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It also makes significant changes in the financial assistance people can receive to buy a health plan.\u003c/p>\n\u003cp>\"Our legislation transfers power from Washington back to the states,\" said House Ways and Means Committee Chairman Kevin Brady in a statement. \"We dismantle Obamacare's damaging taxes and mandates so states can deliver quality affordable options.\"\u003c/p>\n\u003cp>The bill would offer tax credits, refundable in advance, to people with incomes below $75,000. But those credits will be lower in many cases than the subsidies now offered in the ACA.\u003c/p>\n\u003cp>The bill, which will go through many revisions and challenges, was released late Monday by two House committees, Ways and Means and Energy and Commerce. Members are expected to start voting on parts of the bill Wednesday.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Rep. Frank Pallone, D-N.J., and Richard Neal, D-Mass., the ranking Democrats on the Energy and Commerce and Ways and Means committees, issued a joint statement saying the bill would \"rip healthcare away from millions of Americans, ration care for working families and put insurance companies back in charge.\"\u003c/p>\n\u003cp>The legislation will need approval by the full House and the Senate before it goes to President Trump for his signature. Until then, most of what is known as Obamacare will stay in place.\u003c/p>\n\u003cp>But it's far from clear that Republicans in the House are unified in their support of the bill. Members of the far-right Freedom Caucus have said they oppose giving tax credits to people who don't pay any federal income tax.\u003c/p>\n\u003cp>And with only a slim majority in the Senate, only a few Republican defections could defeat the bill there.\u003c/p>\n\u003cp>Four Republican senators wrote a letter to Majority Leader Mitch McConnell saying they were concerned an early draft of the House plan would not adequately protect people who have insurance through Obamacare's Medicaid expansion. And Sen. Rand Paul was among three conservative Republicans who criticized an earlier version of the bill as \"Obamacare lite.\"\u003c/p>\n\u003cp>Under the proposed bill, tax credits would start at $2,000 a year for individuals under age 30, rising to $4,000 for those of 60. The proposal, first seen in a Feb. 10 draft of the bill, has been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/02/24/517074764/gop-health-bill-draft-would-cut-medicaid-emphasize-tax-credits\">criticized \u003c/a>as too meager to cover the full cost of a health insurance plan that provides full benefits.\u003c/p>\n\u003cp>But the proposed tax credit could potentially pay for insurance that protects only against a catastrophic health event.\u003c/p>\n\u003cp>They would begin to be phased out at incomes of $75,000 for individuals and $150,000 for families.\u003c/p>\n\u003cp>To encourage people to buy coverage, the plan allows insurers to charge a 30 percent penalty to people who let their insurance lapse, and then try to buy a new policy.\u003c/p>\n\u003cp>In states that expanded Medicaid, people who are eligible can continue to enroll until January 1, 2020, and those states would continue to benefit from the federal government paying a greater share of the health costs of those beneficiaries.\u003c/p>\n\u003cp>Several taxes contained in the ACA would be repealed at the end of this year. These include taxes on health insurers, pharmaceutical and medical device manufacturers, and a tax on high-cost employer-sponsored group health plans (aka Cadillac plans).\u003c/p>\n\u003cp>An analysis by \u003ca href=\"http://avalere.com/expertise/managed-care/insights/capped-funding-in-medicaid-could-significantly-reduce-federal-spending\">Avalere Health\u003c/a> and \u003ca href=\"https://cdn2.vox-cdn.com/uploads/chorus_asset/file/8045899/Scanned_from_a_Xerox_Multifunction_Printer.0.pdf\">McKinsey\u003c/a> of an earlier draft of the bill, which contained many of the same provisions, concluded that it would lead to millions of people losing coverage.\u003c/p>\n\u003cp>The plan offered by the House Republicans falls short of the outright repeal that has been demanded by more conservative members, including those in the House Freedom Caucus.\u003c/p>\n\u003cp>That could be due to the shift in public attitudes toward the ACA in recent weeks.\u003c/p>\n\u003cp>Public opinion has grown more favorable as major changes appeared imminent. A Kaiser Family Foundation \u003ca href=\"http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-future-directions-for-the-aca-and-medicaid/\">tracking poll\u003c/a> in late February found 48 percent having a favorable opinion versus 42 percent viewing the law unfavorably. Kaiser says the shift is due largely to a change in the view of political independents, among which 50 percent now view the law favorably.