Act now to maintain access to your doctor if Medicare payment rates go down

For some time now, people covered by Medicare have been having an increasingly difficult time finding primary care physicians who will accept them into their practice. This has been a problem due to the fact that low Medicare rates of payment make it very difficult for primary care doctors to be financially successful. Now, there is a danger that this access problem might become a full fledged crisis around the nation.

On December 1, 2010  Medicare rates for physicians are scheduled to decrease by more than 23%, and then, on January 1, 2011, rates are scheduled to go down another 7%. This is not because of health care reform, but rather is due to Medicare's sustainable growth rate (SGR) formula, which automatically pays doctors less if the use of medical services paid for goes up, in order to "balance the budget". Congress has avoided fixing this problem, and now, with a likely Republican majority  in one or both houses of the new Congress pledging no new spending, it is very possible that nothing will be done to rectify the situation.

 Is there anything that you or a loved one on Medicare can do to maintain future primary care access if this happens? Fortunately, yes there is! Look into signing up with a Medicare Advantage plan that your doctor accepts which contracts directly with physicians to provide care for Medicare patients. These plans often work in creative ways with physicians to enhance primary care coverage, and save money by screening and treating early to reduce costs. In my medical group, Family Care Network, we contract with four MA plans, and we ask all new patients to sign up with one of those in order to become a patient with us. Open enrollment for choosing a new Medicare Advantage plan begins November 15, 2010. A good approach is to ask your doctor's office what plans they work with, and then visit an independent Medicare insurance agency to review your options and pick the plan that is right for you!

10 big health reform changes yet to come

Yesterday marked a major milestone in our progress to create a high-performing health care system for the United States. Provisions in the Affordable Care Act have now taken effect, such as the requirement for insurance plans to allow young adults to join or stay on their parents' plan until age 26, and a ban on insurance plans' practice of "rescinding" coverage after individuals get sick.

There are additional health care reforms are coming in the next months and years that I am looking forward to. These are designed to improve how our care is organized, delivered, and paid for. Here are 10 big changes yet to come:

1. Health Insurance Exchanges and New Market Rules
Health insurance exchanges will give us the ability to compare and choose among health plans, while setting the rules for fair competition.
2. New Nonprofit Plan Choices
Innovative, nonprofit cooperatives have transformed health care delivery into mission-driven, patient-centered, and value-enhancing systems that are accountable to patients and consumers.
3. Health Plans will be required to meet minimum medical loss ratios and requests for Insurance Premium Increases will be reviewed.

4. New changes to encourage primary Care and disease prevention
These include increased primary care payment rates under Medicare and Medicaid, preventive services without patient cost-sharing, and support of community and employer prevention and wellness programs. The act also increases funding for community health centers and the National Health Service Corps. These provisions start to focus our health system on primary care, encourages doctors o enter primary care specialties and get us ready for more fundamental payment reforms.
5. Stimulate Innovation
The Accountable Care Act establishes a Center for Medicare and Medicaid Innovation, which will allow us to test innovative payment methods for the personal medical home. Medicare reimbursement rates are decreased by 1 percent for hospitals that have high rates of readmission for certain conditions. Individual states will be allowed to test integrating Medicare and Medicaid-covered health services provided to the poor on Medicare.
6. Accountable Care Organizations
These are collections of health care providers that can formally assume responsibility for the cost and quality of health care given to a defined group of patients. Research has shown that ACOs have the potential to reduce growth in health care costs and improve patient outcomes by introducing incentives for efficient use of resources and encouraging greater coordination of care.
7. Independent Payment Advisory Board
This board has authority to identify areas of waste and opportunities for improving the quality of care for Medicare beneficiaries. The board’s recommendations will take effect in years when Medicare costs are projected to exceed predetermined rate-of-increase targets—unless Congress passes legislation to override those recommendations, in which case Congress would be responsible for achieving the same level of savings.
8. Quality Improvement and Public Reporting
The law requires public reporting of physician quality and patient experience through a "Physician Compare" Web site for Medicare beneficiaries. It also makes Medicare data available for pooling with data on provider performance from other payers—an important step toward creation of an all-payer provider performance database. (Privacy will be protected.) Reports by health plan will be available to the public.
9. Medicare Private Plan Competition
Plans must compete on value, quality and service, and will no longer receive extra funds.
10. A Tax on High-Premium Health Insurance Plans
The new law imposes a 40 percent excise tax on health plans with premiums in excess of $10,200 for individual policies and $27,500 for families, to take effect in 2018. This will be adjusted in case of unexpected increases in medical costs prior to 2018.

