Government-Run Health Care & Higher Taxes Top List of Concerns

On the heels of the new $856 billion health care bill proposed yesterday by Senate Finance Committee Chairman Max Baucus, doubt over health care reform passing this year still looms across the American public.

Fifty-four percent of U.S. adults surveyed believe health care reform will not pass this year compared to 41 percent who do, according to the results of a new Deloitte Center for Health Solutions study.

While many doubt legislation will pass, those surveyed who watched President Barack Obama’s address last week (44 percent versus 55 percent who did not watch) were inclined to agree (68 percent) versus disagree (30 percent) with the components of the President’s reform plan.

"Consumers are at a crossroads and while the majority of Americans surveyed (84 percent) believe some form of change is needed, many are confused by the complexity of the system and often default to their own personal experience with the system rather than look at the functionality of the entire system," said Paul Keckley, Ph.D. and executive director of the Deloitte Center for Health Solutions.

"Interestingly, respondents said they trust physicians and health care providers (37 percent) the most when it comes to reforming the health care system, followed by the White House (21 percent), Congress (13 percent), employers (11 percent) and health insurance companies (seven percent)."

Concern over the government running health care was a common theme throughout the survey results.

Sixty-one percent of respondents believe that Congress is likely to make the health care situation worse than better, and 55 percent thought government solutions to health care will ultimately cost more and deliver less compared to private sector solutions.

While the economy is still a major concern, 51 percent believe that health reform should not wait until the economy is better compared to 47 percent who thought it should wait.

Top concerns regarding health care reform expressed by consumers surveyed include:

• Thirty-seven percent do not want the government to run health care.
  Twenty percent did not want their taxes to increase to cover health care for others.
• Thirteen percent were concerned that they did not understand the proposals.
• Twelve percent thought they might have to wait too long to see a doctor if the public option is passed.
• Only five percent were concerned about issues related to end of life care.

"Given consumer concerns regarding the public option and government-run health care, the current bill appears to be more in line with what consumers we surveyed may be more comfortable with," added Keckley.

"Our survey results indicate that while the majority believe the health care system needs to change, 48 percent want improvements, but not a major overhaul of the system. This supports the idea that a more moderate, incremental approach may be the answer," added Keckley.

Additional findings from the survey include:

• Seventy-three percent of respondents believe it is important for every American to have health insurance.
• The uninsured (60 percent) and underinsured (55 percent) respondents were more likely to believe a major overhaul of the U.S. health care system is needed.
• Fifty-seven percent of respondents believe Town Hall meetings have been an effective forum for gaining feedback from the public compared to 35 percent who did not think they were.
• Respondents were split when it came to ranking the U.S. health care system, with approximately half (48 percent) agreeing that the U.S. health care system was the best system in the world compared to nearly half (48 percent) who disagreed.
• Fifty-five percent of those surveyed do not believe coverage for the uninsured should be the sole focus of the debate.
• Respondents were most familiar with terms such as the public option (46 percent), health care co-ops (34 percent) and health insurance exchanges (28 percent), compared with terms such as comparative effectiveness research (20 percent) and the medical home (19 percent).

Methodology:

The Deloitte Center for Health Solutions commissioned Harris Interactive to conduct a nationally representative telephone survey of 1,010 U.S. adults 18 years-old and older from Sept. 10 -13 to gauge consumers’ opinions of health care reform following the President’s address to the nation on Wednesday, Sept. 9th.

Data were weighted to be representative of the total U.S. adult population on the basis of age, sex, geographic region and race. The survey has a sampling error of + or – 3.1 percent at the 95 percent confidence level.

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Each year, the Centers for Medicare & Medicaid Services (CMS) revises the reimbursement rates for all services. During the review and revision process for the coming year, there’s often at least one or two areas that bring about heated discussion in the private sector over reimbursement, generally because of a reduction or a less-than-wanted/less-than-desired increase. This year, as over the past few years, home oxygen was a hot topic.

