Managed plans in Medicare show improved quality
Buffalo News
October 13, 2014
http://www.buffalonews.com/business/managed-plans-in-medicare-show-improved-quality-20141013
The overall quality of managed Medicare plans available in the Buffalo Niagara region improved slightly over the last year, according to ratings by the Centers for Medicare and Medicaid Services. The 22 Medicare Advantage plans with prescription drug coverage offered to senior citizens and people with disabilities in Erie County for 2015 have an average rating of 4.07 stars out of 5, a modest gain over the 3.95 stars the same plans averaged for the current year. The most notable change from 2014 to 2015 saw the rating for HealthNow New York, parent company of BlueCross BlueShield of Western New York, rise from an average of 3.5 stars to 4.5 stars. “The CMS rating is great news for our Medicare Advantage members,” David W. Anderson, president and CEO of HealthNow New York, said in a statement.
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Medicare fines more South Florida hospitals for readmitting patients
Miami Herald
October 11, 2014
http://www.miamiherald.com/news/local/community/miami-dade/article2673788.html
Across the Sunshine State, hospitals in record numbers — 148 in all — are feeling the sting of millions of dollars in Medicare fines for having too many patients return within a month for additional treatments, federal records released this month show. The average fine levied against Florida hospitals for readmitting patients nearly doubled since last year, from about a quarter of 1 percent of Medicare payments to more than a half of 1 percent, according to data analyzed by Kaiser Health News. New penalties began this month. Most of the hospitals — 115 of the 167 surveyed — will pay higher penalties over the prior year. In Miami-Dade and Broward, at least 32 hospitals will pay penalties next year for readmitting patients at rates that exceed government standards, including Kendall Regional Medical Center, which will pay the highest penalty rate in the area at 1.71 percent.
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Medicare penalizes Washington-area hospitals for readmissions
The Washington Post
October 11, 2014
http://www.washingtonpost.com/local/medicare-penalizes-washington-area-hospitals-for-readmissions/2014/10/11/f06d32f4-50a8-11e4-babe-e91da079cb8a_story.html
Every general hospital in the District of Columbia and its Virginia suburbs has been fined for having too many Medicare patients readmitted within a month for additional treatment, federal records show. Medicare penalized a record 2,610 hospitals nationally in its third year of fines. Reston Hospital Center and Fauquier Hospital in Warrenton were among 39 hospitals in the country to receive the maximum penalty: a 3 percent cut in payments for every Medicare patient admitted from this month through September 2015. Providence Hospital will be docked 2.61 percent, the most of any hospital in the District, according to an analysis of the Medicare data by Kaiser Health News. Two hospitals that are part of regional giants, Sibley Memorial Hospital — part of the prestigious Johns Hopkins Medicine system — and Inova Fair Oaks Hospital will each lose 1.93 percent of Medicare payments. Culpeper Regional Hospital will lose 2.87 percent.
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Nebraska Medicare Part B premium and deductible unchanged
Lincoln Journal Star
October 10, 2014
http://journalstar.com/business/local/nebraska-medicare-part-b-premium-and-deductible-unchanged/article_12523bde-9868-547c-a88f-3c306ab154d8.html
For the approximately 270,636 Nebraskans enrolled in Medicare Part B, premiums and deductibles will remain unchanged in 2015 at $104.90 and $147, respectively, the government announced. Centers for Medicare and Medicaid Services, part of the Department of Health and Human Services, also said that the average premium for people enrolled in a Medicare Part D prescription drug plan is estimated to increase "modestly" to $32 per month. According to HHS, compared to Congressional Budget Office projections for 2015 made in 2009, premiums will be more than $125 lower over the course of a year. Secretary of Health and Human Services Sylvia Burwell said in a news release: “The Affordable Care Act is working to improve affordability and access to quality care for seniors and people with disabilities.” CMS Administrator Marilyn Tavenner added: "The stabilization of Part B premiums is another example of how we are containing health care costs to provide a more sustainable and affordable health delivery system." Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment and other items.
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Medicare’s basic monthly premium unchanged in 2015
The Boston Globe
October 10, 2014
http://www.bostonglobe.com/news/nation/2014/10/10/medicare-basic-monthly-premium-unchanged/TvNLAAumGrrY5zvOPWFsFK/story.html
The Medicare ‘‘Part B’’ premium that most older people pay for outpatient care will stay the same in 2015 — $104.90 a month. The government says it is the third consecutive year that the basic monthly premium has held steady. Higher premiums paid by upper-income beneficiaries are also unchanged. These are for people with an income greater than $85,000 a year, or $170,000 for married couples. Medicare enrollment is growing as baby boomers enter retirement. But costs-per-beneficiary have barely risen the past four years. That is because of spending cuts by President Obama and Congress, as well as low inflation in health care. Medicare’s hospital deductible will rise by $44 next year, to $1,260. But many people carry additional insurance to cover such costs.
