Blue Moon Benefits Group

Healthcare Reform Law’s Fate Uncertain…

blue_moon_benefits — Wed, 28 Mar 2012 12:09:44 +0000

Healthcare Law’s Fate Uncertain After Sharp Questioning From Supreme Court Justices.Media reports and analyses last night and this morning portray the Supreme Court as leaning towards ruling against the constitutionality of the Affordable Care Act. Yesterday’s hearing generated widespread coverage on both TV and print. However, only the CBS Evening News, among the three network newscasts, led with the court hearing.
According to Brian Williams, on NBC Nightly News (3/27, story 2, 3:05), “A lot of the experts have been predicting that the law would probably stand, but after today, all bets are off.” On the CBS Evening News (3/27, lead story, 4:40, Pelley) Jan Crawford said, “The healthcare law is considered President Obama’s signature achievement, but…it appeared a majority of the Justices were ready to describe the individual mandate another way — unconstitutional.”
According to the Washington Post (3/28, Fahrenthold, Aizenman), “By the end of Tuesday’s long-awaited oral arguments, the individual mandate…seemed to be in trouble.” Adam Liptak, in a front-page article for the New York Times (3/28, A1, Subscription Publication), also says “the available evidence indicated that the heart of the Affordable Care Act is in peril.” Liptak continues, “If the indications from Tuesday’s arguments are correct…the ruling may undo parts or all of the overhaul of the health insurance system, deal Mr. Obama a political blow in the midst of the presidential election season, and revise the constitutional relationship between the federal government and the states.”
Justice Kennedy gets the lion’s share of the attention, and “skeptical” is, by far, the adjective most often used to describe the tone of his questioning. A Los Angeles Times (3/28, Savage, Levey) headline reading “Skeptical Kennedy Signals Trouble For Obama’s Healthcare Law” is a concise summation of the day’s analysis.
In an analysis touted on the Drudge Report Tuesday, The Hill (3/27, Strauss) reported New Yorker legal analyst Jeffrey Toobin, on CNN (3/27, 12:07 PM EST), described the hearing as a “trainwreck for the Obama administration,” and Kennedy as “enormously skeptical.” Toobin added, “This law looks like it’s going to be struck down. … All of the predictions, including mine, that the justices would not have a problem with this law were wrong.” Toobin also claimed Solicitor General Donald Verrilli “did a simply awful job,” characterizing Verrilli as “nervous,” and “not well spoken.”
On NBC Nightly News (3/27, story 2, 3:05, Williams), NBC’s justice correspondent Pete Williams reported, “It does seem the majority of the justices are skeptical that Congress has the power to pass such a sweeping law.”
David Leonhardt, in an analysis for the New York Times (3/28, Subscription Publication), says, “Many legal scholars, including some conservatives, have been predicting that the Supreme Court will uphold” the ACA, but “after Tuesday’s arguments, when several justices asked skeptical questions about the heart of the law, a political lens seemed relevant, too. … Skeptical questions from the bench are often an indicator of how justices will ultimately vote — and many court experts expressed surprise at the apparent agreement among the conservatives, including” Kennedy.
Bill O’Reilly, in his opening monologue for Fox News’ The O’Reilly Factor (3/27), said “most of the justices” were “openly skeptical about the power needed to impose Obamacare.” O’Reilly added that “the consensus is” Verrilli “did not make a strong argument.”
Roll Call (3/28, Dennis, Drucker, Subscription Publication) quotes Senate minority leader Mitch McConnell as saying, “It was noteworthy that the four more liberal members of the court were mainly peppering the plaintiffs and the other five were mainly peppering the government, leading us to hope this awful law will be overturned.” Sen. Ron Johnson added, “I was encouraged that they were asking the right questions.”
Fox News’ Special Report (3/27, lead story, Bream) reported Kennedy “unleashed an unexpectedly candid assessment of the individual mandate today that has supporters terrified the Affordable Care Act could be toast.”
The Wall Street Journal (3/28, Kendall, Subscription Publication), in an article titled, “Kennedy Leaves Both Sides Hopeful,” says some liberal analysts are still hopeful that Kennedy will side with the Administration.
NBC’s Pete Williams, on CNBC’s The Kudlow Report (3/27), said, “It’s quite clear the four conservatives…believe this law is unconstitutional, and it’s equally clear that the four liberal members of the court…would vote to uphold it. … But tonight I think the future of the healthcare law is very much in doubt.” Williams, on MSNBC’s Hardball (3/27, Matthews), added, “It wasn’t a great day for the administration. … It’s quite clear they didn’t pick up any of the conservatives,” which means “the question comes down to” Kennedy, and “for most of the questioning…he showed great skepticism.”
