Joseph Rugg's Health Law Blog

In the weeks since the Supreme Court ruled that states could opt out of a plan to vastly expand Medicaid under President Barack Obama’s health care law, several Republican governors have vowed to do just that, attacking the expansion as a budget-busting federal power grab.

But it may not be so easy. A battle is brewing here in Florida, where Gov. Rick Scott took to national television soon after the ruling to announce that he would reject the expansion. Advocates for the poor and some players in the health care industry — especially hospitals — intend to push back.

Hospital associations around the country have already signed off on cuts to reimbursement rates under the health care law on the assumption that the new paying customers they would gain, partly through the Medicaid expansion, would more than cover their losses.

See on www.theledger.com

For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.

Contrary to conventional wisdom that Medicaid patients often use hospital emergency departments (EDs) for routine care, the majority of ED visits by nonelderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems, according to a new national study by the Center for Studying Health System Change (HSC). About 10 percent of nonelderly Medicaid patient ED visits are for nonurgent symptoms, compared with about 7 percent for privately insured nonelderly people. Nonetheless, there are clearly opportunities to develop less-costly care options than emergency departments for both nonelderly Medicaid and privately insured patients.

To reduce ED use, policy makers might consider how to encourage development of care settings that can quickly handle a high volume of potentially urgent medical problems. Policy makers may want to focus initially on conditions that account for high ED volume that could likely be treated in less resource-intensive settings. For example, diagnoses of acute respiratory and other common infections in children and injuries together account for about 53 percent of ED visits by children aged 0 to 12 covered by Medicaid and almost 60 percent of ED visits by privately insured children aged 0 to 12. While some infections and injuries will be too serious to treat elsewhere, lower-cost settings that can provide a moderate intensity of care and urgent response time likely could reduce emergency department use.

See on www.hschange.org

Dr. Hyman asks “how do we stop and turn back the tsunami of chronic disease, in particular, diabesity – the continuum of obesity, pre-diabetes, and diabetes that is the major driver of 21st century suffering and costs?”

He points out that “diabesity is the hidden cause of most heart disease, hypertension, high cholesterol, stroke, dementia, many cancers (breast, colon, prostate, pancreas, liver, and kidney), and even depression. Yet is it almost never treated directly because there is no good drug for it.”

The focus on preventive care is the solution to controlling the rate of increase of healthcare costs.  Like Stephen Covey’s “sharpening the saw” metaphor, preventive care cannot be achieved without making an investment in changing the way healthcare is delivered; the payoff comes later.

See on drhyman.com

For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.

Critics of the new health care law, having lost one battle in the Supreme Court, are mounting a challenge to President Obama’s interpretation of another important provision, under which the federal government will subsidize health insurance for millions of low- and middle-income people.

Starting in 2014, the law requires most Americans to have health insurance. It also offers subsidies to help people pay for insurance bought through markets known as insurance exchanges.

At issue is whether the subsidies will be available in exchanges set up and run by the federal government in states that fail or refuse to establish their own exchanges.

See on www.nytimes.com

For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.

Medicare is trying new tactics to cut costs for complex patients and keep them healthier, although some health-policy observers say they don’t go far enough.

Under the 2010 health overhaul law, the agency is giving health-care providers incentives to band together and coordinate care for groups of patients. If their costs fall by a great enough percentage, the providers get to pocket some of the savings.

Another part of the law will allow Medicare to impose financial penalties on hospitals that readmit high numbers of patients within 30 days of discharge. Readmissions like these often signal a preventable post-hospital complication. Federal officials are working to help hospitals reduce infections and other ailments that patients acquire inside hospitals by 40% over a three-year period under a piece of the law.

“Better quality care with fewer complications is actually less expensive,” says Paul McGann, a deputy chief medical officer at the Centers for Medicare and Medicaid Services innovation center.

Past efforts by Medicare to coordinate care have yielded little, if any, savings. A report by the nonpartisan Congressional Budget Office this year found that Medicare paid 34 programs over a decade to coordinate care or provide disease management. The efforts, on average, had no effect on Medicare expenditures or hospital admissions, the report found.

See on Scoop.it – Changing Healthcare for the Better

There really is no excuse not to be well informed about the most significant legislation and the most important Supreme Court decision in many years.

This policy brief from the Kaiser Family Foundation describes the Supreme Court’s decision on the Affordable Care Act and discusses the implementation of health reform now that questions about the constitutionality of the law have been resolved.

See on www.kff.org