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2013 Republican Response: A Healthcare Review

2013 Republican Response: A Healthcare Review:
Earlier this week, I posted on the President’s State of the Union address.  Now its time to discuss the Republican Response.
The main critic offered by Senator Marco Rubio is how Obamacare is increasing health care costs, shifting these costs to employers, and slowing down employment growth and the growth of employer-provided insurance.
And because many government programs that claim to help the middle class, often end up hurting them instead.  For example, Obamacare was supposed to help middle class Americans afford health insurance. But now, some people are losing the health insurance they were happy with. And because Obamacare created expensive requirements for companies with more than 50 employees, now many of these businesses aren’t hiring. Not only that; they’re being forced to lay people off and switch from full-time employees to part-time workers.
Rubio claims that he supports Medicare with one hand but his support is based on cutting benefits.  This is justified based on the (not at all unreasonable) logic that for Medicare to continue, it must do so in a more fiscally responsible form.
The biggest obstacles to balancing the budget are programs where spending is already locked in. One of these programs, Medicare, is especially important to me. It provided my father the care he needed to battle cancer and ultimately die with dignity. And it pays for the care my mother receives now.
I would never support any changes to Medicare that would hurt seniors like my mother. But anyone who is in favor of leaving Medicare exactly the way it is right now, is in favor of bankrupting it.
Republicans have offered a detailed and credible plan that helps save Medicare without hurting today’s retirees. Instead of playing politics with Medicare, when is the President going to offer his plan to save it? Tonight would have been a good time for him to do it.
Senator Rubio is likely referring to Paul Ryan’s plan to make Medicare a voucher system starting with individuals 55 and over.
Senator Rand Paul also delivered a Republican Response. Although he did not target healthcare directly, he did call for significant across the board spending cuts, including the sequester. His Penny Plan would slash government spending by 1 percent over the next 6 to 7 years to balance the budget. Sen. Paul does descirbe the effect of government spending on elderly savings (implicitly through added inflation).
Contrary to what the President claims, big government and debt are not a friend to the poor and the elderly. Big-government debt keeps the poor poor and saps the savings of the elderly. This massive expansion of the debt destroys savings and steals the value of your wages.

"Changing the Climate of Healthcare"

Free-Market Healthcare? Nursing Home Payment and Financing

Free-Market Healthcare? Nursing Home Payment and Financing:
Although many people believe that the U.S. healthcare system is a free-market, that is far from the case.  Consider nursing homes.  Two-thirds of patient spending on nursing home care comes from public sources.

Not only do public funds pay for the variable cost of running nursing homes, but the federal government also provides low-interest loans to nursing homes. MedPAC reports:
Lending by the Department of Housing and Urban Development (HUD) continues to be an important source of funds [for nursing homes]. Since 2008, HUD’s lending dramatically increased as a result of an overhaul of its federally insured mortgage program for nursing homes under Section 232/222. Between 2010 and 2011, the number of HUD financed projects increased 14 percent (to 421 projects), with insured amounts totaling $3.4 billion in 2011…HUD is expected to maintain the same level of activity for 2012, but projects may be smaller.
Public financing is not a problem if the government is receiving a good value for its money. It appears, however, that skilled nursing facilities are making money hand over fist.
In 2010, the aggregate Medicare margin for freestanding SNFs was 18.5 percent, the 10th consecutive year with average margins above 10 percent. Since 2006, Medicare payments per day have increased faster than costs per day, resulting in growing SNF margins. From 2009 to 2010, aggregate Medicare payments per day grew 4.2 percent, while Medicare costs per day grew 3.6 percent…There has been a large decline in the number of SNFs with negative Medicare margins and the size of their losses.
Another reason it appears that CMS is overpaying for services is that Medicare’s FFS program pays a 34 percent higher price to skilled nursing facilities than do private insurers through Medicare Advantage. Although MA beneficiaries needing SNF services are likely healthier than FFS needed similar services, it is unlikely that patient case mix justifies this differential.
Nursing homes have generally been losing money on Medicaid patients.  The aggregate non-Medicare margin was -1.2 percent in 2010.

"Changing the Climate of Healthcare"

The Effect of Medicaid P4P on Nursing Home Quality

The Effect of Medicaid P4P on Nursing Home Quality:
Over 10 million Americans need long-term services and supports to assist them in life’s daily activities.  Of these, 1.6 million reside in a nursing home. Nursing home care, however, is expensive ($74,800 per year) and and quality is highly variable.
To improve the quality of care, many states have begun adopting pay-for-performance (P4P) programs for nursing homes.
Between 2002 and 2009, eight states adopted Medicaid-sponsored P4P programs in nursing homes all of which primarily targeted quality of care for long-stay (or chronic care) residents…programs have been previously described (Werner et al. 2010). Briefly, most states use a payment model based on a point system that is translated into per diem add-ons. For each measure included in the payment model, each nursing home is evaluated and earns points based on either its ranking compared with other nursing homes in the state or, in one state, whether it has achieved a target level of performance. The earned points are summed across all measures and translated into a per diem add-on for all Medicaid resident days, where nursing homes with more points receive higher add-ons. The total possible bonus amount varied across states from an add-on valued at about half a percent of the per diem rate to over 5 percent with bonuses in most states ranging