The CBS Evening News (3/27, lead story, 4:40, Pelley) reported that the Administration “says the mandate will make sure that everyone has health care, while keeping insurance affordable, but opponents say it is a dangerous new power for the government, forcing citizens to buy a product.” CBS’s Jan Crawford added, “The conservative Justices and Kennedy, a moderate, expressed concerns the law gave Congress broad new powers to dictate behavior,” while “all four of the Court’s liberal Justices defended the law.”
McClatchy (3/28, Doyle, Lightman) reports that the justices “cast serious doubts on the Obama administration’s signature health care law Tuesday, emboldening the Republicans who now are eagerly campaigning to kill it.” According to McClatchy, Solicitor General Verrilli “stressed…that the 40 million uninsured Americans posed what he called ‘an economic problem’ that Congress is empowered to fix.” McClatchy adds, “In a potentially sobering sign for the Obama administration, even [Kennedy] the justice most commonly considered to be a swing vote made pointed observations about the insurance-buying mandate.”
The Washington Post (3/28, Barnes, Aizenman) says Kennedy “suggested” that the Affordable Care Act “invoked a power ‘beyond what our cases allow’ the Congress to wield in regulating interstate commerce.” Paul Clement, “the former George W. Bush administration solicitor general representing 26 states challenging the law, picked up on that theme, saying the government was defending an ‘unprecedented’ act by Congress with no limiting principle.”
The Los Angeles Times (3/28, Savage, Levey) notes Kennedy “described it as ‘unprecedented’ for the federal government to impose an ‘affirmative duty’ on people to buy a product.” According to the Times, “In his closing argument, Verrilli urged the justices to defer to the choices made ‘by the democratically accountable branches of government,’” but “the court, which has five Republican appointees, did not sound as though it was inclined to do so.”
Mike Sacks, in the Huffington Post (3/28), reports, “From the very start, things did not go well for the government’s argument that” the mandate is “constitutional.” Sacks says Verrilli “began his argument not with his usual calm and clear delivery, but rather with a case of coughs that seemed to take him off his game. And just as he was starting to recover his composure,” Kennedy “asked, ‘Can you create commerce in order to regulate it?’” which “adopted the framing of the case put forward by those challenging the mandate.”
The Wall Street Journal (3/28, Bravin, Subscription Publication) notes Justice Scalia said the Administration’s argument was akin to saying: “Everybody has to buy food sooner or later, so you define the market as food, therefore, everybody is in the market. Therefore, you can make people buy broccoli.”
USA Today (3/28, Wolf, Heath) says the “conservative justices suggested they might be willing to send lawmakers back to the drawing board just months before a presidential election. … Inside the courtroom…the most significant law signed by Obama came under sharp attack by justices appointed by his Republican predecessors. Outside, hundreds of demonstrators packed onto the sidewalk in front of the marble courthouse, shouting over each other.”
According to Politico (3/27, Brown, Gerstein, Haberkorn), “Before the arguments, many court watchers said they expected the law would be upheld, and a few even predicted that as many as eight justices would back the constitutionality of the mandate.” But “after the session, court watchers said a 5-4 decision along partisan lines striking down the mandate was a distinct possibility — harkening back to other politically divisive, sharply divided rulings from the court, such as Bush v. Gore in 2000.”
Sam Baker, in a post for The Hill (3/27), wrote, “The sense of a possible election-year defeat in the courtroom for the president’s signature domestic achievement was unmistakable.”
However, on NBC Nightly News (3/27, story 3, 1:30, Williams), legal correspondent Savannah Guthrie said, “Oral arguments are not always an indicator of where the court will come out,” and noted that in “the DC circuit, very conservative judges grilled the government’s lawyers,” but, “ultimately those conservative judges were in the majority upholding the healthcare law.”
The Washington Times (3/28, Cunningham) reports, “The justices also posed rigorous questions to…Clement and Michael Carvin, attorneys for the National Federation of Independent Businesses and 26 states, probing for answers to why they say the government can’t require Americans to buy coverage ahead of time to pay for their own health care. … ‘When you are born, and you don’t have insurance, and you will in fact get sick, and you will in fact impose costs, have you perhaps involuntarily — perhaps simply because you are a human being — entered this particular market?’ Justice Stephen Breyer asked Mr. Carvin.”
Also reporting on the hearing are the AP (3/28, Sherman), Roll Call (3/28, Dennis, Drucker, Subscription Publication), the National Journal (3/28, Khan, Friedman, Subscription Publication), CQ (3/28, Norman, Subscription Publication), NPR (3/28, Totenberg) “Shots” blog, the Huffington Post (3/28, Young), Forbes (3/28, Fisher), the Detroit Free Press (3/28, Spangler), HealthDay (3/28, Esposito), Medscape (3/28), MedPage Today (3/28), WebMD (3/28, Lowes), and Modern Healthcare (3/28, Subscription Publication).