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Medicare Premiums to Remain Flat
The Wall Street Journal
October 9, 2014
http://online.wsj.com/articles/medicare-premiums-to-remain-flat-1412869970
Most Medicare beneficiaries will pay monthly premiums of $104.90 for 2015, the same as this year and last year, while cost-sharing for hospital and skilled nursing stays will increase slightly, the Obama administration said Thursday. The premiums cover doctor’s visits, outpatient care and medical supplies under what is known as Part B of the federal insurance program for people over age 65. Higher-income seniors pay more. An individual whose tax return shows income between $85,000 and $107,000, for example, will pay $146.90 a month. Annual deductibles for most people using services under Part B will also remain unchanged for 2015 at $147, federal officials said. The deductible for admission to a hospital under Part A of the program is increasing to $1,260 for the first 60 days of a period of illness in 2015, up from $1,216 this year. Beneficiaries in skilled nursing facilities will pay $157.50 a day after their 20th day there in 2015, up from $152 a day this year. Health and Human Services Secretary Sylvia Mathews Burwell said the steadiness in premiums was a sign of slowed cost growth within Medicare, which she attributed in part to the 2010 federal health law.
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Pharma Sues Again Over Orphan Drug Discounts to Hospitals
The Wall Street Journal
October 9, 2014
http://blogs.wsj.com/pharmalot/2014/10/09/pharma-sues-again-over-orphan-drug-discounts-to-hospitals/
An ongoing feud between the pharmaceutical industry and a federal agency over a discount drug program for certain hospitals is back in court. The industry trade group has filed another lawsuit trying to block the U.S. Health Resources and Services Administration from enforcing a rule that allows so-called safety net hospitals and clinics to obtain orphan drugs at a discount. Orphan drugs are used to treat rare diseases. Under this program, which is called 340B, drug makers must offer discounts of up to 50% on all outpatient drugs to hospitals and clinics that serve indigent populations. There are roughly 2,000 such institutions, although the number was expanded thanks to the Affordable Care Act. Two months ago, however, the HRSA issued a rule that angered drug makers, because safety-net institutions are allowed to obtain orphan drugs at a discount, but only if these medicines are prescribed to treat a condition other than the disease for which orphan status was granted.
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No increase in Medicare Part B premiums
The Hill
October 9, 2014
http://thehill.com/policy/healthcare/220255-no-increase-in-medicare-part-b-premiums
Premiums and deductibles in Medicare Part B will remain the same next year, saving seniors more than $125 compared with projections, federal health officials said Thursday. The Centers for Medicare and Medicaid Services (CMS) touted the news as a boon to seniors and evidence that ObamaCare is successfully slowing the growth of healthcare costs. "The stabilization of Part B premiums is another example of how we are containing healthcare costs to provide a more sustainable and affordable health delivery system," CMS Administrator Marilyn Tavenner said in a statement. "This means even greater financial and health security for our seniors next year as their premiums will remain unchanged." Medicare Part B covers care from doctors, durable medical equipment, outpatient hospital stays and some home health services. Seniors enrolled in the benefit will pay $104.90 and $147 for premiums and deductibles, respectively — the same amount as this year.
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GOP wants to block Obamacare payments
The Washington Examiner
October 8, 2014
http://washingtonexaminer.com/gop-wants-to-block-risk-corridors/article/2554540
A group of Republican senators are pushing a plan to block $1 billion in payments to insurance companies meant to smooth over their entry into Obamacare marketplaces. In a letter to Speaker John Boehner, Sen. Marco Rubio proposed blocking the "risk corridor" payments, which compensate insurers who underestimate the costs of providing insurance through the Affordable Care Act. Critics charge that the payments are, in effect, taxpayer-funded bailouts. “The American people expect us, as Members of Congress, to fulfill our Oath of Office and defend the Constitution,” Rubio wrote. “Therefore, we must act to protect Congress’ power of the purse and prohibit the Obama administration from dispersing unlawful risk corridor payments providing for an Obamacare taxpayer bailout.” The letter was signed by 13 additional GOP senators, including John Barrasso of Wyoming, Mike Lee of Utah and Ted Cruz of Texas.
