Medicare Extends Enrollment Period For Those Affected By Sandy


By Susan Jaffe

November 8th, 2012, 1:18 PM

Medicare beneficiaries battered by Superstorm Sandy have one less problem to worry about: Federal officials have extended the Dec. 7 deadline to enroll in a private medical or drug plan for next year for those still coping with storm damage.

The Centers for Medicare & Medicaid Services “understands that many Medicare beneficiaries have been affected by this disaster and wants to ensure that all beneficiaries are able to compare their options and make enrollment choices for 2013,” Arrah Tabe-Bedward, acting director for the Medicare Enrollment and Appeals Group, wrote in a Nov. 7 letter to health insurance companies and State Health Insurance Assistance Programs.

Beneficiaries hit by the storm can still enroll after the midnight Dec. 7 deadline if they call Medicare’s 24-hour information line,1- 800-Medicare (1-800-633-4227).  Representatives will be able to review available plans and complete the enrollment process over the phone.

“We are committed to giving people with Medicare the information and the time they need to make important decisions about their coverage,” Medicare spokeswoman Isabella Leung said in an e-mail.  Medicare officials have not set a new deadline but have encouraged beneficiaries to make their decisions soon if possible.

Seniors currently in a plan will be automatically re-enrolled for next year in the same plan.

The extra time also applies to any beneficiaries who normally get help from family members or others to sort through dozens of plans but who have been unable to do so this year because they live in storm-ravaged areas.  Neither beneficiaries nor those who provide them assistance will be required to prove that they experienced storm damage.

“This is a really important recognition by CMS to accommodate Medicare enrollees affected by Hurricane Sandy,” said Leslie Fried, director for policy and programs at the National Council on Aging, a Washington, D.C., advocacy group.

In the aftermath of Hurricane Sandy, the Obama administration declared Connecticut, New Jersey, New York and Rhode Island as “major disaster areas,” according to the U.S. Federal Emergency Management Agency.  In addition, FEMA issued emergency declarations for parts of Delaware, the District of Columbia, Maryland, Massachusetts, New Hampshire, Pennsylvania, Virginia and West Virginia.

More than 4 million seniors in those states are enrolled in drugs-only plans and more than 2.8 million have Medicare Advantage policies, which includes medical and drug coverage.

Susan Jaffe can be reached at Jaffe.KHN@gmail.com

English: In the United States, Medicare benefi...

English: In the United States, Medicare benefits compared for younger vs. older workers. According to author Joseph Fried, this graphic uses information from: C. Eugene Steuerle and Adam Carasso, “The USA Today Lifetime Social Security and Medicare Benefits Calculator,” (Urban Institute, October 1, 2004), from: http://www.urban.org/publications/900746.html. Note: The calculator does not include the value or cost of the Social Security disability program. (Photo credit: Wikipedia)

This post has been corrected.  Earlier versions mistakenly said coverage for those who do not enroll in a 2013 plan would expire at the end of the year. CMS says instead that seniors already in a plan will be automatically re-enrolled for next year in the same plan.

ACO ‘Predecessor’ Saved Medicare Money, According To JAMA Study


House Republican Press Conference on Health Ca...

House Republican Press Conference on Health Care Reform House Republican Leader John Boehner (R-OH) (Photo credit: House GOP Leader)

Insight from Donald Berwick

Insight from Donald Berwick (Photo credit: Gates Foundation)

Topics: Health Costs, Delivery of Care, Medicare, Quality, Aging

Sep 12, 2012

The study found that the Medicare Physician Group Practice Demonstration resulted in health care savings.

Reuters: Doctor Incentive Groups May Save Money, With Effort
According to a new study, a precursor to the Accountable Care Organizations that policymakers are hoping will lower health costs and improve quality did reduce spending in some organizations, but not in others. ACOs and the earlier pilot program, known as the Medicare Physician Group Practice Demonstration, emphasize shared savings for groups of health workers and award bonus payments based on their quality of care (Pittman, 9/11).

Kaiser Health News: Capsules: Medicare Pilot Program Shows Cost Savings Treating Dual-Eligibles
Researchers Tuesday released a deeper look at the Physician Group Practice Demonstration, one of the federal government’s first pay-for-performance experiments to improve health care and reduce costs for the Medicare population. They found that it created significant savings — especially for dual eligibles, which is the population who receives health coverage through both Medicare and Medicaid and who are often the health system’s sickest and costliest patients (Kulkarni, 9/11).

The New York Times: New Medical Care Networks Show Savings
The nation’s nine million “dual eligibles,” as they are known, make up 15 percent of the Medicaid population but account for 39 percent of the program’s spending. … The findings come as accountable care organizations are forming around the country. According to the Department of Health and Human Services, more than 150 such groups now serve about 2.4 million Medicare patients  (Goodnough, 9/11).

Modern Healthcare: Spending Varied Widely In Early ACO Test, Report Says
Medicare spending varied widely among 10 physician groups that tested accountable care ahead of healthcare reform, with the most notable reductions among low-income, medically complex seniors, a newly published estimate shows. On average, Medicare spending for low-income seniors also covered by Medicaid, a population known as dual eligibles, declined by $532 annually for elderly patients included in the five-year accountable care pilot (Evans, 9/11).

Medpage Today: ACO Precursor Saved Money
Colla and colleagues also found that most of the overall savings were achieved through reductions in acute care hospitalizations … They also saw a significant variation in savings across practice groups, ranging from an overall mean per-capita annual savings of $866 to an increase in expenditures of $749. The reason for such differences remains unclear, but the researchers suggested that organizations that start out with higher spending levels have greater opportunities to achieve savings (Fiore, 9/11).

In other Medicare news -

The New York Times: As Medicare Fraud Evolves, Vigilance Is Required
Officials are also noticing a huge increase in problems in the home health care and hospice areas. For instance, some Medicare recipients are persuaded to sign up for “free” massages in their homes, and Medicare is fraudulently billed for physical therapy. Or, unscrupulous doctors approve patients for hospice care who are not terminally ill and may be experiencing something as minor as recent weight loss (Konrad, 9/11).

CQ HealthBeat: Medicare Official Reminds Insurers Of Consequences Of Low Ratings
In an effort to discourage participation in low-performing Medicare Advantage health plans, a top Medicare official Tuesday reminded an audience of insurers that seniors who want to enroll in such plans will have to call the company rather than joining online. Jon Blum, deputy administrator of the Centers for Medicare and Medicaid Services, told a conference sponsored by the trade group America’s Health Insurance Plans (AHIP) that Medicare beneficiaries will get warnings about health plans that have received ratings of fewer than three stars for three consecutive years. … The decision to discourage seniors from enrolling in low-rated plans was in a document released in April (Adams, 9/11).

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Benefit Security Card .. HALF of the U.S live ...

Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) …item 2..Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) … (Photo credit: marsmet481)

Ga. Gov. Signals Willingness To Discuss Medicaid Expansion Compromise


Centers for Medicare and Medicaid Services (Me...

Centers for Medicare and Medicaid Services (Medicaid administrator) logo (Photo credit: Wikipedia)

Topics: Medicaid, States, Health Reform, Politics

Aug 30, 2012

After the Georgia governor seemed to rule out Medicaid expansion in a convention speech, a spokesman qualified that it might change if the state had options not now on the table.

Atlanta Journal-Constitution: Deal’s Medicaid Decision Could Put Hospitals At Risk
Gov. Nathan Deal‘s decision to reject the expansion of Medicaid prescribed by the Affordable Care Act would leave thousands of the poorest Georgians uninsured and threaten the bottom lines of hospitals that were counting on new income from the changes. … Word of Deal’s decision set off a wave of anxiety among hospital officials and patient advocates in the state, with one saying that the governor is “certainly putting hospitals at risk,” and another calling the decision a mistake. “I have diabetics who lose legs because they do not get wound care or get to see a podiatrist,” said Carole Maddux, CEO of Good Samaritan Health & Wellness Center in Pickens County. “These are people who will be applying for disability and going on Social Security. … They were perfectly healthy, contributing members of society before that. It’s very short-sighted” (Teegardin, 8/30).

Georgia Health News: Medicaid Expansion: Room For Compromise?
The door may not be closed on a Georgia Medicaid expansion after all. Gov. Nathan Deal had appeared to rule out expanding Medicaid while speaking Tuesday to the media in Tampa at the Republican National Convention. “No, I do not have any intentions of expanding Medicaid,” Deal said, according to the AJC. “I think that is something our state cannot afford.” Deal spokesman Brian Robinson, though, told the Associated Press, “Today, the governor said if the state’s only options remain the ones that are available today, he would oppose taking part in the expanded Medicaid program.” Robinson, asked by Georgia Health News on Wednesday to clarify his remarks, said in an email that the governor would reassess his expansion decision if Medicaid were changed to a “block grant” approach (Miller, 8/29).

