National Health Expenditures Data Released
Jul 28, 2015

National Health Expenditures Data Released

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Money in syringeAccording to a report released today in Health Affairs by the CMS Office of the Actuary healthcare spending growth is projected to average 5.8% over the period 2014 through 2024. In the three decades leading up to 2008 the average annual growth rate was 9%.

So let’s see. Demographics will really begin to swell Medicare participation in the decade ahead. It is likely that more states will politically have to embrace Medicaid expansion. Diagnoses and treatment innovation is still being largely driven by private investment seeking high-risk returns. Industry consolidation on both the provider and insurer sides is eliminating market price competition. And we’re only going to see 6% annual cost increases they say . . . you buying it?

Here are some highlights from the CMS press release:

Spending in 2014 is projected at $3.1 trillion, or $9,695 per person, an increase of 5.5 percent over 2013. Prescription drug spending increased 12.6 percent but private health insurance increased at 5.4 percent, Medicare at 2.7 percent and Medicaid at 0.8 percent.

Medical price inflation was 1.4 percent, while hospital, and physician and clinical services increased at 1.4 and 0.5 percent, respectively.

Per-capita insurance premium growth in private health plans is projected to be at 2.8 percent in 2015 based upon the assumptions that there will be an increase in relatively healthier enrollees and a greater prevalence of high-deductible health plans offered by employers.

Is is estimated there will be 19.1 million new enrollees in Medicare over the next 11 years.

While per capita Medicaid spending is projected to have decreased by 0.8 percent in 2014 (owing to new enrollees being relatively healthier), overall spending is projected to have increased by 12.0 percent due to Medicaid expansion.

The rate of insurance coverage in the US is projected to increase from 86.0 percent to 92.4 over the next 11 years.

The full OACT report is available online via the CMS website.

Cheers,
  ~ Sparky

Filed Under: In the News, National Healthcare Exenditures · Tagged: , , ,
Jul 11, 2015

Advance-Care Planning

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The cover story of this coming week’s edition of Modern Healthcare (subscription required) focuses on end-of-life directives. The now infamous death panels phenomenon that became coupled with fears over the Independent Payment Advisory Board (IPAB) and rationing of knee and hip replacement procedures for Medicare recipients. I first wrote about this topic in November of 2012.

So here we are going on three years later and to my knowledge there have been no elderly individuals dragged before a panel of subjective arbiters charged with determining whether or not a person shall live or die. Not to diminish the reality of systemic rationing, as I have also written upon here – and that it will increase dramatically as an issue and concern in proportion to the demand for healthcare of an aging society.

But it has and continues to seem certain that admonishing public policy that raises awareness about the challenges of rationing and end-of-life care through increased and improved communication is rather wrongheaded. Fortunately, pragmatism seems to be winning over irrationality, and there are continued efforts to recognize the realities of having to address how scarce healthcare resources are allocated.

CMS announced last week that its proposed 2016 Medicare Physician Fee Schedule would incorporate physician payment for end-of-life conversations with patients. Though Medicare already provides for advance care planning upon enrollment the new rule would create new and separate advance care planning codes. Numerous medical societies and health organizations have pushed for reimbursement of advance-care planning as a separate, stand-alone service.

In good part much of the support was a desire to be paid for work already being performed. But to some extent it also represents an incentive to provide a service. And there’s the rub: what’s being incentivized? Education and awareness – or an inherent bias to abridge care and treatment options in favor of resource conservation that could be manifested in income to the clinical practitioner?

Indeed, it’s a slippery slope, and we need to be vigilant in understanding the impact of frequently dramatic differences between how an end-of-life is planned and what actually takes place at care settings in the hands of clinicians whose primary directive is to preserve life. From a policy perspective there are multiple elements that may yet contribute more to this discussion (e.g., the apparently defunct IPAB and the Patient-Centered Outcomes Research Institute).

For now, however, there is a greater opportunity to empower patients with more knowledge and information to assist them in their personal decision making regarding end-of-life care. That’s a good thing.

