What Has PAMED Done to Improve Tort Reform in Pennsylvania?

Pennsylvania has made amazing strides in medical liability reform WITHOUT CAPS! Follow the link to see the  summary of opportunities that other states can pursue without damaging victims’ rights.

What Has PAMED Done to Improve Tort Reform in Pennsylvania?

Most Pennsylvania physicians — more than 93 percent according to a 2009 study published in the Journal of the American Medical Association —report that they continue to engage in defensive medicine as a result of the state’s hostile medical liability environment.

Physicians often ask us, “What has the Pennsylvania Medical Society [PAMED] done to address this problem in the past and what are you doing now to achieve meaningful tort reform in Pennsylvania?”

What Has PAMED Done to Improve Tort Reform in Pennsylvania?

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Navigating Medicare Policy on Physical Therapy and Other Services - NYTimes.com

 

For years, some people on Medicare had difficulty getting insurance coverage approved for physical therapy, occupational therapy and other treatments. The prevailing approach was that if the therapy was not helping to improve a patient’s condition, then it was not eligible for coverage.

“They’d get denied because they weren’t improving, or because they had plateaued,” said Judith Stein, executive director of the Center for Medicare Advocacy, a nonprofit consumer group. The situation was especially difficult, she said, for patients with chronic or degenerative conditions, like Parkinson’s disease or multiple sclerosis.

That is changing, as a result of a 2013 settlement of a lawsuit that the center and others brought against the secretary of the Health and Human Services Department, the parent agency of the Centers for Medicare and Medicaid Services, which oversees Medicare. The suit claimed that Medicare billing contractors were inappropriately denying coverage for “skilled” care by applying an “improvement” standard as a rule of thumb.

Because of the settlement, the agency updated its policy manuals last year. The revisions make clear that if treatment is needed to prevent or slow further deterioration in a patient’s condition, “coverage cannot be denied based on the absence of potential for improvement or restoration.” The update applies to therapy provided in nursing homes, in outpatient clinics and at home. (The agency maintains that the revision was not a change, but was made to “clarify” what had been existing Medicare policy.)

Navigating Medicare Policy on Physical Therapy and Other Services - NYTimes.com

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Hospitals wounded by politics - Opinion - The Times-Tribune

 

Scranton’s three hospitals are among more than one-third of hospitals statewide that lost money in 2013. More than half of the state’s hospitals had profit margins lower than 4 percent for the year, the threshold for sustainability according to the Pennsylvania Health Care Cost Containment Council.

It’s a trend that likely will continue statewide through 2014 and beyond unless the Corbett administration abandons its politically inspired resistance to the Affordable Care Act’s expansion of Medicaid.

The losses have multiple causes, but one key driver is the rising cost of uncompensated care — treatment for patients who have no private or public insurance and cannot pay.

According to the council, known as PHC4, Pennsylvania hospitals provided more than $1 billion in uncompensated care in 2013, a 5 percent increase over 2012.

Gov. Tom Corbett foolishly has rejected a portion of the federal health care law which, in other states that have accepted it, has begun to diminish levels of uncompensated care and provide hospitals with much-needed revenue.

Under the ACA, the federal government pays 100 percent of the cost of Medicaid expansion to cover uninsured low-income workers in the first two years and covers 90 percent of the cost thereafter.

It’s an extraordinary deal for states. In Pennsylvania, it would have pumped about $17 billion into the health care economy through 2019, including about a $1.6 billion direct reduction in the amount of uncompensated care. That reduction likely would be higher because many people now receiving treatment at hospitals would have insurance enabling them to see other providers first.

Hospitals wounded by politics - Opinion - The Times-Tribune

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Medicine’s Top Earners Are Not the M.D.s - NYTimes.com

THOUGH the recent release of Medicare’s physician payments cast a spotlight on the millions of dollars paid to some specialists, there is a startling secret behind America’s health care hierarchy: Physicians, the most highly trained members in the industry’s work force, are on average right in the middle of the compensation pack.
That is because the biggest bucks are currently earned not through the delivery of care, but from overseeing the business of medicine.
The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries, according to an analysis performed for The New York Times by Compdata Surveys: $584,000 on average for an insurance chief executive officer, $386,000 for a hospital C.E.O. and $237,000 for a hospital administrator, compared with $306,000 for a surgeon and $185,000 for a general doctor.


And those numbers almost certainly understate the payment gap, since top executives frequently earn the bulk of their income in nonsalary compensation. In a deal that is not unusual in the industry, Mark T. Bertolini, the chief executive of Aetna, earned a salary of about $977,000 in 2012 but a total compensation package of over $36 million, the bulk of it from stocks vested and options he exercised that year. Likewise, Ronald J. Del Mauro, a former president of Barnabas Health, a midsize health system in New Jersey, earned a salary of just $28,000 in 2012, the year he retired, but total compensation of $21.7 million.
The proliferation of high earners in the medical business and administration ranks adds to the United States’ $2.7 trillion health care bill and stands in stark contrast with other developed countries, where top-ranked hospitals have only skeleton administrative staffs and where health care workers are generally paid less. And many experts say it’s bad value for health care dollars.

Medicine’s Top Earners Are Not the M.D.s - NYTimes.com

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Paper: Gov. Tom Corbett health plan would need 700 workers

 

HARRISBURG (AP) — Gov. Tom Corbett’s Healthy PA, an alternative to expanding Medicaid, will require the state to hire more than 700 new employees, a newspaper reported Monday.

The figure was far higher than most states have experienced and came as a surprise to some experts in public policy, The Philadelphia Inquirer said.

Most of the new hires would be caseworkers in offices scattered around the state, said Bev Mackereth, Corbett’s public welfare secretary. She said that under Pennsylvania’s system, the caseworkers do more than in some other states, including evaluating those who sign up for potential eligibility for other benefits as well.

She said in an interview Monday that Pennsylvania also trails some other states in automation, which adds to the cost.

“We’re getting there, and we’re not where other states are,” she said. “Some states have everything automated — it’s very easy for them to do.”

The newspaper said the state has estimated about 605,000 people would be newly eligible under Healthy PA. The first-year cost of the 700-plus new hires will be just over $30 million, much of it subsidized by the federal government.

Mackereth said the additional personnel costs would be more than covered by the estimated Healthy PA savings of $125 million.

The Department of Public Welfare estimates it would require even more new workers — about 1,200 of them — to expand Medicaid under the President Barack Obama’s landmark health care law.

Corbett, a Republican seeking a second term this year, is waiting to hear back from federal regulators about Healthy PA. It would use Medicaid expansion money to provide private insurance coverage for the same group of people. Those private insurers would be able to operate without some of Medicaid’s coverage rules.

Paper: Gov. Tom Corbett health plan would need 700 workers

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Geisinger Health Plan enrolls more than 20,000 through Obamacare - themorningcall.com

 

Geisinger Health Plan, a health insurance company serving Lehigh, Northampton and 39 other Pennsylvania counties, added more than 20,000 members during the first open-enrollment period under the federal Affordable Care Act, the company announced Monday.

"We are extremely happy with the number of individuals who selected Geisinger Health Plan for their health insurance coverage," says David Brady, vice president of health care reform and commercial business development. "We felt it was important to offer individuals who were shopping on the marketplace a choice of coverage options that focused on quality and customer service. Based on our results, Pennsylvanians agreed."

Geisinger Health Plan offered 26 plans on the federal marketplace and GeisingerMarketplace.com, its private site, the company said in a statement.

Geisinger Health Plan enrolls more than 20,000 through Obamacare - themorningcall.com

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