Politico Pro: Medicaid Opt-Outs Could Ding Employers
It’s not just hospitals who stand to take a financial hit if states don’t fully expand their Medicaid programs. Employers could find themselves the subject of some collateral damage, too. If Congressional Budget Office projections are correct, about 3 million more low-income individuals will be added to health insurance exchanges – rather than Medicaid – as a result of the Supreme Court decision making the Medicaid expansion optional. That means there will be a larger group of low-income people who could trigger the Affordable Care Act’s employer penalty (Millman, 8/29).

Meanwhile in other state Medicaid news –

Miami Herald: 1.6 Million Floridians Would Get Health Care If Medicaid Is Expanded
Almost 1.6 million Floridians making less than $15,372 a year were not covered by health insurance in 2010 and would be eligible for Medicaid if the state went along with a controversial expansion of the program under President Barack Obama’s health care law. Some of those people would be newly eligible for coverage under the law, while others already qualify for Medicaid but have not signed up. Gov. Rick Scott has said the state will not go along with an optional expansion of Medicaid eligibility, at least in part because of potential costs (Peltier, 8/29).

Los Angeles Times: Medi-Cal Recipients Warned They Could Lose Day Health Care Benefit
State health care officials are warning certain Medi-Cal recipients that they are in danger of losing their ability to attend adult day health care centers, where they receive nursing care, social services and meals. To continue receiving the benefit, officially called Community-Based Adult Services, eligible Medi-Cal beneficiaries must be in managed care, according to state officials. Nevertheless, thousands of eligible patients have opted out of managed care, said Jane Ogle, a deputy director at the California Department of Health Care Services (Gorman, 8/29).

Sacramento Bee: Dentists Say Cal Expo Clinic Illustrates Care Gap
The two-day, massive free dental clinic at Cal Expo over the weekend yielded more than 2,000 tooth extractions and just as many lessons learned. California Dental Association officials say each extraction is further evidence that the state’s decisions in 2009 to eliminate adult Denti-Cal services and shut down a schools-based dental disease prevention program are having dire consequences. When the state wiped out virtually all adult Denti-Cal benefits – California’s version of Medicaid’s dental coverage – nearly 3 million people were stripped of oral health coverage (Craft, 8/30).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

CMS Moves Forward With Initiative To Coordinate Medicare Primary Care


Centers for Medicare and Medicaid Services (Me...

Centers for Medicare and Medicaid Services (Medicaid administrator) logo (Photo credit: Wikipedia)

Topics: Health Costs, Medicare, Quality, Health Reform

Aug 23, 2012

The Centers for Medicare & Medicaid Services‘ Innovation Center will administer the program, which was created by the 2010 health law. Five hundred medical practices have been selected to participate.

The Hill: Medicare Improved Project Linked To Health Law Takes Next Step
Federal health officials are moving forward with a plan to reward health care providers that improve services for Medicare patients. The four-year project will be administered by the Medicare agency’s Innovation Center, a creation of the 2010 health care law that seeks to reduce costs and improve health care delivery. The center’s latest effort aims to foster well coordinated primary care within Medicare. The Medicare agency announced that it has selected the 500 medical practices that will participate. They will receive about $20 per beneficiary per month in exchange for providing new services (Viebeck, 8/22).

The Associated Press: Clinics Get Incentive To Improve Health Care
A federal initiative will give a handful of primary care clinics in Salem a financial incentive for proving more coordinated and better quality health care to Medicare patients. Four Salem clinic locations have been selected to participate in the Comprehensive Primary Care Initiative, a four-year program administered by the Centers for Medicare & Medicaid Services (Wong,  8/22).

Politico Pro: Primary Care Initiative Targets Medicare Costs
CMS will spend $300 million over 3 1/2 years to pay primary care practices an extra fee for managing Medicare patients, an effort to lower costs and improve care for more than 300,000 beneficiaries nationwide. The CMS Innovation Center announced on Wednesday the 500 practices in seven regions that will participate in its Comprehensive Primary Care Initiative. The effort also engaged Medicaid plans and private insurers to enhance payments and reach “hundreds of thousands” of other patients beyond the Medicare population, Innovation Center Director Richard Gilfillan said in a conference call with reporters (Norman, 8/22).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

State Roundup: Restraining Order Issued In Mo. Health Exchange Fight


The seal of the United States Department of He...

