Patient Choices May Narrow As Insurers Adjust To Healthcare Overhaul.

The Chicago Tribune (9/5, Japsen) says the federal healthcare overhaul's focus on quality "implies that consumers will get better care because doctors and hospitals will be measured against the best performers, but there may be an unintended consequence: It could leave patients with fewer choices of medical care providers, depending on which health plans they purchase. ... Among measures to ensure quality, the law requires state-regulated health plans, largely those selling policies to individuals and small to medium-size businesses, to spend at least 80% of premium dollars on medical care. That's squeezing insurers' profits. As a result, health plans are using the quality measures as a way to scale back choices of doctors and hospitals in certain networks."

        With a similar focus, the Minneapolis Star Tribune (9/5, Yee) says the White House "is hoping that the measures will help quell critics of the healthcare law, turning it from a promise and an abstraction in people's minds to a program with real-life benefits. Many of the looming fixes address items that have infuriated consumers about their health insurance over the years. In addition to allowing all kids to stay on their parents' insurance until age 26, the new provisions include preventing insurers from denying coverage to sick kids, gradually closing the doughnut hole that leaves a gap in seniors' drug coverage, and doing away with caps on annual and lifetime medical costs."

Mental Health Parity Act Could Affect About 113 Million Americans.

The Los Angeles Times (9/6, Worth) reported that "the Mental Health Parity and Addiction Equity Act of 2008, by some estimates, could affect the health coverage of approximately 113 million Americans," yet exactly "how it will affect them...will vary widely." Employees of larger companies "will see mental coverage given equal treatment with medical coverage," but "the effect on out-of-pocket costs is unclear," noted the Times. The purpose of the law, which went into effect in July, "is to create equal coverage between medical/surgical services and mental healthcare services."

        The UK's Press Association (9/7) reports that "men are more likely than women to suffer problems with memory and thinking as they age," according to a study published in the journal Neurology. Rates of "mild cognitive impairment[MCI]" were "found to be 1.5 times higher in men than in women." MCI "involves a level of mental decline beyond that which can be explained by normal ageing. It is often associated with Alzheimer's disease later in life." For the study, researchers "tested the memory and thinking skills" of more than "2,000 people aged 70 to 89 in Minnesota," and found that "almost 14% of participants had MCI, 10% were suffering from dementia, and 76% had normal mental faculties." In addition, a total of "19% of men had MCI" compared with "14% of women."

        TheUK's Independent (9/7, Laurance) reports that lead researcher Dr Ronald Petersen said, "This is the first study conducted... to find a higher prevalence of MCI in men. The finding that the frequency of mild cognitive impairment is greater in men was unexpected, since the frequency of Alzheimer's disease is actually greater in women. It warrants further study."

        Reuters (9/7, Joelving) notes that although there are no drugs available to treat MCI, Petersen said that lifestyle changes may have a positive effect. He suggested activities such as reading and going to the movies, besides interaction with friends and family and in general leading an active life.

Study Questions If Health Reform Can Maintain Access To Primary Care.

The New York Times (9/7, A15, Sack) reports, "In a snapshot of systemic waste, researchers have calculated that more than half of the 354 million doctor visits made each year for acute medical care, like for fevers, stomachaches and coughs, are not with a patient's primary physician, and that more than a quarter take place in hospital emergency" departments. The Times adds, "The authors of the study...said it highlighted a significant question about the new federal health care law: can access to primary care be maintained, much less improved, when an already inadequate and inefficient system takes on an expected 32 million newly insured customers?" Notably, this "study is the first to quantify the problem, according to Dr. Stephen R. Pitts, the lead author and an associate professor of emergency medicine at Emory University."

Some Health Reform Provisions Take Effect This Month.