In an announcement late this year, CMS announced it was reviewing issues related to sleep apnea, as the number of Medicare claims over the past few years have shot up like rocket. Much of that is attributed to patient education, community awareness, and various outreach efforts, such as those initiated by Awake In America, the National Sleep Foundation, and other organizations.

Most insurance companies use Medicare guidelines, as well as reimbursement rates, for setting their own coverage and reimbursement guidelines. For that reason, many people like to know, but also have a right to know, what the reimbursement rate is for any particular service or medical/health care product.

Awake In America has assembled a list of sleep apnea therapy-related items with the associated minimum and maximum national 2009 reimbursement rates listed. Each item is shown with the Medicare (CMS) description and HCPCS code, which you will find on insurance and Medicare billing and and most explanation of benefit statements.

Reimbursement costs for sleep apnea therapy items, such as CPAP and bi-level (BiPAP) machines, nasal CPAP masks, tubing, heated humidification chambers, heated humidifiers, among others, are listed in the 2009 Medicare Reimbursement Rate file.

You may download the 2009 Sleep Apnea Therapy Medicare Reimbursement Rate file from Awake In America’s site.

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Americans are taking on more financial responsibility for their health care and, as a result, need access to a robust suite of tools and information in order to make informed decisions.

The insurance company, in a press release, says it is attempting to "support and encourage members to be informed health care consumers" in various initiatives, including "expansion of its health care transparency initiatives to additional markets," which include Connecticut; Massachusetts; Fort Myers, Fla.; Colorado; Raleigh/Durham, NC; Ohio; Pittsburgh, PA; West Virginia, among other locations.

"We know that many people conduct online research before making major buying decisions. In fact, according to a Pew Internet and American Life report, 80 percent of American Internet users, or some 113 million adults, have searched for health information online," Mark Bertolini, Aetna’s president, was quoted as saying in the press release.

Aetna’s "suite of health care transparency tools" are available through Aetna Navigator, a member self-service site which includes the following resources:

• Medical Procedure by Facility Cost: Launched in November 2007, this tool is now available in 36 markets and provides members with facility-specific and managing physician costs for over 30 common medical procedures — such as maternity care, CT scan, colonoscopy and sleep study — from admission through discharge.
• Physician-specific Clinical Quality and Efficiency Transparency: Launched in August 2006, this program provides members with physician-specific indicators based on adverse events, 30-day hospital re-admit rates, overall efficiency in use of medical services, and volume of Aetna members treated. Aetna members have access to clinical quality and efficiency information in 34 markets for 12 specialty categories including cardiology, cardiothoracic surgery, gastroenterology, general surgery, neurology, neurosurgery, obstetrics and gynecology, orthopedics, otolaryngology, plastic surgery, urology and vascular surgery.
• Physician-specific Price Transparency: Launched in August 2005, this tool is now available in 49 markets and offers access to physician-specific pricing for up to 30 of the most common services and procedures, by specialty, such as routine office visits, allergy tests, x-rays, and mammograms.

In addition to the expansion to the cost tools, Aetna recently introduced the Aetna Navigator Health Information Guide for members looking for a starting point to find answers to questions about their health care, types of treatment and cost of services — before, during and after they seek care.

According to the press release, Aetna members also have access to quality of care information for hospitals around the country through the Aetna Navigator Hospital Comparison Tool. When members use the search tool, a report will allow them to compare hospitals and make better decisions about where to access hospital care for themselves and their families. Hospitals may be compared based on the number of patients treated each year, complication rates, mortality rates, as well as the average length of stay for more than 150 procedures and diagnoses. Other hospital quality information, such as results from The Leapfrog Hospital Survey, may be reviewed on the site, the insurance company noted in the press release.

For individuals who are not Aetna members, but would like to check out the system, a "test-drive" is available on Aetna’s public site.

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The Centers for Medicare & Medicaid Services (CMS) today expanded Medicare coverage for continuous positive airway pressure (CPAP) devices to include beneficiaries who have been diagnosed, using a home sleep test, with obstructive sleep apnea. CMS also announced changes to simplify certain test requirements.

