Health Reform

The votes are in. State insurance regulators, from the National Association of Insurance Commissioners (NAIC), voted unanimously Thursday morning on definitions for the Medical Loss Ratio (MLR). The “medical loss ratio” refers to the amount of money insurers spend on providing actual health and medical care to their customers. The Affordable Care Act sets minimum standards for the MLR -- large, group insurers have to spend at least 85 percent of their money on medical care (it’s 80 percent for small group or individual policy insurers). That means that only 15 percent can go to expenses that don’t specifically improve patient health, like administrative overhead and advertising costs.

The NAIC spent the week in Florida trying to reach a consensus on MLR policy -- answering questions like: what counts as “medical” spending? Will the MLR calculation take place at the state or national level? And how do we account for changes in the role of brokers in the new insurance marketplace? HHS will rely heavily on the NAIC recommendations to craft final regulations.

Jordan Rau of Kaiser Health News has penned a must-read on rapidly rising hospital prices in California that lays out in compelling detail some of the factors that drive sharp differences particularly within local communities. If you are concerned about provider costs continuing to rise in the wake of reform (as you must be if you care about health policy) you should go over and read the whole thing.  

One of the things that jumped out for me was further documentation of the connection between market share and payment rates. We hear a lot about this issue as it relates to differences across regions but this dynamic plays out within local communities as well:

State government officials should not step in and block portions of the health care reform law that they disagree with. The law was intentionally designed to empower state and local authorities; they have the power to adapt and transform the law according to their unique market needs. If governors and their appointees refuse to implement the law, then the millions of Americans who have been waiting for solutions for their health care to improve will need to exercise their democratic ability to influence the process.

Jim Abrams of the AP has a good overview piece on the remarkably productive Congress -- everyone may yell about gridlock but this Congress has passed a historic health care bill, the economic stimulus package, Wall Street accountability (not to mention making college loans more affordable, Cash for Clunkers to help revive the auto industry, credit card consumer protection, tax credits for first-time home buyers, and regulation of tobacco, to name a few).

It’s the most productive Congress, Abrams quoted several experts as saying, since the Great Society years, when a Democratic-led Congress created Medicare, Medicaid and passed civil rights laws -- and then got hammered in the next election.

The expert public opinion analysts over at the Kaiser Family Foundation took a deeper look into the polling numbers on the repeal of health reform, and it turns out we are not the only ones skeptical about the supposed clamor for repeal:

When it comes to understanding public opinion on the new health reform law, poll watchers might be forgiven for being confused as to whether repeal is actually a popular option or not. Over the course of the past month, at least eight well-respected polls have asked Americans whether they support the idea of repealing health reform, and, as the chart [here] shows, responses have been all over the map, ranging from a high of 51 percent in an NBC News/Wall Street Journal poll to a low of 26 percent in our September Kaiser Health Tracking survey.

This week's Health Wonk Review is up over at the Healthcare Economist, where -- inspired by the daring rescue in Chile -- Jason Shafrin has MINED the Internet for the best in health policy writing. Joanne Kenen's continuing campaign for a rational discussion of palliative care makes the list. Aaron Carroll breaks down why the U.S. hasn't hit the health spending "sweet spot" like other OECD countries, but John Goodman doubts the ACA's three major cost cutting measures will succeed in getting us there. Meanwhile, the Notwithstanding Blog is skeptical of a government fighting obesity (a major indirect cost driver) while still subsidizing high fructose corn syrup. If you've been glued to your TV, you missed some great health policy blogging this week. Head over to the Healthcare Economist blog now and check it out!

So just how fast does that revolving door spin? The Kaiser Family Foundation this week released several reports on Medicare spending for people in nursing homes or other long-term care facilities.  Of course it's no surprise that these patients are expensive -- they wouldn’t be in nursing homes if they were in perfect health. But the reports shed a lot of light on just how expensive their care is -- and just how often they go in and out of emergency departments, the hospital, and skilled nursing facilities.

These patients cost Medicare $14,538 -- nearly twice the annual cost of the average Medicare beneficiary. (Remember that Medicare pays for doctors and hospitals and the like -- whether the person lives at home or in a long-term care (LTC) setting. Medicare does not pay for long-term care. Medicaid pays for the long-term care of low-income people.)

This post was originally published in iHealthBeat, www.ihealthbeat.org.

HHS recently released a package of regulations clarifying the definition of achieving "meaningful use" of electronic health record systems. Eligible providers and hospitals must meet the meaningful use criteria to qualify for government incentives and bonus payments for the adoption of EHR systems. The regulations signify a milestone accomplishment in moving forward our nation's commitment to the universal adoption of EHRs.

Each day, the American health care system conducts more transactions than the New York Stock Exchange, most of them on paper and at risk of human error. The Institute of Medicine estimates there are between 44,000 and 98,000 deaths attributed to medical errors each year, andwhile not all errors can be precluded by the adoption of EHRs, there is no question that standardized, interoperable systems will move us in the direction of improved quality and efficiency and reduced errors and waste.

If we want to improve quality and control costs in our health care system, we need verifiable, reliable information about what works and what doesn’t. Comparative effectiveness research (CER), which compares two or more medical treatments, tests, or interventions to see which one works better for patients, is the key to figuring this out.

The journal Health Affairs themed its October issue around the “new era” of comparative effectiveness research. The health reform law advances CER by establishing the Patient-Centered Outcomes Research Institute (PCORI), a public-private entity that will establish research priorities, set the agenda, and provide for research to be carried out. The GAO recently announced the members of the PCORI Board of Governors. (The GAO is home to the Comptroller General, who was in charge of board appointments).

One of the most unfortunate side effects of the way the right demonized health reform through the "death panel" fiction was that it made people, particularly older people, genuinely afraid that health reform would harm them, maybe even hasten their deaths. In truth, health reform holds the potential -- if we implement it well and build on it wisely -- to give people more choices about where and how they age and die, give them more opportunity for them to ensure that the treatment and services they get as they enter their final years is the treatment they want.