Health Insurance

13.7 Million Young Adults Could Benefit from Healthcare Reform

Modern Healthcare is reporting this morning on the results of a new report published by the Commonwealth Fund, which says that up to 13.7 million young adults who are currently without insurance could qualify for coverage under several provisions of the healthcare reform law, thus alleviating medical debt for this age group.

Beginning this September, health insurers are required to extend dependent coverage to people up to the age of 26, for all group and individual policies. According to the Commonwealth Fund, this provision could cover 1.2 million young adults next year, of whom 650,000 are currently uninsured, and 550,000 have individual coverage. Some insurers have already begun extending this benefit.

Another provision, expanded Medicaid eligibility, which will begin in 2014 under the new law, could insure up to 7.1 million young adults currently without coverage. In the same year, insurance exchanges and premium subsidies could help even more young adults get insurance, while an end to the practice of gender rating could help young women gain affordable coverage.

Sara Collins, vice president for affordable health insurance for the Commonwealth Fund, said, “The affordability issue is significant for this age group.”

Last year, roughly 76% of young adults without insurance went without needed medical care because of costs, and 60% of them had trouble paying medical bills, according to a phone survey conducted nationwide by the Commonwealth Fund last May and June.

Health Insurance

CDC Targets Central-Line Bloodstream Infections with New Tech

The Centers for Disease Control and Prevention (CDC) has announced the launching of a new initiative with the goal of more quickly identifying central-line-associated bloodstream payments in hospital patients.

The initiative, sparked by the fact that roughly 250,000 patients in American hospitals develop such infections every year, with a cost of anywhere from $5,734 – $22,939 per patient for treatment, is a joint research project with the healthcare quality-improvement and group-purchasing organization Premier, and the Chicago Prevention Epicenter at John H. Stroger Jr. Hospital of Cook County. One of the ancillary goals of the project is to develop a way to automate the reporting of central-line associated infections. It will use an “electronic surveillance system” containing an infection-detection algorithm, developed by Chicago Prevention Epicenter researchers, and using the CDC’s current infection definition as developed by the National Healthcare Safety Network, to screen blood samples at Premier’s 2,300 member hospitals for potential infections.

As with the surveillance system currently in place, only patients who are suspected of having a bloodstream infection will be screened, but under the new initiative, the screenings will be performed with a high-speed electronic tool. The project, set to last two years, will measure whether the combined infection definitions, along with automated surveillance technology, will help healthcare providers more quickly identify and treat central-line-associated bloodstream infections.

The CDC has not stated whether or not this will roll out to other hospital systems any time soon.

Health Insurance Medicare

Medicare Payments to Decline 0.1%

Modern Healthcare is reporting that under a new rule issued by the CMS, Medicare inpatient payments to acute-care hospitals will decline by about $142 million – or 0.1% – during the 2011 fiscal year.

The new rule addresses payments rates and policies for inpatient services received by Medicare patients in roughly 420 long-term-care, and 3,500 acute-care hospitals. Richard Umdenstock, president and CEO of the American Hospital Association said, in a written statement that members of his organization were, “deeply disappointed with today’s proposal. Plain and simple: this policy will undermine hospitals’ ability to care for patients and communities across the country.”

The CMS is proposing a 2.4% annual inflation increase in Medicare payments in acute-care hospitals, which is only slightly higher than charges in the 2010 fiscal year, but it is also adding a negative adjustment of 2.9 percentage points in order to recoup estimate spending excesses that took place in the 2008 and 2009 fiscal years due to changes in hospital coding practices. With these two adjustments, and other factors that may affect spending, the agency has come up with the estimate of a decrease of 0.1% in 2011.

When researching documentation and coding trends under the Medicare severity diagnoses-related groups (MS-DRGs) earlier this year, the Medicare Payment Advisory Commission found that hospitals were more accurate with their coding procedures with resulted in the receipt of higher payments. However, while hospitals may have been getting more money, the coding changes did not “…reflect increases in patients’ severity of illness,” said the agency, explaining the reasoning behind recouping payments.

Umbdenstock countered with the belief that hospital patients really are getting sicker, saying, “Hospitals supported the move toward a more refined payment system that would better characterize patient severity, yet CMS’ coding offset distorts any improvements to payment accuracy.”

Like acute-care facilities, long-term care hospitals will also receive adjustments, though their inpatient Medicare payments are expected to increase by $41 million, about 0.8%, in the 2011 fiscal year.

It is not yet known whether any kind of coding policy will affect the cost of health care coverage for Medicare patients.

Health Insurance

Healthcare Reform Passes the House

Not long before midnight Sunday night/Monday morning, after nearly a year of heated debate, the U.S. House of Representatives passed the healthcare reform bill, in a 219-212 vote, in which all the House Republicans and thirty-four Democrats voted against the bill. It has been sent to President Obama to be signed into law.

Just after they passed the initial bill, the House then passed a supplemental “fix-it” bill which, among other things, removes Nebraska’s exemption from paying for Medicaid expansion in that state. That bill will go to the Senate for review, where, according to CNN news reports, the Republicans will likely do everything they can to stop it, using parliamentary points of order.

In order to help the bill pass, President Obama had to make several concessions, one of which – an executive order pledging White House support of existing strictures against Federal funding of abortion, except in the cases of rape, incest or when the mother’s life is in jeopardy – is drawing as much heat from women’s organizations like Planned Parenthood and NOW as the entire bill is taking from Republican critics, who feel it intrudes into the healthcare system in a heavy-handed fashion.

Some of the changes the bill will bring include a ban on insurers refusing coverage to people with pre-existing medical conditions, and an expansion of the government-sponsored health plan for the poor.

All totaled, the bill bring more, and more dramatic, changes to the American healthcare system than any legislation since the bill creating Medicare in 1965.