[…] If the goal of CMS is to reduce the number of “never events” – but not to discourage doctors from treating high-risk patients who may be more likely to suffer complications – it would seem to make more sense to evaluate reimbursement for “never events” on a case-by-case basis. Zero-tolerance policies rarely make sense when you consider all of the possible scenarios, and the “never events” list basically amounts to a zero-tolerance policy.
Archives for March 2011
Spending Caps Will Help Individual Families But Won’t Reduce Overall Costs
[…] But although the spending caps will be beneficial to families that have large medical expenses, they do nothing to actually address the rising cost of health care, and the over-utilization that is also driving costs. This has been a recurring theme with a lot of the provisions created by health care reform: we’re finding ways to spread the costs in a more equitable fashion, but we’re not really addressing the fact that the total cost burden of health care in this country isn’t sustainable on its current trajectory, no matter how much we spread it out across the population.
High Deductible Plans And Reduced Spending
[…] Most of us agree that we need to find a way to reduce overall healthcare spending, but we also need to make sure that we don’t compromise future healthcare outcomes in the process. While some of the issues mentioned in the study – such as the drop in routine blood tests for people with diabetes – are definitely concerning, we shouldn’t simply assume that a reduction in overall preventive care will automatically lead to poorer health in the future.
Covering Primary Care Expenses With A Clinic Membership
[…] It’s always good to see new innovations that help to expand access to healthcare, and clinic memberships that allow people to cover their day to day medical expenses with a predictable annual fee and low cost appointments is likely to be quite popular, especially among people who can’t afford comprehensive health insurance. But as with any other product, a clear awareness of what you’re purchasing (or being offered, if an employer is covering the cost) will help to avoid future surprises.
Senate Bill 200 Begins The Process Of Creating Colorado Exchange
[…] Senate Bill 200 (the Colorado Health Benefit Exchange Act), co-sponsored by Senator Betty Boyd (D – Lakewood) gets the ball rolling on the health insurance exchange that the state will have to have in place by 2014. Specifically, the bill would create a “nonprofit unincorporated public entity known as the Health Benefit Exchange”. It includes guidelines for the appointment of a 12-member board of directors (9 of whom will be voting members) who will oversee the exchange, and lays out their responsibilities. […]
Good Reading At Grand Rounds And The Cavalcade Of Risk
[…] I wrote last fall about the new high risk pool in Colorado – GettingUsCovered – and how it differs from our existing high risk pool, CoverColorado (which has been operating for two decades). In states like Colorado that have existing state pools in addition to the federally-backed pools, there may be adequate options for people with pre-existing conditions, assuming that funding for both programs holds out until 2014. But in states that only have a PPACA-created pool, there are definitely some cracks to fall through, including the requirement that applicants be uninsured for six months before they can join the pool.
United HealthOne Finally Changes Initial Charge Protocol
Good news for those applying to United HealthOne:
Beginning with applications received on March 24, 2011, the processing of credit card or EFT payment will not take place until the application is approved and issued.
It’s about time. It was tough to explain to clients “and yeah, they’re going to charge you before they’ve even made a decision.”
New CoverColorado Provider Fee Schedule
As of April 1, 2011, CoverColorado will be switching to a new fee schedule for reimbursing providers. In the past, CoverColorado has used the Rocky Mountain Health Plans provider network, and doctors were paid according to the RMHP network-negotiated rates when they treated CoverColorado members. The new CoverColorado-specific fee schedule applies to any provider who treats a CoverColorado member, regardless of whether that provider is part of the RMHP network or not. […]
Medicaid Outcomes – Separating Causation From Correlation
[…] But the shortage of doctors who will accept new Medicaid patients could definitely be seen as a significant obstacle to receiving care for people who rely on Medicaid to cover their healthcare costs. It’s likely that there is a long list of reasons why people on Medicaid have poorer health outcomes (and we have to be careful to not mistake correlation with causation). But it’s reasonable to assume that the difficulty Medicaid patients experience in finding a doctor isn’t doing anything to improve their health outcomes.