The seal of the United States Department of Health and Human Services. The symbol represents the American People sheltered in the wing of the American Eagle, suggesting the Department’s concern and responsibility for the welfare of the people. The colors are reflex blue and gold. This seal is now just used for mainly legal purposes; the department has a separate logo which is used for its visual identity. More information here and here. (Photo credit: Wikipedia)

Topics: States, Politics, Health Reform, Mental Health, Insurance, Marketplace

Aug 22, 2012

A selection of health policy news from Missouri, California, Texas and Kansas.

Politico Pro: Restraining Order Issued In Exchange Fight
A judge issued a temporary restraining order Tuesday against Missouri’s secretary of state, Robin Carnahan, to prevent her from finalizing the language of a ballot question on health insurance exchanges. Lt. Gov. Peter Kinder, a Republican, sought the restraining order while a state court considers whether the language of the ballot question is biased, a claim leveled by Kinder and the state’s top Republicans. GOP lawmakers are pushing for voters to decide whether to deny Democratic Gov. Jay Nixon the authority to unilaterally establish a health insurance exchange in Missouri to comply with the federal health law. But Carnahan, a Democrat and the state’s top elections official, gets to write the language (Cheney, 8/21).

California Healthline: Senate OKs Oral Chemotherapy Mandate
Health insurers will need to cover oral chemotherapy medication if a bill passed Monday by the Senate is signed by the governor. Today, the Assembly is expected to concur on AB 1000 by Henry Perea (D-Fresno), a decision that would send the bill to the governor’s desk for a signature. The mandate on oral chemotherapy coverage would not necessarily apply to coverage within the Health benefits for the exchange, but said he has not yet had conversations with the Benefit Exchange. Bill author Perea said he’s talking with legislators about the possibility of including oral chemotherapy medication among the essential health exchange staff. … A similar bill was passed twice before and vetoed both times by Republican Gov. Arnold Schwarzenegger. Perea is hoping for a different outcome with Gov. Jerry Brown, a Democrat (Gorn, 8/22).

Houston Chronicle: Most Mental Health Clinics Have Suspect Medicare Claims
A troubling new report on for-profit mental health centers reveals nearly all of those in Houston have problems with their Medicare claims, confirming many of the problems first reported by the Houston Chronicle nearly a year ago. The report from the U.S. Department of Health and Human Services Office of Inspector General, found that 13 of the 16 clinics in Houston – 81 percent – had “questionable” claims submitted to Medicare. These types of clinics, known as “community mental health centers,” offer intense mental health therapy in an outpatient-setting, as an alternative to a mental health hospitalization (Langford, 8/22).

California Watch: State’s Political Watchdog To Investigate Health District Conflicts
The state’s political watchdog agency has launched investigations into whether officials in two publicly funded health care districts in the Bay Area and Southern California were involved in decisions that benefited them financially. The investigations by the California Fair Political Practices Commission, made public this week, will focus on whether three current and former board members violated the state’s conflict-of-interest laws (Gollan, 8/22).

Kansas Health Institute News: Feds Accept KanCare Waiver Request
Officials at the federal Centers for Medicare and Medicaid Services have accepted Kansas’ Section 1115 Medicaid waiver application as complete and today began taking public comments on the proposal. … The application, if approved by the secretary of the U.S. Department of Health and Human Services, would allow the administration of Gov. Sam Brownback to move forward with its plan to remake the state’s Medicaid program as KanCare, the governor’s plan to hire three insurance companies to manage Medicaid services day-to-day. The Kansas Medicaid program has about 380,000 enrollees and costs about $2.9 billion a year (8/21).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Ryan’s Medicaid Proposals Emerge As Campaign Issue


speaking at CPAC in Washington D.C. on Februar...

speaking at CPAC in Washington D.C. on February 10, 2011. (Photo credit: Wikipedia)

Centers for Medicare and Medicaid Services (Me...

Centers for Medicare and Medicaid Services (Medicaid administrator) logo (Photo credit: Wikipedia)

Topics: Health Costs, Medicaid, Politics, Aging

Aug 15, 2012

News outlets report that the changes to Medicaid proposed by likely GOP vice presidential nominee Rep. Paul Ryan would have immediate and far-reaching consequences for millions of people, including poor seniors.

The Washington Post: Medicaid Shapes Up As Major Battleground
Mitt Romney’s choice of Rep. Paul Ryan (R-Wis.) as his running mate has reignited a debate over the future of Medicare. But Ryan’s proposed cuts to Medicaid, the other huge federal health program, could have quicker and more far-reaching consequences, with the potential to dramatically affect state budgets and health care for millions of people (Somashekhar, 8/14).