New Ryan Plan Reignites Political Debate Over Spending, Medicare…

blue_moon_benefits — Wed, 21 Mar 2012 12:55:02 +0000

New Ryan Plan Reignites Political Debate Over Spending, Medicare.
House Republicans offered a budget plan yesterday which they said would reduce federal spending by over $5 trillion over the next ten years. The plan is getting a great deal of coverage in today’s newspapers – though it was not mentioned on the network newscasts last night. Most of the coverage portrays the plan as an election-year tactic by Republicans to draw contrasts between themselves and Democrats on fiscal issues. Many stories also report on the fierce criticism of the plan from the White House and congressional Democrats who say the proposal would bring an end to Medicare and punish the poor and the middle-class while protecting the wealthiest Americans.
Fox News’ Special Report (3/20, lead story, Baier) reported Rep. Paul Ryan, “the Republicans’ point man on money matters…unveiled his latest plan to try to make the federal books a little less unbalanced.” Ryan “proposed a sweeping reform of everything from taxes to Medicare today as part of the new Republican budget plan. And he began with a GOP favorite.” Ryan: “First, we propose that we repeal the President’s disastrous healthcare law.”
Also on Fox News’ Special Report (3/20, Baier), Ed Henry reported that the White House is “again charging, as they did last year, that the Ryan budget would end Medicare as we know it, even though it’s gone through some changes. Last year, it was a full privatization of Medicare, this year it’s just a partial privatization. Despite that tweak, White House officials like [NEC director] Gene Sperling today, basically said, ‘this will wipe out traditional Medicare.’” Sperling: “Death spiral is the term that is used in insurance for exactly for this process where adverse selection pulls out people and leaves those in the pool facing higher and higher costs.”
The New York Times (3/21, Weisman, Subscription Publication) reports that the proposal reflects Republicans’ “vision of a smaller government, a flatter tax code and a free-market Medicare system.” The Times says Republicans are “banking that fears over surging federal deficits will trump longstanding voter allegiances to popular government programs.” The plan would “reshape Medicare into a system of private insurance plans, shrink programs for the poor and turn them over to state governments, and try to simplify the tax code for individuals and businesses.” It also calls “reducing spending below the cap agreed to in last year’s debt limit deal, raising the prospect of a tense fiscal clash just a month before the election.”
The Washington Times (3/21, Cunningham) reports that the proposal is “the third such GOP plan in the past month to try to change Medicare, and it runs smack into the White House and congressional Democrats, who say the GOP is tangling with an issue that will cost them votes in November.” While Ryan “revised key elements of his Medicare plan from last year,” he “still proposes having the federal program compete with private plans and giving seniors a voucher to choose the plan they like.” The Times notes that while all sides agree that Medicare needs changes, “Republicans and Democrats are struggling to find any common ground over how to make it sustainable.”
The Washington Post (3/21, Helderman, Montgomery) calls the plan a “bold but risky election-year marker,” that congressional Republicans “plan to use the document to demonstrate their willingness to tackle the nation’s difficult fiscal problems head-on.” The Post adds that the plan, which would cut federal spending by $5.3 trillion over the next decade, “provided new fodder for Democrats, who argued that Republicans would slash the social safety net while protecting the rich.” House Budget Committee chairman Paul Ryan “says he will stage a vote on the plan in the House Budget Committee on Wednesday, and that he has the necessary support to move it to the House floor.”
USA Today (3/21, Davis) reports that Ryan said the plan is “philosophically rooted in reducing Americans’ reliance on the federal government.” He “acknowledged and dismissed the political risks of voting on a non-binding proposal for sweeping changes to popular programs in an election year,” saying, “If we simply operate based on political fear, nothing is ever going to get done.”

