The big concern will be for staffing as hospitals already have inadequate staffing and with baby boomers coming, they are forcing cuts in staffing just as numbers of people rise. We will see lower wages and with that a fall in quality.
Remember our old friend at the center of this NSA surveillance scandal BOOZ and Co. They are an International private management company tasked with making businesses profitable. The Affordable Care Act is only about consolidating the health industry into global corporations and is only profit-driven. So, these 'forced' staffing changes and quality of care is simply the BOOZ first step to a lean and mean profit machine that is the US health care industry. None of the policies work to reign in on massive health industry fraud in the $200-400 billions each year. In fact these global health systems will be as unaccountable as Wall Street so they will prey on the public. So whether Third Way corporate democrats or republicans...the goal is global and profit with lost patient access and quality! JUST GET RID OF YOUR INCUMBENT AND RUN AND VOTE FOR LABOR AND JUSTICE.
Booz & Company strongly believes that consumerism is a revolutionary force that will fundamentally alter the status quo in the health industry. We work with our clients—payors, hospitals and health systems, and life sciences companies—as they seek to understand all the implications of this new world and become leaders in the consumerization of healthcare.
AMA: Cuts to physicians who treat Medicare patients hurt jobs, patient access and Medicare modernization
Jeremy Lazarus, MD | Policy | September 13, 2012
A guest column by the American Medical Association, exclusive to KevinMD.com.
Physicians contribute significantly to both the health of our patients and the economic health of our nation, and a new report shows that the 2 percent Medicare spending sequestration cut will put the jobs supported by the health care industry in jeopardy.
The AMA recently teamed up with the American Hospital Association (AHA) and the American Nurses Association (ANA) to release a new study showing that hundreds of thousands of jobs will be lost due to the Medicare sequestration cut dictated by the Budget Control Act.
Right now, we have an aging population of baby boomers who need the health care Medicare makes available, and we also have Americans who are grateful to have – or are looking to find – the good jobs the health care system provides. Common sense tells you that this is not a good time to take a hatchet to health care, which saves American lives and puts Americans to work.
The new report gives us a first look at the direct and indirect employment impact of the sequestration cuts to Medicare. It estimates that during the first year of this sequester, more than 496,000 jobs will be lost, and this number will grow to a job loss of 766,000 by 2021. Coupled with the looming 27 percent cut in payments to physicians who treat Medicare patients caused by the flawed Sustainable Growth Rate enacted by Congress, this sequestration cut will hurt patient access to care and will insert more uncertainty into Medicare. We need stability in the Medicare program as we work to promote high quality, high value, better coordinated patient care.
Payments to physicians who treat Medicare patients have been nearly frozen for a decade while the cost of caring for patients has increased by more than 20 percent, creating a huge gap between Medicare payments and the cost of providing care to seniors. Those who rely on Medicare for their health care already face roadblocks to physician access: according to a 2010 MedPAC survey, about one in four Medicare patients looking for a new primary care physician has had trouble finding one.
As we look to shape the health care system of the future that focuses more on keeping patients healthy and coordinating their care, physician practices must make investments in technology, hiring new staff and training for their current staff. The impending sequester, paired with more than a decade of essentially flat Medicare payments, denies practices the resources they need to make these investments in the future of health care.
As part of the AMA’s new strategic plan, we currently have the opportunity to improve and restructure care delivery and payment policy. Physicians have already begun transitioning into alternative payment and delivery models, both in Medicare and the private payer market, and many ground-breaking innovations are already underway. It is critical that we continue our work to modernize physician practices and support the coordinated care that can improve patient health and prevent costly complications.
Congress must take action to remove the threat of an impending cut to physicians who care for Medicare patients. The AMA, along with state and specialty medical societies, sent a letter to Congress today urging the passage of legislation to nullify the sequestration cut. To prevent widespread patient access problems, significant job losses and slowed progress toward Medicare innovation, we must have stability in payments for those who treat Medicare patients.
- See more at: http://www.kevinmd.com/blog/2012/09/ama-cuts-physicians-treat-medicare-patients-hurt-jobs-patient-access-medicare-modernization.html#sthash.iwiJDzR9.dpuf
Now, Medicare Advantage is known to be a driver of wasteful Medicare spending and it is based on the fact that it is handled by private insurance companies and not with normal Medicare administration so the private margins are too high. It is also with Advantage that all of that much toted 'doc fix' originates. All of this sucks billions of dollars from Medicare and it simply gives more affluent people access to specialty care.
The main source of cost savings that was to come from doctors and business was tied to these cuts to Medicare Advantage. You see in this article the republicans love this because it is a profit-maker for business on the backs of this public program.