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Medicare Revises Nursing Home Rating System
The New York Times
October 6, 2014
http://www.nytimes.com/2014/10/07/business/medicare-alters-its-nursing-home-rating-system.html?_r=0
The federal government on Monday announced substantial changes to the government’s five-star rating program for nursing homes, a widely used consumer tool that has been criticized for its reliance on self-reported, unverified data. The five-star rating system has become the gold standard for evaluating the nation’s more than 15,000 nursing homes since it was put in place five years ago, even though two of the major criteria used to rate the facilities — staffing levels and quality statistics — are reported by the nursing homes themselves and generally are not audited by the federal government. On Monday, officials said they would make several changes, starting in January, aimed at addressing some of these concerns. Nursing homes will have to begin reporting their staffing levels quarterly using an electronic system that can be verified with payroll data. And officials will initiate a nationwide auditing program aimed at checking whether the so-called quality measures rating — which is based on information collected about every patient — is accurate.
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Medicare to overhaul rating system for nursing homes
The Hill
October 6, 2014
http://thehill.com/policy/healthcare/219934-medicare-to-overhaul-rating-system-for-nursing-homes
The Obama administration is seeking to improve a government system that offers quality ratings for nursing homes around the country. The Centers for Medicare and Medicaid Services (CMS) on Monday announced an initiative to enhance Nursing Home Compare, a consumer tool that evaluates long-term-care providers, in part by increasing the number and types of quality measures used. “We are focused on using as many tools as are available to promote quality improvement and better outcomes for Medicare beneficiaries,” said Marilyn Tavenner, CMS administrator, in a statement. “Whether it is the regulations that guide provider practices or the information we provide directly to consumers, our primary goal is improving outcomes.” The announcement took place as President Obama signed the IMPACT Act into law. The measure aims to establish a standard system for collecting quality, payment and other data from post-acute care facilities.
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The surprising Obamacare experiment that saved taxpayers $24 million last year
The Washington Post
October 6, 2014
http://www.washingtonpost.com/news/storyline/wp/2014/10/06/the-surprising-health-care-experiment-that-saved-taxpayers-24-million-last-year/
The social worker pulls on blue latex gloves and a surgical face mask. She steps into the hospital room, where sheer curtains dim the September afternoon sunlight. James Watley, 53, sits upright in bed, recovering from a bone marrow transplant. He’s sipping ginger ale through a straw. An orange rests at his hip, as though he’s guarding it. Unprompted, Watley makes his case to stay. “I can’t go back,” he tells her, softly. “This is it. The last stand. Next one’s the box.” He came here from a Brooklyn homeless shelter, where his oxygen tank was considered a fire hazard. It’s at least an hour by subway from the Montefiore Medical Center in the Northwest Bronx, where he receives treatment for blood cancer. Last time, he fainted on the train. Deirdre Sekulic, 42, doesn’t argue. Her job is guided by one belief: Sick people with no home cannot heal. Moral implications aside, that’s an expensive problem for the nation.
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Missouri consumer group sues feds over health insurance rate information
St. Louis Dispatch
October 1, 2014
http://www.stltoday.com/news/special-reports/mohealth/missouri-consumer-group-sues-feds-over-health-insurance-rate-information/article_f290dc2f-a6b2-5a74-9de7-7342a365613b.html
A Missouri consumer advocacy group is suing the federal government in an attempt to force the public disclosure of health insurance rate information ahead of the upcoming enrollment period. The Consumers Council of Missouri said it filed the lawsuit late Tuesday in U.S. District Court in St. Louis after its Freedom of Information Act request for the rate filings was denied by the U.S. Department of Health and Human Services. The council said it is looking for information about pricing and insurers’ reasons for raising or lowering rates. “It seems to be the only way we are going to have a chance to get this information,” said Joan Bray, the council’s executive director and a former Democratic Missouri state senator.
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GAO Opinion Bolsters GOP Case on Insurer Risk Payments
Roll Call
October 1, 2014
http://blogs.rollcall.com/healthopolis/gao-opinion-bolsters-gop-case-on-insurer-risk-payments/?dcz=
A group of Republican lawmakers on Tuesday obtained a legal opinion on legislative instructions for funding a key factor enticing health insurance participation in the state and federal exchanges. Exchange health plans can be obtained without restrictions due to preexisting health conditions and eliminating insurance limitations on preexisting conditions is a primary objective of the Affordable Care Act. However, to avoid a catastrophic insurance market breakdown, the law instituted an individual coverage mandate, which broadens the coverage pool. Also, the law added a temporary premium stabilization program for insurers to re-balance the coverage risk. The federal government subsidizes plans that have losses above a set amount and recovers money from plans that have gains. CQ Health Beat’s (@CQHealthTweet) Rebecca Adams reported that the Centers for Medicare and Medicaid Services, in insurance exchange rules issued in May, tweaked the amounts this year given to insurers to cover losses and offset the cost of caring for high-cost patients.
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