A Great Opportunity to Discuss Progress in Health Care

The origin of tour word for doctor comes from the Latin word doceō, which means "I teach". We have recently been living through an explosion in medical knowledge, and for this reason, the doctors of the Whatcom County Medical Society are proud to present an event every fall that seeks to communicate with our patients around these developments. The Mini-Medical School is presented by Medical Society members on current topics of interest or controversy in medicine.  Beyond physicians sharing information, these presentations offer an opportunity to talk with physicians about how they think about health and disease, how they analyze problems and how they apply science in their work. I hope that we have a great turnout. Here is this years schedule!

Wednesday, September 8 “Food Sensitivity: allergies, intolerances and strong convictions”

Dr. Kevin Dooms, Bellingham Asthma, Allergy and Immunology

Wednesday, September 15 “Health Care Reform: what’s in it for me?”

Dr. David Lynch, Family Care Network

Wednesday, September 22 “Whatcom CSI: fact and fiction of death investigation

Dr. Gary Goldfogel, Whatcom County Medical Examiner

Wednesday, September 29 “The Evidence is Clear: surgery is the most effective treatment for obesity and diabetes”

Dr. Walter Medlin, PeaceHealth Medical Group

Wednesday, October 6 “Cancer: the art and science of diagnosis and treatment”

Drs. Ian Thompson and William Hall, Northwest Radiation Oncology Associates

Wednesday, October 13 “Vaccine-preventable diseases and vaccines: how safe and how effective?”

Dr. Greg Stern, Whatcom County Health Department

All lectures are free to the public and will be held 7:00—8:30 p.m. at St. Luke’s Health Education Center, 3333 Squalicum Parkway, Bellingham, WA

Information: call (360) 676-7630 or email: wcms@hinet.org

The right man for the job has Bellingham and Whatcom County connections

The White House has announced that President Obama will bypass the nomination process of the United States Senate in order to make a recess appointment of Dr. Donald Berwick to be the head of the Centers for Medicare & Medicaid Services (CMS). This is due to the fact that the White House has been unable to even get a hearing scheduled by the Senate, much less go through the process.

I believe that this nomination is of great importance, and it signals that the administration is serious about moving forward on creative and needed health care reform. Dr. Berwick has been universally praised by a wide spectrum of health care leaders as the best man for this job. President Obama has chosen a strong advocate for a patient-centered health-care system to be in charge of much of health-care reform. This is a very good thing!

There are three aspects of health-care reform that must be considered simultaneously if we are to achieve real reform - cost, access and quality. Cost and access have both proven to be politically polarized topics. Quality, however, should be what unites us all, and that is the experience that Dr. Berwick brings to the table. Dr. Berwick has done more than anyone champion quality and his organization, the Institute for Healthcare Improvement (IHI), is famous among physicians for catalyzing health-care providers around how to improve their care and decrease error. This should not be an ideological issue. Unfortunately, the radical right has already pounced on this announcement, and referred to Berwick as a "radical". This is a tragedy. If Dr. Berwick is a radical, it is because he favors that health care reform must revolve around thechoices, preferences and desires of patients, and not insurance companies. That truly would be a radical change from what we have today. He elevates the needs of patients above insurance companies, government or medical providers.

It has been my privilege to work with Dr. Berwick right here in Bellingham and Whatcom County. The Pursuing Perfection project began in 2001, when Family Care Network and St. Joseph Hospital worked with other community partners to reorganize their work around the patients that we serve. We were one of13 locations in the US and Europe to focus on fundamental improvement in patient care throughout the health care system, and Dr. Berwick traveled to meet with us as a part of the involvement of IHI. He is the real deal.