More funds go to Medicare Advantage
Published: April 2, 2013 at 11:36 PM WASHINGTON, April 3 (UPI) --
After a bipartisan push by 160 members of Congress, the U.S. government said Medicare Advantage plans for seniors won't be cut 7 percent to 8 percent in 2014.
The Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services, announced a growth rate for Medicare Advantage of 3.3 percent for 2014, instead of the rate released last February of a decrease by 2.2 percent.
Carl McDonald, Citi managed care analyst, told clients in a report in February the typical for-profit managed care plan targets profit margins of only 5 percent, and non-profits even less, therefore the original anticipated cut to Medicare Advantage would "turn almost every plan in the industry unprofitable," Forbes magazine reported.
Karen Ignagni, chief executive officer of America's Health Insurance Plans, the national trade association representing the U.S. health insurance industry, applauded the reversal by CMS.
"By being responsive to the more than 160 members of Congress from both parties who raised concerns about the impact of the proposed payment rate on seniors, CMS has taken an important step to help stabilize Medicare Advantage at a time when the program is facing significant challenges," Ignagni said in a statement.
America's Health Insurance Plans' Coalition for Medicare Choices represents more than 1.3 million Medicare Advantage beneficiaries who since 1999 participated in dozens of town hall meetings and rallies involving members of Congress and staff, wrote hundreds of letters to the editors of newspapers and made more than 1 million contacts with their members of Congress, AHIP said.
In February the Coalition for Medicare Choices initiated a TV ad campaign that featured seniors with Medicare Advantage plans sharing their concerns about what cuts to Medicare Advantage would mean to them.
In response to the ad, more than 40,000 Medicare Advantage beneficiaries contacted Congress urging their representatives to contact CMS to oppose the cut before it was to be finalized April 1, AHIP said.
Alyene Senger, research assistant for health policy studies at the Heritage Foundation in Washington, said the Medicare Modernization Act of 2003 offered Medicare beneficiaries Medicare Advantage plans, provided by private health insurance companies, instead of receiving their benefits via the original Medicare plan Parts A and B.
However, in 2003 the physician fee cuts were perceived as too high and ever since then, Congress has overridden the legislation -- with the so-called doc fix. For the last 10 years the physician fee reduction was overridden by Congress, compounding each year, with a 25 percent reduction expected for next year, Senger said.
CMS incorporated the assumption that Congress would later this year override the physicians' fee reduction because it was a more reasonable expectation than the reduction required under sustainable growth rate formula, Senger said.
"The CMS decision to not cut Medicare Advantage the expected 2.2 percent allows the plans and benefits to stay pretty much the way they are for now," Senger told United Press International. "However, one of the parts of the Affordable Care Act was to bring Medicare Advantage costs down to the cost of traditional Medicare by 2017."
The GOP-controlled Congress allowed private HMOs to compete for Medicare patients under the rationale that the efficiency of private business and the competition among many private health insurance plans would reduce the expenses for the healthcare of seniors better than traditional Medicare run by the government.
However, these savings never materialized so Congress boosted the reimbursement to Medicare Advantage, which now gets paid 114 percent what traditional Medicare gets paid to care for a patient. This extra 14 percent -- a taxpayer subsidy -- cost the government from $795 per beneficiary in 2004 to $1,138 in 2009, a study by George Washington University found.
The share price of private health insurance companies Humana, UnitedHealth Group, Aetna, Cigna and WellPoint -- the private health insurance companies that provide most of the Medicare Advantage plans -- rose from 4 percent to 8 percent Tuesday, CNN/Money reported.
Justin Simon, an analyst for Washington research firm Heights Analytics, said the government's decision to cancel the Medical Advantage cut was done to curry favor with U.S. Senate Republicans to clear the way for the confirmation of CMS acting Director Marilyn Tavenner, CNN/Money reported.
CMS has had six acting administrators since 2006, but none was confirmed by the Senate, and with the Affordable Care Act going into effect later this year it's critical a CMS chief be confirmed as soon as possible, Simon said.
"Medicare Advantage is a beloved program of the Republican Party," Simon told UPI. "Medicare Advantage is polarized and partisan and for better or for worse the GOP showed the ability to defend the program from some fairly significant cuts."
Let's not forget that it was Obama and Third Way corporate democrats in the Senate that made it OK to take Medicaid out of Federal protection and sent it to states to decide how to fund....along with massive cuts to funding. The idea of Medicaid expansion is simply sending people to a program that is being made into a public health service with very little health care. THIS NEEDED TO BE DONE TO MAKE HEALTH CARE PROFITABLE...REMEMBER, HEALTH FRAUD TO MEDICARE AND MEDICAID IS IN THE HUNDREDS OF BILLIONS EACH YEAR!
