If The Health Care Overhaul Goes Down, Could Medicare Follow?, from Julie Rovner of NPR

A growing number of health experts are warning of potential collateral damage if the Supreme Court strikes down the entire 2010 Affordable Care Act: potential chaos in the Medicare program.

"The Affordable Care Act has become part and parcel of the Medicare system, encouraging providers to deliver better, more integrated, better coordinated care, at lower cost," says Judy Feder, a public policy professor at Georgetown University and former Clinton administration health official. "To all of a sudden eliminate that would be highly disruptive."

Sara Rosenbaum, a professor of health law and policy at George Washington University, puts it a bit more bluntly: "We could find ourselves at kind of a grand stopping point for the entire health care system."

And it's not just Democrats warning of potential problems. Gail Wilensky, who ran Medicare and Medicaid under President George H.W. Bush, says she doesn't think it's likely that the court will strike down the entire health law. But if it does, she says, "it seems like it takes everything with it, including those aspects that are only very peripherally related to the expansion of coverage."
So why are experts so worried?

One reason is that the law changed the payment rates for just about every type of health care professional who treats Medicare patients. Every time Medicare sets a payment rate, it needs to cite a legal authority. And for the past two years, says Rosenbaum, that legal authority has been the Affordable Care Act.

So if the law is found unconstitutional, she says, every one of those changes "doesn't exist anymore because the law doesn't exist."

And the result? "You have agencies sitting on two years of policies that are up in smoke," she says. "Hospitals might not get paid. Nursing homes might not get paid. Doctors might not get paid. Changes in coverage that have begun to take effect for the elderly, closing the doughnut hole might not happen. We don't know."

more...

A gathering storm of federal regulations, Op-ed from AMEDnews.com

Overlapping and sometimes conflicting requirements on physicians will prove overwhelming to many practices unless they are changed.

Editorial. Posted April 30, 2012.

A storm is brewing, and many physicians are worried that they won’t be able to batten down the hatches in time.

Physicians are right in the center of the paths of multiple, colliding fronts in the form of more federal requirements, in particular under the Medicare program. The sheer size and timing of the increased regulatory burdens are raising serious concerns that some practices will founder when those rules hit them.

• See related content

Preparing for just one of these new requirements is a significant undertaking for a physician practice, especially a small one. Upcoming requirements that doctors adopt and use electronic health records systems, prescribe medications electronically, report quality information to the government, and upgrade their claims reporting systems each demand significant time and resources that are hard to come by for many practices.

But what will happen when these requirements all kick in at about the same time? Physicians and their staffs will be struggling to meet overlapping deadlines, tackle implementation problems that arise and resolve conflicts among mandates that in some cases were authorized under different pieces of legislation. They will be doing all of that while worrying about the next scheduled Medicare pay formula cuts and deep, automatic deficit reduction cuts that are set to slash physician rates even more.
Amid all the complexity and confusion, some physicians might not even realize how soon the trouble might arrive.

more...

5 Key Facts Must Inform the Medicare Reform Debate, from PR News Release

press release

April 26, 2012, 2:02 p.m. EDT

WASHINGTON, April 26, 2012 /PRNewswire via COMTEX/ -- NCOA Issues Statement on the 2012 Medicare Trustees Report

The April 23 release of the Medicare Trustees Report provides an important opportunity to better understand the challenges the nation faces in strengthening and improving Medicare for the future.

To inform the debate, the National Council on Aging (NCOA) has issued an analysis of five key facts that it believes must be understood and considered as policymakers look for solutions to keep Medicare strong for current and future older adults.

"We need to move beyond political spin and hyperbole to focus on the facts so that we can make informed, rational decisions about Medicare's future," says Howard Bedlin, NCOA Vice President for Public Policy and Advocacy. "In June, NCOA will become chair of the 68-member Leadership Council of Aging Organizations coalition ( www.lcao.org ) for one year. Protecting and strengthening the Medicare program will be a top priority during our term."

The 5 key facts include:

Medicare "solvency" only applies to Part A Hospital Insurance (HI) and can be misleading. It is untrue to state that Medicare will be "insolvent," "bankrupt," or "go broke" in 2024. There are four parts to the Medicare program (A, B, C, and D), and reports on solvency only apply to Part A Hospital Insurance. In 2024, 87% of Part A benefits could be paid for. Therefore, it is more accurate to state that in 2024 there will be a shortfall in the Medicare Part A Hospital Insurance Trust Fund.

more... http://www.marketwatch.com/story/5-key-facts-must-inform-the-medicare-reform-debate-2012-04-26

What patients pay: Dr. Don Berwick and Jim Capretta debate shifting health care costs

Already there’s a growing trend in health care to move more of the cost of care onto patients in an effort to make them think twice about what they need and how to protect and their financial interest. In Massachusetts, for example, enrollment in limited or tiered health plans is on the rise. Such plans offer cheaper premiums but penalize people for using providers thought to be higher cost.
Dr. Don Berwick, former administrator of the Centers for Medicare & Medicaid, and Jim Capretta, who serviced as associate director at the White House Office of Management and Budget under President George W. Bush, took sharply different stances on what shifting costs to patients could mean during a wide-ranging debate last night hosted by the Pioneer Institute.

