Two medical groups in Connecticut, the Fairfield County Medical Association and the Hartford County Medical Association, won a temporary reprieve against United Healthcare’s plan to cut an estimated 2,200 doctors from its Medicare Advantage network (click here to see an archive of our coverage of the story). The order prevents United Healthcare from terminating any of the two associations’ members from its network, notifying Medicare Advantage customers that some providers will be terminated as of February 1, 2014 and removing the associations’ and affected doctors from its 2014 physician directories. The injunction is expected to remain until the court can rule on the merits of the claims. United Healthcare is planning on appealing the decision.
Connecticut’s health insurance exchange is intended to extend coverage to the uninsured, small businesses, and individuals buying their own plans. But, Kevin Counihan, CEO of Connecticut’s exchange, Access Health, recently stated that the exchange could serve others, too. According to Counihan, changes in the health insurance market could mean that the exchanges may soon become relevant to those individuals who get coverage through their employers, calling it the “401K-ing of health insurance.” Similarly to companies transitioning from offering pensions with benefits to giving employees a fixed amount of money to invest for retirement, companies may approach health benefits by giving employees a fixed amount of money and then allowing them to buy what they want on the exchange.
In order for this change to take place, health insurance exchanges, both private and publicly run, must exist and allow customers to comparison-shop. However, individuals will need to be well educated about all their options so that they can make the best decisions. Connecticut’s exchange, Access Health, is currently developing an All-Payer Claims Database, a tool meant to help consumers learn about health insurance costs and quality.
A new OIG report reviews the extent to which Medicare nursing home residents are hospitalized. The report discovered that in FY 2011, one quarter of Medicare residents in nursing homes were transferred to hospitals for inpatient admissions where Medicare spent $14.3 billion. The OIG states that the higher than average resident hospitalization rates can be avoided through better care and recommends that CMS develop a quality measure that describes hospitalization rates and then assess this measure during surveys of nursing homes. CMS agrees with OIG on the recommendations and is working on developing a hospitalization measure for nursing home residents and a re-hospitalization measure for Medicare SNF residents. In addition, CMS will add these measurers to the quality measures surveyors review.
A new study has led to a breakthrough in the method to identify people who will suffer from Alzheimer’s disease. The research published in the current issue of the Journal of Alzheimer’s Disease predicted with 90% accuracy which mild cognitive impairment sufferers would develop the disease within two years. A combination of brain imaging analysis and a neuropsychological assessment led the team to discover which subjects would develop Alzheimer’s and which ones would not. Researchers note that recall and recognition episodic memory tasks were highly suggestive of progression to dementia.
At this year’s legislative session, Connecticut lawmakers discussed a bill that would make it easier for private, for-profit hospital companies to purchase physician practices from a nonprofit hospital that it planned to take over. Lawmakers have been wary of for-profit hospitals and what they could mean to the state, considering the fact that Connecticut currently only has one for-profit hospital. The main concern regarding these hospitals is figuring out if quality of care would be compromised in favor of savings for shareholders.
Some industry experts cite a long list of complaints, fines and legal settlements that have arisen from some of these for-profit hospitals. But, proponents of for-profit hospitals state they have made changes to their companies and that most hospitals in the state looking to be acquired feel comfortable to move forward.
Yes and no. Counselors, brokers, and online assisters throughout the country are giving mixed reviews to the updated website, with some applicants successfully completing the process and others facing the same glitches and crashes. According to figures from CMS, the response times have dropped to 1 second and error rates were under 1 percent due to the technology fixes but other organizations monitoring the site said that several states had response times from 8 to 18 seconds.
This year’s Medicare ratings are out and more than two thirds of Connecticut hospitals will face Medicare penalties for not having proper clinical-care measures in the fiscal year that began on October 1. 23 Connecticut hospitals will also lose Medicare funding because of high rates of readmitting patients within 30 days of discharge. Hospitals can receive penalties and incentives under the value-based program based on how well they perform on a variety of clinical measures like patient satisfaction measures and mortality rates for certain conditions.
Medicare’s penalty formula has proven to be somewhat controversial but many providers and consumers believe a rating system is important for choosing the right provider. Do you believe publicly available information like Medicare ratings make more knowledgeable health care consumers? We’d love to hear your thoughts.
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