2012 BCBSNC Prescription Claim Form

blue_moon_benefits — Thu, 01 Dec 2011 02:51:19 +0000

2012 BCBSNC Prescription Claim Form

New Medicare Part-B Premium Announced…

blue_moon_benefits — Fri, 28 Oct 2011 12:19:17 +0000

“Modest” Increase In Medicare Premiums Announced….
The announcement regarding Medicare premiums received extensive and mostly positive coverage, as officials and experts expressed satisfaction that the increase is smaller than expected. The CBS Evening News (10/27, story 6, 0:25, Pelley) reported, “Last week, we told you Social Security recipients are getting a raise tied to the inflation rate. Well, today we hear that seniors will be paying more for Medicare premiums next year. The government raised the basic monthly payment for Part B to $99.90 and for most folks that’s an increase of about $3.50 a month.”

The New York Times (10/28, A15, Pear, Subscription Publication) reports, “Administration officials rejoiced at the modest increase, which could pay political dividends to President Obama as he tries to win the votes of older Americans in his bid for re-election.” Furthermore, “officials said the smaller increase showed their prudent management of the program, using tools provided by the new health care law to control costs.” The Times quotes Jonathan D. Blum, deputy administrator of the federal Centers for Medicare and Medicaid Services, who “said officials were seeing ‘much lower utilization and spending growth’ in Medicare than they had expected.”

The Wall Street Journal (10/28, A6, Radnofsky, Subscription Publication) cites HHS Secretary Kathleen Sebelius, who said that retirees could see about $40 more each month because of a higher Social Security benefit coupled with the smaller Medicare premium increase. The AP (10/28, Alonso-Zaldivar) reports that according to Sebelius, it is “pretty remarkable” that the premiums will remain low. She remarked, “Thanks to the Affordable Care Act, Medicare is providing better benefits at lower cost.”

The Boston (MA) Globe (10/28, Kotz) “Daily Dose” blog reports that “Sebelius called the lower-than-expected premium increase ‘the latest round of good news’ and added that the projected increases in Medicare costs were lower than expected partly because of greater competition among health plan providers put in place by the Affordable Care Act.”

The Hill (10/28, Pecquet) reports in its “Healthwatch” blog, “CMS Administrator Donald Berwick said the lower-than-expected premiums hike was due to two principal factors: historically low healthcare utilization rates, due in part to the healthcare reform law’s investment in prevention and the 3.6 percent Social Security cost-of-living (COLA) hike announced earlier this month.” In a statement, Rep. Pete Stark (D-Calif.), said, “These reductions are a direct result of the Medicare reforms included in the Affordable Care Act �� further affirmation of the positive impact health reform is already having on Americans’ pocketbooks.”

The Washington Times (10/28, Cunningham) quotes Berwick, who said, “We are excited about being able to offer people better Medicare at less cost. That just makes sense.”

The Washington Post (10/28, Kliff) reports, “The announcement was the third piece of good news about Medicare premiums this year.” AARP’s legislative policy director, David Lerner, remarked, “This small increase is welcome news.”