Berwick, now a senior fellow at the Center for American Progress, called the idea of giving patients more “skin in the game” a “vicious idea.”

“Most people do not use health care as a recreational good,” he said.

http://www.boston.com/Boston/whitecoatnotes/2012/04/what-patients-pay-don-berwick-and-jim-capretta-debate-shifting-health-care-costs/ecIrKifQiqwTsiQfYweZ5K/index.html

Grassley, Kohl push Medicare on Sunshine Act

Sens. Chuck Grassley and Herb Kohl push the Centers for Medicare & Medicaid Services to issue its final ruling on implementation no later than June. Is that enough time for medical device and pharmaceutical companies to prepare?

A bipartisan duo in the U.S. Senate is again pushing the Centers for Medicare & Medicaid Services to finalize the Sunshine Act, which requires medical device and pharmaceutical companies to file detailed reports on payments and gifts to physicians and other health care providers.
In an April 4 letter to CMS chief Marilyn Tavenner, Sens. Chuck Grassley (R-Iowa) and Herb Kohl (D-Wis.) said they're disappointed that CMS blew the October 2011 deadline for implementing the Sunshine Act.
"We request that the final rule on implementation be released no later than June of this year so that partial data collection for 2012 can commence," the senators wrote (PDF). "We also strongly urge CMS to work closely with stakeholders to finalize these rules to that they comprise a feasible approach to providing the valuable data that patients deserve."

for entire article,
http://www.massdevice.com/news/grassley-kohl-push-medicare-sunshine-act

Health IT impact of Supreme Court decision depends on extent of ruling

http://www.fiercehealthit.com/story/health-it-impact-supreme-court-decision-depends-extent-ruling/2012-04-02?utm_medium=nl&utm_source=internal 

When the U.S. Supreme Court heard oral arguments about the constitutionality of the Affordable Care Act (ACA) last week, the news media went a little crazy. Despite the evident skepticism of some justices about the individual mandate to buy insurance, there still is no reason to assume that the High Court will knock down the entire healthcare reform law--or even the individual mandate. One or more swing votes are still in play, and nobody has a crystal ball that can forecast the outcome.

But from the perspective of health IT, whether the court chooses to strike down just the insurance mandate or the entire law is critically important. As the Health Information and Management Systems Society (HIMSS) pointed out recently, the statute includes provisions related to "quality reporting initiatives, pay-for-performance initiatives, adoption of state HIEs, operating rules and standards, and health IT work force development."

That's just the beginning. The business model for accountable care organizations (ACOs) is based partly on the Medicare shared savings program authorized by the law--and ACOs cannot exist without a robust IT infrastructure. The ACA also authorizes a bundled payment pilot that depends on coordination of care between hospitals and post-acute-care facilities. And another ACA provision requires Medicare to levy penalties for excessive readmissions, forcing hospitals to bolster their ability to communicate with other providers and patients.

Read more: Health IT impact of Supreme Court decision depends on extent of ruling - FierceHealthIT http://www.fiercehealthit.com/story/health-it-impact-supreme-court-decision-depends-extent-ruling/2012-04-02?utm_medium=nl&utm_source=internal#ixzz1qugKrIcw
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What's impact on N.J. if health care law overturned?

http://www.app.com/article/20120328/NJNEWS/303280072/What-s-impact-on-N-J-if-health-care-law-overturned-

Written by
Bonnie Delaney, Asbury Park Press, Staff Writer
 

Love it or hate it, the Affordable Care Act has already helped New Jersey’s senior citizens save an estimated $95 million by closing the Medicare prescription plan doughnut hole. As of last June, 2.5 million young adults nationwide have gained coverage through a provision that requires employers and health insurers to allow them to stay on their parents’ plans until they turn 26.

But those popular components of the act — as well as many others like guaranteed coverage for people with pre-existing conditions — could be lost if the U.S. Supreme Court strikes down the 2010 law passed by Congress and challenged by 26 states as unconstitutional, said Joel C. Cantor, director of the Rutgers Center for State Health Policy and a professor of public policy at Rutgers...

BEHIND THE NEWS

An August 2011 report by the Rutgers Center for State Health Policy, headed by Joel C. Cantor, said the following estimates of changes in coverage could be expected with implementation of the Affordable Care Act:

• The number of uninsured in New Jersey will decline from 14.5 percent of the non-elderly population to 8.6 percent, increasing the number of covered people by about 444,000.
• The non-group health insurance market will gain the most covered individuals, increasing from 2.8 percent of the non-elderly to 7.6 percent, an increase of about 362,000 people. Of those enrolled in non-group coverage after reform, more than half would be eligible for federal tax credit subsidies.
• Medicaid/NJ FamilyCare also will expand substantially under reform, increasing from covering 13.6 percent to 16.7 percent of the non-elderly in the state, an expansion of about 234,000 individuals. More than half of this projected increase will be non-parent adults (132,000), although it is projected that the number of enrolled children will also increase.
• The percentage of people with employer-sponsored coverage will decline slightly.