Medicaid cuts could come from Democrats
The administration's Medicaid proposal has Jay Rockefeller nervous. | Jay Westcott/POLITICO
Close By J. LESTER FEDER | 6/28/11 11:26 PM EDT Defenders of Medicaid have been fighting hard against Republican proposals to cut the program, but they’re just waking up to the threat of one proposed by the Obama administration.
It’s an idea to change the way federal matching funds work and save money in the process — and it would probably do it by shifting costs to the states. If that happens, Medicaid advocates fear, the states will just pass on the cuts to providers and, ultimately, the patients.
In the budget blueprint unveiled in April, President Barack Obama proposed adjusting the way federal matching funds paid to the states are calculated for Medicaid and its companion, the Children’s Health Insurance Program. Sources close to the administration tell POLITICO that White House officials have been trying to develop the idea into a version that could become part of a deal in the ongoing deficit reduction talks.
Today, state dollars in these programs are matched at different rates for different populations. For the Medicaid population, under the matching formula known as the Federal Medical Assistance Percentages, the federal government pays an average of about 57 percent of the national costs. For CHIP, the rate is about 70 percent.
And when the Patient Protection and Affordable Care Act expands Medicaid coverage starting in 2014, the federal government will initially pick up all of the costs of the new population entering the program, then scale back to 90 percent in later years.
The administration wants to create what’s known as a “blended rate” for these programs, recalculating the levels so states receive federal dollars at the same rate for all populations in joint state-federal health programs. And in the process, they want to contribute to Medicaid savings totaling $100 billion.
This has Sen. Jay Rockefeller (D-W.Va.) nervous.
“What we know is that in order to generate ‘at least $100 billion’ in savings, any blended-rate proposal would have to severely reduce federal Medicaid and CHIP payments to every state over time, with some losing a lot more than others,” Rockefeller said. “And the underlying needs and costs don’t disappear — they just move from the federal side of the ledger to the state side.”
“Such a substantial cost shift to already financially strapped states would force states to reduce or eliminate Medicaid coverage, cut provider payments even more and completely undermine the Children’s Health Insurance Program. This is not a viable option and would spawn a formula fight among the states,” he said.
One reason little attention has been paid to the blended-rate proposal is that the administration has been noticeably silent on it. The only public information it has released on the plan came in the fact sheet accompanying the president’s April speech, which contained a single sentence on the issue that also references introducing a new mechanism for enhanced federal support during hard economic times.
“The president’s framework would replace the current complicated federal matching formulas with a single matching rate for all program spending that rewards states for efficiency and automatically increases if a recession forces enrollment and state costs to rise,” it reads.
But despite the public silence since then, White House officials have been actively developing a detailed proposal that could be part of a budget deal, sources close to the administration say.
This information void has led advocates to hold their fire, especially in the face of threats that were getting a lot of public attention: block-granting the program, capping federal expenditures or repealing Affordable Care Act prohibitions on cutting the program in the run-up to 2014.
Read more: http://www.politico.com/news/stories/0611/57976.html#ixzz2W1kEo84R
Let's be clear....It has been Third Way corporate democrats in Obama and the Senate that came into this crisis with no intention of holding corporations responsible for tens of trillions of dollars in fraud and tax evasion and it is the same Third Way corporate democrats who gave a record amount of tax protection to the rich and corporations these few years. THEY ARE THE ONES RESPONSIBLE FOR WHAT IS HAPPENING TO THE POOR. Education reform is about closing schools and creating charters to privatize and marginalize the poor. Health care reform was all about creating global health systems that are purely profit-driven so there is no intent or keeping entitlements. Obama and the Senate were the ones who sent Medicaid control to the states with massive cuts knowing the poor would lose their health care access for goodness sake. The Justice Department has been missing in action for all kinds of civil liberties/civil rights/ and simple Rule of Law that protects the poor and middle class and that is Third Way corporate democrats doing this!
STOP ALLOWING CORPORATE DEMOCRATS TO SHIFT THE BLAME......RUN AND VOTE FOR LABOR AND JUSTICE NEXT ELECTIONS!!!!
NC state senator dismisses protests as ‘circus’
Meredith Clark, @MeredithLClark11:16 AM on 06/09/2013 MSNBC
Protests at the North Carolina state capitol may be growing steadily, but that’s not enough to make one Republican lawmaker take the weekly acts of civil disobedience known as “Moral Mondays” seriously.
State senator Thom Goolsby, whose New Hanover County district includes the city of Wilmington, wrote an op-ed in the Chatham Journal deriding the demonstrations, even going so far as to suggest the “Loony Left” coalition of civil rights leaders, clergy, and North Carolinians of all ages, races, and class backgrounds should have named the action “Moron Monday.”