Kaiser Health News: FAQ: Ryan’s Plan Would Make Key Changes In Medicaid, Too
Under Ryan’s plan, the federal share of Medicaid spending would become a block grant indexed for inflation and population growth. States would have more flexibility over who is covered and what benefits are offered. … Opponents of Ryan’s plan say it would lead states to reduce enrollment, cut benefits or require more cost-sharing from beneficiaries (Carey, 8/14).

The Associated Press: The Other Paul Ryan Plan: $800B In Medicaid Cuts
Rep. Paul Ryan’s plan for Medicare gets all the attention, but the GOP vice presidential candidate has proposed more fundamental changes to medical care for the poor and disabled. Under the Wisconsin congressman’s Medicaid plan, states would take over the program. Simultaneously, Ryan’s proposed budget would reduce projected federal spending by about $800 billion over 10 years, shrinking Medicaid as a share of the overall national economy. The plan has passed the Republican-led House two years in a row (Zaldivar, 8/15).

Bloomberg: Medicaid Cuts Ryan Doesn’t Tout Would Limit Aid To Poor Seniors
Paul Ryan’s plan to overhaul Medicare wouldn’t affect today’s seniors. His Medicaid proposal would.  While the Republican vice-presidential candidate is careful to avoid touching Medicare benefits for anyone at or near retirement, his budget would impose immediate cuts to Medicaid, the health-care program for the poor that funds nursing-home care and other benefits for 6 million U.S. seniors. “It’s very easy to forget about these people,” said Howard Gleckman, a resident fellow at the Urban Institute, a Washington-based policy research group. “It’s a big, big cut” (Faler, 8/14).

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

State Roundup: Abortion-Rights Groups Mostly Silent On Fetal Pain Laws; Conn. Advocates Worry Over Medicaid Cuts


Topics: States, Health Reform, Uninsured, Quality, Public Health, Politics, Mental Health, Medicaid, Marketplace, Insurance, Women’s Health, Hospitals, Health IT, Delivery of Care

Aug 14, 2012

A selection of health policy stories from Arizona, Connecticut, Florida, Minnesota, Oregon, California, Tennessee, Kansas and Wisconsin.

Politico: Abortion-Rights Groups Absent On Pain Laws
When new limits on abortions are proposed, abortion-rights groups usually go all out to stop them. So why haven’t they gone all out against state fetal-pain laws, enacted in nine states since early 2010? These laws ban abortion after 20 weeks, based on the controversial assertion that the fetus can then experience pain. They’re handing victories to anti-abortion groups, and so far there’s only one major challenge from an abortion-rights group: in Arizona, where the 9th Circuit Court early this month temporarily blocked the state law (Smith, 8/13).

CT Mirror: Health Care Advocates Remain Wary Of LIA Changes, Even As DSS Scales Back Restrictions
After advocates for mentally ill and disabled residents warned that a new plan to limit the number of people receiving state Medicaid benefits would hurt that population in particular, the state has somewhat modified its plan. DSS spokesman David Dearborn said the agency would revise its planned application to the U.S. Centers for Medicare and Medicaid Services regarding the Medicaid for Low Income Adults program, known as LIA (Phaneuf, 8/13).

Health News Florida/Kaiser Health News: Readmit Rates Cost FL Hospitals
Lower Medicare reimbursement rates are coming for hundreds of hospitals across the country and for 131 in Florida with “excess readmission” rates, according to analysis of CMS data by Kaiser Health News. … Nine hospitals around the state, including Florida Hospital in Orlando, will deal with a 1 percent gap caused by the penalty. Even though half of the 22 facilities in the Florida Hospital system will be penalized under the Hospital Readmissions Reduction Program, hospital officials said care won’t be affected (8/13).

Minneapolis Star Tribune: Hospitals Face Penalties If Patients Quickly Return
Minnesota hospitals will lose an estimated $1.7 million in Medicare payments next year under a new program that penalizes hospitals for higher-than-average rates of readmission. The penalties are based on the 30-day readmission rates for Medicare patients with three common conditions — heart attacks, heart failure and pneumonia — between 2008 and 2011. The penalties, which will affect 29 Minnesota hospitals, will average about one-tenth of 1 percent of their annual Medicare payments, the Minnesota Hospital Association said (Lerner, 8/13).