Also covering the story were the Baltimore Sun (10/28), Reuters (10/28, Selyukh), Bloomberg News (10/28, Eisenberg), CQ (10/28, Adams, Subscription Publication), and Modern Healthcare (10/28, Zigmond, Subscription Publication).

Consumer Reports Finds More People Putting Off Healthcare, Cutting Medication

blue_moon_benefits — Wed, 28 Sep 2011 12:06:55 +0000

NAHU Newswire…
Bloomberg News (9/28, Wechsler) reports on a Consumer Reports survey of “1,226 consumers taking at least one medication,” finding that “one in six American households and one in four with incomes less than $50,000…felt stress over how much they must spend on medical care,” and “almost half [48%]…said they didn’t fill prescriptions, took less medicine than a prescribed dose or failed to undergo a medical test advised by their physician,” up from “39 percent reported in 2010.” Dr. John Santa, director of Consumer Reports’ Health Ratings Center, said, “The rising percentage of people putting off health care makes us wonder if we are really done with the recession.” Santa also advised physicians “to ask patients whether they are having trouble paying for drugs or medical care, and patients…should tell them when they are financially stressed.”

The Los Angeles Times (9/28, Stein) comments on the same survey in its “booster shots” blog, “Americans aren’t just cutting costs these days by clipping coupons — they’re also making some potentially dangerous choices about prescription drugs.” Among those: “16% don’t fill prescriptions, 13% have taken a drug that expired, 12% skipped a dose without checking in with the doctor or pharmacist, 8% cut pills in half and 4% shared their medicines.”

The New York Times (9/28, Carrns) similarly says in its “Bucks” blog, “Americans are spending less money out of their own pockets each month on prescription drugs, probably because of greater use of lower-cost generics,” yet many are still “cutting costs on pills in ways that are unsafe.” And “lower-income people, those without drug benefits and those with monthly drug costs of more than $50, were most likely to take such steps.”

WebMD (9/28, Mann) reports that “many people do not fill their prescriptions, take expired pills, skip doses, or split pills — all to lower costs.” Lisa Gill, the editor of prescription drugs for Consumer Reports, recommends that physicians “find out the costs of medications in advance.”

Survey Finds Health Insurance Costing More, Covering Less

blue_moon_benefits — Wed, 28 Sep 2011 12:05:51 +0000

NAHU Newswire…
Major national news outlets including network news gave substantial coverage to a Kaiser Family Foundation report on health insurance coverage and costs. The reports emphasized the higher rates and reduced coverage with one outlet noting that family insurance now costs more on average than a small car. Many also noted the report’s conclusion that the Affordable care act was responsible for a small amount (2 percent) of the increase in rates. NBC Nightly News (9/27, lead story, 3:00, Williams) reported, “a crippling trend in America,” adding “it comes down to the choice…between your money or your health.” NBC (Yang) said, “At the same time insurance is covering less. Employers say rising insurance costs forced them to choose between providing good benefits or hiring new workers or giving raises.” The authors of the Kaiser Family Foundation survey “say it’s too early to tell what will happen in 2014, which is when the key elements of President Obama’s healthcare reform take effect.”

ABC World News (9/27, story 5, 0:30, Sawyer) reported, “The Kaiser survey finds that over the past ten years, health insurance premiums are up 113% while wages have increased only 34%.”

The CBS Evening News (9/27, story 2, 0:20, Pelley) reported, “While the value of homes has been falling, the cost of healthcare has been rising. A report on health insurance costs today says the average annual family premium is $15,073. That’s up 9% from last year. Employers generally pick up the majority of the costs.”

The New York Times (9/28, A1, Abelson, Bernstein, Subscription Publication) reports on its front page that the Kaiser survey results are “creating more uncertainty for the Obama administration and employers who are struggling to drive down an unrelenting rise in medical costs.” Partly that’s because “Kaiser estimates that one to two percentage points of the increase this year is related to provisions of the law already in effect,” and partly because, “many businesses cite the cost of coverage as a factor in their decision not to hire, and health insurance has become increasingly unaffordable for more Americans.”