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>We will have more on this story as it develops.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=GOP+Bill+Would+Repeal+Obamacare+Taxes+And+Penalties%2C+Keep+Some+Subsidies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"After weeks of internal debate, House Republicans have released their plan for the Affordable Care Act, aka Obamacare. It faces challenges from within the GOP, from interest groups — and the public.","status":"publish","parent":0,"modified":1488853545,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":23,"wordCount":734},"headData":{"title":"GOP Bill Would Repeal Obamacare Taxes and Penalties, Keep Some Subsidies | KQED","description":"After weeks of internal debate, House Republicans have released their plan for the Affordable Care Act, aka Obamacare. It faces challenges from within the GOP, from interest groups — and the public.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"GOP Bill Would Repeal Obamacare Taxes and Penalties, Keep Some Subsidies","datePublished":"2017-03-07T00:23:43.000Z","dateModified":"2017-03-07T02:25:45.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"301729 https://ww2.kqed.org/stateofhealth/?p=301729","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/03/06/gop-bill-would-repeal-obamacare-taxes-and-penalties-keep-some-subsidies/","disqusTitle":"GOP Bill Would Repeal Obamacare Taxes and Penalties, Keep Some Subsidies","source":"NPR","nprByline":"Joe Neel & Alison Kodjak \u003cbr>NPR","nprImageAgency":"Allison Shelley/Getty Images","nprStoryId":"518864390","nprApiLink":"http://api.npr.org/query?id=518864390&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2017/03/06/518864390/gop-bill-would-repeal-obamacare-taxes-and-penalties-keep-some-subsidies?ft=nprml&f=518864390","nprRetrievedStory":"1","nprPubDate":"Mon, 06 Mar 2017 19:18:00 -0500","nprStoryDate":"Mon, 06 Mar 2017 18:49:00 -0500","nprLastModifiedDate":"Mon, 06 Mar 2017 19:18:28 -0500","path":"/stateofhealth/301729/gop-bill-would-repeal-obamacare-taxes-and-penalties-keep-some-subsidies","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>After years of waiting, it's finally here.\u003c/p>\n\u003cp>The \u003ca href=\"https://waysandmeans.house.gov/event/markup-budget-reconciliation-recommendations-repeal-replace-obamacare/\">Republican plan\u003c/a> to \u003ca href=\"https://energycommerce.house.gov/news-center/press-releases/energy-and-commerce-republicans-release-legislation-repeal-and-replace\">reshape \u003c/a>the Affordable Care Act — what they call \"repeal and replace\" — kills the requirement that everyone buy health insurance by eliminating the tax penalty for those who don't have coverage. It also makes significant changes in the financial assistance people can receive to buy a health plan.\u003c/p>\n\u003cp>\"Our legislation transfers power from Washington back to the states,\" said House Ways and Means Committee Chairman Kevin Brady in a statement. \"We dismantle Obamacare's damaging taxes and mandates so states can deliver quality affordable options.\"\u003c/p>\n\u003cp>The bill would offer tax credits, refundable in advance, to people with incomes below $75,000. But those credits will be lower in many cases than the subsidies now offered in the ACA.\u003c/p>\n\u003cp>The bill, which will go through many revisions and challenges, was released late Monday by two House committees, Ways and Means and Energy and Commerce. Members are expected to start voting on parts of the bill Wednesday.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Rep. Frank Pallone, D-N.J., and Richard Neal, D-Mass., the ranking Democrats on the Energy and Commerce and Ways and Means committees, issued a joint statement saying the bill would \"rip healthcare away from millions of Americans, ration care for working families and put insurance companies back in charge.\"\u003c/p>\n\u003cp>The legislation will need approval by the full House and the Senate before it goes to President Trump for his signature. Until then, most of what is known as Obamacare will stay in place.\u003c/p>\n\u003cp>But it's far from clear that Republicans in the House are unified in their support of the bill. Members of the far-right Freedom Caucus have said they oppose giving tax credits to people who don't pay any federal income tax.\u003c/p>\n\u003cp>And with only a slim majority in the Senate, only a few Republican defections could defeat the bill there.