Minnesota Public Radio: Careful Look At State Employees Health Benefits May Save Taxpayers Millions
The state of Minnesota is terminating health insurance coverage for about 3,100 family members of state employees. The action comes after the state conducted an audit to determine whether anyone was improperly receiving benefits. Supporters of the audit say it is proof the program is working, and that it could save the state millions of dollars (Scheck, 8/14).

The Oregonian: Hospital Error Reports Up Slightly In Oregon — And That’s Good News
Reports of errors in Oregon hospitals grew slightly last year, according to the Oregon Patient Safety Commission. But that might actually be good news. The commission relies on voluntary reporting, and has been struggling to persuade hospitals to improve their reporting. More reports will allow the state to better improve safety, says Bethany Higgins, the commission’s executive director. “You can clearly see that there’s improvement across the board with the quantity as well as the quality of the reports submitted, as well as the timeliness with which they are submitting them,” she said, adding, “We have a long ways to go” (Budnick, 8/13).

HealthyCal: NPs On The Frontlines
Glide, situated in the heart of San Francisco’s gritty Tenderloin neighborhood, is a haven for the homeless. Outside the shelter’s door, though it is just before noon, a group of men and women line up to wait for a bed for the night or a hot meal. … Hints of the state-of-the-art health center on the top floors of the onetime hotel start inside the lobby, in the form of posters and flyers announcing services ranging from free HIV testing to tai chi classes. Patricia Dennehy, the director of Glide Health Services, has learned that low-income patients make better health decisions when providers focus on the entire person, not just the illness that landed them in the examining room. Challenges such as poverty, inadequate housing and unemployment can eventually wreak havoc on people’s health (Ramirez, 8/14).

The Associated Press: Tennessee Nursing Job Market More Competitive
Health care experts say Tennessee’s nursing job market has grown more competitive in recent years. According to the Tennessee Board of Nursing, there were more than 83,000 registered nurses in the state in 2011, and 21 new schools were added between 2000 and 2011 (8/13).

Reuters: Health Startups Learn To Compete In Silicon Valley
It may not sound as flashy as social media, but health care is becoming a new star in Silicon Valley. Driven by the promise of enormous payouts, entrepreneurs are using the latest technology and design to help save lives, and make money. But it’s tough to grab a share from the big companies, which are dominant in certain fields in health care, such as Electronical Medical Records, or EMR, where doctors store and manage patients’ digital health data (Tian, 8/14).

California Healthline: Designing A New Tier Of Dental Professional In California
About two million California kids will gain access to dental coverage over the next few years as a result of the Affordable Care Act and the state’s decision to shift children from Healthy Families to Medi-Cal, California’s Medicaid program. ACA also will provide more dental coverage for some adults. That’s generally considered good news in the dental and children’s health communities … but who’s going to do the work? … The California Legislature this month will consider a bill aimed at improving dental care for underserved children. SB 694, by Sen. Alex Padilla (D-San Fernando Valley), would … launch a project to train a new level of oral health care professional in California — people less educated than dentists but with enough training to perform some dental procedures (8/13).

Kansas Health Institute News: Changes Under Way For Determining In-Home Medicaid Services
State officials are changing the way they determine which in-home Medicaid services are provided to the frail elderly and people who are physically disabled. The new system will rely on a single agency or organization with a presence in each of the state’s 105 counties to assess what services a person will receive. Currently, there are more than 30 organizations involved with the process. Some assess only the elderly. Others focus solely on the physically disabled (Ranney, 8/13).

Kansas Health Institute News: Kansas Looks To Wisconsin For ADRC Model
In Wisconsin, it’s easy for frail seniors or people who are physically disabled to find out if they are eligible for the Medicaid services that could help them live at home and avoid or delay the move to a nursing home. All they have to do is call the Aging and Disability Resource Center (ADRC) in their county. They’ll be hooked up with someone who can assess their conditions, figure out how to pay for the services and put them in touch with the providers who can make it happen (Ranney, 8/13).

Milwaukee Journal Sentinel: Mental Health Advocates Urge Abele To Fund Community Care
Advocates for community mental health services called on Milwaukee County Executive Chris Abele on Monday to reinvest savings from downsizing the Mental Health Complex into community services in his 2013 budget. Abele was reminded that he signed a resolution last year promising to do just that. However, the 2013 budget request by the county’s Behavioral Health Division does not set aside for community services the $1.5 million in savings from closing an acute-care unit at the complex, shutting down part of another unit at the complex and privatizing some mental health services elsewhere (Schultze, 8/13).

