Tag: "Medicare"

House & Senate Agree on Balanced Budget Resolution

The House and Senate Budget Committees have announced that their conference committee has agreed on a balanced budget resolution. The conference report is 106 pages, so it will take me a few days to complete an analysis.

Nevertheless, it is important to recognize that this is an important achievement and the result of a lot of hard work by Dr. Price, Senator Enzi, their colleagues and staff. For many years, the Senate ignored its legal obligation to pass a budget.

With respect to health care, the resolution repeals and replaces Obamacare in full. It also continues to increase Medicare premiums for high-income households, and transitions to Paul Ryan’s “premium support” model for future beneficiaries.

One of the items I had been hoping for is offsets to pay for the bungled Medicare “doc fix” of last month. The resolution states that it accounts for the full cost of that “doc fix” (page 45). Okay, but the current president will not sign this budget. Are we meant to expect that the next President will take responsibility for the unfunded spending authority this Congress gave President Obama?

Banned from Medicare; Still Billing Medicaid

Yahoo! News has a special report about physicians who have been banned from billing Medicare or some state Medicaid programs because of fraud, but are still billing other states’ Medicaid programs:

 A doctor who took kickbacks from a Pennsylvania hospice involved in a multimillion-dollar fraud. An Ohio psychiatrist who billed for treating no-show patients. A Georgia optometrist who claimed he conducted 177 eye exams in one day.

Their transgressions vary. What these doctors have in common is that each was paid by a state Medicaid health insurance program after being kicked out of another state’s Medicaid system or the federal Medicare program.

More broadly, 32 states and the District of Columbia supplied data showing they paid at least $79 million to 269 of the 1,800 providers after their terminations elsewhere. But the data was incomplete. Extrapolating from what could be verified, Medicaid payments to banned providers could easily reach into the hundreds of millions of dollars.

Mind boggling incompetence? Or government business as usual?

Churn: Data Lacking on Critical Question

The media and most health policy wonks focus only on the number of insured versus uninsured people. They don’t really care if people are enrolled in Medicaid, Medicare, Obamacare plans, employer-based benefits, or whatever. As long as the percentage insured goes up, they are satisfied.

One of the problems this disguises is “churn” – people moving between different types of coverage, which leads to disrupted care. It is something that Obamacare surely makes worse, by introducing a new type of coverage for people within a certain range of income.

However, the people in charge of the new system are almost completely ignoring this problem, according to Modern Healthcare:

Experts say churn can be disruptive to people’s continuity of benefits and healthcare, particularly if they have medical conditions for which they are receiving treatment. In addition, it can be harder for people to access healthcare providers, particularly specialists, if they switch to Medicaid, which often pays lower rates.

“For a patient under a physician’s care for a condition like cancer or renal failure, changing providers in the midst of chemotherapy or dialysis can be incredibly disruptive,” said Chris Stenrud, executive director of government relations at Kaiser Permanente.

A CMS spokesman said no data on churning between private plans and Medicaid were available for the nearly three dozen states using the federal marketplace. But a committee of health plans selling products on the federal exchange that has been tracking the trend has noted a small but steady exodus from exchange plans. The committee, however, could not determine whether the people exiting the exchange plans were transitioned to Medicaid or employer coverage or became uninsured.

The solution to churn is a refundable, universal tax credit that allows people to buy health insurance of their own choosing, and getting rid of the artificially fragmented market that Obamacare has made worse.

Republicans Reach for Redemption on Medicare “Doc Fix”

Politico reports that Congressional Republicans might be having second thoughts about the extremely flawed, so-called Medicare “doc fix” legislation that they sent to President Obama a few days ago. One of those flaws was that the spending in the bill was not offset by cuts to other federal spending – which is why almost every Democrat in Congress voted for it too.

Well, they appear to be getting the message that NCPA has been sending them since March 25:

…… one GOP source said negotiators had resolved a sticking point over how to offset a recently enacted bipartisan Medicare overhaul that was not entirely paid for. The source said the agreement is likely to offset the overhaul, often called the “doc fix,” starting next year.

Better late than never. How they will get President Obama to sign any bill that offsets spending that was already committed by his signature on March 15 is unclear. (All they had to do in the original bill was remove two short sentences that exempted the spending from the so-called PAYGO scorecards. Had they done so, they would not have to worry about it today.)

Barack Obama Has the Last Word on the Medicare “Doc Fix”

I thought that I had given the last word on the flawed Medicare “doc fix” last Monday. Nope: That honor goes to President Obama. During the three week period the secretly negotiated “doc fix” legislation was being rushed through Congress (“rushed” because the Senate was in recess for most of it), I wrote an article suggesting Republicans who voted for it might be casting their first vote for Obamacare. Well, don’t take my word for it. Now that he’s signed the bill, President Obama has hosted a fabulous garden party for the politicians who voted for it. Yahoo has the whole story, including a photo of Speaker Boehner planting a bipartisan kiss on the cheek of Minority Leader Pelosi. One of my charges was that the law increased federal control of the practice of medicine.