\u003c/p>\n\u003cp>Four Republican senators wrote a letter to Majority Leader Mitch McConnell saying they were concerned an early draft of the House plan would not adequately protect people who have insurance through Obamacare's Medicaid expansion. And Sen. Rand Paul was among three conservative Republicans who criticized an earlier version of the bill as \"Obamacare lite.\"\u003c/p>\n\u003cp>Under the proposed bill, tax credits would start at $2,000 a year for individuals under age 30, rising to $4,000 for those of 60. The proposal, first seen in a Feb. 10 draft of the bill, has been \u003ca href=\"http://www.npr.org/sections/health-shots/2017/02/24/517074764/gop-health-bill-draft-would-cut-medicaid-emphasize-tax-credits\">criticized \u003c/a>as too meager to cover the full cost of a health insurance plan that provides full benefits.\u003c/p>\n\u003cp>But the proposed tax credit could potentially pay for insurance that protects only against a catastrophic health event.\u003c/p>\n\u003cp>They would begin to be phased out at incomes of $75,000 for individuals and $150,000 for families.\u003c/p>\n\u003cp>To encourage people to buy coverage, the plan allows insurers to charge a 30 percent penalty to people who let their insurance lapse, and then try to buy a new policy.\u003c/p>\n\u003cp>In states that expanded Medicaid, people who are eligible can continue to enroll until January 1, 2020, and those states would continue to benefit from the federal government paying a greater share of the health costs of those beneficiaries.\u003c/p>\n\u003cp>Several taxes contained in the ACA would be repealed at the end of this year. These include taxes on health insurers, pharmaceutical and medical device manufacturers, and a tax on high-cost employer-sponsored group health plans (aka Cadillac plans).\u003c/p>\n\u003cp>An analysis by \u003ca href=\"http://avalere.com/expertise/managed-care/insights/capped-funding-in-medicaid-could-significantly-reduce-federal-spending\">Avalere Health\u003c/a> and \u003ca href=\"https://cdn2.vox-cdn.com/uploads/chorus_asset/file/8045899/Scanned_from_a_Xerox_Multifunction_Printer.0.pdf\">McKinsey\u003c/a> of an earlier draft of the bill, which contained many of the same provisions, concluded that it would lead to millions of people losing coverage.\u003c/p>\n\u003cp>The plan offered by the House Republicans falls short of the outright repeal that has been demanded by more conservative members, including those in the House Freedom Caucus.\u003c/p>\n\u003cp>That could be due to the shift in public attitudes toward the ACA in recent weeks.\u003c/p>\n\u003cp>Public opinion has grown more favorable as major changes appeared imminent. A Kaiser Family Foundation \u003ca href=\"http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-future-directions-for-the-aca-and-medicaid/\">tracking poll\u003c/a> in late February found 48 percent having a favorable opinion versus 42 percent viewing the law unfavorably. Kaiser says the shift is due largely to a change in the view of political independents, among which 50 percent now view the law favorably.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>We will have more on this story as it develops.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=GOP+Bill+Would+Repeal+Obamacare+Taxes+And+Penalties%2C+Keep+Some+Subsidies&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/301729/gop-bill-would-repeal-obamacare-taxes-and-penalties-keep-some-subsidies","authors":["byline_stateofhealth_301729"],"categories":["stateofhealth_2442","stateofhealth_15","stateofhealth_14","stateofhealth_1"],"tags":["stateofhealth_2808","stateofhealth_2874","stateofhealth_218","stateofhealth_105","stateofhealth_2519","stateofhealth_2865","stateofhealth_365"],"featImg":"stateofhealth_301730","label":"source_stateofhealth_301729"},"stateofhealth_111557":{"type":"posts","id":"stateofhealth_111557","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"111557","score":null,"sort":[1448382650000]},"guestAuthors":[],"slug":"what-you-need-to-know-about-medicare-open-enrollment","title":"What You Need to Know About Medicare Open Enrollment","publishDate":1448382650,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{},"content":"\u003cp>\u003ca href=\"http://kff.org/medicare/state-indicator/total-medicare-beneficiaries/\" target=\"_blank\">More than 5 million Californians\u003c/a> get their health insurance from \u003ca href=\"https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-medicare.html\" target=\"_blank\">Medicare\u003c/a>, the federal health insurance program for people 65 and over, and for people under 65 who have certain disabilities.