Healthy buzz

Stories and blog posts of interest on health care

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More Medicare data released today: How I’d use it

This morning, in conjunction with Health Datapalooza, the Centers for Medicare and Medicaid Services is releasing data, by hospital, on charges for the most-common inpatient stays in 2012 and what Medicare paid for them.

It did so for the first time last year after an uproar about hospital prices triggered by Steven Brill’s “Bitter Pill” story in Time Magazine.

Predictably the conversation around this data will focus on which hospitals raised their list prices the most from 2011 to 2012.

While there’s no question that medical costs are important—and becoming more important as patients pay a greater share of the bill—this data has two big limitations. (I’ll explain later why I still think it’s useful)

First, what Medicare pays isn’t determined by what a hospital charges. Instead, the federal government sets reimbursement rates based on a patient’s primary diagnosis, the hospital location and certain patient characteristics. Second, almost no one pays a hospital’s list price (the charges it submits to Medicare.) Private insurance companies all negotiate lower rates, and many patients without insurance receive charity care discounts.

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Data on Medicare payments to doctors set to be released next week

As early as next week, the federal  government will release a massive database on the payments made to 880,000 health care professionals serving seniors and the disabled in the Medicare program, officials said this afternoon.

The data will cover doctors and other practitioners in every state, who collectively received $77 billion in payments in 2012 in Medicare’s Part B program. “With this data, it will be possible to conduct a wide range of analyses that compare 6,000 different types of services and procedures provided, as well as payments received by individual health care providers,” Jonathan Blum, principal deputy administrator of the Centers for Medicare and Medicaid Services, wrote in a blog post today.

“Providing consumers with this information will help them make more informed choices about the care they receive.”

The data will be released as early as next Wednesday.

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Why every metric for judging Obamacare’s success is flawed

One day very soon, the focus on Obamacare will turn from signing up new enrollees to quantifying the law’s success—or failure.

The six-month open enrollment period, during which consumers sign up for health plans under the Affordable Care Act, is supposed to end today. But the U.S. Department of Health and Human Services, as well as many states running their own marketplaces, are giving some extra time to consumers who’ve had trouble signing up.

It’ll probably all wrap up by April 15. Then, the final numbers will be tallied and the pronouncements will begin. Politicians on both sides of the aisle will use the same data to proclaim that they were right about the law.

Last Thursday, the Obama administration said that more than 6 million people have signed up for coverage on the health insurance exchanges, meeting the projections set out by the Congressional Budget Office. Republicans have countered by questioning how many enrollees have paid their first month’s premium, the final step necessary for coverage to be in effect.

Dr. David Blumenthal of the Commonwealth Fund recently told me that any attempt to review the success of the law must go beyond those who sign up for coverage on the exchanges. It should include those who gained coverage through the expansion of state Medicaid programs for the poor, as well as young adults who are now able to stay on their parents’ health plans because of the law.

“I think the real success of the law will be judged over 5 years, not six months,” he said. “In fact, this president, President Obama, has until January 2017 to establish it as a fixture in the American social policy firmament.”

That may well be true, but now seems like a reasonable time to take stock. So, how should success—and ultimately the law itself—be judged? Here’s what some experts are saying about which metrics to use and the problems with each.

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Smokers fuming after glitch costs them Obamacare coverage

(Photo courtesy of Terry Wetherby)

Retired New Hampshire nurse Terry Wetherby doesn’t hide the fact that she smokes.

She checked the box on HealthCare.gov saying she uses tobacco and fully expected to pay more for her insurance policy under the Affordable Care Act. “It’s not a secret at all,” she said.

Wetherby dutifully paid the premium Anthem Blue Cross and Blue Shield charged her for January and again for February—and believed she had coverage effective on Jan. 1.

Then when Wetherby went to pay her March premium, she was told she couldn’t. A check arrived in the mail refunding her February premium with a two-word explanation: “Contract cancelled.”

Turns out, Wetherby was among about 100 smokers in New Hampshire caught up in a “technical glitch” that caused them to lose their new health insurance policies because they had been mistakenly charged non-smoking rates, according to the New Hampshire Department of Insurance.

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As Obamacare deadline nears, conservative author finds little to praise

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(Photo credit: American Enterprise Institute)

The final countdown is under way to sign up for health insurance under the Affordable Care Act before this year’s open enrollment cycle closes on March 31. Assuming the deadline is not extended by the Obama administration, most consumers won’t be able to sign up for health insurance again for many months.

After a disastrous rollout, enrollment via HealthCare.gov and state insurance exchanges has picked up, and recently surpassed the 5 million mark. But it’s unclear how many consumers have paid their first month’s premium (a prerequisite for having coverage) or how many were previously uninsured (the target demographic for the law).

In recent months, we’ve checked in with insurance consultants and officials at the Kaiser Family Foundation and Commonwealth Fund to get their views about how the law is working. Today, we check in with Dr. Scott Gottlieb, a resident fellow at the American Enterprise Institute. It’s no secret that Gottlieb, a physician and former deputy commissioner at the Food and Drug Administration, is critical of the law. He’s written lucidly about it for Forbes and others.

This interview has been edited for length and clarity.

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Best reads on Obamacare enrollment

There have been a flood of stories, including one by me, about what we can learn from the Obamacare enrollment numbers released by the U.S. Department of Health and Human Services earlier this week. Here are some of the more-insightful reads:

A guide to understanding Obamacare’s sign-up numbers, by Sarah Kliff, Washington Post

Implementing Health Reform: A January Exchange Enrollment Report, by Timothy Jost, Health Affairs blog

Subsidized exchange enrollment data and trends, by state, by Galen Benshoof, The Incidental Economist

Sorry, Conservatives: Based On The Latest Sign-Up Figures, There Won’t Be An Obamacare Death Spiral, by Avik Roy, Forbes

Most states lag in health insurance sign-ups, by Ricardo Alonso-Zaldivar and Kevin Vineys, AP

For Many, Few Health-Plan Choices, High Premiums on Online Exchanges, by Timothy W. Martin and Christopher Weaver, the Wall Street Journal

One-Fifth of New Enrollees Under Health Care Law Fail to Pay First Premium, by Robert Pear, New York Times

Finally, be sure to check out the Kaiser Family Foundation’s data. Way cool.

Happy reading

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When a university hospital backs a surgical robot, controversy ensues

Flipping through the New York Times magazine a few Sundays ago, former hospital executive Paul Levy was taken aback by a full-page ad for the da Vinci robot.

It wasn’t that Levy hadn’t seen advertising before for the robot, which is used for minimally invasive surgeries. It was that the ad prominently featured a dozen members of the surgery team at the University of Illinois Hospital and Health Sciences System. “We believe in da Vinci surgery because our patients benefit,” read the ad’s headline.

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(Photo by Paul Levy)

“While I have become accustomed to the many da Vinci ads, I was struck by the idea that a major university health system had apparently made a business judgment that it was worthwhile to advertise outside of its territory, in a national ad in the New York Times,” Levy, former chief executive of the prestigious Beth Israel Deaconess Medical Center in Boston, told me by email.

As Levy scanned the ad further, he noticed that at the bottom the ad bore a copyright for Intuitive Surgical Inc., the maker of the da Vinci system. It included this line: “Some surgeons who appear in this ad have received compensation from the company for providing educational services to other surgeons and patients.”

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