Primary care physician shortage looms in Louisville

Written by
Patrick Howington
The Courier-Journal
2:42 AM, Mar. 28, 2012

They are the quarterbacks of the health care system — generalists who monitor the entire body, give preventive care, spot problems early and send patients to specialists if needed.

Despite their key role, primary care physicians are in increasingly short supply, and a new study says the shortage is expected to become critical soon in Louisville — as it has been in many rural areas of Kentucky for years.

The impending Louisville shortage is due to a perfect storm of factors — an aging population that will need more care, a large number of doctors approaching retirement, and medical students shunning primary care practices for specialties with higher pay and better hours.

By 2020, Jefferson County will need 455 new primary care doctors — almost as many as the number that work in local medical practices now. The new doctors will be needed to replace current doctors who are expected to retire and to meet federal guidelines for serving the projected 2020 population, according to the study the Louisville Primary Care Association commissioned.

And that doesn’t take into account the extra demand for more doctors when health reform could cause millions more Americans to have health insurance in 2014 if upheld by the Supreme Court.

“We see a real workforce crisis in the future — in the immediate future,” said Bill Wagner, executive director of Family Health Centers, a group of community clinics serving low-income residents. “It is a perfect storm.”

Family Health Centers is a member of the primary care association. Others are the Park DuValle Community Health Centers, the Louisville Metro Department of Public Health & Wellness, and the University of Louisville’s dental school and primary care centers.

The study, conducted by REACH Inc. and based on a survey of local physicians, found that about one-third of all the primary care doctors — general internists, family practitioners and pediatricians — are 56 or older and plan to retire within 10 years.

The combination of impending retirements, expected population growth and the trend toward doctors working strictly inside hospitals or urgent-care centers rather than holding office hours means that:

• Jefferson County will need to attract 220 new family practitioners by 2020, or more than the current supply of 167 who don’t work solely at institutions such as the VA Medical Center or hospices.

• An additional 192 general internists and 43 pediatricians will be needed.

• While Louisville has 697 primary care doctors overall, only 517 of them are in typical office settings where they can have an ongoing relationship with patients — and 178 of those are expected to retire by 2020.

To replace those retirees and add other new doctors to meet federal guidelines calling for 100 primary care physicians per 100,000 people, the study projected that 455 new primary care doctors will be needed by 2020.

And not enough younger doctors are in line to fill that gap.

Shift to higher pay

Saddled with $100,000 or more in medical school loans, graduates in recent years haven’t chosen lower-paying primary care as often as older generations did, statistics show.

In the past 15 years, the number of U.S. medical school seniors who entered residencies in family medicine has fallen from 17 percent in 1997 to 8 percent last year, according to the Association of American Medical Colleges. However, the number has rebounded slightly since 2009.

The picture is similar at the U of L School of Medicine. The number of entering medical students the school believed would go into primary care upon graduation, based on statements at the time of admission, has declined 50 percent in the past 11 or 12 years, said Dr. Steve Wheeler, associate dean for admissions.

“The debt load in medical school has increased, the ability to repay debt is influenced by salary once you get out, and primary care is at the low end of that spectrum,” said Wheeler, who is also associate professor of family and geriatric medicine.

On average, primary care doctors are paid as little as half as much as specialists, such as radiologists and invasive cardiologists, according to a national compensation survey.

Yet they typically see many more patients a day and must complete exhaustive paperwork to oversee patients’ overall care.

The time demands and administrative burden are perhaps as important as the pay gap in students’ decisions to shun primary care in recent years, experts said.

“I think it has become a much more difficult environment to enjoy working with your patients in,” Wheeler said.

“It’s more difficult, more stressful, and less rewarding” than it used to be, Dr. Greg Ciliberti, a Louisville internist for 26 years. “And then you’ve got the other stress of, you’re trying to run a business and you never get a raise.”

Not just rural

In Kentucky, physician supply has typically been seen as a rural problem, given that some counties are served by a handful of doctors — while Louisville is home to large hospital companies and a university medical school.

But both in Louisville and nationwide, “I don’t think there’s any question that it’s not just a rural issue,” said Dr. Dan Varga, chair of the Kentucky Medical Association’s physician workforce committee.

