President Obama was right last week to pivot to two things in the wake of the Supreme Court’s Affordable Care Act (ACA) decision: (a) a plea to Republicans (yet again) to please, pretty please drop their opposition to the law and join him in tweaking it and fixing what remains broken in healthcare, and (b) Medicaid expansion.
It’s probably too much to hope Republicans will drop their fierce attempts to trash, dismember or repeal the law—as the political season leading to the Nov. 2016 elections gets underway in earnest. But Medicaid expansion could prove a fruitful path to concrete results.
As a reminder, the 2012 Supreme Court decision on the ACA nullified the law’s provision compelling states to expand Medicaid. Instead, it made such expansion voluntary. Continue reading…
Health Datapalooza once again lived up to its reputation as the liveliest and most eclectic health IT confabs of the year. Energetic and sleek young entrepreneurs mingled with government bureaucrats, academic types, consultants, current and former ONCers, a smattering of providers, app developers, data geeks, and patient advocates at this year’s conference, held in Washington D.C. June 1 to 3 with about 2,000 in attendance.
Although the speeches, app demonstrations, and panel sessions broke little new ground, that’s not the point. The point is to maintain the excitement, optimism and commitment, to update the vision, showcase the creativity, and extol the virtues and power of data-driven care improvement. Perhaps not as the solution to all the health system’s woes, but a fair share of them.
I didn’t discern a dominant theme, but amid the ra-ra and fun there was a good amount of hand-wringing around these issues:
1. Failure to engage the vast majority of consumers/patients in their own care—with data, medical records and Yelp reviews in hand. Some two-thirds of providers attesting to stage 2 meaningful use reported that not a single patient had requested their data or records. Continue reading…
This year’s Datapalooza conference, June 1-3, in Washington, D.C. takes place as health data edges close to becoming “a thing” in the cultural landscape. Consumers may not know it yet, but all that fitbiting, medical social networking, and test result accessing through patient portals could soon swell into a full-fledged consumer movement.
You can almost hear it now: “Hey man, did you upload your stats after your knee surgery—you know, how much you’re walking, your pain levels, and all that?”
Or, to a newly diagnosed cancer patient: “Be sure to track your treatment experience online. It’s kind of cool to do and helps researchers figure out what works and doesn’t.”
Or: “Check this app out—you can enroll in a clinical trial in, like, 5 minutes.”
This is, of course, what many health data heads have forecast for years. It’s also now crystal clear that the use of big data to improve health care is no longer a research backwater. To be sure, there’s hype around the potential to dramatically alter physician and consumer behavior via big data analytics. We are still dealing with human beings, folks. As well, concern about privacy continues to vex health data entrepreneurs, researchers, and consumers.
I’ve never met the man, and I don’t mean this personally, but Florida Gov. Rick Scott is an idiot. Rather, more specifically, the way he has managed Florida’s Medicaid expansion, or lack thereof, is idiocy on the altar of political ideology and kneejerk Republican healthcare doctrine.
Other governors are fighting Medicaid expansion, of course. It’s a major battleground in the implementation of the Affordable Care Act (ACA). But Scott, 62, and governor since 2011, has raised his resistance to the level of high political theater that defies commonsense and hurts Florida residents.
If you haven’t been following this lately, here’s a quick recap: In April, Scott filed suit against the federal government (HHS) over federal funding for a special Florida program, launched in 2005, called the Low Income Pool (LIP). The funding—due to be about $1.3 billion in 2015-16 and combined with about $1 billion in state funds—compensates safety-net hospitals for care of low-income, uninsured people. It’s set to expire on June 30 and must be reauthorized by HHS.
Scott and Florida claim in the suit that HHS is trying to force the state to expand Medicaid against its will and in violation of federal law—that law being the now-famous 2012 Supreme Court decision that gave thumbs up to constitutionality of the ACA but nixed the law’s mandate requiring states to expand Medicaid. Medicaid expansion is thus voluntary. (A half dozen or so Republican governors who were initially opposed to Medicaid expansion have relented; the most recent are in Utah and Missouri. To date, 29 states plus DC have expanded Medicaid under the ACA and 17 have not. In four states, including Fla, it’s being debated.)