Cheers,
  ~ Sparky

Image credit: Martin Kozlowski for WSJ

Filed Under: End-of-Life Directives, In the News · Tagged: , , ,
Jul 10, 2015

Of Flags & Windmills

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I’m sure today’s contribution (one of two hopefully) will come as a great relief to those (both) of you who have been waiting patiently for a new post to the PolicyPub. I hadn’t planned on taking such a long hiatus, but the further it went along the easier I found it to escape the self-prescribed responsibility of producing blog content. I do truly enjoy writing, but I have to say I’ve also very much enjoyed some other distractions in the interim. Maybe I will write some about that down the road.

Anyway, I haven’t decided yet whether to still focus only on healthcare policy or expand the Pub’s spectrum to include general policy interests that appeal to a much broader audience. If anyone is still out there reading, perhaps you can give me some feedback.

I thought I might start back by dipping my toe in the water with a timely, non-healthcare policy issue.  And in keeping with the soggy great lakes summer this has been, as long as I am choosing to get my toe wet why not get entirely sucked into and soaked by the whirlpool of controversy surrounding the Confederate flag. Not only is the issue timely and more widely of interest than ICD-10 implementation, but so is my perspective having just returned this week from an annual trip to Gettysburg with my twelve year-old son.

Having been a student of the Civil War since his age I could easily turn the Pub into a daily diatribe on that subject alone. Whether it would be interesting or not – well, let’s just say there are fortunately many others who know quite a bit more about it and have both the time and artistic ability to cover it better than me.

But what I have learned over the years is the connection between slavery and the Civil War is as complex a study as you could hope to find in American history. Those having just a smidgeon of that understanding will admit candidly at least to themselves that the Confederate battle flag stands for a lot more than the institution of slavery to a great many people – then and now.

For starters, a fair reading of soldiers’ diaries on both sides of the conflict will quickly help one understand that slavery was not in the least a primary motivation that caused men on either side to risk and experience death in very often the most horrific fashion imaginable. The same could not be said for the powers that be responsible for starting the war – and hasn’t that always been the case throughout history. 

This is what to a historian is fascinating, complex and confusing. As the author Shelby Foote said, “people who say slavery had nothing to do with the war are just as wrong as those who say slavery had everything to do with the war.” But if you take slavery away as an issue then there most likely would have been no war. So it’s ultimate role cannot be diminished even if not fully understood.

That 19th century perspective of the flag notwithstanding, the 20th century was witness to countless occasions when the confederate battle flag was carried as part of protests and rallies that were blatantly racist, vitriolic and bigoted in both foundation and intent. And so to those generations alive today it is understandable their symbolic association of the flag is one of hatred, intolerance and fear. From this perspective I find it impossible to argue against removing it from government properties as was done yesterday in Columbia.

But to and for the memories of the thousands of men who died on the wrong side of history and morality I hope we will remember that symbols can mean many different things to many people. One cannot meaningfully judge history without being able to walk in the shoes of its actors.

Walking the battlefields and reading and hearing about the tremendous sacrifices that were made by all of the men who died in Gettysburg the Confederate battle flag has served as a symbol for a great deal more than the unfortunate place it occupies today in the hearts and minds of many.

I think there is more to this story, however. Beyond all of the symbolism and rhetoric that has provided salable content for media outlets in a manner and fashion normally ascribed only to sausage making is a very scary reality: we are becoming a country with a phenomenal ability to tilt at windmills. Not only have we become overly adept at tilting, we do so now at full gallop whilst trying to pass the horse ahead of us in order to be first off the cliff.

We have lost our common sense, balance and perspective – our ability to have intelligent, factual and candid debate. Social media has become a sadly expedient venue for pretending to express individual thoughts and ideas while the substance supporting those ideas is void.

So what does all this mean from my perspective on the Confederate flag issue? I think South Carolina made the right call to remove the confederate battle flag from statehouse grounds. No brainer. But the National Park Service removing items for sale containing the Confederate flag from its book store in Gettysburg? Just another example of more lemmings not wanting to be left at the station.

Cheers,
  ~ Sparky

Filed Under: Confederate Flag, Editorials & Opinions · Tagged: , , , ,