Health Care Reform

The  Society of Actuaries (SOA) recently predicted health insurance costs in the individual market would increase 32% by 2017.  Not good news, especially considering that the blame for this increase was placed at the doorstep of the Accountable Care Act (ACA).  Contrary to the expectations of those who developed the new reform laws, the SOA asserts that this increase is in part due to the poor health status of the new enrollees now eligible under the ACA.

Six years ago, I wrote about the emergence of retail clinics as “…The Next New Thing” in the delivery of health care.  Even then, for almost 10 years these enterprises had been offering basic medical care in drug stores in nearly half the states in the country at about 12 percent of the cost of an emergency room visit and a third of the cost of a visit to an urgent care center.At the time, the California Health Care Foundation opined that, “If successful, this could change the way many people receive routine, non-urgent medical care, with significant implication

Last week, federal and state officials released their long-anticipated Memorandum of Understanding (MOU) implementing a three-year effort to lower costs and improve the coordination of medical care provided to nearly half a million California seniors who are enrolled in both Medicare and Medi-Cal.  If approved by the feds, passive enrollment of program beneficiaries over a 12-to-18-month period will start in seven counties (Orange, Riverside, San Bernardino, San Diego, San Mateo, Alameda and Santa Clara) in October.  What this means is that the dual-eligible program beneficiaries

A physician specialist that I see regularly ordered a diagnostic test to check on my medical condition.  He explained to me that two tests were available and he disclosed which of the two he preferred.  Of course, I did what most patients do—I chose his preference.  Later I would learn that his preference cost almost twice as much as the other test and that I would have to pay more than $500 for the part of the bill not paid by my health plan.  I hasten to add that I am not upset with my doctor.  Rather, I am ticked off at myself and my health plan for how this play

We’ve all heard this one.  When asked about Congress or our state legislature, voters give low performance ratings to both followed by, “but my representative is a good guy.”  It would seem that the same holds true about constraining the growth of health care costs.

Demand for emergency room care in California has increased by 26 percent over the last decade while capacity has remained flat or declined in most service areas. Accordingly, some health care analysts recommend that hospitals be allowed to operate freestanding emergency departments (FEDs) to help meet a growing need in the state. FED supporters also believe that the enactment of health care reform will put greater stress on existing hospital emergency departments because as many as 40 hospitals in California, most with emergency rooms, will close in the coming years.

“… and pretty soon you’re talking real money.” The late Senator Everett Dirksen (R-IL), a politician who often spoke passionately about the debt ceiling, federal spending and the growth of government, is rumored to have made this statement to reporters about the way Congress thinks about the federal budget.  Well, the Rand Corporation may have found a billion dollars that can be taken off our nation’s yearly health care tab.

The federal health care reform law enacted in 2010 – the Patient Protection and Affordable Care Act (PPACA) – excluded illegal immigrants from eligibility for inclusion under its expanded health insurance coverage provisions. Now it would appear that health coverage for these immigrants will not be in the immigration reform plan the White House and Congress will likely hammer out later this year.

Last week, the Internal Revenue Service (IRS) and the Health and Human Services Agency (HHS) published rules governing the individual mandate that, according to HealthLeaders Media, “include such extensive exemptions that only 2% of the population would owe a penalty, or ‘shared responsibility payment’ for not having coverage under a health plan.”

The December 31st Ventura County Star news report that Community Memorial Health System (CMHS)  will no longer hire people who use tobacco gets my vote for the best New Year’s resolution made by a health care organization.By taking this bold action, CMHS, which runs two hospitals and a network of clinics in west Ventura County, joins but a handful of providers of hospital care in California, if not the nation, to move beyond on-campus smoking bans with this more restrictive

Medicare cost the federal government $528 billion in 2010.  Current projections place that funding level above $1 trillion in 2020, and that’s after deducting $45 billion in payment cuts per year to providers and Medicare Advantage plans during that period, as ordered by the federal Patient Protection and Affordable Care Act (PPACA).

Once a year for the past seven years, our community of hospitals in Southern California comes together to honor the most giving of themselves, the laborers of the planet.  Okay, so we are a little biased about the people working in our hospitals. Here are but five of the extraordinary people we honored last week along with their stories.

Our first award went to a nurse and social worker on the front lines of a busy hospital who teamed up to fix a problem that plagues emergency rooms everywhere … frequent fliers.