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This Week in Health Care Reform - April 11th, 2014

Ahead of CMS announcing changes to the program, bipartisanship finds a landing spot in the fight to protect Medicare Advantage; exchange enrollment gets a firm (second) deadline; new polling tells the same story where the health care law is concerned; the doors get flung open on Medicare physician payment information; and, a guiding set of telehealth principles for the states gets its day in the sun.


Health Care Reform

Coming Together for Medicare Advantage: As expected, this past Monday saw the Centers for Medicare & Medicaid Services (CMS) release its final determination regarding changes to the underlying payment structure for Medicare Advantage for 2015.  And, while the agency’s decision was greeted with some cautious optimism, experts were quick to point out that, despite CMS scaling back its original proposed payment changes, cuts to the popular program are still expected next year.  Ahead of CMS’ announcement, though, it bears highlighting the amount of bipartisan Congressional support that rallied to protect Medicare Advantage and its 15 million beneficiaries from the harm posed by the initial proposed payment cuts.  When all was said and done, more than 270 members of Congress from both sides of the aisle had come to the program’s defense.  Whether penning Op/Eds, convening Congressional hearings, delivering speeches on the House floor, or simply adding their name to the numerous letters that went out to CMS, the Department of Health & Human Services (HHS), and the White House, these elected officials responded to the voices of their constituents – raised in alarm over the proposed changes to the critical program – and marshaled their collective energies to stand beside them.  While some chose to focus on the politics leading up to (and resulting from) CMS’ final decision, we think it’s still worth celebrating the spirit of comity that united so many of our elected officials.  For those of you who can count your lawmaker amongst the many that stood up on behalf of Medicare Advantage’s millions of enrollees and their families, be sure to let them know that you appreciate all that they did to protect the program by reaching out to them today. 

Deadline Redux:
With so many Americans running into last-minute issues trying to sign up for coverage through the exchange marketplace, the Administration announced prior to the open enrollment period ending earlier this month that any consumer who began an application prior to the window closing, but was unable to complete the process, would be granted an extension to purchase coverage.  Last week, the White House announced that April 15th would stand as their deadline.  And, as the smoke continues to clear on the just-closed open enrollment period, some have already moved on to the challenges lurking in wait for the start of the next sign-up window later this year.  Even as it conducts its own post-mortem, the Administration appears poised to capitalize on what it interprets to be a largely successful enrollment period.  Some Democrats, however, are electing, instead, to tread lightly

ACA Polling:
A handful of recently released polls underscore the difficulties that lay ahead for the Affordable Care Act, particularly in a midterm election year.  One such survey, released by NPR, spoke to those exact intricacies.  In that poll, the health care law proved more popular than its author (47 percent approval rating for the law compared to the President’s 46 percent).  While a separate Gallup poll, in which the percentage of uninsured Americans was shown to have dipped to its lowest point in six years (15.6 percent), offered supporters something of a safe messaging harbor, a pair of election surveys pointed to the challenges Democrats face when voters head to the polls in November.  Perhaps less surprising amongst the two, the USA TODAY/Pew Research Center survey depicting how the Affordable Care Act resonates with voters.  In that survey, more than 8-in-10 said that a candidate’s position on the law will be an ‘important’ factor in determining how they vote, with 54 percent labeling the issue as ‘very important.’  Most tellingly, however, was the 2:1 ratio by which this latter group disapproved of the law.  Meanwhile, the new Associated Press-GfK national poll painted an even bleaker picture for Democrats.  Of most concern, the 14 percentage point difference between those who favor a Republican-led Congress (51 percent) and those who would rather have a Democrat-controlled one (37 percent).

Medicare Doc Data Released:
Earlier this week, CMS made data available for the first time that details how much Medicare providers were paid in 2012. According to the data, the top 1 percent of the roughly 825,000 individual medical providers accounted for 14 percent of the $77 billion billed to Medicare that year.  In Florida alone, 100 doctors received a total of $610 million in payments.  While the media coverage has focused on Medicare’s top-billers, evidence suggests that doctors might not be the single, largest driver of costs.  One analysis shows that the cost of drugs accounts for a growing piece of overall Medicare spending, prompting observers to warn about the limitations of the newly released data.

Telehealth & the FSMB:
For many, the promise of telehealth is within our reach.  The staid and restrictive limitations that, in the past, have limited the scope of what the practice of virtual medicine has only hinted at, are slowly being brought up to date.  Connectivity, they maintain, is the key to realizing a generational shift in the delivery of health care.  Access, availability, costs, and innovation all stand to benefit if only regulators found a way to remove the barriers to the widespread adoption of telehealth.  A recent study by Deloitte brings this claim into sharp focus, estimating that in 2014 alone, virtual doctor visits could potentially save more than $5 billion when compared to the cost of in-person visits.  Currently, less than half of all states have passed rules mandating coverage of commercially-provided telehealth services, despite the clear advantages of its deployment.  Recently, though, one group set out to address the real need for a guiding set of principles that states can look to as they develop their own policies governing telehealth.  The Federation of State Medical Boards (FSMB), a national nonprofit organization representing the medical and osteopathic boards of the country, brought together a diverse collection of stakeholders through a collaborative process, the result of which was the development of the “Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine.”  With FSMB slated to hold their annual meeting later this month, this draft policy is expected to be offered up for ratification.          

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Looking Ahead

With open enrollment on the exchange marketplace (mostly) closed, analysis now turns to what the final numbers really tell us.  And, now that Americans have done their part, onlookers have a word of advice for the Administration, even as experts caution that the real headaches are only about to begin.

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