Makena – No Good Options For Health Insurers
[…] Over the last several years, most of the major health insurance carriers in Colorado have increased the out of pocket portion that an insured has to pay for prescriptions. Most individual policies now have prescription deductibles, and a lot of carriers have designated very expensive drugs as a separate tier that requires a percentage copay from the insured, rather than a flat amount. And of course, premiums continue to climb. The Makena story is an example of why this happens, and it has nothing to do with health insurance carrier profits. When insureds see their health insurance premiums skyrocket again, where do you think they will point their finger?
Does Colorado’s New Maternity Law Impact Underwriting?
[…] The language in the Division of Insurance FAQ page does seem to create some confusion on the issue. Stating that “A person who is already pregnant may obtain insurance at this time” could be interpreted in various ways… some might see it as saying that the person may obtain insurance if the carrier allows it (which none of them currently do), while others might see it as stating that the DOI interpretation of the law requires carriers to treat a current pregnancy as a specific exclusion rather than cause for an outright decline. […]
Maternity Coverage On Renewing Individual Policies
Since January 1, 2011, all new individual health insurance policies issued in Colorado have included maternity coverage as required by a new state law. The text of the bill was quite clear in stating that its provisions would apply to all “policies issued or renewed on or after the applicable effective date of this act.” (see the top of page 3 of the text). But until now, there was still some confusion around maternity coverage and policy renewals, and inconsistencies in how the law was being applied. […]
Using HRA Funds To Purchase Individual Health Insurance
[…] However, it appears that the Colorado Division of Insurance has repealed its 2009 order regarding the use of HRA funds to purchase individual health insurance. Final Agency Order O-11-064 details the questions involved (including issues regarding eligibility for CoverColorado) and concludes that “Self-funded employee benefit plans sponsored by a private company such as an HRA, are employee benefit plans under ERISA and are not subject to the jurisdiction of the Commissioner.” […]
Mandatory Health Insurance Does Not Prevent Medical Bankruptcies
[…] The study’s authors note that implementing mandatory health insurance rules is not likely to result in a significant decline in the number of medical bankruptcies nationwide unless we also focus on improving the level of coverage that people have (to reduce out of pocket exposure), and on expanding access to disability insurance that can help provide income to people who are unable to work because of a major illness or injury. […]
HHS Proposes Waivers To Allow States Flexibility In Healthcare Regulation
[…] Colorado has been taking an active role in reforming healthcare for some time now. And our legislators are obviously still focusing on healthcare reform at a state level, from several different angles. Based on the initiative the state has shown over the last few years, I’m guessing that if the state waivers are available from HHS as of 2014, Colorado will likely take advantage of the opportunity to craft at least some aspects of our own healthcare regulation.
A Bill To Extend And Enhance The Regulation Of Midwifery In Colorado
I often write about bills in the Colorado legislature that pertain to healthcare, but Senate Bill 088 is one that is particularly important to me on a personal level. The law in Colorado regarding the regulation of direct-entry midwives is up for review this year. SB 088 renews the existing regulations, and would also allow direct-entry midwives in Colorado to provide some additional services, such as sutures and the administration of Vitamin K to newborns and RhoGAM to Rh- mothers. […]
Colorado Bill Would Allow State To Opt Out Of Federal Healthcare Laws
The Healthcare Opportunity and Patient Empowerment (HOPE) Act (HB 1273) was introduced in the Colorado House of Representatives this week, with primary House sponsorship from Reps Nikkel and Stephens (the House majority leader), and primary Senate sponsorship from Senator Kopp. The idea behind HB1273 is to allow Colorado to legally opt out of the PPACA – not just the individual mandate portion, but the entire law. […]
The Complexities Of Tort Reform
Tort reform has long been a contentious topic in the healthcare reform debate. Many Republican lawmakers – on both a state and federal level – have proposed tort reform as one of the major platforms of their alternative healthcare reform proposals. It’s the sort of issue that people tend to see as black and white, but is really many shades of grey. […]