\u003c/p>\n\u003cp>There’s a lot going on with Medicare right now. Premiums will rise next year for about one-third of its Part B enrollees. (I’ll help you decipher some of Medicare’s alphabet soup below.)\u003c/p>\n\u003cp>And premiums will increase for other Medicare coverage, such as some prescription drug plans.\u003c/p>\n\u003cp>“The standalone prescription drug plans will have the most dramatic changes next year,” says Margaret Reilly, program manager for a \u003ca href=\"http://www.hicapservices.net/new/html/contact_us.htm\" target=\"_blank\">Medicare counseling service\u003c/a> in Northern California.\u003c/p>\n\u003cp>Now through Dec. 7 is a critical time for many of you with Medicare because it’s open-enrollment season. I’ll provide some tips on what to look out for.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Premium Increases\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html\" target=\"_blank\">Part B \u003c/a>is known as the “medical insurance” portion of Medicare, and helps pay for outpatient medical care such as doctor visits, lab tests and durable medical equipment.\u003c/p>\n\u003cp>Next year, about 30 percent of Part B enrollees will pay $121.80 (or more) instead of $104.90.\u003c/p>\n\u003cp>\u003ca href=\"http://kff.org/medicare/issue-brief/whats-in-store-for-medicares-part-b-premiums-and-deductible-in-2016-and-why/\" target=\"_blank\">Here’s who will pay the higher premiums\u003c/a>:\u003c/p>\n\u003cp>• People who are dually eligible for Medicare and Medicaid (called Medi-Cal in California). But Medicaid pays their premium – and the increase – on their behalf.\u003cbr>\n• Medicare beneficiaries who made more than $85,000 as an individual or $170,000 as a couple. This group also has to\u003ca href=\"https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html\" target=\"_blank\"> pay a surcharge \u003c/a>depending on their income. For example, an individual who made $200,000 would have to pay a total of $316.70 per month.\u003cbr>\n• New Medicare enrollees in 2016.\u003cbr>\n• Part B enrollees who are not receiving Social Security benefits.\u003c/p>\n\u003cp>\u003cstrong>Medicare Advantage and Part D Open Enrollment\u003c/strong>\u003c/p>\n\u003cp>If you have a Medicare Advantage or Part D plan, now’s the time to make changes through Dec. 7. First, a few definitions.\u003c/p>\n\u003cp>Unlike “\u003ca href=\"https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/original-medicare/how-original-medicare-works.html\" target=\"_blank\">Original Medicare\u003c/a>,” which is administered by the federal government, \u003ca href=\"https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/how-medicare-advantage-plans-work.html\" target=\"_blank\">Medicare Advantage\u003c/a> plans are offered by private companies. Medicare pays them to cover your benefits. In addition to your monthly Medicare premium, you may need to pay a premium for your Medicare Advantage plan.\u003c/p>\n\u003cp>They usually include prescription drug coverage.\u003c/p>\n\u003cp>\u003ca href=\"https://www.medicare.gov/sign-up-change-plans/get-drug-coverage/get-drug-coverage.html\" target=\"_blank\">Part D\u003c/a> plans allow you to add prescription drug benefits primarily to Original Medicare.\u003c/p>\n\u003cp>If you already have a Medicare Advantage or Part D plan and don’t want to explore other options for next year, it could cost you.\u003c/p>\n\u003cp>Consider that 22 of the 28 standalone Part D plans in California next year \u003ca href=\"http://www.cahealthadvocates.org/news/drugs/2015/review-coverage-options-2016-and-save.html\" target=\"_blank\">will have higher premiums\u003c/a>, says Elaine Wong Eakin, executive director of \u003ca href=\"http://www.cahealthadvocates.org/index.html\" target=\"_blank\">California Health Advocates\u003c/a>, a Medicare advocacy and education group.\u003c/p>\n\u003cp>The premium hikes range from 90 cents per month to – gulp – $98.70, she says. Five plans will have premium reductions and one stays the same.\u003c/p>\n\u003cp>To find out what’s happening to your plan’s premium, look at your “\u003ca href=\"https://www.medicare.gov/forms-help-and-resources/mail-about-medicare/plan-annual-notice-of-change.html\" target=\"_blank\">Annual Notice of Change\u003c/a>,” which you should have received in the mail earlier this fall. (If you didn’t receive it, call your plan.)\u003c/p>\n\u003cp>This document also should include the plan’s drug formulary, which can add or drop medications from year to year.\u003c/p>\n\u003cp>“If the drugs you take this year are not going to be on next year’s formulary, you want to know that,” Reilly says.\u003c/p>\n\u003cp>Unfortunately, the formularies can be difficult to navigate, she says, so you can also call 1-800-MEDICARE with a list of your medications, and a customer service rep can help you.