In this week’s summary, you’ll find details on the latest changes as states implement more and more provisions of the Affordable Care Act, a tribute to Dr. C. Everett Coop and two new studies looking at health care costs and the fiscal impact of incorrect or missed diagnoses.
Affordable Care Act/Medicaid
Despite recent concern about the possibility of higher insurance premiums once the Affordable Care Act is fully implemented, a recent Health and Human Services Department report counters this assumption. The report found that double-digit increases to health insurance premiums significantly dropped because of the Affordable Care Act. The average premium hike was 30% less last year than in 2010. The drop is “consistent with the increased scrutiny that such requests now receive,” said the report, which also cited decreasing health care costs. The average increase in health insurance premiums has fallen significantly since the healthcare law — and its provisions allowing the health department to review certain rates — took effect in 2010. The agency said rate review has contributed to those declines.
The New York Times reports that officials within the Obama administration said this week that states could cut Medicaid payments to many doctors and other health care providers to hold down costs in the program. Medicaid insures 60 million low-income people and will soon cover many more under the new health care law. The administration’s position, set forth in a federal appeals court in California, has broad national implications as it comes as the White House is trying to persuade states to expand Medicaid as part of the new law. In a brief filed with the United States Court of Appeals for the Ninth Circuit, in San Francisco, federal officials defended a decision by California to cut Medicaid payments to many providers by 10 percent (Pear, 2/25).
The Centers for Medicare & Medicaid Services (CMS) announced that it is giving 25 states a total of $300 million to fund the development and testing of new medical care payment methods, as required under the Affordable Care Act. Six states will receive most of the money for Model Testing: Arkansas ($42 million), Maine ($33 million), Massachusetts ($44 million), Minnesota ($45 million), Oregon ($45 million), and Vermont ($45 million). These states are already positioned to implement State Health Care Innovation Plans which include patient-centered medical homes (PCMHs) and accountable care organizations (ACOs). Colorado, New York, and Washington will also receive pre-testing support with funding going toward the continued development and refinement of their State Health Care Innovation Plans, which must be submitted to CMS within six months. New York’s share is about $1 million.
The Washington Post writes that over the past several months, America’s hospitals have been able to reduce the share of patients who must return for treatment almost as soon as they are discharged. According to statistics compiled by CMS, the nationwide rate of hospital readmissions of Medicare patients within 30 days of discharge declined to about 17.8 percent by last November after remaining stuck near 19 percent over the five years that the data has been collected, and likely for decades prior to that. Officials at CMS are crediting new financial penalties that have been imposed on hospitals with high readmission rates under the Affordable Care Act with the reduction in readmissions. The changes also include extra funding and incentives for hospitals and outpatient providers to do a better job of coordinating care for patients after they head home. (Aizenman, 2/27).
As provisions of the Affordable Care Act continue to take effect, a new battle is looming between hospitals and health insurers over how much health-care providers will get paid under new insurance plans that will be sold in the exchanges. The Wall Street Journal reports that to keep costs low, the insurers are pressing for hospitals to grant discounts from the rates hospitals usually get in commercial plans. In return, participating hospitals would be part of smaller networks of providers. Hospitals will be paid less by the insurer, but will likely get more patients because those people will have fewer choices (Mathews and Kamp, 2/28).
Dr. C. Everett Koop, who was widely regarded as the most influential surgeon general in American history and played a crucial role in changing public attitudes about smoking, died on Monday at his home in Hanover, N.H. He was 96 (AP, 2/25).
A new study, which appeared in JAMA Internal Medicine, looked at the incorrect or missed diagnosis in the primary care setting. According to the study, missed, incorrect or delayed diagnoses were most frequent in conditions common in primary-care settings, such as pneumonia, congestive heart failure, acute renal failure, cancer and urinary tract infections. Researchers analyzed 190 instances of diagnostic errors that occurred over a 12-month period, from October 2006 to September 2007, at the ambulatory-care sites of two large hospitals.
More efficient early-stage studies, advanced genetic screening and the need for better drugs have helped a few cancer treatments obtain faster approval in the past two years. “We hope to be able to shave years off the time it takes to get final approval and save hundreds of millions of dollars per drug,” the New York University Cancer Institute’s Robert Schneider said (Reuters, 2/25).
Treating a sprain in a U.S. hospital can cost $4 to $24,000, making a trip to the emergency room financially risky for uninsured patients, researchers said. A new study found wide variety between the lowest and highest charges for 10 common conditions, highlighting the unpredictability of health-care costs. Bills were $50 to more than $73,000 for urinary tract infections, $15 to $17,797 for headache care and $29 to $29,551 for intestinal infections.