Palm Beach Brain and Spine

Make sure that patients understand their condition, take their medicine and see their primary care doctors so they don’t wind up back in the hospital. Common sense things, right?  Only until the Affordable Care Act threatened hospitals with the loss of money, however, did such coordination of care start to become common.

Four out of five hospital in Florida still “re-admit” too many patients, but the law is pushing them to improve care.  It is a less-publicized but crucial component of the law that Republicans have voted 40 times to repeal, delay or defund.  New Gingrich, who railed against the law as a presidential candidate, blasted fellow Republicans Wednesday for not having a viable alternative to it.

Make sure that patients understand their condition, take their medicine and see their primary care doctors so they don’t wind up back in the hospital.  Common sense things, right?  Only until the Affordable Care Act threatened hospitals ith the loss of money, however, did such coordination of care start to become common.

Speaking at the Republican National Committee’s summer meeting, Mr. Dingrich said, “I will bet you, for most of you, you go home in the next two weeks when your members of Congress are home, and you look them in the eye and you say, ‘What is your positive replacement for Obamacare?’ They will have zero answer.”

Indeed.  The law is hardly perfect.  But even though it won’t take full effect until 2015, it is already having a positive impact on health care quality.  The law rewards doctors and hospitals for improving care to Medicare patients and penalizes them when patients get sicker as a result of poor coordination and follow-up.  One measure is excessive hospital readmissions.

As the Post’s Stacey Singer reported, 80 percent of Florida hospitals will be penalized by Medicare next year for above-average readmission rates, including nine out of 13 Palm Beach County hospitals.  The penalties are forcing hospitals to make quality of care, not quantity of care, the priority.

Jupiter Medical Center, a nonprofit that recently held a summit on improving post-release coordination of care, is one of the four hospitals that will not see a penalty.  The others include Bethesda Health in Boynton Beach, which owns Bethesda Hospital East and Bethesda Hospital West, and Boca Raton Regional, all of which also are independent nonprofits.  Tenet Healthcare’s Good Samaritan Medical Center, a for-profit that received a .02 percent penalty for 2013, improved enough to become the fourth.

This is the second year that Boca Raton Regional, which sees a large number of Medicare patients, has escaped penalties.  Chief Medical Officer Dr. Charles Posternack said most patients are highly educated and affluent, which makes transition of care less challenging than for other hospitals.  He said educating patient about their disease and medications is key, along with ensuring follow-up care.

“It’s the culture of the hospital,” Dr. Posternack said.  “It’s important not just to get them to have to come back in again because you just didn’t do a good job.”  Is this what Republican critics of the Affordable Care Act want to repeal, delay and defund?

“The good: Better hospitals” by Rhonda Swan in The Palm Beach Post on August 16, 2013

On Thursday, U.S. Department of Health and Human Services Secretary Kathleen Sebelius held a media call and press conference in Tampa to announce new Affordable Care Act grants to help consumers enroll in insurance plans.  There was no such announcement, however, when the administration decided months ago to delay for some insurers the limit on out-of-pocket expenses the can impose on insurers.

There is a case to be made for the administration latest delay of a key provision in the law.  But because the delay doesn’t make the law look good, the administration buried the announcement online in a February FA Q put out by HHS and the Labor and Treasury departments.

The health care law is complex, and implementing its numerous provisions will be a challenge for the administration.  But it’s not as if the country hasn’t been here before, and recently.  Consider the rollout of Medicare Part D, the prescription drug program, in 2005.

“Although the officials implementing Part D encountered significant technical, educational, and coordination difficulties at first, eight years later … the public generally views the program as a success,” says a June study by the Center on Health Insurance Reforms.  The center looked at Part D for lessons on implementing the Affordable Care Act.  “While flaws remain,” the Part D study said, “a program born amidst partisan controversy and launched with considerable wariness has emerged to become a core part of Medicare.”

Such partisan controversy makes the Obama administration wary of communicating anything about the health care law that could be deemed negative.  Last month, the administration used a blog post to announce a one-year delay of the employer mandate.  Though Kaiser Health News reported the new delay in April, opponents of the law didn’t pounce on the issue until the New York Times reported it this week.

Beginning in 2014, the law caps annual out-of-pocket costs at $6,350 for individuals and $12,500 for families.  The provision will not be enforced for some employer insurance plans, though, until 2015.

Those employers have separate benefit managers for different parts of their coverage, such as medical care and drugs.  Their technical systems can’t communicate with one another yet.  Out-of-pocket limits will be enforced for all plans on the insurance exchanges, plans with only one administrator, and all new plans.

It’s not the disaster opponents make it out to be.  But it is a setback for consumers with chronic ailments and high drug costs.  The administration should just say that.

“The bad: Too much secrecy” by Rhonda Swan in The Palm Beach Post on August 16, 2013