This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Florida

Florida (Photo credit: colros)

Generic Drugs Saved U.S. $1T Over 10 Years, Industry Study Finds


Topics: Health Costs, Marketplace

Aug 03, 2012

Generic drug makers released a study Thursday that found generic pharmaceuticals have saved the U.S. — through private prescriptions as well as Medicare and Medicaid — more than $1 trillion over 10 years.

The Hill’s Healthwatch: Study: Generic Drugs have Saved U.S. $1 Trillion
Generic drugs have saved the health care system more than $1 trillion over the last decade, according to research released Thursday by the generics industry. The industry is pushing for expanded use of generics in Medicare and Medicaid, and the new research suggests that generics have helped control the government’s spending on prescription drugs (Baker, 8/2).

CQ HealthBeat: Generic-Drug Study Touted In Effort To Reduce Health Care Costs
Generic drugs saved consumers more than $1 trillion over 10 years and offer a prime area in which to find savings in health care, the generic drug industry and Democrats said Thursday. A study by the IMS Institute for Healthcare Informatics, a market research company, showed that savings from generic drugs amounted to $1.07 trillion between 2002 and 2011, including $193 billion in 2011 alone (Ethridge, 8/2).

Medpage Today: Industry: Generics Saved $193 Billion
The General Pharmaceutical Association (GPhA) is spotlighting the savings in an effort to encourage policymakers to protect and spur use of their products through an upcoming critical budgetary debate. “As government leaders in Washington and across the country look for ways to cut health care costs, this new analysis details the remarkable savings achieved through the use of generic medications,” states the fourth annual Generic Drug Savings analysis (Pittman, 8/2).

The Associated Press: Report: Generic Drugs Saved $193 Billion In 2011
The fourth annual report, produced for the Generic Pharmaceutical Association, found use of generic prescription drugs in the U.S. saved about $193 billion last year alone. That amount was up 22 percent from the $158 billion in savings from generics in 2010, and was more than three times the $60 billion in savings in 2002, the report states (Johnson, 8/2).

In other news related to drug costs –

Reuters: Cash Rewards Keep People On Their Medications
Weekly rewards of as little as $5 could keep people on track with their medications, says a new study. … For the new study, Dr. Nancy Petry and her team at the University of Connecticut looked at 21 studies that offered incentives to people taking medication for tuberculosis, substance abuse, HIV, hepatitis, schizophrenia and stroke prevention (Sheriff, 8/2).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Super-Bug Technology Draws High-Tech Attention


Topics: Health IT, Hospitals, Marketplace, Public Health

Aug 02, 2012

The Wall Street Journal’s Venture Capital Dispatch: Hospitals Investigate Start-Up Technologies For Superbug Disinfection
The Centers for Medicare & Medicaid Services has said 2012 will be the year that hospitals should start paying to treat infections contracted on their premises. Many investors have the issue pegged as a janitorial concern, and not necessarily the purview of high-tech gadgets. But others see an enormous unmet need, where several small companies are vying to unseat giants like Johnson & Johnson in a potentially lucrative field. Hospitals are now turning to esoteric technologies–including robots that use xenon ultraviolet light technology–to combat the germs (Hay, 8/1).

This is part of Kaiser Health News‘ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

Tennessee Cuts Medicaid Benefit Funding For Some Long-Term Care Patients


By Guy Gugliotta

Jul 29, 2012

This story was produced in collaboration with wapo

In a unique experiment being watched nationally, Tennessee is revising its Medicaid long-term care options to make it harder for certain low-income elderly people to qualify for state-paid nursing home care.

The state is focusing on seniors who officials say need assistance but not in a nursing home and not with an equivalent level of treatment in home or community-based services. The state TennCare Medicaid program will pay up to $15,000 a year to help these participants stay in their homes or receive meals and other services in adult day care facilities or other less restrictive community settings.Under its old program, all participants qualifying for long-term care under TennCare—whether they were in a nursing home or other care—were entitled to benefits equal to the cost of a nursing home.

The program, which has received federal approval and began this month, is the first of its kind in the nation because it creates this new category of patients who don’t qualify for nursing home care. Up to now, under federal law, everyone who receives long-term care under Medicaid first had to qualify to be admitted to a nursing home.

“Federal law requires that program eligibility be tied to eligibility for nursing homes,” said Matt Salo, executive director of the National Association of Medicaid Directors. “Tennessee is stepping ahead to create this new category of at-risk individuals whose benefits are not linked to nursing homes.”