Here’s what the President had to say about that:

“I shouldn’t say this with John Boehner here, but that’s one way that this legislation builds on the Affordable Care Act,” Obama said, adding, “But let’s put that aside for a second.”

Bipartisan Medicare Reform: Debt and Deficits, All the Way Down

The extremely flawed so-called Medicare “doc fix” has passed. Its direct consequences include increasing federal government control of the practice of medicine and increasing deficits by at least $141 billion through 2025. However, it also has implications far beyond Medicare’s physician fee schedule, to post-Obamacare reform and general governance. Let’s tackle the fee schedule first. This “doc fix” was promoted as solving the problem that Congress has to increase Medicare’s physician fees at least once a year beyond the rate of growth originally legislated in 1997. If this did not happen, physicians’ fees would drop by about 20 percent, and they would reduce Medicare beneficiaries’ access. This “doc fix” abolishes the 1997 formula in favor of fixed, nominal rates of growth. As a consequence, the fee schedule is not “fixed” in the sense that it is “solved”. It is “fixed” in the sense that Congress has dictated the total amount that will be paid to physicians in future years. It will go up 0.5 percent per year from 2016 through 2019. Then, the amount freezes, and doctors enter a war of all against all, competing against each other for shares of an amount that will inexorably shrink in inflation-adjusted terms. It gets even more bureaucratized after 2025, but there is no point thinking about that because the whole thing is almost certain to unravel before then.

Hospitals “Turbocharge” Medicare Claims

Today’s Consumer Price Index release shows a big jump in prices for hospital services. The Wall Street Journal has an exemplary piece of investigative journalism discussing one way hospitals gouge Medicare:

A Wall Street Journal analysis of Medicare claims data and financial filings from medical facilities shows that many hospitals increased prices faster than costs rose, affecting outlier payments. The Journal identified $2.6 billion in overpayments Medicare made to general hospitals between 2010 and 2013 because of overestimates of hospitals’ costs—about one-sixth of outlier payments in the analysis.

At Christ Hospital, more than 40% of outlier payments between July 2012, when the hospital was acquired by an investor group during bankruptcy proceedings, and the end of 2013 were due solely to an increase in prices, the Journal analysis shows.

The Medicare agency took steps in 2003 to deter hospitals from raising prices to increase outlier payments, sometimes referred to as “turbocharging.”

(Christopher Weaver, Anna Wilde Mathews, & Tom McGinty, “Medicare Pays as Hospital Prices Rise,” Wall Street Journal, April 15, 2015)

Well, that’s 12 years ago, and it obviously hasn’t worked. The only way to get hospitals to quite manipulating chargemaster prices is to get the government out of fixing hospital charges.

28 Percent of Federal Taxes Go To Health Care

27.49 percent, actually. Weekly Standard’s Jeryl Bier used the White House’s own calculator to figure this out. The trend is not our friend:

In 2010, the year Obamacare passed and was signed into law, the healthcare percentage was 24.10. The following year, 2011, it dropped to 23.7 percent, and in 2012 dropped still further to 22.45 percent. After this, however, the trend sharply reversed. In 2013 the healthcare share jumped to 25.19 percent, and the latest numbers posted this week for 2014 show the highest proportion yet at 27.49 percent, a full 22 percent increase over 2012.

Means Testing Medicare Premiums

Soon after House Speaker John Boehner and Minority Leader Nancy Pelosi surprised the House of Representatives with a so-called Medicare “doc fix” that would cement important Obamacare gains, NCPA sprang into action and proposed an alternative.

Since March 25, this blog has been heavily loaded with articles addressing the topic. Unfortunately, we were not able to overcome the Obamacare coalition this time, and the legislation passed without amendments.

Many readers have asked why I did not address means-testing Medicare premiums, which account for about $34 billion of the revenue raised in the bill. The answer is that Part B (physician) and Part D (prescription drug) premiums have been means tested for years. The “doc fix” does not include a change in principle in this regard. Also, increased means testing has long been proposed by most Republicans and conservatives, so that measure did not constitute a broken promise like the rest of the bill did.

“Doc Fix”: The War of All Against All Begins!

The U.S. Senate passed H.R. 2, the so-called Medicare “doc fix,” 92-8 last night.  By the time you read this, President Obama will likely already have signed it. He’s eager to do so, because it locks in Obamacare’s vision of the relationship between physicians and the state.

This was a seriously flawed bill, as NCPA has discussed exhaustively (here and here). Now, doctors and patients will have to get used to a new reality where the federal government and beltway lobbyists’ priorities are more deeply embedded in physicians’ offices than ever.

Billy Wynne at the Health Affairs blog has a very good, dispassionate response to the bill’s passage. Wynne starts by describing the Merit-Based Incentive Payment System (MIPS):