If a man like Dr. Don Berwick cannot find a smooth confirmation because of political polarization, then no leaders can. That means that the best people will continue to ignore the call of public service, since an unimpeachable record of achievement will be less important than political ideology. What a shame. No, what a tragedy.

A Creative and Welcome Development

The State of Washington has just announced the creation of the Washington Health Program, which is a non-subsidized version of the Basic Health Program (BHP). Like the Basic Health Program, the new offering is administered by the Washington State Health Care Authority (HCA).

This is a creative and welcome development! Washington residents currently have few, if any, affordable options for health care coverage. Right now, there are more than 100,000 people on the BHP waiting list, who cannot enroll due to a lack of funding by the state. The Washington Health plan will provide folks with a more affordable option designed for basic, no frills medical care coverage. The new program provides essentially the same benefits as the BHP, but with no subsidy and no cost to the state. Enrollees pay the entire premium, plus a small amount for administrative costs.

The HCA is contracting with Community Health Plan (CHP) of Washington to provide the coverage. The plan lowers the purchase cost by including a cap on annual costs. Enrollees having the option of choosing a $75,000 or $100,000 expense cap in health care coverage per year. According to past experience, less than 2% of BHP enrollees accumulated $75,000 or more total cost in 2009.

Some details from the HCA:
· Premiums are to be as low as $100 per month.
· A 35 year-old could expect to pay between $125 and $183 depending on their location and the coverage options they select.
· Washington Health is available to any state resident who is not enrolled in the BHP, Medicaid, or eligible for Medicare.
· It is designed for low income people, but there are no income limitations. It is available statewide.
· Community Health Plan (CHP) is contracted mainly with federally qualified community clinics, and there are few private primary care physician in their network.
· Coverage is expected to begin July 1 and applications are being taken now through the Washington Health website at www.washingtonhealth.hca.wa.gov. Applications can also be requested toll-free at 1-800-660-9840.

The Dawn of a New Day - 5 BIG wins in the Health Care reform Act

1. Health insurance companies will not be able to discriminate against you because you have a pre-existing condition.

The problem has been that millions of adults and children have been denied insurance specifically because they have a medical condition. The Kaiser Family Foundation says that 21 percent of people who apply for health insurance on their own get turned down, or charged a higher price or offered a plan that does not cover their pre-existing condition. This will stop!

2. Young adults will be able to keep their parents' insurance until age 26.

The health care reform legislation requires insurance companies to allow dependent children to stay on their parents' insurance policies until age 26. The children can't have jobs that offer insurance, and they must be claimed as dependents on their parents' taxes.

Currently dependents get booted off Mom and Dad's health insurance much earlier than this, depending on the state they live in, sometimes as early as age 19. This will stop!

3. You will be eligible for a subsidy to buy insurance if you make less than $88,000 per year for a family of four.

Starting in 2014, the health care reform bill provides subsidies for people who don't get insurance from their employers and therefore have to buy it on their own. The amount of the subsidy will computed based on your income, whether you're single or have a family, your age, and where you live. For example:

• A 40-year old making $30,000 a year in a medium-cost area of the country will get an $850 subsidy toward buying a policy, which should cost about $3,500, according to a Kaiser Family Foundation subsidy calculator.

• A 40-year-old in the same city who has a family of four and is making $60,000 will get a $4,220 subsidy toward a policy that costs $9,435.

You can estimate your own subsidy by using this Kaiser subsidy calculator.

4. If your employer does not offer insurance, that might change!

Starting in 2014, if your company employs more than 50 people, it will be required to offer you a health plan that covers at least 60 percent of your overall health costs, or the company will be fined $750 per year per full-time worker. That fine could increase to $2,000 if the reconciliation act passes.

5. Health care reform has major benefits for senior citizens!

The AARP reports that health care legislation does important things for seniors:

• It gives people on Medicare new access to free preventive services such as screenings for cancer and diabetes.
  
• It will decrease and then, by 2020 it will close the "doughnut hole," Part-D drug payment gap where Medicare stops paying once a senior has spent more than $2,830 on prescription drugs and resumes when the individual's out-of-pocket spending has reached about $4,550.
• Spending for Medicare beneficiaries is budgeted to increase 2 percent each year.

