It’s been a long few weeks, and temperatures have not subsided.  The AC needed–the cooling off that would come with accountability throughout the stakeholders of consumers, patients, physicians, health plans, health services, pharma-device-biospecialties, etc.– is not on the horizon.    Today, the heated up consumers have shown they have lost confidence in our economy, and the stockmarket dropped 350 points already today. The Congress is worn out from its weary negotiations, and members have recessed for 5 weeks, leaving less than 90 days for negotiations by the SuperCommittee, who will, in turn, “solve” the money crisis, we hope.  But, the money counting has begun. Does this matter to health care, employee engagement, and accountable care?  It sure does, as it reflects the impact that loss of revenue and loss of taxes will have on our ability to get health care coverage for more citizens.

Then, another stunning blow:  In an overlooked clause in the PPACA legislation, Massachusetts hospitals will recoup $275M in Medicare reimbursements, and 7 other states will also be receiving new Medicare dollars, while the rest of the states get hit for these dollar transfers.  The article, in the Associated Press, explains it this way:

Hospitals in Massachusetts will reap an annual windfall of $275 million through a loophole enshrined in the new health care law. Hospitals in most other states will get less money as a result.

Hospital association executives in other states are up in arms over the news, buried in a Medicare regulation issued Monday. It comes at a time when hospitals face more cuts under the newly signed federal debt deal.

“If I could think of a better word than outrageous, I would come up with it,” said Steve Brenton, president of the Wisconsin Hospital Association.

Even Medicare says it is concerned about “manipulation” of its inpatient payment rules to create big rewards for one state at the expense of others.

Hospitals in 41 states will lose money as result of the change. The biggest loser: New York, which is out $47.5 million.

Seven states come out ahead, though none do as well as Massachusetts. Runner-up New Jersey stands to gain $54 million, or about 20 percent of the Massachusetts windfall.

President Barack Obama’s health care overhaul was supposed to lead to reforms in Medicare’s byzantine payment system. Critics say this latest twist will encourage hospitals and other big players to game the system in a scramble for increasingly scarce taxpayer dollars.

Hospitals are paid under a complex set of formulas for their services for Medicare recipients.  When these kinds of shifts are made, the hospitals, of course, must take the hit–unless they are in the “lucky” states.  But, as you may imagine, these less-fortunate hospitals have bills to pay, too.  So, they often raise pricing on the other national payers of health care:  the employers.  This means we can expect to see the employer-provided costs of health insurance to go up, which means employers have one of 3 alternatives:

1/ pay the increase.  But their sales are down (witness the plunging consumer spends) and their insured population (workers, families) have already absorbed 100%+ increases in insurance costs over the past 10 years;

2/ pass the increase to their covered lives.  See #1 above, and note that recently Kaiser Family Foundation published research that showed that 61% of the uninsured in America are part of a family with a fulltime employee who is offered affordable health care and chooses to not take it. Passing costs to employees who choose not to take it does not make a healthier employee nor a healthier corporation.

3/ do not offer insurance.  Well, it will sure save dollars for America’s employers (up to $13,700 per family in 2010).  But it certainly will not increase employee engagement in their health or performance, and it will not add to the total health improvement for employers, who are experiencing the aging and sicker workforces that have been documented over and over again.

So, Turning on the AC, as noted in my previous blog, hasn’t quite worked so well in the past few weeks.  Accountable Care may well have become AcCOUNTable care, emphasis on the count.  I hope that those that received the reimbursed dollars will be able to support the only reasonable outcome:  send people to those states for the coverage they will not find in their own. Another reason for Medical Travel, but, alas, it’s not about improved health.  It’s about improved reimbursement, just as many have feared.

FOR IMMEDIATE RELEASE

Michael Taylor MD FACP, Chairman of Center for Health Value Innovation, Lauds Consumer Engagement and Support for Wellness Programs

ST. LOUIS, Mo. – May 13, 2009 –The Center for Health Value Innovation, (www.vbhealth.org), the nation’s premier organization dedicated to establishing value and producing evidence for sustainable health and financial improvement, cites the importance of co-pay incentives in fostering consumer engagement to improve employee behaviors, reduce the cost trend, and accelerate positive outcomes. Mike Taylor, M.D., FACP, medical director of health promotion at Caterpillar Inc. and chairman of the Center, points to the successes documented by members of the Center including commercial payers, private sector employers, municipalities, health systems, and provider organizations.

“Employers look to Washington for revisions that will enable them to adopt wellness programs and effectively reward wellness performance,” says Dr. Taylor.  “These may include eliminating the 20 percent cap on such rewards, removing the tax to employees – which adds a dollar burden where they least need it– and easing the accommodation rule which can diminish the effect of population health rewards. These changes will help employers engage their populations in improved health management.”

Taylor says that an increasing number of businesses are using the Center’s principles of ‘Data, Design, Delivery, and Dividend’ to reap the rewards of engagement, lowered health cost trend, improved productivity and quality of care.

“With the alignment of stakeholders, increased provider participation in incentive-based designs, and public and private support for wellness initiatives, the Center anticipates an uptake in the emergence of value-based product offerings,” says Dr. Taylor.  “The Center applauds the general direction of all these discussions that are emphasizing the importance of health and wellness. Personalized benefits designs along with wellness incentives are proven to improve consumer health.”

Jack Mahoney, M.D., chief medical officer of the Center, adds, “As we experience the first tremors of what will be a massive shift in health care in this country, the pioneering leaders at the Center, like Mike Taylor, are ready to share their collective experiences and wisdom in driving the value of health dollars.”

About The Center for Health Value Innovation:
Information exchange for value-based design
Launched in 2007, The Center for Health Value Innovation is a multi-stakeholder not-for-profit (501c3) alliance focused on employers that drives the financial value of health dollars.  www.vbhealth.org <http://www.vbhealth.org> .