Obstructive sleep apnea (OSA) is a condition characterized by the complete cessation of breathing for a period of at least 10 seconds (apnea) during sleep. In most instances, obstructive sleep apnea is diagnosed by counting the number of sleep disturbances that occur during a specific time interval. Up to four million Medicare beneficiaries may suffer from some form of obstructive sleep apnea.

The CPAP devices provide air pressure through a face mask to help the person maintain a patent airway which ensures the person does not stop breathing during sleep.

Medicare‘s current policy provides CPAP coverage only for beneficiaries who have obstructive sleep apnea diagnosed using a specific type of sleep test called polysomnography in an attended sleep laboratory setting. CMS‘ new policy will add coverage for CPAP following a positive at-home sleep test.

In the at-home tests, the patient will wear a device while sleeping that will collect and record data about airflow and other measurements. The patient will then take the device to their physician. From there, the the data collected by the device will be used to determine whether the patient has obstructive sleep apnea or needs further sleep studies or assessment.

Some patients with obstructive sleep apnea do not continue with CPAP treatment or do not improve on treatment. Thus, CMS is limiting initial coverage of CPAP for obstructive sleep apnea to twelve weeks to determine if the beneficiary will respond to the CPAP treatment. Long-term CPAP is covered for those beneficiaries who continue and respond to treatment.

"Our revised policy provides more options for Medicare beneficiaries and their treating physicians," said CMS acting Administrator Kerry Weems.

"At the same time, we remain vigilant to ensure that Medicare payments for these services do not create incentives for inappropriate use," Weems added.

CMS will continue to monitor the use of the CPAP home testing services, examining the potential for fraud and abuse as well as making recommendations to implement appropriate safeguards to mitigate potential risk.

The final national coverage determination announced today is available on the CMS web site at http://www.cms.hhs.gov/center/coverage.asp.

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Previously uninsured adults who received Medicare coverage reported improvements in health, especially those with cardiovascular disease or diabetes, according to a study published in the December 26 issue of JAMA.

“Uninsured near-elderly adults, particularly those with cardiovascular disease or diabetes, experience worse health outcomes and use more health services as Medicare beneficiaries after age 65 years than insured near-elderly adults. Because chronic diseases are prevalent and insurance coverage is often unaffordable for older uninsured adults, the impact of near-universal Medicare coverage at age 65 years on the health of previously uninsured adults may be substantial,” the authors write.

J. Michael McWilliams, M.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues assessed the association of acquiring Medicare coverage at age 65 years with trends in self-reported health outcomes from ages 55 through 72 years for previously uninsured adults, especially those with cardiovascular disease or diabetes.

The researchers analyzed survey data, collected from 1992 through 2004, from the nationally representative Health and Retirement Study, which included 5,006 adults who were continuously insured and 2,227 adults who were persistently or intermittently uninsured from ages 55 to 64.

Changes in health trends were compared for previously uninsured and insured adults after they acquired Medicare coverage at age 65 years. The areas of health surveyed included general health, change in general health, mobility, agility, pain, depressive symptoms, and a summary measure of these, along with adverse cardiovascular outcomes.

The researchers found that before age 65 years, summary health scores worsened at a greater rate for uninsured adults than for insured adults and were significantly worse at age 65 years. Compared with previously insured adults, previously uninsured adults reported significantly improved health trends after age 65 years for the summary measure and several component measures.

Relative to previously insured adults with cardiovascular disease or diabetes, previously uninsured adults with these conditions reported significantly improved trends in summary health, change in general health, mobility, agility, and adverse cardiovascular outcomes but not in depressive symptoms.

Previously uninsured adults without these conditions reported improvement in depressive symptoms but not in summary health or any other measure. By age 70 years, the expected difference in summary health between previously uninsured and insured adults with cardiovascular disease or diabetes was reduced by 50 percent.

“Our findings have important policy implications. Proposals to extend insurance coverage to uninsured near-elderly adults have been introduced in the U.S. Congress and endorsed by the American College of Physicians. Providing earlier health insurance coverage for uninsured adults, particularly those with cardiovascular disease or diabetes, may have considerable social and economic value for the United States by improving health outcomes,” the authors conclude.

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.