The Washington Post (9/28, A1, Aizenman) reports on its front page that the Tuesday release of a Kaiser Family Foundation and Health Research & Educational Trust annual survey highlighted “premiums for employer-sponsored health insurance continued to escalate this year even as the share of workers getting less generous coverage reached a new high.” Drew Altman, president of the Kaiser foundation said, “Without any real national discussion or debate, there’s a quiet revolution going on in what we call health insurance in this country. Health insurance is becoming less and less comprehensive.” Though roughly half of Americans “are covered by an employer sponsored health plan,” yet “nearly 70 percent report being worried about having to pay more for healthcare or health insurance. Almost a third are ‘very worried.’”

McClatchy (9/28, Pugh) notes that Kaiser President Altman is uncertain if the sharp premium increases are temporary or part of a larger trend. “Karen Ignagni, the president of America’s Health Insurance Plans, said the increasing cost of medical care was the main culprit behind the rate increases.” Also “insurers may have set rates higher this year thinking that the Affordable Care Act would increase their costs.”

The Los Angeles Times (9/28, Helfand) reports, “The price of health insurance provided by employers for families jumped 9% this year over 2010 as rising healthcare expenses contributed to the largest premium increases in six years.” In response, “companies and workers are increasingly turning to high-deductible policies that require workers to pay more out of their pockets for medical care.”

The Wall Street Journal (9/28, Mathews, Subscription Publication) says that with many employers and employees turning to higher deductible plans, the sharp growth in premium prices seems counter-intuitive, though other industry experts emphasize that the remaining pool of candidates tends to be older and more likely to draw on the insurance.

USA Today (9/28, Kennedy) reports, “As Congress works to decrease the federal deficit by cutting health care programs such as Medicare, policy experts say health providers will have to find money elsewhere, which could force insurance premiums higher for most Americans.”

Bloomberg News (9/28, Young) reports, “The average cost of a family policy climbed 9 percent in 2011 to $15,073, according to” the Kaiser Foundation’s “poll of 2,088 private companies and state and local government agencies.” It also found that “the average price of a family plan has risen 113 percent since 2001.” White House Deputy Chief of Staff Nancy-Ann DeParle’s blog posting is cited saying that “premium increases aren’t the result of the health overhaul,” but instead are due partly to “insurers [having] overestimated the new law’s effect and the gain in health-care spending this year.”

The Financial Times (9/28, Rappeport, Subscription Publication) says that the increase undercuts the Administration’s argument that its healthcare reform would cut costs.

Reuters (9/28, Selyukh) reports that Altman said, “There are a variety of factors that could have been responsible for (premium increases), but the major reason is not the healthcare reform.”

Modern Healthcare (9/28, Daly, Subscription Publication) reports, “The only factor among many possible drivers to the latest premium increase that the survey authors were able to quantify were two provisions of the Patient Protection and Affordable Care Act that went into effect last year: a requirement for plans to offer coverage to the young adult offspring of their enrollees and mandated coverage of preventive care. Those provisions composed up to 2 percentage points of the 9% increase, the authors found in a separate analysis.”

The National Journal /Kaiser Health News (9/28, Appley, Subscription Publication) reports premiums have grown by “triple the growth seen in 2010.” And “the White House quickly weighed in, accusing private health insurance companies of reaping profits based on forecasts of rising costs that didn’t turn out to be accurate.” While, “many factors drive premium growth, the main one [is] actual spending on medical care.”

Politico (9/28, Feder) reports, “Premiums for employer-provided health insurance jumped 8-9 percent in 2011, passing $15,000 for family coverage – which is more than the cost of a Ford Fiesta.” More coverage appears in AFP (9/28), The Hill (9/28, Pecquet, Baker) “Healthwatch” blog, and CNN (9/28).

Federal Employees See 3.8 Percent Increase. The Washington Post (9/28, Davidson) reports in its “Federal Diary” column, “Health insurance premiums for non-postal federal employees and all retirees will increase an average of 3.8 percent in 2012.” Yet “when your pay is frozen, as federal pay is through this year and next, the premium boost amounts to another hole in your wallet.”