It’s done. Congress on April 14 passed and the president signed into law a bill that terminates one of the most egregious and silliest examples of dysfunctional government in recent years—the so-called “sustainable growth rate” (SGR) formula for doctors’ fees under Medicare.
A previous blog explained the background and protracted lead-up to this moment.
First, a round of applause for bipartisan agreement—however obvious it was that had to happen in this case. The vote in the house was 392-37. In the Senate, it was 92-8.
Praise is also in order for enacting two more years of funding for the Children’s Health Insurance Program and $7.2 billion in new funding over two years for community health centers, a program that was expanded under the Affordable Care Act and serves low-income families. There’s also welcome help for low-income Medicare beneficiaries and rural hospitals.
But the main thrust of the law is to kill one (failed) program that adjusted doctors’ fees under Medicare and create a new and hopefully better one.
The U.S. Senate has an opportunity next week to hammer the final nail in the coffin of the failed “sustainable growth rate” (SGR) formula for Medicare physician payment. At the same time, it can move the U.S. closer to a system that pays doctors for the quality of care they deliver, not the quantity.
Bear in mind that Medicare pays about a third of the tab each year for all physician services in the U.S.
For those who have not been following this issue (and I don’t blame you, it’s convoluted, even tortuous), here’s a quick recap:
The House in a rare bipartisan vote (392-37) voted on Thursday, March 26 to repeal the SGR formula, which has been in place since 1998. The formula, part of the Balanced Budget Act of 1997, was intended to constrain Medicare spending by pegging annual physician fee updates to a target based on the growth in overall physician spending and the gross domestic product.
The formula never worked. I’ll spare you the details on that. Suffice is to say that the disparities between the growth in physician costs and GDP over the period 2002-2013 were such that reducing physician fees each year by the amount the formula dictated were—well, let’s just say they were very politically distasteful. Continue reading…
There are dozens of ways to take stock of the Affordable Care Act as it turns 5 years old today. According to HHS statistics:
- 16.4 million more people with health insurance, lowering the uninsured rate by 35 percent.
- $9 billion saved because of the law’s requirement that insurance companies spend at least 80 cents of every dollar on actual care instead of overhead, marketing, and profits
- $15 billion less spent on prescription drugs by some 10 million Medicare beneficiaries because of expanded drug coverage under Medicare Part D
- Significantly more labor market flexibility as consumers gained access to good coverage outside the workplace
Impressive. But the real surprise after five years is that the ACA may actually be helping to substantially lower the trajectory of healthcare spending. That was far from a certain outcome. Dubbed the Patient Protection and Affordable Care Act for public relations purposes, there were, in fact, no iron clad, accountable provisions that would in the long run assure that health insurance or care overall would become “affordable.”
ACA supporters appear to have lucked out—so far. Or maybe, just maybe, it wasn’t luck at all but a well-placed faith that the balance of regulation and marketplace competition that the law wove together was the right way to go.
To be sure, other forces such as the recession were in play—accounting for as much as half of the reduction in spending growth since 2010. But as the ACA is once again under threat in the Supreme Court and as relentless Republican opposition continues, it’s worth paying close attention to new forecasts from the likes of the Congressional Budget Office (CBO) and the actuaries at the Centers for Medicare and Medicare Services (CMS).
The ACA is driving changes in 17 percent of the U.S. economy that, if reversed or interrupted, would have profound impact on federal, state, business, and family budgets. A quick look at some important numbers follows:
Of the many hidden gems in the Affordable Care Act, one of my favorites is Physician Compare. This website could end up being a game changer—holding doctors accountable for their care and giving consumers a new way to compare and choose doctors. Or it could end up a dud.
The outcome depends on how brave and resolute the Centers for Medicare and Medicaid Services (CMS) is over the next few years. That’s because the physician lobby has been less than thrilled with Physician Compare, and, for that matter, with every other effort to publically report measures of physician performance and quality.
I’d give CMS a C+ to date. Not bad considering it’s the tough task. The agency has been cautious and deliberate. But after the many problems with Hospital Compare, Nursing Home Compare, Home Health Compare, and Dialysis Facility Compare—not to mention the shadow of healthcare.gov’s initial rollout—that’s understandable. They want, I hope, to get this one right from the get-go. And competition from the private sector looms.