“No matter where you’re talking about, we clearly have an aging primary care workforce,” because primary care has been “so unpopular” a career choice in recent years, said Varga, chief medical officer of Kentucky’s St. Joseph hospitals and a former Louisville internist.

“There just aren’t as many students who see that as their call,” Wheeler said.

Given that trend, Wagner said he doubts that medical schools will train enough primary care doctors to fill the gap.

Wagner said his clinics already have a difficult time recruiting primary care doctors in the face of competition from higher-paying hospital operations that increasingly are hiring doctors as full-time employees.

That can leave doctors at Family Health Centers and similar clinics stretched even further to handle their patient load.

“There’s not enough of us,” said Dr. Sarah Fortuna, a staff doctor at FHC’s Iroquois clinic on Taylor Boulevard, during a brief break between seeing patients, updating charts and conferring with a medical technician. “We’re getting more and more patients, but we’re not getting any more staff.”

Fortuna said she probably doesn’t get enough time with her patients.

“I try,” she said. “But is the clock ticking in the back of my head? Yes. I know I have to get to day care at the end of the day, and my techs have other things they have to get to as well.

“I try to stop long enough to give them the time, but there’s days when I go home and go, ‘I know I’ve made (patients) come back in three weeks because I want to talk to them more.’ ”

Fortuna, 39, a single mother and former Air Force doctor, said she doesn’t regret her decision to go into primary care. She likes treating a wide variety of conditions and is “a people person, so I wanted to have long-term relationships with my patients.”

Making the switch

Fortuna said it would be nice to make more money, but that’s not enough to make her switch to a specialty.

But many primary care doctors have done just that.

Fortuna said she trained in a group of eight primary care residents at Eglin Air Force Base in Florida, ending in 2003 — and four of them have since entered specialties.

“They were faced with longer and longer hours in private practice, and most of them didn’t want to do that,” she said. “They wanted to have a life. So they opted out.”

Dr. Dan Garcia, a Louisville allergist, was a pediatrician for 17 years before becoming an allergist in the early 1990s — a move he said he made for his health and to see his family.

With long hours at the office combined with hospital rounds, “I wasn’t getting to see my children” because of caring for other people’s children, said Garcia, 64.

“We had our fifth child, and I came down one morning … Patrick was about 4 months old, and he looked at me like I was a complete stranger, because I hadn’t seen him for over a week,” Garcia said.

A heart bypass operation convinced Garcia he needed a slower pace, and he underwent two years of training to become an allergist. Instead of working 12 hours or more a day, he now works 8 to 10.

“It’s been well worth it,” he said. “The tail doesn’t wag the dog any more.”

Cost of solutions

Though there is a consensus that more primary care doctors are needed, the solutions aren’t easy — and often call for money that isn’t there.

Medical associations have advocated repaying emerging doctors’ medical-school debt as an incentive for them to enter primary care. The National Health Service Corps has such a repayment program, but only for doctors who agree to practice in underserved areas.

And national proposals to increase medical schools’ federal funding for training primary care physicians have lost out to deficit-cutting measures in recent years, said Christiane Mitchell, director of federal affairs for the Association of American Medical Colleges. She said the organization’s top priority is to avoid cuts to existing funding, though it believes federal training money should actually be increased.

With pay levels persuading many doctors to leave primary care or not enter it, some private health insurers and the federal Medicare program are moving to boost reimbursements for primary care physicians compared with specialists.

Last year, the Obama administration established a Medicare pilot program, called for under the 2010 health reform law, to pay primary care doctors to supervise teams of “physician extenders,” such as nurse practitioners, to treat target populations. The so-called “patient-centered medical home” program would directly reward primary care doctors for their time-consuming role in coordinating patients’ care.

Health insurer Aetna announced a pilot program in January to give extra monthly pay to physicians whose practices qualify as patient-centered medical homes, while last July Louisville-based Humana announced a program to award nearly $10 million to primary care practices that show quality improvements.

WellPoint, the parent company of Anthem health plans, also announced a national program in January to pay more to some primary care doctors who keep patients healthy.