The Detroit News (9/6, Burden) reported, "More health care reform measures are kicking in, with many of them taking effect this month. While Michigan's major insurers say the changes will have little, if any, impact on health care premiums, analysts say consumers can expect insurance rate hikes eventually." The "two major changes this month include extending insurance coverage for dependents to age 26 and barring insurers from not accepting children 19 and younger because of pre-existing conditions. Both changes could add significant numbers to the ranks of the insured."

        Likewise, the Winston-Salem Journal (9/7, Craver) reports, "The rollout of federal health-care reform reaches two more key dates over the next few weeks. On Sept. 23, insurers and insurance plans must allow children under age 26 to stay on their parents' policy," although "in some cases, there is an exception for an adult child who has an offer of job-based coverage." The Journal also notes that "stronger consumer protections also come into effect Sept. 23 that will be felt as individuals and families renew or buy coverage."

Berwick Moving Ahead With Test Sites For New Models Of Providing Care.

The Boston Globe (9/6, Rowland) reported, "Newly installed Medicare chief Donald Berwick, keeping a low public profile after encountering controversy over his appointment, is moving quickly behind the scenes to seed the US health care system with 100 to 300 sites to test new models of caring for patients." Since his appointment, Berwick "has made launching the sites a high priority, according to officials and industry executives." The Globe noted that "Berwick has declined media interview requests and has kept a low public profile, except for a few tightly controlled appearances," although "in a web video produced by" the HHS "public affairs staff, he says of his new job: 'I love it. This agency has just won my heart.'"

Healthcare Law May Expand End-Of-Life Options.

The Washington Post /Kaiser Health News (9/7) reports, "About this time last year, voters and politicians were consumed by the rumor, fanned by health-care overhaul opponents, that the legislation would include 'death panels' of government bureaucrats who could 'pull the plug on Grandma' if she needed costly care." And although "a July poll by the Kaiser Family Foundation found that 36 percent of seniors still believe that the overhaul creates 'death panels,'" in fact, "in some ways, the new law will expand options for patients at the end of life." For instance, the healthcare law expands options for hospice care, "establishes a three-year 'concurrent care' demonstration program at 15 sites nationwide," and "allows children who are enrolled in Medicaid or the Children's Health Insurance Program (CHIP) to receive both hospice and curative care."

More Americans Switching To High-Deductible Plans To Reduce Costs.

In his Los Angeles Times (9/7) column, David Lazarus writes that about "150,000 Blue Shield customers with individual insurance policies...will experience yet another rate hike Oct. 1," and "an additional 180,000 Blue Shield members will see their rates go up by an average of 18.3% over the next year." In addition, approximately "800,000 Anthem Blue Cross individual policyholders will see their premiums rise by an average of 14%." Lazarus notes that "a recent survey by the Kaiser Family Foundation found that 16% of individual policyholders nationwide have switched to less-comprehensive plans to keep costs down. A quarter of individual policyholders now have an annual deductible of $5,000 or more."

Millions Expected To Seek Care At "Safety Net" Centers.

The Baltimore Sun (9/5, Cohn) reported, "Millions of the nation's newly insured are expected to land in...'safety net' centers when they seek out care, potentially doubling the number of patients in the next decade, experts say." One such center in Baltimore, MD, "offers one-stop shopping for patients, providing primary care and other services, including mental health care, gynecology services and health education that officials say ultimately saves money by keeping people out of the emergency rooms and hospitals." Throughout the country, "there are more than 1,200 such centers, known as federally qualified health centers because they are supported by the government and operate under its rules. They make up the largest national network of primary care providers, according to the National Association of Community Health Centers."

Floridians Can Join State Discount Drug Program By Sending A Text Message.

The Miami Herald (9/4, Shah) reported, "Floridians can now sign up for the state's discount prescription drug card at the touch of a few cell phone buttons." State residents can sign up for the program, which "entitles users to discounts of an average of 33 percent off brand-name and generic prescription drugs," by sending "a text message with the letters FDDCRX to the [number] 22700. In return, users will get a message that explains that the virtual card is accepted at participating pharmacies and that the program is not a substitute for insurance."

