that bill more than $30,000 to Medicare Part B and care for more than 100 patients a year should start recording their quality data and documenting how they are using technology to support their practice, ACA International’s Collector magazine editor Anne Rosso May previously reported.  

The first performance period of the program is currently underway and during this time providers can pick their pace to report data to Medicare. They can choose to test the Quality Payment Program on a limited basis, participate for only part of the calendar year or participate for the full calendar year. This reduced set of requirements for 2017 gives providers time to fine-tune their basic infrastructure and get familiar with what’s expected of them.

The proposed rule for 2018, “would amend some existing requirements and also contains new policies for doctors and clinicians participating in the Quality Payment Program that would encourage participation in either Advanced Alternative Payment Models or the Meritbased Incentive Payment System,” CMS reports.  CMS has also used feedback from healthcare providers to craft the second year of the program.

“We’ve heard the concerns that too many quality programs, technology requirements, and measures get between the doctor and the patient,” said CMS Administrator Seema Verma in the news release.  “That’s why we’re taking a hard look at reducing burdens. By proposing this rule, we aim to improve Medicare by helping doctors and clinicians concentrate on caring for their patients rather than filling out paperwork.”

Healthcare providers who participate in Medicare serve more than 57 million seniors and the Quality Payment Program is designed to promote greater value within the industry.  If finalized, the proposed rule would further advance the agency’s goals of regulatory relief, program simplification, and state and local flexibility in the creation of innovative approaches to healthcare delivery, CMS reports. 

More information on the Quality Payment Program is available here: qpp.cms.gov and in a fact sheet from CMS: http://ow.ly/CXKn30dRMTH

 

Consumers Expect Higher Costs Under American Health Care Act

Since the U.S. House of Representatives approved the American Health Care Act (AHCA) on May 4 and the U.S. Senate, at press time, continued to review the plan, consumers overall say they have an “unfavorable” view of the legislation and are pessimistic about its impact on their healthcare costs and quality of care, according to the Henry J. Kaiser Family Foundation Health Tracking Poll.  Fifty-five percent of respondents to the poll said they have an unfavorable view of the AHCA and 31 percent said they have a favorable view of the plan to repeal and replace the Affordable Care Act, according to a news release from the Kaiser Family Foundation.

“There is also a considerable enthusiasm gap with a larger share saying that they have a ‘very unfavorable’ view (40 percent) than saying they have a ‘very favorable’ view (12 percent),” it states.  Consumers are more pessimistic about the healthcare plan now compared to in December, after the elections, but before the proposal in the 115th Congress was introduced.  Forty-five percent of respondents to the poll in May said the AHCA would result in higher healthcare costs compared to 28 percent who provided that response in December.

“In addition, a third now expect their ability to get and keep health insurance and the quality of their healthcare to get worse under the pending bill, compared to about one in five that said so in December,” according to the news release.  The poll also shows that 55 percent of respondents want the U.S. Senate to make significant changes to the version of the AHCA passed in the House or not pass the legislation. The Henry J. Kaiser Family Foundation has been following the public opinion on the Affordable Care Act since 2010. The May poll shows consumers continue to have more favorable views of the Affordable Care Act than unfavorable, 49 percent and 42 percent, respectively.  Additional findings in the poll include:

-Thirty-one percent of consumers have favorable views of the AHCA.

-Republicans have more favorable views of the AHCA (67 percent) than of the Affordable Care Act (12 percent.) Among Democrats and independents, 48 percent have more favorable views of the Affordable Care Act than of the AHCA (30 percent.)

-However, a majority of consumers in the poll (74 percent) say it is “likely” that the president and Congress will move forward with repealing and replacing the Affordable Care Act.

See a graph based on data from the poll in Data Watch. 

More information: http://ow.ly/MMQH30cg9qk

Out-of-Pocket Costs Catching up with Medicare Beneficiaries

Medicare beneficiaries are facing higher out-of-pocket costs that amount to a “substantial” share of their income, according to an issue brief from The Commonwealth Fund, “Medicare Beneficiaries’ High Out-of -Pocket Costs: Cost Burdens by Income and Health Status.”  There are 56 million people, or 17 percent of the U.S. population, who rely on Medicare, according to the report. By 2024, one-fifth of the population will have Medicare coverage. The benefits exclude dental, vision, hearing and long-term services coverage, and there is no limit on out-of-pocket costs for the covered services, it states.

As more consumers become eligible for Medicare, The Commonwealth Fund reports they will find the need to supplement their coverage, “since the program has relatively high cost-sharing and no limit on patient liability for covered benefits.”  Research on beneficiaries’ financial burdens for the brief is based on the 2012 Medicare Current Beneficiary Survey, with 11,299 responses and population and spending data projected to 2016.  The respondents shared their experiences with access to care, medical services and spending activity, including costs for services not covered by Medicare.

Overall, the survey shows beneficiaries spent an average of $3,024 in out-of-pocket costs each year, according to the report. Findings also include that 15 million Medicare beneficiaries spent 20 percent or more of their income on healthcare premiums plus medical care, including cost-sharing and services that are not covered, it states.  Medicare beneficiaries also face costs from a separate private plan for prescription drugs.

“If they want to buy private Medigap supplemental coverage for cost-sharing, they incur significant additional premiums,” according to the report.  “Even after they pay for supplemental drug and Medigap plans, beneficiaries face the cost of dental, hearing, vision, and long-term services—all excluded from Medicare. For beneficiaries with multiple illnesses or serious functional limitations, out-of-pocket costs can easily add up to thousands of dollars per year.”  Findings on costs for Medicare beneficiaries also include:

-Hospitalization costs for beneficiaries are $1,300 and they pay 20 percent of bills for physician care.

-They also pay a $1,600 annual premium for Medicare Part B medical services.

-Annual Medigap, the supplemental coverage for Medicare cost sharing, premiums are $2,000 per beneficiary, but can be significantly higher in some states. “Medigap has notably high overhead costs: administrative costs and profits absorb 20 percent of premiums on average.”

-Private Medicare Advantage plans are available for beneficiaries interested in opting out of traditional Medicare plans. While those plans have lower cost-sharing in general, it has increased significantly in recent years.

Overall, the report shows that 5.4 million beneficiaries with only Medicare and no supplemental coverage are subject to higher healthcare costs.  “These beneficiaries spent an estimated $5,374 on out-of-pocket costs in 2016 compared to $2,587 for beneficiaries who received supplemental coverage from Medicaid. With incomes too high to qualify for Medicaid but too low to afford supplemental coverage, 32 percent of Medicare-only beneficiaries spent 10 percent or more of their income on health care,” according to the report.

Financial burdens and unmet needs from Medicare leave beneficiaries at risk.  As Medicare enters its sixth decade and the Baby Boom population becomes eligible, the costs of the program will increase, likely placing it on the policy agenda,” the report concludes.  “Financial burdens and access gaps highlight the need to approach reform with caution.  Already-high burdens suggest restructuring cost-sharing to ensure affordability and to provide relief for low-income beneficiaries,” the report concludes.

More information:  http://ow.ly/iCQY30cc4m8

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