between 3 and 4 percent of the per diem rates.
Consumer response to publicly-reported nursing home quality measures on Nursing Home Compare, however, has been limited.
Are nursing homes themselves responding to the state P4P initiatives? A paper by Werner, Konetzka, and Polsy examines this question. Because the different states implemented the P4P programs at different times, the authors are able to use a difference-in-differences approach to examine how the P4P programs affected quality.


The authors find the following:
Quality improvement under P4P was inconsistent. While three clinical quality measures (the percent of residents being physically restrained, in moderate to severe pain, and developed pressure sores) improved with the implementation of P4P in states with P4P compared with states without P4P, other targeted quality measures either did not change or worsened. Of the two structural measures of quality that were tied to payment (total number of deficiencies and nurse staffing) deficiency rates worsened slightly under P4P while staffing levels did not change.
The authors caution that hopes for P4P to produce dramatic improvement in nursing home quality should be tempered.

Methodological Details

The authors limit the analysis to long-stay residents, defining a long-stay resident as those with at least one quarterly or annual assessment in addition to an admission (or prior quarterly/annual) assessment. This approach ensures that the resident has been in the nursing home for at least 90 days. Other methodological details are described as follows:
To avoid overweighting sicker residents who may have more frequent assessments, we limit each resident to only one assessment per quarter in our final dataset. Following conventions set out by the CMS for measuring nursing home quality (Nursing Home Quality Initiative 2004), if a resident has more than one assessment per quarter, we choose the most recent assessment in that quarter. Finally, also following CMS conventions, we do not include admission assessments, as patient outcomes on admission cannot be attributed to the admitting nursing home’s quality of care.
To risk adjust, the authors use we the same resident-level characteristics defined by CMS technical specifications for each quality measure (Morris et al. 2003; Nursing Home Quality Initiative 2004). In addition, they authors also include age, gender, and race as additional covariates.

"Changing the Climate of Healthcare"


Government cannot fix healthcare

This article by Mike Hassinger helps to highlight the unbashed ignorance of this administrations inability to appropriately address access to healthcare. Their lack of understanding in staggering and their quickness to mandate through powerplay without due consideration of the unintended consequences again highlights how the personal grab for political power is at the heart of these so called reforms.
The only hope is that states and other private for profit and non-profits work together to create cross lines co-ops that are market driven and use technology, performance based pay models that are really new healthcare models. Do we really believe that government with all it's success with Medicare can reform. To that they would have to start with themselves and I don't see that happening anytime soon.

Medicaid Math and Naked Numbers

July 11, 2011 10:06 am

by Mike Hassinger · 10 comments

Can someone help a liberal arts major out? My math skills are not the best. I can’t count to 21 unless I’m naked, so please, feel free to check these numbers. You can even use decimal points if you’d like. The AJC reports this morning that “In fiscal year 2011, [Georgia] paid roughly $1.7 billion for Medicaid and PeachCare…” and in the same article, “Medicaid and PeachCare for Kids currently provide health care to roughly 1.7 million low-income Georgians.

So, $1.7 billion divided 1.7 million people is what, $1,000 per low-income person, right? And the feds kick in about $5 billion more, which is, umm, $2,900 or so for each low-income person, right? Let’s call it $4,000 per poor person. (When counting naked, you should always round up.)

Now let’s add 600,000 more poor people when Obamacare expands Medicaid eligibility to people under 65 who earn $30,000 per year. (That’s about 133% of the poverty level for a family of four.)

“…officials say the 600,000-plus people expected to join [Medicaid] under the federal health care overhaul starting in 2014 could cost the state an additional $2.1 billion by the end of this decade.”

So these 600,000 soon-to-be-eligible low-income people will cost Georgia taxpayers 3.5 times as much as the currently eligible 1.7 million low-income people are costing Georgia taxpayers now? Let me put my shoes back on.

Medicaid is currently $180 million short, and as State Sen. Renee Unterman notes: “We can’t afford who we have on Medicaid right now.

Even a non-math major can see that the cost curve is being bent in the wrong direction. I thought the intent of Obamacare was to make quality healthcare affordable and accessible for everyone. That noble goal brings to mind the sign in auto repair shop that read: “Our service- Good. Fast. Cheap. Pick any two.” That’s the reality with healthcare. You can give it to everyone, or make it the best in the world, or make it cheaper. Pick one.

"Changing the Climate of Healthcare"


Welcome! I can help you navigate through the mass of health care information and make an informed choice by providing sound information in the full context. I look forward to hearing from you.