North Carolina’s $345M Medicaid Cut To Begin In October 2011

blue_moon_benefits — Mon, 29 Aug 2011 12:32:39 +0000

NAHU Newswire…
The Charlotte (NC) Observer (8/28, Bonner) reported North Carolina’s $354 million Medicaid cut takes hold in October, including eliminating eye exams and glasses for adults and “limiting payments for deep cleaning dental treatments for people who have gum disease to once every two years from once a year. Outpatient physical therapy, occupational therapy and speech therapy for adults will be limited to three visits a year.”

Medicare Spending On Hospice Care Has Risen Sharply.

blue_moon_benefits — Mon, 08 Aug 2011 13:19:49 +0000

NAHU Newswire…
USA Today (8/8, Kennedy) reports that “Medicare spending on hospice care rose 70% to $4.31 billion” from 2005 to 2009 while “for-profit hospices were paid 29% more per beneficiary than non-profit hospices.” This comes as “some of the nation’s largest for-profit hospice companies” such as Vitas and Gentiva “are paying multimillion-dollar settlements for fraud claims and facing multiple investigations from state and federal law enforcement agencies.” Jodi Nudelman, a regional inspector general for HHS said about the report via webcast, “Certain hospices seem to be seeking out beneficiaries with particular characteristics, and these beneficiaries are often found in nursing facilities.” Nudelman added that a reduction for payments for hospice in nursing facilities is being considered by the Center for Medicare and Medicaid Services.

CMS Unveils New Website With Hospital Quality Data.

blue_moon_benefits — Mon, 08 Aug 2011 13:18:40 +0000

NAHU Newswire…
The Hill (8/6, Baker) reported in its “Healthwatch” blog that the Centers for Medicare and Medicaid Services “announced new programs Friday to help consumers compare hospitals based on quality.” The agency “launched a new website that allows users to compare not just hospitals, but also doctors and nursing homes. The site compares facilities based on several criteria, including the satisfaction of previous patients.” CMS Administrator Don Berwick said, “These efforts are designed to also encourage providers to deliver safe, patient-centered care that consumers can rely on and will motivate improvement across our health care system.”

CQ (8/6, Reichard, Subscription Publication) reported that CMS “officials said they have also updated data on an existing website devoted to hospitals in an effort to help consumers compare facilities. And they’ve added new information, including how well hospitals guard against infection during outpatient surgical procedures.” In addition, “the agency outlined a fresh set of goals for the ‘QIOs’ — the independent organizations that contract with Medicare to improve the quality and efficiency of care under the program.”

Modern Healthcare (8/6, Evans, Subscription Publication) reported that according to Berwick, the site “would allow ‘one-stop shopping’ for consumers looking for information on quality or the type of services provided by hospitals, physicians, nursing homes, home care or dialysis providers.” Also on Friday, the agency “released data…on hospital readmissions for heart attacks, heart failure and pneumonia that found little change in performance.” In fact, the data showed “only small changes to the readmissions rate, according to Medicare, which compared data for the years 2007 through 2010 against data for the years between 2006 and 2009.” The Daily Record (NJ) (8/7, Ungaro) also covered the story.

BCBSNC Launches Treatment Cost Estimator Tool

blue_moon_benefits — Tue, 02 Aug 2011 13:35:02 +0000

Date: 08/01/2011
Today, Blue Cross and Blue Shield of North Carolina launched a new Treatment Cost Estimator designed to help our members make informed health care decisions by providing data on the costs of elective procedures. The tool, found on mybcbsnc.com, replaces our previous cost estimation tool and adds cost information to our provider search tool.

The tool provides average costs for 59 common elective procedures. Please refer to the list below. We believe this information will help members become informed consumers and take an active role when they have choices to make about their health care. Additional information and more medical procedures will be added to the tool later this year.

Frequently Asked Questions:
What is the Treatment Cost Estimator tool?
The new Treatment Cost Estimator is a web-based tool that provides members with information about the relative cost of 59 elective procedures. This tool gives our customers an estimated range of what a procedure may cost and provides them with information about how the cost may vary based on the physician/hospital they choose.

