Credit Robert Neubecker for The New York Times
by Ron Lieber
“At any given moment, there is a large group of citizens who want nothing more than to make absolutely certain that they are impoverished enough to qualify for Medicaid sooner rather than later. Someday, you might be one of them.
“Welcome to the (perfectly legal) world of Medicaid planning, the plain-vanilla term for the mini-industry of lawyers and others who help people arrange their financial lives so they don’t spend every last dime on a nursing home. Once properly impoverished under the law, then Medicaid, which gets funding both from your state and the federal government, picks up the tab.
“Whatever twists and turns the health insurance debates in Washington take, Medicaid will be at the center, and the program will probably affect you and your family more than you know. After all, if you run out of money in retirement, it is Medicaid that pays for most of your nursing home or home-based care.”
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How would changes to the health care system affect Pennsylvania, and what does our state’s current health care landscape look like?
Acting Department of Human Services Secretary Teresa Miller was called upon to provide that expertise in a hearing before the U.S. Senate Committee on Finance during consideration of the Graham-Cassidy-Heller-Johnson Proposal. (It was later announced that there would not be a vote
on that proposal.)
Here are state-specific health care statistics from Miller’s testimony:
- Before the Affordable Care Act, 10 percent of Pennsylvanians and 16 percent
of Americans nationwide went uninsured.
- Since the ACA’s passage, the national uninsured rate has fallen to 8.6 percent;
Pennsylvania’s uninsured rate has dropped to 5.6 percent – the lowest it has ever been.
- More than 40% of Pennsylvanians – 5.4 million people – have pre-existing conditions and cannot be denied health insurance coverage due to the ACA.
- Approximately 4.5 million Pennsylvanians no longer have to worry about large bills due to annual or lifetime limits on benefits, and 6.1 million Pennsylvanians benefit from access to free preventive care services.
- Medicaid serves 2.8 million Pennsylvanians, or 22 percent of the commonwealth’s population. This includes:
- 1.2 million children
- Nearly 250,000 seniors
- 565,000 individuals who receive outpatient mental health services
- 215,000 individuals relying on substance use disorder treatment.
- In 2015, Medicaid paid for more than 58,000 births in the commonwealth – nearly
40 percent of Pennsylvania’s total births.
- The Medicaid expansion of the ACA has resulted in the coverage of more than 715,000 newly eligible Pennsylvanians.
From the Centers for Disease Control and Prevention (CDC): “It has been recognized for many years that people 65 years and older are at greater risk of serious complications from the flu compared with young, healthy adults because human immune defenses become weaker with age. While flu seasons can vary in severity, during most seasons, people 65 years and older bear the greatest burden of severe flu disease. In recent years, for example, it’s estimated that between 71 percent and 85 percent of seasonal flu-related deaths have occurred in people 65 years and older and between 54 percent and 70 percent of seasonal flu-related hospitalizations have occurred among people in that age group. So influenza is often quite serious for people 65 and older.”
“How we put a price tag on hospitals | The data science that’s helping us crack the code of hospital cost variation.” – Amino
by Sameera Poduri
“Economists and consumers alike have often observed (and suffered from) extreme cost variation in healthcare, not only based on the service itself and the doctor who performed it, but also determined by the facility where it was performed. Hospitals in particular are known to charge wildly different prices for similar care, and we’ve had little insight into why or how.
“Our first step toward uncovering healthcare costs led us to physician level cost estimates for more than 100 procedures, searchable by the doctor one might choose to perform that procedure. Such granularity can help people stay in network, calculate their out-of-pocket costs ahead of time, and budget for a procedure.
“Today, we’re excited to announce that we’ve put a dollar sign on 45,000 facility-insurer combinations across the country—including hospitals, imaging centers, and urgent care centers—so that people can not only understand the total cost of a procedure, but also know where it might be cheaper (and of the same or better quality) nearby.”
Click here to read this article at amino.com in its entirety.
“‘Every time it’s a battle’: In excruciating pain, sickle cell patients are shunted aside” – STATNews
by Sharon Begley
“Amy Mason had toughed it out for hours one day this past July, trying warm soaks and heating pads and deep breathing to soothe pain that felt like her bones were being sawed with a rusty blade.
“She knew this was a life-threatening emergency of sickle cell disease, in which her misshapen red blood cells were getting stuck in her blood vessels like tree limbs in a storm sewer. But she delayed going to the emergency room; previous visits hadn’t gone well.
“Just before midnight, Mason, 34, finally had her boyfriend drive her to a Mobile, Ala., hospital. She told the triage nurse that she was having one of the worst sickle cell crises of her life and that she was off the far end of the 1-to-10 pain scale. She was told to wait.
“As the hours passed, Mason begged her boyfriend to take her to another hospital, then passed out from the pain. She awoke, she told STAT, to her boyfriend’s shaking her and pleading with her to stay with him. I can’t do this anymore, Mason whispered.”
Read this article in its entirety at STATNews.com.
“Shedding New Light On Hospice Care: No Need To Wait For The ‘Brink Of Death’” – CaliforniaHealtline
“A few weeks ago, Kathy Brandt’s 86-year-old mother was hospitalized in Florida after a fall. After rushing to her side, Brandt asked for a consult with a palliative care nurse.
“‘I wanted someone to make sure my mother was on the right medications,’ Brandt said.
“For all her expertise — Brandt advises end-of-life organizations across the country — she was taken aback when the nurse suggested hospice care for her mother, who has advanced chronic obstructive pulmonary disease, kidney disease and a rapid, irregular heartbeat.
“‘I was like — really?’ Brandt remembered saying, struggling with shock.
“It’s a common reaction.”
“Medicare has been experimenting with new payment models to bring down health care costs, improve health care quality and promote healthy communities. One payment model launched in 2013 is a ‘shared-saving program’ that involves ‘Accountable Care Organizations.’ What are Accountable Care Organizations (ACOs)?
“ACOs are groups of doctors and/or hospitals, home health agencies and nursing homes that have contracted with the Centers for Medicare and Medicaid Services (CMS) to coordinate patient care in ways that reduce health care spending and promote quality. If they succeed at lowering costs, they increase their revenues; they share in the savings. ACOs respond to the belief that hospitals and doctors need better incentives to keep patients healthy, improve care quality and reduce costs.
“People enrolled in traditional Medicare can also be enrolled in ACOs. According to the HHS Office of the Inspector General (OIG), those enrolled in an ACO tend to be older and have more health risk factors than the typical person with Medicare.”
Photo: David Plunkert
by Paula Spahn
“In April, Nancy Niemi entered Vidant Medical Center in Greenville, N.C., with cardiac problems. She stayed four nights, at one point receiving a coronary stent.
“Then she went home, but felt faint and took several falls. Five days later, her primary care doctor sent her back to the hospital. This time, her stay lasted 39 days while physicians tried various medications to regulate her blood pressure.
“Though they eventually succeeded, Mrs. Niemi, 84, a retired insurance agent, had grown so weak that she could no longer walk.
“They said, ‘She really needs to go to a skilled nursing facility for physical therapy,’ recalled her son Tom Krpata, 63, who’d come from his home in Holliston, Mass., to be with her.
“He agreed, but soon learned one of the brutal truths of Medicare policy:”
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