After he touted Republican policies that have decimated public education funding, health care, and voting rights, Goolsby dismissed the protesters as part of a radical fringe.
“The old hippies have found a new hobby and have once again fallen in love with the sound of their own voices,” Goolsby wrote.
Reverend William Barber, President of the North Carolina NAACP and a leader of the protests, says that the protests, at which more than 300 people have been arrested over six weeks, will continue. “The issue here is [the far right] policies are so extreme and immoral that when exposed it makes them respond in a frenzy of vitriolic words,” Barber wrote in an email. The power of Moral Monday is that it shines a light on attitudes and actions that mighy have otherwise gone on without the public knowing.”
This week activists have planned both “Moral Monday” and “Witness Wednesday” actions.
Correction: An earlier version of this story incorrectly stated that State Senator Thom Goolsby’s district included Charlotte. In fact, the New Hanover County district that he represents includes the city of Wilmington.
Illinois is a Third Way corporate democratic state as is Maryland and they both took an ax to Medicaid. Obama is from Illinois. All of these pols have overseen government as health fraud was and is rampant......they know where the entitlement money went!!!!
Medicaid proposal makes nearly $1.4 billion in cuts
By Carla K. Johnson May 21, 2012 11:00PM
Illinois moved closer to drastic Medicaid cuts Monday with proposed legislation that could excise nearly $1.4 billion from the state’s program by shrinking benefits, such as regular adult dental care, and cutting payments to most hospitals and nursing homes.
The measure, backed by Gov. Pat Quinn, falls short of the $2.7 billion in cuts that Quinn originally said would be needed to prevent the health care program for the poor and disabled from collapsing.
Legislative sponsors said revenues, including Quinn’s proposed $1 cigarette tax increase, will be dealt with separately, and are needed to make the plan work.
“I honestly believe it is just not doable” without the cigarette tax, said Sen. Heather Steans, a Democrat who served on a four-member bipartisan Medicaid committee.
The measure, filed as a House amendment to a Senate bill, includes $240 million in payment rate cuts to hospitals and nursing homes. But it spares doctors from rate cuts, along with 51 rural community hospitals and about 20 urban hospitals that care for poor patients.
The legislation eliminates most dental care for adults, but keeps emergency dental care. It limits adult eyeglasses to one pair every two years, pays the same amount for cesarean sections as for vaginal deliveries — unless the C-section is medically necessary — and limits podiatry care to people with diabetes.
The bill would eliminate Illinois Cares Rx, a program that helps nearly 200,000 seniors get prescription drugs, which concerns the AARP.
“Not only are they trying to balance the budget on the backs of Illinois seniors, but cutting Illinois Cares Rx will not help balance the budget,” said David Vinkler of AARP, who added that seniors will end up going to the hospital and nursing homes more often when they can’t afford their medications.
Medicaid payments to many hospitals would be cut by 3.5 percent, but the bill exempts rural community hospitals and safety-net hospitals from the cuts. Association of Safety-Net Hospitals spokeswoman Julie Sznewajs said Latino and black caucus members are “standing strong for their communities” by supporting the exception.
“Lawmakers are hearing loud and clear that safety-net hospitals play a critical role in treating the poor and underserved,” Sznewajs said. A spokesman said the Illinois Hospital Association also is still evaluating the bill.
Democratic Rep. Sara Feigenholtz, a sponsor of the legislation and a Medicaid work group member, said she expects a vote in the House on Wednesday or Thursday. She said she hopes some Republicans can support the approach.
“There’s been a great deal of goodwill built up on this long camping trip,” said Feigenholtz said, referring to the negotiations that led to the measure, including the work of the bipartisan Medicaid committee. “I don’t want to speak for (Republicans), but I’m optimistic.”
Republican Sen. Dale Righter, who serves on the Medicaid committee, had some kind words for the legislation, but said he was not quite ready to call it bipartisan. Righter said he likes the section that — as he puts it — “cuts up the state’s Medicaid credit card.”
Illinois has been able to delay Medicaid payments by pushing them into the next fiscal year, but the bill would phase that out, something Righter called an “important long-term reform.”
At a Monday press conference in Springfield, Quinn said the next 10 days are “crucial, really, for not just today but for our kids.”
“We must restructure our Medicaid system to prevent collapse and we must reform our pension system so we don’t have an ocean of liability that confounds Illinois for years to come,” Quinn said.
The governor dismissed questions about gambling expansion, saying he won’t let himself be distracted from more important issues and hopes lawmakers won’t either.
“Sometimes down here, shiny objects can distract people. We don’t want any of that,” Quinn said. “My job as governor is to keep my eye on the ball and to try to keep all the legislators’ eye on the ball.”