Can the tool be used for all BCBSNC plans?
Cost comparison information is not available to members on the following plans:
Medicare Advantage (Blue Medicare)
Medicare Supplement
FEP
Dental-only

What data is used to calculate the cost estimations?
Blue Cross and Blue Shield of North Carolina has joined other Blue plans across the country in providing new cost range information for various types of treatments and procedures based on network claims data.

The costs listed in the tool represent a range of the average treatment costs at a particular hospital. This tool calculates costs using a methodology which is broken into two components:

There are several steps involved in generating costs of a procedure at a particular facility. First, we collect claims data and categorize the information into cases of care. Cases of care represent a collection of services such as the doctors’ charges, the hospital charges, lab tests, etc. related to a particular procedure. Second, the cases are reviewed to remove any outliers/exceptions that may skew the averages. Third, cost bands/ranges are created for each procedure based on these averages.

Each office visit is assigned a code to specifically identify the procedure/service that is being provided. Costs are assigned to each procedure code; along with a standard rate based on the location (Zip Code) of the where the service takes place. This cost value is displayed within the application.

Is the tool intended to provide medical advice and exact payment information?
The cost information provided is intended to be used as a reference tool for our members’ convenience and is not a substitute for medical advice from or treatment by a medical professional for specific medical conditions.

Estimates are not intended to be an exact calculation of claim payment and do not contain all health benefit plan terms, conditions, limitations and exclusions that may apply to a member’s coverage. Also, estimates are not a guarantee of payment or prior approval for a particular service.

Members should not avoid getting health care nor should they make health care decisions based on the cost estimates displayed on this website. Only patients and their doctors can decide which medical decision is best for them.

Why is there such a wide variation in price for a certain procedure?
Doctors’ and hospitals’ rates may vary based on differences in selected treatment plans based on individual needs. This information is intended to be used as a reference tool for our members’ convenience and discussion with their doctors.

Why is BCBSNC introducing the tool?
Health plan designs increasingly require consumers to make informed decisions about their health care, and consumers do not always have the information to determine what they will be required to pay or why. The goal of introducing this type of tool is to support members as they consult with their physician and make decisions about where to seek the health services they need.

How do I use the new tool?
Blue Cross and Blue Shield of North Carolina members need to log into Member Services online at www.mybcbsnc.com to get treatment cost information. Once logged in with their Member ID and secure password, members can use our doctor or facility search to see cost ranges associated with specific practices or facilities.

Members may also use the Treatment Cost Estimator in Member Services to see the general cost range for 59 elective procedures, without selecting a specific physician or hospital.

For doctor or facility searches:
www.mybcbsnc.com and click on Find a Doctor at the top right of the web page.
Complete the fields to search for a doctor or facility.
Select a type of facility to choose a type of treatment or procedure.
Select your treatment from the category menu under “Get Treatment Cost Estimates.”
Click “Search” and look for the cost range information on the right side. You may open or close the search field area after the results are visible.

For general treatment costs:
www.mybcbsnc.com.
Make sure the first three letters of your Member prefix are correct in the first field.
Enter your ZIP code.
Select a type of treatment or procedure from the drop down menu.
Click “Search” for results. You may open or close the search field area after the results are visible.

How does the functionality change the tool I have been using?
In the provider search tool, in addition to obtaining name, location and distance to a provider, you will also be able to access relative cost information which represents the allowed amount for the service. You can use this information to get a general cost comparison depending on the physician or hospital you choose.

Will my provider have access to the information?
The tool is available to all BCBSNC members who are registered on Member Services. BCBSNC has notified all impacted providers regarding this information. Please feel free to share the information with your physician if you have questions and would like to discuss options for where you should have treatment.

Does the cost displayed include all services related to my treatment?
The treatment costs you see represent a collection of services such as the doctors’ charges, the hospital charges, lab tests, etc. related to a particular procedure. The cost generally includes all services related to your treatment; however, some follow-up care may not be included depending on your treatment plan.

Can I use the tool even if BCBSNC is not my primary insurer? The purpose of this tool is to provide cost comparison information between facilities. The relative value may not be as high if BCBSNC is not the primary insurer.

How often is the tool updated?The tool is updated every 6 months in April and October. Additional procedures will be added to the tool by the end of the year.