Public input is needed on how to lower PPACA and ACA costs and increase participation from consumers and providers

The Centers for Medicare & Medicaid Services (CMS) seeks public input on reducing the regulatory burdens of the Patient Protection and Affordable Care Act (PPACA)

The Centers for Medicare & Medicaid Services (CMS) today issued a Request for Information (RFI) seeking recommendations and input from the public on how to create a more flexible, streamlined approach to the regulatory structure of the individual and small group markets. Our goal through this process is to identify and eliminate or change regulations that are outdated, unnecessary, or ineffective; impose costs that exceed benefits; or create inconsistencies that otherwise interfere with regulatory reform initiatives and policies.

“We are looking for valuable feedback on how to change existing regulations in ways that put patients first, promote greater consumer choice, enhance affordability and return more control over healthcare to the States,” said CMS Administrator Seema Verma. “Through this step, CMS is asking consumers to send us innovative ideas that will help stabilize and strengthen the individual and small group health insurance markets.”

Consumers who have obtained coverage through the Exchanges are facing significant premium increases. A recent report issued by our Department of Health and Human Services states that the average premium in the 39 states using HealthCare.gov in 2017 increased from $232 in 2013 to $476 in 2017, which is a 105 percent increase. Consumers are also dealing with fewer plans to choose from and a continuous stream of issuers exiting the Exchanges.

The RFI follows steps CMS has already taken to help improve the health care system, including issuing the Market Stabilization Final Rule on April 18, 2017. This new rule will place downward pressure on premiums, limit special enrollment period abuses, and help to improve choices; while also reducing regulatory burden. The RFI will be open for public comment for 30 days.

To view the Request for Information, please visit: https://www.federalregister.gov/public-inspection/

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Treatment gaps in rheumatoid arthritis

By Rita Baron-Faust, MPH

Even with health insurance, some patients with rheumatoid arthritis (RA) may not be adequately treated. This news comes from an analysis of a large nationwide pharmaceutical claims database.

Analysis of claims data from 4.66 million American adults treated for RA between January 2005 and September 2008, finds that only two-thirds of patients with newly diagnosed disease received DMARD therapy during the first year after their diagnosis.

And 28% received no DMARDs at all, just treatment for symptoms.

Those patients receiving only symptomatic relief tended to be older and had more co-morbidities and contraindications to methotrexate, according to the industry-sponsored retrospective cohort study.

At the same time, the authors observe, “this population was arguably underserved because 38% of this inception cohort did not see a rheumatologist in year one, and 15% never saw one over a median of 2.3 years of follow-up.”

Although one-fifth did receive biologics within 12 months, there was extensive medication switching among the group, and a relatively rapid decline over time in patients who stayed on the drugs.

The analysis reveals a somewhat lower incidence of RA than other population studies, but a similar age and gender adjusted prevalence of RA (0.63% overall, and 0.33% in men and 0.92% in women).

While the data lack supporting clinical information, such administrative databases can reflect actual treatment patterns in daily clinical practice. The same patterns of treatment of RA have been seen in other studies, they note.

The study was aimed at determining whether physicians were following current American College of Rheumatology RA treatment guidelines.

There could be a number of reasons for the apparent under-treatment of patients, the study authors speculate: lack of physician awareness of, or disagreement with, treatment guidelines; and determinations that patients were too old, their disease too mild, or there were contraindications for therapy.

Patients may have also wanted to avoid drug treatment due to adverse effects or costs, they add.

Within 12 months after their diagnosis, 65%, 64%, and 20% of the incident cohort (those without an apparent prior diagnosis of arthritis) had been prescribed corticosteroids, non-biologic DMARDs, and TNF-inhibitors, respectively.

Medicare billing cost for chest pain per state

medicare cost for chest pain.JPG

Governing compiled average hospital costs for various treatments, ranking states by cost. The following states were found to have the highest average aggregate rankings, indicating the most expensive medical costs:

1. California
2. New Jersey
3. Nevada
4. Florida
5. Pennsylvania
6. Texas
7. Alaska
8. Colorado
9. Arizona
10. South Carolina

http://www.governing.com/gov-data/health/average-medical-hospital-costs-by-state-map.html

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Most expensive: cardiac surgery, brain hemorrhage, septicimea, kidney, GI, vascular-circulatory

Strategy to fix health care

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Health consumers want to email their doctors, have cheaper drugs, can access an array of allied health pros – integrative care team from acupuncturists, massage therapists, herbalists, naturopathic docs, and more, and caregiving costs for seniors must be shouldered by their health insurance, and so many other health care issues.

Below are strategies written by the pros at:

https://hbr.org/2013/10/the-strategy-that-will-fix-health-care

In health care, the days of business as usual are over. Around the world, every health care system is struggling with rising costs and uneven quality, despite the hard work of well-intentioned, well-trained clinicians. Health care leaders and policy makers have tried countless incremental fixes—attacking fraud, reducing errors, enforcing practice guidelines, making patients better “consumers,” implementing electronic medical records—but none have had much impact.

Maximizing value for patients

It’s time for a fundamentally new strategy. At its core is maximizing value for patients: that is, achieving the best outcomes at the lowest cost. We must move away from a supply-driven health care system organized around what physicians do and toward a patient-centered system organized around what patients need.

Patient Outcomes and Full Range of Services

We must shift the focus from the volume and profitability of services provided—physician visits, hospitalizations, procedures, and tests—to the patient outcomes achieved. And we must replace today’s fragmented system, in which every local provider offers a full range of services, with a system in which services for particular medical conditions are concentrated in health-delivery organizations and in the right locations to deliver high-value care.

Integrative Care

The strategy for moving to a high-value health care delivery system comprises six interdependent components: organizing around patients’ medical conditions rather than physicians’ medical specialties, measuring costs and outcomes for each patient, developing bundled prices for the full care cycle, integrating care across separate facilities, expanding geographic reach, and building an enabling IT platform.

Cleveland Clinic and Germany’s Schön Klinik

The transformation to value-basedCleveland Clinic and Germany’s Schön Klinik health care is well under way. Some organizations, such as the , have undertaken large-scale changes involving multiple components of the value agenda. The result has been striking improvements in outcomes and efficiency, and growth in market share.

To downsize or not and in need of home care in bay area

Many seniors are in a dilemma to downsize or not considering the cost of living in the bay area. Health wise, seniors are not mobile as they used to be.  In case of any medical emergency, they need to act fast and be close to a hospital or health care facility.  Many emergencies happen during the night and early morning and signs and symptoms cannot easily be detected by family members.

The cost of houses in the bay area skyrocketed that it is common sense to sell an expensive home and live in a small unit and use the sale of the house for health care costs and retirement income.

Many young couples opted for smaller affordable homes to be able to have enough money for other important expenses.

It is sad that many families in the bayarea are spending half of their income on house rent.  Many older generation plans to move out of the bay area to downsize and spend their retirement money wisely.

In care homes, many seniors have sold their homes to pay for nursing homes.

In the bay area, half of the jobs are contractual and families have to move from city to city to find an affordable place to live.

Some of those who stayed prefer their parents, who are now grandparents, to care for their babies and waiting for the time when they do not need babysitter to move away from expensive houses in the bay area.

Many take two jobs and spend less time with family to pay for house rent.

Others use every room in their house as rental income to supplement their income and pay for mortgage or get extra retirement income.

Others use airbnb or live in a rented room while they have their house being rented out for income.

What will you do to afford the housing costs in the bay area? Email motherhealth@gmail.com

For caring caregivers for homebound bay area seniors, call 408-854-1883.