Archive for November, 2011

Tracing the Evolution of American Health Care Through Medicare

This article first appeared in the journal Health, Culture and Society.

I. Before Medicare

Since its inception as a government sanctioned public health insurance program, Medicare has been both a bone of contention between political parties and a beacon from which to gauge the changes in American health care as a whole. Passed as part of the Social Security Amendments of 1965, Medicare had as its focus individuals sixty five years of age and older, with a similar yet state-run program, Medicaid, addressing the medical needs of people with certain disabilities and low income families. Over time, however, Medicare has grown to be the preeminent standard for our nation’s health care in its entirety, with nearly every substantive change to its core foundation signaling a corresponding restructuring of our overall health care system.

The modifications imposed on Medicare, both by market forces and federal legislation, stand as a series of growing pains from which to mark the evolution of the American health care model. By charting these changes through the decades we can better understand the ways in which health care as a whole has morphed from a cost based system to one of performance evaluation. In turn, this may provide us with a glimpse into health care’s future if certain fundamental issues are not addressed in current reform legislation.

The rise of the government’s role in providing health care to its citizens came relatively late in America’s history. For much of its first two centuries the burden of caring for the sick and injured fell to neighbors, friends and relatives, with additional support from individual communities and religious groups. Visits by an actual doctor were generally limited to the home and dictated by local demographics. Almshouses and charity wards provided a certain degree of medical service, as hospitals were few and far between, and often existed solely upon the largess of the surrounding vicinities. Those who had the opportunity to visit a hospital prior to the twentieth century more than likely did so after an accident or as the result of an unfortunate designation of insanity.

Read the complete article here.

 

Keeping score on health care reform

This article first appeared in the Daily Journal on November 9, 2011.

As 2011 enters its penultimate month, the fledgling Patient Protection and Affordable Care Act continues to unfold, and at times, unravel. Nearly two years after its passage, federal regulations are still building upon the original 2,700 pages, even as the threat of repeal dangles over the Executive Branch like a Sword of Damocles. With its fate resting in the hands of the U.S. Supreme Court and Electoral College, and speculation as to whether the justices will make a move before the American voters have a chance to weigh in making headlines daily, it appears that many of health care reform’s latest additions may be here to stay.

The New and Improved Accountable Care Organizations

At the forefront of reform stand the new and improved accountable care organizations (ACOs), health care partnerships designed to monitor the quality and efficiency of doctors and hospitals and create new quality standards for compensation. The original version of the ACOs released last April met with significant industry-wide opposition, so much so in fact that three additional federal agencies exerted their authority heavily on the rewrites. First, the Office of the Inspector General clarified the implications of physician self-referral laws and federal anti-kickback statutes, thought by many to be glaring omissions from the original version.  Likewise, the Federal Trade Commission confirmed that entry into ACOs will not require a mandatory antitrust review, while at the same time creating an antitrust “safety zone” for ACOs approved by the Centers for Medicare and Medicaid Services. The Internal Revenue Service provided another critical component by establishing participation guidelines for charitable organizations without compromising any tax-exempt status.

Under the revised regulations, retrospective assignment of patients gave way to a preliminary prospective-assignment method, identifying beneficiaries quarterly with an opportunity for a final reconciliation after each performance year.  The new regulations also cut in half the number of quality measures to which ACOs must adhere (from 65 to 33) while adding some flexibility within each calendar year as to when ACOs must perform. Compliance with electronic health records has also been discarded as a condition of participation, although the digital medical record remains an important quality measure.

The Many Ways To Save

As the nation’s growing financial struggles threaten health care reform’s very survival, it is no wonder the government is trying to tighten its belt in any way it can. Continue reading →

 

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