But Anthem’s Kentucky organization took a broader and earlier approach in 2008 by boosting all primary care office-visit reimbursements to a level higher than specialists get, said Mike Lorch, an Anthem vice president.

“What we’re counting on, and what we firmly believe, is that … as you improve reimbursement so they can take better care of the patient, you’re going to see a payback in cost of care,” Lorch said.

Without regular access to a primary care doctor, he said, “a lot of times you’re going to end up in the (emergency room), and that’s the most expensive setting.”

SOURCE:

http://www.courier-journal.com/article/20120327/NEWS01/303280053/Louisville-primary-care-physicians-shortage?odyssey=tab|topnews|text|News

Region’s hospitals, insurers keep close eye on impact of federal decision

9:21 PM, Mar. 26, 2012  |  

Written by

Laura Ungar for the Louisville Courier-Journal

It’s been cited as a driving force behind the proposed but thwarted merger involving University Hospital and a Catholic health care system.

It’s inspired new partnerships called “accountable care organizations,” including one being piloted by Norton Healthcare and Humana.

And it’s been hailed as providing extended coverage for more than 35,000 young adults in Kentucky.

The federal health reform law has already started making an impact locally — so area health advocates and officials are tuned in to this week’s Supreme Court proceedings.

“I think the entire health care sector and insurance sector are watching this closely because it has significant implications on both industries,” said Stephen Williams, chief executive officer of Norton. “This is very far-reaching.”

Jodi Mitchell, executive director of Kentucky Voices for Health, a coalition of health advocacy groups, said her organization takes no position on the arguments before the Supreme Court, instead concentrating on educating the public about health reform. But she added: “We expect the law will be upheld.”

One of the most well-known provisions of the Affordable Care Act, as the reform law is called, requires insurers that offer coverage to children on their parents’ plans to make that coverage available until the child is 26.

That portion of the law took effect in September 2010. According to the U.S. Department of Health & Human Services, 35,610 young Kentuckians already have gained coverage through that provision. In Indiana, 38,480 young adults gained coverage.

“This is helpful for college students going to school who can’t afford coverage,” Mitchell said. “And because they’re generally healthy, they’re advantageous on plans where you’re trying to spread out the risk.”

This week’s arguments before the Supreme Court won’t involve that provision, nor several others of the broad-ranging law, but instead will focus on a key and controversial provision — requiring nearly all Americans to have health insurance by 2014.

According to the U.S. Census Bureau, an average of 15.5 percent of Kentuckians — or 663,000 people — lacked health insurance from 2008-2010, as did 12.8 percent of Hoosiers, or 813,000 people. Nationally, 15.8 percent of Americans lacked health insurance during that period.

Health care experts say the reform law eventually would bring the rate of uninsured Americans down by about 60 percent.

Louisville-based Humana Inc., one of the nation’s largest health insurers, said it has long supported universal health coverage for all Americans.

And the company said that other parts of the reform law, such as requiring insurers to cover all applicants regardless of their health condition, cannot work without the “individual mandate” provision. Otherwise, healthy people could pass up insurance while sicker people would get it, raising premiums for all.

Officials at local hospital systems, which provide charity care for many uninsured patients and have unpaid bills from others, have said projections of how many people would gain coverage under the reform law are encouraging.

But they add a caveat — saying it’s unclear if projected gains in patients who would get insurance under health reform would be offset by funding reductions in a state and federal program for hospitals that treat large numbers of low-income people.

Officials at University Hospital, which cares for large numbers of uninsured patients, talked about this uncertainty during the debate involving the proposed merger with Jewish Hospital & St. Mary’s HealthCare and Lexington-based St. Joseph Health System, which is part of Catholic Health Initiatives of Denver. Gov. Steve Beshear ultimately rejected the proposed three-way merger, and Jewish and St. Joseph merged without University to create KentuckyOne Health.

Officials at those health care organizations — as well as others such as Norton and Baptist Hospital East — have said the reform law encourages them to partner with others to become more efficient, improve care and reduce costs.

Norton and UK leaders said the law is one of the main reasons behind their partnership, announced in June. That partnership includes a statewide stroke collaboration and a cancer program that would share resources.

Norton and Humana are also piloting an “accountable care organization” for commercially insured patients, a program that establishes financial incentives for health care providers to improve quality, eliminate waste and control costs. Louisville is one of four national sites in the ACO Pilot Project of The Engelberg Center for Health Care Reform at the Brookings Institution and The Dartmouth Institute for Health Policy and Clinical Practice. Officials said the program brings a emphasis on wellness and preventive care for patients.

Last October, the U.S. Centers for Medicare & Medicaid Services finalized new rules under the health reform law to help doctors and hospitals better coordinate care for Medicare patients through ACOs. The Medicare program is designed to reward ACOs that lower the growth of health care costs while still providing quality care.

Williams said Norton will still go forward with the ACO and partnerships no matter what happens with the health reform law.

“Even if major parts of it get repealed, I believe what we are doing and what other providers are doing we will continue to do,” he said. With health care expenditures making up 18 percent of the Gross Domestic Product in the United States, “we have to bend the cost curve or we are going to cripple the economy.”

SOURCE:

http://www.courier-journal.com/article/20120326/NEWS01/303260073/Region-s-hospitals-insurers-keep-close-eye-impact-federal-decision-

Passport, Leadership host Chamber breakfast

by Brittany Wise – Grayson County News Gazette
03.25.12 – 12:00 pm

Representatives from Passport Health Plan, along with Leadership Grayson County hosted Thursday’s Chamber of Commerce breakfast at the Centre on Main, where a new local Passport board member was announced, along with the 2012 Leadership class and the new Executive Director of the Grayson County Chamber of Commerce.

Passport’s Chief Executive Officer, Mark B. Carter, spoke to the group about the non-profit organization’s service in central Kentucky. The group serves 16 counties, including Grayson, and provides health care for around 5,000 Grayson County residents – about 20 percent of the county’s population.

Carter explained that through the group’s partnerships with hospitals, primary care providers and a large number of specialty physicians, they are able to provide excellent quality healthcare to residents who would otherwise not have healthcare.

Carter boasted of the group’s #13 ranking among similar agencies country-wide, adding that all but two of the top 100 ranked companies were located in either New England or the West Coast, which makes Passport’s excellent slot an even more powerful accomplishment.

It was also announced that local business-owner Steven Elder has joined the Passport Health Plan Board.

Elder said of the group, “Passport Health Plan truly brings the community together. Their committee and board structures allow concerned citizens like myself to bring perspectives to the table and work collaboratively to find innovative solutions that work for everyone.”

Another exciting announcement for the Elder family was the reveal of the new Executive Director of the Grayson County Chamber of Commerce, his wife, Tara Elder.

Tara will be stepping into the shoes of former Director Caryn Lewis, who is leaving the position to work for the Grayson County School System.

Before Caryn’s departure, however, she had the opportunity to announce this year’s Leadership Grayson County class, which includes: April Bowman, with Wilson & Muir; LaShawn Cole-Hack, with Head Start; Tara Elder, with Grayson County Chamber of Commerce; Kindra Ewing-Jones, with Grayson County Extension Office; Valerie Farris, with Elder Wealth management; Alicia Harrell, with City of Leitchfield; Lisa Jones, with Grayson County Public Library; Amanda Joyce; Jessica Kelley, with Carter Harrell State Farm; Ellis Kiper, with Rocky-K Log Homes; Harold Miller, with WRECC; Trish Niles, with Mid-Park, Inc.; Carrie Petrocelli, with Twin Lakes Home Health; Natalie Taul, with Grayson County Extension Office; and Christopher Wilborn, with United Way of Central Kentucky.

SOURCE:

http://www.gcnewsgazette.com/view/full_story/17984858/article-Passport–Leadership-host-Chamber-breakfast?instance=popular

Passport employee’s award to benefit OVEC’s Head Start

By The Staff
Friday, March 23, 2012 at 3:00 am       (Updated: March 23, 3:06 am)

Marcelline Coots, one of the first individuals to be hired at Passport Health Plan in 1997, has been named the 2012 Making A Difference award winner by the Association for Community Affiliated Plans (ACAP), and that’s going to benefit the Ohio Valley Educational Cooperative’s Head Start program.

She was selected from a pool of candidates submitted by the national organization’s 57 affiliated health plans located throughout 27 states. ACAP serves more than 10 million Medicaid and CHIP members across the country.

In her honor, ACAP is presenting a $500 donation to her charity of choice, OVEC, in a ceremony Wednesday at the cooperative’s office on Alpine Drive in Shelbyville.

Coots, whose daughter attends  Christian Academy of Louisville, serves on the advisory council and community board of the OVEC.

She is the main member outreach event planner for Passport Health Plan and has participated in or planned numerous special events.

“Marcelline embodies the mission of Passport Health Plan – to improve the health and quality of life of our members,” Passport Health Plan CEO Mark B. Carter said in a press release announcing her award. “She’s done things like learn to drive a truck for some of Passport’s large outreach events. That’s the kind of commitment that Marcelline has demonstrated every day during the length of her service here, and I’m delighted that she is being recognized in this manner.”

SOURCE:

http://www.sentinelnews.com/content/business-briefcase-march-23-2012

The Health Law And The Supreme Court: A Primer For The Upcoming Oral Arguments

Later this month, the high court will consider the fate of the health law. Here are key points to keep in mind while watching the action.

Topics: Supreme Court, Politics, Health Reform

By Stuart Taylor, Jr.

Mar 15, 2012

How big is the constitutional challenge to the Obama health care law, which the Supreme Court will hear on March 26-28?

For starters, it’s big enough for the justices to schedule six hours of arguments — more time than given to any case since 1966. After all, the Affordable Care Act is arguably the most consequential domestic legislation since the creation of Medicare in 1965.

It’s also big enough to attract more briefs than any other case in history. At least 170, including more than 120 “friend-of-the-court” or amicus briefs, have been filed, many of which are joined by 10, 20 or more groups of every imaginable description.

And, finally, it’s big enough to cause the justices to postpone until October half of the 12 cases that they would ordinarily hear in April in order to clear time to get started on the health care opinions that they are expected to issue by the late June, or possibly, early July.

 

What’s it all about?
The immediate issues, in the order the court will hear them, begin with the question of whether the so-called “individual mandate” — which requires that almost all Americans without coverage buy individual health insurance policies or pay fines — is ripe for adjudication now. Or must the case be deferred until 2015 because of the 1867 Anti-Injunction Act, which bars federal courts from ruling on the constitutionality of tax laws before payments are due?

After that come the arguments about what many consider the central issue: whether the mandate, which is unprecedented, should be voided because it represents an unconstitutional exercise of Congress’ powers to regulate commerce and to levy taxes.

Next is what becomes of the law’s hundreds of other provisions, covering 2,700 pages, if the mandate is unconstitutional? Are some or all of them “severable,” meaning that Congress would have wanted them to stand even if the mandate falls? For example, what about the provisions establishing tax credits to help small businesses and individuals buy health insurance and taxing large employers that do not provide full-time employees government-approved coverage?

Apart from those issues, does the law’s expansion of Medicaid violate the sovereignty of the states by effectively requiring them to spend more of their own money or forfeit all of the federal Medicaid money they now receive?

What’s the likely outcome?
Nobody knows. It’s clear that the court’s four more liberal members, like almost all other liberal legal experts, will find the law constitutional in all respects. It’s also clear that conservative Justice Clarence Thomas will vote to strike down much or all of the law. It’s less clear what swing-voting Justice Anthony Kennedy and conservative Chief Justice John Roberts as well as Justices Antonin Scalia and Samuel Alito will do.

Kennedy, Roberts, Alito, and (especially) Scalia — whom the government’s brief quotes five times — have all joined past decisions construing federal regulatory power very broadly. Two respected conservative federal appeals court judges, Laurence Silberman and Geoffrey Sutton, who is one of Scalia’s favorite law clerks, have upheld the law.

What are the major arguments for and against the individual mandate?
Defenders say that the broad constitutional power of Congress to regulate interstate commerce, and the even broader power to “lay and collect taxes,” both provide ample authority for requiring that people buy insurance as part of a comprehensive scheme to end “discriminatory insurance practices that have excluded millions of people from coverage based on medical history,” in the words of a brief by Solicitor General Donald Verrilli.

The same brief also asserts that uninsured people consume $43 billion a year worth of emergency-room and other health care for which they do not pay, costs that are shifted to insurers and that raise insured families’ average premiums by more than $1,000 a year. Critics of the law dispute these numbers.

The 26 states challenging the law (along with a business group and four individuals) say, in the words of a brief by Paul Clement, who was solicitor general under President George W. Bush: “The individual mandate rests on a claim of federal power that is both unprecedented and unbounded: the power to compel individuals to engage in commerce in order more effectively to regulate commerce. This asserted power does not exist. … It is a revolution in the relationship between the central government and the governed.”

Clement also stresses that President Barack Obama and his allies in Congress insisted during the debate before the measure became law that the financial penalty for failing to comply with the individual mandate is not a tax. They should not be allowed, he argues, to “enact legislation that would not have passed had it been labeled a tax and then turn around and defend it as a valid exercise of the tax power.”

The Anti-Injunction Act?
This reconstruction-era statute bars courts from considering the constitutionality of tax laws until payments are due. It will apply here if the court deems the individual mandate’s penalty provision a “tax.”

Because the mandate is not scheduled to take effect until 2014 and the first penalties would not be due until 2015, the federal courts would not yet have jurisdiction to consider the constitutionality of the penalties or the mandate. In other words, consideration of the case would be postponed until 2015, and, therefore, such a decision would convert the biggest case in decades into the biggest anticlimax in Supreme Court history.

Both sides say that the Anti-Injunction Act does not apply. But the court appointed a lawyer as “friend of the court” to argue that it does, as one federal appeals court held. This appointment signaled the court’s care to observe arguable limits on its jurisdiction even when the parties agree that it has jurisdiction.

What are the major arguments on severability?
The government says that if the court strikes down the mandate, it should defer until future cases any ruling on the severability of most other provisions. But, if it does rule on severability, the government maintains that only two other provisions should go down with the mandate. Those are the “guaranteed-issue” and “community-rating” provisions, which bar insurers from denying coverage or charging higher premiums because of medical history. Without the individual mandate, the government says, those provisions would send premiums soaring by creating incentives for healthy people to defer buying insurance until they need health care.

The 26 states argue that the mandate was deemed by Congress to be “necessary to make the other provisions work as intended,” and that the court should strike down the whole law.

The court appointed another friend-of-the-court lawyer to write a brief arguing that a decision striking down the mandate should leave the rest of the law — including guaranteed issue and community rating — intact.

What are the major arguments on Medicaid?
The government asserts that “it is well settled that Congress’s spending power includes the power to fix the terms on which it will disburse funds to the states,” that Congress has repeatedly expanded the state-federal Medicaid program, and that this new expansion will not “impose significantly onerous burdens on the states.”

The 26 states counter that the Medicaid expansion unconstitutionally coerces them because it “threatens States with the loss of every penny of federal funding under the single largest grant-in-aid program in existence — literally billions of dollars each year — if they do not capitulate to Congress’ steep new demands.”

Stuart Taylor, Jr. is an author and contributor to the National Journal and other publications.

SOURCE:

http://www.kaiserhealthnews.org/Stories/2012/March/15/supreme-court-curtain-raiser.aspx

Kentucky Gov. Beshear Announces Resignation of Cabinet for Health and Family Services Secretary Janie Miller

Gov. Beshear Announces Resignation of Cabinet for Health and Family Services Secretary Janie Miller
Governor initiates search for replacement; interim Secretary named
FRANKFORT, Ky. (Feb. 7, 2012) –

Governor Steve Beshear announced today that Cabinet for Health and Family Services (CHFS) Secretary Janie Miller has resigned her position, effective Feb. 29, to seek other opportunities. Sec. Miller was among Gov. Beshear’s first appointments in his first term and brought a broad wealth of state government and health care program knowledge to this key area of human service programs.

“Janie Miller has done extraordinary work in an especially difficult time. In the depths of an economic recession, more and more Kentuckians turned to CHFS for needed services, and Sec. Miller found ways to meet those needs despite the challenges of a very lean budget,” said Gov. Beshear. “Her efforts to provide health insurance for children, to implement wellness strategies, and move more than half a million Kentuckians to a managed care health system in less than a year were enormous tasks. Her work has paved the way for generations of healthier Kentuckians. I am grateful for her tireless service.”

Current CHFS Deputy Secretary Eric Friedlander will serve as interim Secretary of the Cabinet. He has served in the Cabinet in a variety of roles since 1985. Gov. Beshear is initiating a search for a new Secretary.

“The Cabinet for Health and Family Services must be responsive not only to the needs of our people, but also be forward-thinking in order to help prevent some of the generational problems, such as obesity and smoking, that continue to hold our state back,” said Gov. Beshear. “I’m launching a national search for a Secretary who can bring in a dynamic vision to build on Sec. Miller’s work.”

Over the last four years under Sec. Miller’s direction, the Cabinet has made great strides in providing more efficient services to Kentuckians while also ensuring that our most vulnerable populations, especially children and elderly citizens, received the health care and protections they deserve.

Since 2007, CHFS oversaw the improvement of care for citizens at Oakwood and Central State facilities and replaced aging infrastructure at Eastern State Hospital, Central State and Glasgow Nursing Facility. As a result of Gov. Beshear’s directive to enroll more qualified children in health care, CHFS streamlined the qualification process and enrolled more than 60,000 children in the Kentucky Children’s Health Insurance Program (KCHIP) and Medicaid.

Sec. Miller devoted a great deal of attention to wellness initiatives, including adding smoking cessation treatments under Medicaid; developing strategies to fight childhood obesity; and creating partnerships to provide preventive dental care to thousands of school-age children in Eastern Kentucky.

Perhaps the most significant challenge to the Cabinet was the transition of 560,000 Medicaid recipients to a managed care program in less than nine months. Under Sec. Miller’s management, three new managed care providers are now operating in the state. The move is projected to save taxpayers $1.3 billion over three years, including $375 million in General Funds.

“I have been blessed with a long and fulfilling career in public service,” said Sec. Miller. “During these last four years during one of the country’s worst economic recessions, we have continued to move forward by looking to the future, with creativity and focus on alignment, integration and partnership across many sectors to improve the lives of vulnerable populations. I have been privileged to serve with CHFS employees who are some of the most dedicated, committed individuals in state government. I am excited about the future.”

Sec. Miller has more than 35 years of experience in various public administrative and regulatory roles, including 21 years in development and administration of health care programs for the state.

Deputy Secretary Eric Friedlander has worked in variety of CHFS programs, including the Office of the Inspector General; the Division of Family Resource and Youth Services Centers; the Commission for Children with Special Health Care Needs; and the Department for Behavioral Health, Developmental and Intellectual Disabilities. This broad array of experience within the Cabinet gives him the foundation to lead the Cabinet through this interim period.

###

This Is The Year Obamacare Takes On Out-Of-Control Health Care Costs

1/19/2012 @ 12:32PM |

By: Rick Ungar

Write down the date. 2012 is the year that some of the more ‘behind the camera’ aspects of the Affordable Care Act will begin to take effect—measures that are designed to primarily impact on the high cost of medicine. Thus, while the measures may not score big headlines, 2012 could well prove to be the most important time frame in the effort to get control of the out-of-control costs that are destroying the American health care system.

Accountable Care Organizations – On January 1, the financial incentives designed to inspire health care providers to form Accountable Care Organizations (ACOs) took effect.

The idea behind an ACO is to bring a number of health care providers, providing different services and specialties, together to better coordinate the care a Medicare beneficiary receives for a variety of conditions. By doing this, the hope is that duplication can be avoided and the improved communication among these providers will increase quality of care and outcomes.

The result is expected to represent just under $1 billion in savings over the next three years.

The reward to providers who form ACOs—and can show improvements in outcomes and cost savings— is a share of the savings they deliver to Medicare. Note that this is not simply a matter of producing cost savings. If the improvements in outcomes are not there, an ACO is not going to profit. Thus, the success of the ACO program would produce a win-win for all involved. Patients will receive better care, providers will earn financial bonuses in success and Medicare will benefit from the savings.


Collection of Data Revealing Treatment Disparities
– It is no secret to anyone that the quality of care received in the United States can be directly tied to one’s race, income and ethnicity. In many cases, it can even be tied to gender.

The ACA intends to do something about this, beginning with the requirement—come March, 2012— that will require increased data collection to highlight this disparity in care and allowing the holes to be plugged in response to what is learned.

“It’s a huge issue,” says Anna Lambertson, executive director of the Kansas Health Consumer Coalition, a statewide advocacy group in Topeka, Kan. “Health disparities include women’s access to health insurance and being charged higher premiums because of gender. If we can find a way to help people navigate the health care system so they are not going to the ER to receive routine care, we can actually lower costs.”

Via Fox Business

As the old saying goes, “knowledge is power”. Having the data to back up the serious problem of disparities in care in America— based on factors that should never be factors— is the first step towards fixing the problem.


Payback:The Insurance Rebates
– With the exception of the Supreme Court decision that will determine whether or not key aspects of the ACA have a future, June will bring this year’s change that is most likely to make headlines – the obligation that health insurance companies who fail to meet the medical loss ratio (MLR) requirements of Obamacare issue rebates to customers. Insurance companies who have failed to spend 80 percent of premium dollars received from individual and small business policy holders (85 percent from large group policies), will be required to send rebate checks to their customers. It is estimated that had the insurance companies been obligated to make such rebates in 2010, the rebates would have totaled about $2 billion dollars.

This requirement will not only put some unexpected cash in the pockets of long-suffering premium payers, it will shine a light on which insurance companies are failing to spend the money you send them on your actual health care.

Value Based Purchasing – Beginning October 1, the Medicare Value-Based Purchasing Program (VBP) will link payments made by Medicare to health care providers to the quality of the outcome they achieve. The program also includes the ‘bundled payments’ you’ve heard so much about.

VBP is more important than you might initially realize. Currently, we have far too many people –about 30 percent of all patients– checking out of hospitals only to check back in a month later. Let that sink in for a moment. Almost one of every three patients who leave a hospital will be back in a month. And we wonder why we spend so much on health care!

And when that patient comes back to the hospital, the hospital once again begins to run up the tab.

Pursuant the rules taking effect in October, this will no longer be the case. If a Medicare participant checks into the hospital for triple-bypass heart surgery, the hospital is going to be paid a set fee for the procedure. If the patient is sent home with insufficient directions to properly care for themselves during the post-surgery period, and is thus required to return to the hospital when things go wrong, the hospital is not going to be paid again. Accordingly, the hospital now has every incentive to do the job right the first time and make sure that the patient has the information necessary to continue improving upon release—including making sure the patient is going to follow-up visits with his or her doctor. The result is a healthier patient and much less spent in recidivist returns to the hospital.


Electronic Health Records
– Also coming on-line in October are the requirements that will force medical providers to get serious about using electronic medical records that will ‘hook up’ physicians to better track the health care their patients have been receiving.

Anyone who has ever been subjected to multiple blood tests as a result of seeing two different physicians within a short time understands how often duplicate tests are performed for no good reason and at great expense.

Now, when a patient goes for an annual physical in May and then is required to see a cardiologist in June, the cardiologist, via an electronic health care records system, will have access to the recent blood test results taken just two months earlier,  allowing the doctor to avoid re-testing.

The potential for savings is huge.

What we see is that 2012 is the year where the ACA begins to seriously take on the high cost of medicine in America – an effort that even the most ardent critic of Obamacare should be supporting.

Whether or not these measures will achieve the desired results remains to be seen. However, the next time someone tries to convince you that health care reform does not tackle our costs problem, I hope you’ll refer them to this data and suggest that their own self-interest requires that they root for these measures to work.

Our health care system really does depend upon it.

SOURCE:
To view this article by Rick Ungar for Forbes, please visit http://www.forbes.com/sites/rickungar/2012/01/19/this-is-the-year-obamacare-takes-on-out-of-control-health-care-costs/