But consumer advocates worry that the $15,000 annual limit will fall short of meeting the needs of some seniors, who could end up going without services or relying on funds from family or friends. Gordon Bonnyman, executive director of the Tennessee Justice Center, said he feared that “a lot of frail people are not going to make it on the reduced package.”

State officials say the money should be sufficient and that seniors whose need for care increases may qualify for more extensive TennCare benefits: nursing home or community-based care up to $55,000 a year.

TennCare hopes to save $47 million from the new program this year. In the longer run, the state expects by retooling the system it will be better prepared to accommodate an expected spike in enrollees as baby boomers grow older.

TennCare’s long-term care system serves 23,705 elderly. TennCare, like Medicaid in other states, is financed with federal and state funds. In addition to low-income seniors, it covers children, pregnant women and the disabled. Tennessee’s financial share for long-term elderly care is $1.1 billion per year.

Nationally, Medicaid plays a key role in long-term care, covering more than two-thirds of all nursing home residents and footing more than 40 percent of the industry’s costs. The average cost per year for nursing home care nationally is about $80,000.

The new program is the second time in three years TennCare has moved to reduce use of nursing homes. In 2009, the state obtained permission from the federal government to offer nursing home patients—and new long-term care enrollees—the option of receiving care in a family- or community-based setting. Under that program, nursing home care would only be required if the alternative setting could not meet the patient’s needs or if the cost of those needs exceeded the $55,000 per year.

That change has been successful. In 2010, around 83 percent of Tennessee’s long-term Medicaid patients were in nursing homes,with 17 percent in home and community settings under a prior waiver.Today, 66 percent of patients are in nursing homes and 34 percent are receivinghome- and community-based services.

Dr. Melinda Henderson, executive director at the UnitedHealthcare Community Plan, one of three managed care organizations that administer Tennessee’s Medicaid system, said patients overwhelmingly choose not to be in nursing homes.

“You kind of lose your independence at a nursing home,” said Sarah Stewart, who lives in Bolivar in rural southwest Tennessee. “I just prefer to be at home and be independent.”

Stewart, 78, had a heart attack in 2008 and is legally blind because of macular degeneration. She was hospitalized for breast cancer surgery in 2011 and put in a nursing home afterward, an experience she did not enjoy, in part, she acknowledged, because she was not allowed to have Molly, her Chihuahua, with her.

The change in the program in 2009 enabled her to leave nursing care last fall and go home, where a caregiver helps her with shopping, housework and personal needs for six hours a day, five days a week. She has five children, eight grandchildren and 13 great-grandchildren — virtually all of them living out of state.  But home care “is making me comfortable,” she said. “I’m very pleased.”

The new program is an outgrowth of what officials learned from the 2009 change.  They said they found that many people didn’t need more than $15,000 a year in assistance.

State officials decided they could raise the level of need for patients to qualify for full long-term care benefits, whether in a nursing home or elsewhere.  The legislature approved the change in April, as did the federal Centers for Medicare & Medicaid Services.

Under the new regulations, the current requirement  – that someone need help with an “activity of daily living” such as dressing or using the bathroom – has been replaced by a complicated weighted point system that makes it considerably more difficult for patients to reach the standard to qualify for nursing home care.

The focus of this endeavor, said TennCare Assistant Commissioner Patti Killingsworth, is to make sure healthier patients who currently qualify for nursing facilities are served “more appropriately” in community-based settings. “We want nursing homes to target patients who truly need their services,” Killingsworth said. The system will spend less, she acknowledged, “but we will serve more people with home- and community-based care.”

Killingsworth said 40 percent of elderly Medicaid patients receiving community benefits before the change spent “less than $15,000 per year” and if they were entering the system now would receive “an appropriate level of benefits.”

Bonnyman, the consumer advocate, said TennCare has not done the analysis to warrant this assertion: “On paper what they’re talking about looks fine,” he said. But “all of this starts with a mandate designed to save $47 million.”

Jesse Samples, executive director of the Tennessee Health Care Association, representing the majority of Tennessee’s 330 nursing homes, agreed with Bonnyman that TennCare’s chief motivation is to save money and also agreed with Killingsworth that nursing homes were the target.

“In an ideal world we would increase funding for all categories of services,” Samples said. “But we’re playing a zero-sum game here. In order to get money for home and community-based services, you have to take it from somewhere else. That would be nursing homes.”