Health Officials Launch Campaign To Enroll Uninsured Children.

The Detroit Free Press (9/4, Anstett) reported, "As millions of children return to school, health leaders launched an unprecedented national campaign Friday to enroll 5 million uninsured children nationwide -- including 172,000 in Michigan -- in free or low-cost health insurance programs." HHS Secretary Kathleen Sebelius "said the Connecting Kids to Coverage Challenge was timed to coincide with the opening of schools because 'no child should be unable to read a book because their vision was not checked' or be unable to participate in school sports because he or she didn't have affordable coverage to pay for a sports physical." Notably, CMS "is giving grants to states to help enroll children in insurance programs."

        Kaiser Health News (9/3) reported that in fact, "Sebelius last February challenged states, the federal government and communities to sign up the 5 million uninsured but eligible children within five years. At a press conference announcing the new study, Sebelius said the results show states have the ability to find and enroll uninsured kids." She stated, "The study confirms that a lot of states do a very good job. ... But the study also gives us a much sharper focus on where kids are who need coverage."

Medicare Patients Kept For Observation In Hospitals Incurring Higher Costs.

The Washington Post /Kaiser Health News (9/7, Jaffe) reports that "some hospitals keep patients under observation for days, and that decision can have severe consequences," because "Medicare considers observation services outpatient care, which requires beneficiaries to cover a bigger share of drug costs and other expenses than they would when receiving inpatient care. And unless patients spend at least three consecutive days as an inpatient, Medicare will not cover follow-up nursing home expenses after discharge." Notably, "claims from hospitals for observation care have grown steadily and so has the length of that care, says Jonathan Blum, deputy administrator at" CMS, and the "trend is emerging as hospitals cope with increasing constraints from Medicare, which is under pressure to control costs while serving more beneficiaries."

Insurers Say Few Doctors Take Advantage Of Counseling Reimbursements.

The Pittsburgh Business Times (9/4, Mamula) reported that recently, "local insurers have begun reimbursing primary care doctors for screening people for drug and alcohol problems" in an attempt "to encourage people with problems to get help." The article added that "screening is seen as a part of a thorough exam, and reimbursement is available for brief counseling sessions." Notably, "even though research has shown the brief intervention approach works, few doctors are doing it."

Administration To Mull Changes To Rules Linked To Resident Work Hours.

The Hill (9/5, Lillis) reported "the Obama administration will 'review and consider' changes to the rules governing the work hours of resident doctors - a group well known for working extensive shifts for months and years on end." The move "comes in response to a petition launched" recently "by a coalition of consumer and labor advocates" who say "the current hour limits aren't strict enough to ensure the well-being of either medical residents or the patients they treat." David Michaels, head of the OSHA, said in a statement: "We are very concerned about medical residents working extremely long hours, and we know of evidence linking sleep deprivation with an increased risk of needle sticks, puncture wounds, lacerations, medical errors and motor vehicle accidents."

Subscriber Tools

Advertise with Custom Briefings: Reach key professionals every morning

NAHU Newswire is a digest of the most important news selected from thousands of sources by the editors of Custom Briefings. The National Association of Health Underwriters does not receive any revenue from the advertising herein. The presence of such advertising does not endorse, or imply endorsement of, any products or services by the National Association of Health Underwriters.

This complimentary copy of NAHU Newswire was sent to debw@urlfinancial.com as part of your NAHU membership. View Custom Briefings' privacy policy.

Neither Custom Briefings nor the National Association of Health Underwriters is liable for the use of or reliance on any information contained in this briefing.

For information about other member benefits, please contact NAHU Member Service Center at 703-276-0220 or membership@nahu.org.

National Association of Health Underwriters | 2000 N. 14th Street Suite 450 | Arlington, VA 22201

Copyright © 2010 by Custom Briefings | 11190 Sunrise Valley Drive, Suite 130 | Reston, VA 20191