PPACA

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“Do Medicare patients have longer waits to see doctors than those with commercial insurance?”

May 5, 2011 in Medicare, Physician Compensation, Supply of Medical Services, Wait Times | 1 comment

…and three other questions about physician care.

Do Medicare patients have shorter waiting times than those with commercial insurance?

  • In the 2010 survey, among those seeking an appointment, most beneficiaries (75 percent) and most privately insured individuals (72 percent) reported “never” having to wait longer than they wanted for an appointment for routine care.
  • Another 17 percent of Medicare beneficiaries and 21 percent of privately insured individuals reported that they “sometimes” had to wait longer than they wanted for a routine appointment.Finding a primary care physician was more difficult for privately insured individuals than for Medicare beneficiaries.  Seventy nine percent of Medicare beneficiaries reported that they had no problem finding a PCP compared to 69 percent of privately insured individuals.

Is Medicare the new Medicaid?

The answer is not yet; providers are still accepting Medicare patients at high rates, but the trend is towards fewer PCPs accepting Medicare.

  • “For 2008, among physicians with at least 10 percent of their practice revenue coming from Medicare, 90 percent accepted new Medicare patients. By specialty, 83 percent of primary care physicians and about 95 percent of physicians in all other specialties accepted new Medicare patients. The rate of primary care physicians accepting new Medicare patients fell from 88 percent in 2007.”
  • Medicare’s payment for physician fee-schedule services in 2009 averaged 80 percent of commercial rates for preferred provider organizations (PPOs)

Is concierge medicine the wave of the future?

Not yet.  In the fall of 2009, researchers found that there were 750 retainer-based or “concierge” physicians.  Thus number represents less than 1 percent of the total number of physicians practicing in the United States.  However, there is a trend towards more concierge medicine.  There was a 50% annual increase in the number of retainer-based practices from 2005 to 2009.

Where types of physician care is growing the fastest (and slowest)?

  • Volume per beneficiary grew 3.3 percent in 2009.
  • However, there was a decrease in 2009 of coronary artery bypass grafts (CABG), cardiovascular stress tests, colonoscopy, standard chest imaging, hip fracture repair, brain MRIs, and coronary angioplasty.
  • Increases in service volume per beneficiary were found in advanced, non-standard computed tomography (CT) scans, outpatient rehabiliation, and spine surgery.

What recent legislation will affect the provision of physician services in the coming years?

  • Since 1991, physicians and other health professionals who practice in designated health professional shortage areas (HPSAs) automatically receive a 10 percent bonus (relative to the fee schedule amount) on all Medicare services they provide.
  • Starting in 2010, CMS no longer recognizes the billing codes for consultation services
  • Starting in 2010, CMS started a four-year transition to practice expense relative values that incorporate data from the Physician Practice Information Survey.
  • Starting in 2011 and ending in 2016, primary care practitioners will receive a 10 percent increase in payments for selected Medicare services, as will general surgeons practicing in HPSAs
  • Under the Physician Quality Reporting System (PQRS), physicians and other health professionals may qualify for a 1 percent bonus on all Medicare services they provide in 2011 and a 0.5 percent bonus in 2012 through 2014.
  • Starting in 2015, those who do not satisfactorily report PQRS measures will be subject to a financial penalty starting at 1.5 percent of their Medicare services.
  • EHR incentive programs provides physicians with incentive payments for meaningful use of electronic health records (EHR).
  • Starting in 2015, eligible physicians who do not satisfy the EHR criteria will be subject to a financial penalty starting at 1 percent of their Medicare services.
  • Reimbursement changes from Health Reform (PPACA) can be found here.

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Detailing the Provisions of the Health Reform Law

August 29, 2010 in Health Reform | 1 comment

Stephen Zuckerman has a nice summary of the key provisions in the Health Reform law (i.e., PPACA).  There are six broad changes: i) the creation of health insurance exchanges, ii) an excise tax on high-cost health plans, iii) creating the Independent Payment Advisory Board (IPAB), iv) Medicare policy changes v) additional emphasis on prevention and wellness, and vi) increased efforts to reduce waste fraud and abuse.  The following sections will discuss each of these changes in more detail.

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How with health reform affect small, medium and large size businesses

August 24, 2010 in Health Insurance, Health Reform | 3 comments

How will health reform affect small, medium and large size businesses?  Linda Blumberg answers this question in this RWJ policy brief.  Blumberg summarizes the legislation as follows:

“Small employers, those with fewer than 50 workers, will face no new requirements but will have new insurance options made available to them through the new health insurance exchanges. These new options have the potential to save money for small businesses that wish to offer insurance to employees.

Medium-size employers, those with 50 to 100 workers, will have access to these new coverage options as well, but may face some financial penalties if their modest income, full-time workers obtain federal subsidies due to a lack of affordable coverage available through the workplace. New coverage sold to small and medium-size groups will be subject to regulations that will make insurance more affordable to groups with higher than average health care needs. Healthier groups will share in these costs more than they do today.

The vast majority of large employers (more than 100 workers)…are the least likely to be significantly affected by health care reform. However, they may experience greater employee participation in their current insurance plans and will face penalties if their full-time workers obtain subsidized coverage through the exchanges.”

This spreadsheet summarizes how key provisions will affect each of these three types of businesses.

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Explaining how Health Reform will alter Medicaid and CHIP

June 7, 2010 in CHIP, Medicaid, Public Policy | 1 comment

Health Reform, also known as the Patient Protection and Affordable Care Act (PPACA), drastically altered the health care landscape.  Congress included health exchanges, and individual mandate, and a number of other reforms into the bill.  Today, I focus on how Health Reform will affect existing programs which care for the nations poor.  In particular, CHIP funds medical care for many of the nation’s youth and Medicaid provides health insurance coverage to low-income Americans.  Both programs operate under a federal mandate, but are run at the state level.  The Kaiser Family Foundation outlines the Health Reform provisions that will alter both the Medicaid and CHIP programs.

To summarize these findings, I have created the following table.

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