Surprise! People favor passage of health reform

A telephone survey of 1,005 adults was conducted by the Gallup organization on March 22, the day after Congress enacted health reform legislation. The margin error is 4 percentage points. The results show that "More Americans call Congress' passage of a healthcare reform bill "a good thing" (49%) than call it "a bad thing" (40%). Reaction is predictably partisan, with independents evenly divided.

In my opinion, when folks really get to understand how this bill will interrupt our endless cycle of cost increase and non coverage, that support will continue to increase!

Gallup concludes, "Passage of healthcare reform was a clear political victory for President Obama and his allies in Congress. While it also pleases most of his Democratic base nationwide, it is met with greater ambivalence among independents and with considerable antipathy among Republicans. Whether these groups' views on the issue harden or soften in the coming months could be crucial to how healthcare reform factors into this year's midterm elections. Given that initial public reaction to Sunday's vote is more positive than recent public opinion about passing a healthcare reform bill, it appears some softening has already occurred."

On the first day that health reform becomes law

The United States House of Representatives is poised to take an historic vote today on whether or not to implement health care reform. You will often hear opponents say that the bill does "not take effect" until 2014, but actually, there are many improvements that will occur right away. This is a good time to reflect on what this vote could mean for all of us.

On the first day that health reform becomes law:

· Annual caps on coverage will be eliminated
· Rescisions - the practice of dumping people even if they have paid their premiums – will be eliminated
· Pre-existing conditions for children will be eliminated, followed later by the elimination of all pre-existing conditions
· Parents will be allowed to have their children on their health insurance policy until age 26
· The "Donut Hole" Medicare Part D drug coverage gap will be decreased with a $250 rebate

In short, in addition to expanding coverage, reducing the deficit and helping to decrease costs, there is a lot other immediate benefits to like in this new bill. We need to encourage our representatives not to blink, and to take this momentous step for all of our citizens.

Guess which country in the graph below has the worst health care statistics

You will often here the opponents of health care reform say that costs are increasing all over the world, and not just here at home. As the graph above makes clear, the costs of US health care are rising much faster than anywhere on the planet. In 2009, health insurance companies made their largest profits in history, and still dealt out staggering premium increases. And after all of this. some people are still scared of some government regulation? We are a nation of suckers!

We can do this

The US Center for Medicare and Medicaid Services has just reported that U.S. health spending reached $2.5 trillion in 2009, and that health care's share of the economy grew 1.1 percentage points to 17.3 percent. This is the largest one-year increase in health care spending since the federal government began keeping track in 1960. Where I work, our insurance asked for a 35% rate increase to maintain our employee coverage for one more year. The same thing happened to my wife's family business this year. This experience has been repeated all over the country.

These findings underscore the fact that we are all experiencing an unprecedented "Tax" on the cost of our health care, except instead of coming from the government, it is being imposed by the insurance industry, who simply pass along their cost of paying for our dysfunctional system, while they also charge us for lobbying our Congressional representatives to stop needed reform. This is sick.

It is time to become outraged! The need for comprehensive health care reform to rein in unsustainable spending growth has never been more clear. The increasing burden on American families, businesses, and our state and local governments cannot be sustained.

What can we do now? Is there anything that might attract bipartisan support? Assuming that the minority party is willing to also work on this, I think that implementing a few modest steps now would help tremendously:

• Require that all be covered, with subsidy for the poor, and real penalties for those who opt out.
• Eliminate pre-existing conditions and have true community rating.
• Establish an online health plan marketplace in each state where plans can compete on benefits, service and price. Allow national plans to compete, but do not eliminate local plans.
• Monitor quality results by plan, and publish the results for all to consider when purchasing.
• Allow everyone to have an income tax deduction for their plan costs (not just employer plans) up to a certain annual cost.
• Enact reasonable tort reform legislation that actually directs most of the money to those who are injured.
• Require payment reform for care delivery, that incentivises provision of primary care, and encourages doctors and hospitals to provide the best care (not the most expensive), and are aware of and held accountable for their quality of care results.

We can do this, but only if our law makers work together and stop playing gotcha like middle school students. Actually, I apologize to the middle school students. They would do a better job.