In this week’s summary, you’ll find a new website with information on Medicaid Managed Care pharmacy benefits, the success of NY’s Kendra’s law, the growing concern of physicians over new Medicare requirements, and more!
The Department of Health’s new website, NYS Medicaid Managed Care and Family Health Plus Pharmacy Benefit Information Center, went live on July 31 and provides information on drug formularies, the prior authorization form, step therapy, etc. by managed care plan. This should serve as a useful tool for consumers, advocates and providers.
The Wall Street Journal writes on doctors “going off the grid” by dropping out of the Medicare program due to poor payment rates and increasing rules for participation. According to the Centers for Medicare and Medicaid Services (CMS), the number of doctors who dropped out of Medicare tripled last year, compared to three years ago. The article also claims that even fewer physicians are accepting new Medicaid patients. There are also growing numbers of doctors not participating in private insurance. While the article concedes that these numbers are not enough to affect implementation of the Affordable Care Act, consumers may have more difficulty in finding physicians to care for them.
Physicians claim that Medicare payments have not kept pace with inflation and that more cuts may be on the horizon. At the same time, requirements on doctors have increased. Those who don’t utilize electronic records and send quality measures to CMS will face penalties in 2015. Alternatively, some physicians are requiring direct payment from patients, often at rates similar to Medicare. However, by keeping overhead lower, (i.e., fewer requirements), the private pay model may work for some practices.
New York’s biggest health story this week is the dramatic changes taking place with Brooklyn hospitals. And as the New York Times write, the impact on inpatient acute psychiatric care in the borough could be significant. Putting aside the politics surrounding the closures of Interfaith and Long Island College Hospital, the removal of Interfaith’s 160 behavioral health beds may be the most pressing problem, according to the Times. The hospital also handles 67,000 psychiatric outpatient visits per hear. The area’s psychiatric care had already been devastated as a result of Hurricane Sandy, which resulted in the still-closed Coney Island Hospital. This news comes on the heels of the announcement to downsize, from 24 to 15, the state’s own mental hospitals.
While the U.S. News and World Report released its list of hospital rankings, Elisabeth Rosenthal of the New York Times describes how complicated such rankings are. Bottom line: rankings may help to improve care at some health care institutions, but consumers are likely to continue to seek care locally.
According to a new study, New York’s Kendra’s Law is working by ensuring that certain mentally ill persons are engaged in treatment. The New York Times reports that while 44 other states have a version of Kendra’s Law, New York’s is the most advanced, largely due to the significant resources the state has invested in its success. New York currently spends $125 million a year for enhanced outpatient mental health services for persons in the outpatient commitment or assisted outpatient treatment aspect of the law. The state also spends $32 million to provide 2,000 to 2,500 persons under court order to receive intensive caseworker monitoring, which ensures that patients attend therapy and stick with their medication regimens. The study was conducted by Duke University and concluded that outpatient commitment programs save money through reducing the ‘revolving door’ nature of mental illness, characterized by frequent hospitalizations, non-adherence to medication regimens and an inability to function in a community. The article also notes that the initial controversy surrounding the enactment of Kendra’s Law still lingers.
The New Yorker has once again published a fascinating article by the surgeon and writer Atul Gawande. Mr. Gawande provides an account of medical innovations from a historical and modern perspective, and why some catch on immediately and others don’t.
Mr. Gawande is well-known in health circles for his 2011 article The Hot Spotters, a must read for persons interested in cost-effectively treating high utilizers of health care.
The New York Times Sunday Review published an opinion piece entitled Why Smokers Still Smoke. The answer: poor self control, or the desire for immediate satisfaction while ignoring long term consequences. The piece contends that under this theory, policies designed to make smoking more difficult make sense, such as banning smoking on hospital grounds.
-Jaime Venditti, 8/2/13