Tag: "Medicare"

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):

Why Are So Many Working-Age People On Medicare Since Obamacare Started?

Gallup has released the full results of its first quarter survey of health insurance. It concludes that the proportion of uninsured Americans has collapsed to the lowest level ever – 11.9 percent.

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The early release of the estimate had predicted 12.3 percent, and it got a little better as the dust has settled on the second open season.

Who’s To Blame For Doctors’ Cash Flow Crisis?

Doctors never cease from complaining about insurers’ bureaucracy. It’s one reason why they cannot stand the repeated Medicare “doc fixes” that have occurred at least once a year for over a decade: When Congress does not increase the physician fee schedule before the previous fix runs out, they fear that Medicare contractors will slow roll their claims, creating a big cash flow problem.

(That’s one reason why the lobbyists supporting today’s fiscally irresponsible “doc fix” waited until March 19 to let us know it was coming to the House of Representatives. Last year’s fix expired on March 31. Delaying until the last minute means the lobbyists can more easily drive politicians into a panicked herd and head them off a fiscal cliff.)

The cash flows can be observed by patients, who receive physicians’ invoices and insurers’ Explanation of Benefits (EOBs). One reader went to the doctor on July 31, 2014. As shown in the graphic below, the health plan processed the claim on August 25 and mailed it to the beneficiary on August 29.

More Criticism of the Medicare “Doc Fix”

From Paul Winfree of the Heritage Foundation:

Rather than a permanent replacement to the Sustainable Growth Rate, it is much more likely that the House doc fix will be shorter term patch requiring another series of patchwork legislation just nine years from now.

From David Hogberg of the National Center for Public Policy Research:

When the Senate returns from recess this week, it will consider the “Medicare Access and CHIP Reauthorization Act” (MACR). The bill has acquired many names such as “The Doc Fix Fix” and “Budget Buster,” but a more appropriate one is “IPAB-lite.”

IPAB — the Independent Payment Advisory Board — was created as part of Obamacare to cut Medicare expenditures whenever those expenditures grew too quickly. Thankfully, IPAB’s unpopularity has thus far prevented it from getting off the ground. Unfortunately, the changes MACR makes to Medicare’s payment system seem very much along the lines of what IPAB would do.

(Readers may be forgiven for wondering when I will let go of this so-called Medicare “doc fix”. We expect a vote in the U.S. Senate tonight – but do not guarantee it!)

Chief Actuary Blows Away Make-Believe Medicare “Doc Fix”

A similar version of this Health Alert appeared at Forbes.

On March 25, the U.S. House of Representatives voted for a fiscally irresponsible so–called Medicare “doc fix” that will add $141 billion to the deficit over the next ten years, according to the Congressional Budget Office (CBO). The U.S. Senate will likely vote on the bill later today, and the same lobbyists who dragged Obamacare into the end zone in 2010 are hoping for another win. This one will be even better, because it will be bipartisan.

Nobody denies the way Medicare pays doctors today is flawed. Every year, Congress has to increase the scheduled amount of money because if it did not, fees would drop by about one fifth. Many doctors would stop seeing Medicare beneficiaries.

There are two major differences between this so-called “fix” and previous ones. The first one is real: Previous increases have been offset by cuts to other government spending, and this one is not. The second one is fiction: That this doc fix is a permanent solution to the fee problem.

That fiction was debunked last week in a report published by Medicare’s Chief Actuary.

Federal Rules Create Big Obstacles for Health Information Technology Entrepreneurs

electronic-medical-recordThis blog has long noted the painful consequences of the federal government’s intervention in health information technology (HIT).  Last February, NCPA published an Issue Brief recommending that the federal government’s ambitions in HIT be rolled back. The major problem is the government’s undue influence in Electronic Health Records (EHRs).

Last month, the Administration published the regulations for stage 3 of the Meaningful Use incentives, which both pay and fine doctors for their use of EHRs in accordance with the rules. Margalit Gur-Arie describes the new rules:

Meaningful use stage 3 is adding a host of structured and codified data elements that you will need to collect and record. To that end, you should consider updating your policies as follows:

  • Require each patient to provide an updated resume at least once a year, because you need to continuously collect and update work history, including positions held, and financial information.
  • In collaboration with your attorney, create a crosswalk based on State laws and meaningful use regulations regarding what you must ask or are barred from asking your patients. For example, in some states you are not allowed to ask about guns in the domicile, and for meaningful use you must inquire how often your patient goes to church, and whether he or she is a homosexual (regardless of your specialty). It’s a fine balance, and you don’t want to break any laws.

From Left and Right; Opposition to Flawed Medicare “Doc Fix”

The U.S. Senate will have to deal with the flawed so-called Medicare “doc fix” Wednesday at the latest, if doctors are not to suffer a significant drop in their payments from Medicare.

Voices from both right and left have discovered serious problems with the bill, and proposing solutions. Here are three examples: