Payers & Providers Midwest Edition – March 29, 2011

8/7/2019 Payers & Providers Midwest Edition March 29, 2011

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Health reform may be under attack fromRepublicans and libertarians, but dontassume its down for the count. At least notin Chicago.

To celebrate the one-year anniversary ofthe passage of healthhealthcare-care reform,a coalition of progressive citizens groups andpolitical leadersgathered at the FirstUnited MethodistChurch at theChicago Temple onMarch 23 for a peprally.

Despite themisinformation,

disinformation,mendacity, andoutright lies aboutthe Affordable CareAct, said William E.McNary, co-director ofCitizen Action Illinois,Insurance companiescant cancel policiesany more! Aint thatgood news?

Seniors are not denied preventive care!Aint that good news?

The crowd, predictably, jumped from thepews to shout and clap.

At the conclusion of his 10-minutestemwinder, McNary exulted: Happy

Birthday, Affordable Care Act! May your daysbe long and your troubles be few.

Its hard to know how long the ACAs dayswill be, but its a sure betthat its troubles are goingto be lasting andsubstantial. Republicansin Congress have made ittheir highest priority tooverturn the law, or ifthats not possible, toblunt its enforcement by

withholding funding orrefusing to enact enablinglegislation.

If they areunsuccessful in thelegislative arena, theyexpect the courts torule against themandate to obtaininsurance coverage. A

number of the nations Republican governorsare putting roadblocks in place to halt

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In Brief

BadgerCare BasicEnrollments Stopped by

Wisconsin DHS

The Wisconsin Department ofHealth Services has haltedenrollment in BadgerCare Basic, astate health program for low-income adults without children.State ofcials said the program,which opened nine months ago,was spending far more than it wasbringing in.

The program, which was notintended to be paid for withgeneral taxes, is running about $2million in the red. By the end ofFebruary, it had brought in $4.2million in premiums and spent$5.8 million to pays claims. Thereare about 6,000 enrolled in theBasic program.

BadgerCare Basic has also runthrough about $1 million infederal aid that was intended to beused as a nancial cushion.Ofcials said they may seek toincrease premiums in the comingmonths.

Deaconess Associatesof Cincinnati Receives$27 Million For Missouri

Nursing Facilities

Deaconess Associations Inc. sold11 long-term care facilities inMissouri for $27 million,according to a report in SeniorHousing News.

Deaconess ran 215-bedDeaconess Hospital in Cincinnatiuntil recently, when it ceased

Continued on Page 3

NEWS

Rally (Continued from Page One)

implementation of the various provisionsthat affect the states, such as insuranceexchanges.

The 13 speakers underscored all thethings that consumers will get:

* A high-risk pool for those with chronicdiseases, according to Will Wilson, anadvocate for people with HIV and AIDS.

* Coverage for young adults on theirparents insurance policies, said PeteCallahan, head of the SEIUhealthcare workers local.

* Security, dignity, andself-respect, in the words ofJohn Cameron, politicaldirector ofAFSCME, the

public employees union, inIllinois. He waved a brandnew Blue Cross Blue Shieldcard issued to his son, whobecame ill while working fora small employer that didntoffer health insurance, andhad been hounded by billcollectors ever since.

Congresswoman JanSchakowsky, a Democratrepresenting Evanston andthe North Side of Chicago,said she felt a new narrative sweepingacross the country, a prairie re starting inWisconsin, after the protests in Madison inFebruary. She denounced these terrible liesbeing spread about Medicare its like elderabuse.

Were going to defend Medicare as acenterpiece of our values. This legislation isgood for everybody, except maybe theinsurance companies who try to gouge usevery day.

We are sending a message today that we

love ObamaCare. It will deliver for thepeople of America.While the speakers of the event talked

repeatedly about the bills enemies mainlytargeting the health insurance companies --they did not address the substantive issuesthat critics have raised:

* The legislation increases federalspending to cover the uninsured.

* The insurance mandate may be moreexpensive than some employers can afford,driving them toward dropping insurance all

together.* The law increases federal oversight of

the healthcare economy and deprives

individuals and companies of the implicitright not to purchase insurance.

On the same day as the rally, statelegislatures in Florida, Montana, andArkansas made clear their intent not toparticipate in individual and small businessexchanges, or to work with the federal

government on implementingother provisions.

The public is still split onthe law. According to a KaiserFamily Foundation poll inearly March, 42% of

Americans support the lawand 46% oppose it. About53% of the public said theyare confused about the law.Of those who oppose the law18% dislike the individualmandate, 19% thinkgovernment has too large arole, and 20% worry aboutthe costs.

None of that wasmentioned in front of the175 listeners gathered in the

Methodist church, which is across the streetfrom City Hall and the Daley Center, namedfor the father of the current mayor of Chicagoand founder of Chicagos famous Democraticmachine. With Democrats holding majoritiesin both houses of the legislature, and a newlyelected Democratic governor, Illinois may bea more receptive political environment forthe thrust of the law than most places.

In 2014, McNary reminded the crowd,in the middle ofPresident Obamas secondterm, insurance companies wont be able to

deny coverage. The event had the feel of apolitical prelude, in fact, to the presidentscampaign for re-election in two years.

In other parts of the country, the lawssponsors have been making themselvesscarce. Washington Postwriter Dana Milbankobserved on the same day that Democrats areplaying under Marquess of Queensburyrules, answering the oppositions often-scurrilous allegations with earnest pleas notto relitigate the past. In wishing away theght, they are losing it.

Rep. Jan Schakowsky


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NEWS

In Brief

providing inpatient services at thehospital.

The buyer of the Missourinursing homes was PlatinumHealth Care LLC, based inSkokie, Ill. In all they acquired852 licensed skilled nursing beds

and 128 assisted living beds,effective Feb. 1.

In July Deaconess sold veother skilled-nursing homes inWestern Missouri. The buyer wasBenchmark HealthcareManagement of Chestereld, Mo.

Deaconess ofcials said theywanted to devote their efforts tofacilities closer to their base insouthwest Ohio. In 2009 thecompany had revenues of $131million.

Hospitals ContributeMore than $6.1 billion

to Iowa Economy,Association Says

Iowa's community hospitalsgenerate more than 137,000 jobsthat add $6.1 billion to the state'seconomy, according to a newstudy by the Iowa HospitalAssociation.

The state's hospitals directlyemploy 70,484 people and createanother 67,247 jobs outside thehospital sector, the study found.Iowa hospitals provide $3.8billion in salaries and benetsand generate another $2.3 billionthrough other jobs that dependon hospitals.

"Just as no one provides theservices and community benetsfound at our hospitals, there isalso no substitute for the jobshospitals provide and create,"said IHA President and CEO KirkNorris.

Enmrollment in Medicare Advantage plansincreased to 11.4 million people in 2010, or

24% of all Medicare beneciaries, theMedicare Payment Advisory Commission saidin March. Enrollment in HMOs, the dominanttype of MA plan, rose 7%, while local PPOenrollment grew by 40%.

On average, beneciaries may choosefrom 12 plans.

The federal government is paying 10%more for beneciaries enrolled in MedicareAdvantage programs than if those persons hadbeen enrolled in fee-for-service Medicare,MedPAC said. This has long been a bone of

contention between congressionalDemocrats, who see this as an unwarranted

public subsidy of managed care plans, andRepublicans, who view Medicare Advantageas a worthy reform.

About 28 million beneciaries wereenrolled in Part D pharmaceutical benetplans in 2010, or 60% of the total. About 10million of those (36% of enrollees) got a lowincome subsidy.

Beneciaries on haver have from 28 to 3Part D options to choose from. For the basicbenet, CMS estimates the average monthlypremium rose $1 from 2010, to $30.

The CEO of the newly independent CookCounty health and hospitals board in Chicagowill leave his post and take a position with aprivate, for-prot hospital operator. William T. Foley, 60, who became chief ofthe Cook County operation in March 2009,stabilized an organization that had been indisarray but came under attack from unions,county commissioners, and members of thepublic after he proposed unpopular solutions tolongstanding problems with the county healthsystem.

One of his initiatives, the planned closing ofunderutilized Oak Forest Hospital and its

replacement with an outpatient clinic, wasvetoed by the states certicate of need boardon March 21. County health ofcials had beenworking on the plan for more than a year, andcounting on $25 million in savings to fundother projects.

The county health system provides care forabout 800,000 residents who have noinsurance, on a budget of around $900 milliona year. It operates Stroger Hospital, whichreplaced the old Cook County Hospital 10years ago, as well as Provident Hospital on theSouth Side and the Oak Forest hospital, as wellas many community clinics. Oak Forest has an

occupancy rate of around 30% and Provident,50%. Stroger is also underutilized.

The Chicago Tribune editorialized last weekin favor of the Oak Forest plan, reminding

readers that Cook County taxpayers pickedup the tab for one of the most spectacularlymismanaged public health systems in thecountry. The health system was separatedfrom direct control by the Cook CountyCommission several years ago, in hopes ofachieving management independence,nancial accountability, and a diminishmenof patronage hiring.

Even so, Foley and his managers cameunder withering criticism from establishedpolitical interests. A union nurse said, Theyare getting rid of frontline workers, andincreasing the managers and consultants, an

sucking money out of the system. Foley andhis management team were called pin-strippimps by a Chicago alderman. These attacktook their toll, Foleys supporters said.

County Commissioner Larry Suffredin sahe was disappointed that Foley left so soon ihis tenure. We are not a system in crisis, aswe were three years ago, he told WBEZ,Chicago public radio. We are a system thatfunctioning but needs to be tended to everyday.

Foley, 60, has accepted a position as CEOrunning hospitals in Chicago for VanguardHealth Systems.

Cook County Board President ToniPreckwinkle said a nationwide search wouldbe conducted to nd a committed publicservant to replace Foley.

Cook County Health Chief ResignsFoley was First CEO of Independent Health Board

MA Plan Enrollment Rises to 24%Medicare Drug Plan Coverage Hits 60%


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Payers & Providers Page

The political fracas over Don Berwicksappointment as director of the Centers forMedicare & Medicaid Services (CMS) is adisturbing indication of the political decline ofAmerica.

Berwick is a brilliant Harvard professor andfounding head of the Institute forHealthcare Improvement. He isalso the brains and visionbehind most of the importanthealthcare initiatives of the pastgeneration, from the IOMreports on quality and safety, to

bundles of evidence-basedpractices to reduce harm, to theidea of a campaign to promotepatient safety. President Obamas selectionof Berwick to lead CMS last yearwas inspired. In the face ofunassailable evidence of spottyquality and safety, unjustiablevariations in care, and impendinginsolvency, Medicare has no choice but totransform itself from a dumb payer into anorganization that promotes excellence inquality, safety, and efciency. There is simply no

other person with the deep knowledge of thesystem and the trust of so many keystakeholders as Don Berwick.

But Berwicks nomination ran into the buzzsaw of Red and Blue politics, with Republicansholding his nomination hostage to their largerconcerns about the Affordable Care Act. In theludicrous debate that ultimately culminated inObamas recess appointment of Berwick, thecentral argument against his nomination wasthat he had once gasp praised the UKsNational Health Service.

President Obama was right to use his recessappointment power to install Berwick as CMS

director. I hoped naively, perhaps that Donwould win over his critics by the time hisappointment expired in December 2011. And,in his eight months in the role, Berwick hasdone a terric job. As always, his speeches onhealthcare reform have been articulate andthought provoking (though one can see a heavybureaucratic hand tamping down Donscharacteristic air and penchant forprovocativeness). He has appointed excellentpeople to key leadership positions, eshed outsome of the new CMS programs such as Value-based Purchasing and the Innovations Center,

and will announce a major initiative in patiensafety in the near future. Impressively, Berwichas accomplished all of this with at least onehand and several ngers of the other tied behhis back: doubt about his own future at CMS,uncertainty about the fate of the Affordable C

Act, and an unrelentingly hosreception by the RepublicansCongress.

But my hopes were dashethe recent statement by Sen.Baucus (D-Montana) thatBerwick is simply not

con

rmable by the Senate. Thannouncement followed a lesent to the White House by 4GOP senators, who argued disingenuously that Berwiclack of experience in the areof health plan operations andinsurance regulation raise serconcerns about his qualicatifor this position.

From the moment of his nomination, Berwplight has been a sad spectacle. I was particudisheartened by the way he was treated beforerecent his testimony before the House Ways a

Means Committee.In the face of this kind of nonsense, I knowseveral superb physician-leaders who wereoffered positions in CMS for roles that shoulhave been once-in-a-lifetime opportunities toshape national policy but turned them downWho needs this? one told me. And theyre r

The smart money is that the White House fold on the Berwick appointment. Lets do whwe can to turn this around. Please contact theWhite House, your senators and representativand the media, and tell them that Don Berwicthe best hope we have to improve our healthcsystem. Tell them that the Senate should hold

hearings on his appointment, and let the chipwhere they may.

OPINION

Berwicks Fate Should Take High RoaSenate Ought to Give CMS Nominee a Fair Hearin

By Robert Wachter, M.D.

Robert Wachter, M.D., is a professor of

medicine at the University of California San

Francisco and chief of the division of hospit

medicine in the UCSF Medical Center. He is

nationally recognized expert on healthcare

quality and blogs at http://community.the-

hospitalist.org/blogs/default.aspx, from wh

this op-ed was adapted.

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