\u003c/p>\n\u003cp>Another option is to go to the \u003ca href=\"https://www.medicare.gov\" target=\"_blank\">Medicare.gov \u003c/a>website. From the home page, click on the “\u003ca href=\"https://www.medicare.gov/find-a-plan/questions/home.aspx\" target=\"_blank\">Find health & drug plans\u003c/a>” link. You’ll be able to enter the names of your drugs, as well as the dosage and frequency. In return, you’ll be told which Part D plans cover your medications most economically, Reilly says.\u003c/p>\n\u003cp>\u003cstrong>Dental and Vision\u003c/strong>\u003c/p>\n\u003cp>Original Medicare \u003ca href=\"https://www.medicare.gov/what-medicare-covers/not-covered/item-and-services-not-covered-by-part-a-and-b.html\" target=\"_blank\">does not cover most dental care,\u003c/a> including dentures. It also doesn’t cover eye exams related to prescription glasses.\u003c/p>\n\u003cp>Some Medicare Advantage plans may offer limited vision and dental coverage, but it may cost you extra. Check with your plan.\u003c/p>\n\u003cp>If you want these benefits and have Original Medicare, or don’t get them from your Medicare Advantage plan, you’ll need to buy a standalone dental or vision plan.\u003c/p>\n\u003cp>And that can be expensive. “There are very limited options for people on Medicare,” says Jeff Album, a vice president at \u003ca href=\"https://www.deltadental.com/Public/index.jsp\" target=\"_blank\">Delta Dental\u003c/a>, California’s largest dental insurer.\u003c/p>\n\u003cp>Album offers some tips for Medicare beneficiaries looking for dental coverage:\u003c/p>\n\u003cp>• If you’re eligible for AARP, then you’re also eligible for the \u003ca href=\"https://www.deltadentalins.com/aarp/index.html\" target=\"_blank\">dental insurance products it sells \u003c/a>(including Delta Dental). Call 866-583-2085 for more information.\u003cbr>\n• \u003ca href=\"https://www.deltadentalins.com/plans_costco/\" target=\"_blank\">Costco\u003c/a> sells a Delta Dental plan to its members.\u003cbr>\n• You can search for dental insurance and discount dental plans on \u003ca href=\"http://www.dentalplans.com\" target=\"_blank\">Dentalplans.com\u003c/a>.\u003c/p>\n\u003cp>You can enroll in standalone dental plans any time of year, Album says, but you often have to commit to the plan for a year and/or face a one-year waiting period for some major services.\u003c/p>\n\u003cp>\u003cstrong>Part B Open Enrollment\u003c/strong>\u003c/p>\n\u003cp>Most people sign up for \u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html\" target=\"_blank\">Medicare Part A\u003c/a> (known as the “hospital insurance” portion) when they turn 65 because\u003ca href=\"https://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html\" target=\"_blank\"> it’s usually free.\u003c/a>\u003c/p>\n\u003cp>But not everyone signs up for Part B right away because some may have job-based insurance. Others don’t want to pay the Part B premium.\u003c/p>\n\u003cp>If you’re over 65 and have job-based insurance, \u003ca href=\"https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html\" target=\"_blank\">you can sign up for Part B\u003c/a> without penalty when you retire or otherwise lose your (or your spouse’s) employer-sponsored coverage. (There are \u003ca href=\"http://www.aarp.org/health/medicare-insurance/info-03-2011/ask-ms-medicare-question-94.html\" target=\"_blank\">some different rules\u003c/a> for people who work for small businesses with fewer than 20 employees.)\u003c/p>\n\u003cp>But if you didn’t have insurance and elected not to sign up at age 65, you get dinged for waiting. You have to pay a premium penalty for every year you delayed enrolling, you can only sign up for Part B from \u003ca href=\"https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html\" target=\"_blank\">January through March each year\u003c/a>, and your coverage won’t be effective until July 1 that same year.\u003c/p>\n\u003cp>(By the way, there are l\u003ca href=\"https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html\" target=\"_blank\">ate enrollment penalties for Part D \u003c/a>as well.)\u003c/p>\n\u003cp>The point is to discourage people from waiting until they’re sick to enroll.\u003c/p>\n\u003cp>“Sometimes people will say, ‘I don’t want to spend the money. I’m not sick’,” Reilly says. “But when they need it, they find out the effective date isn’t until July 1.”\u003c/p>\n\u003cp>Tom Freker, an insurance broker in Fountain Valley, came across two women this year who have cancer, but neither had signed up for Part B when they were originally eligible.\u003c/p>\n\u003cp>They plan on enrolling in January. While they wait for their coverage to kick in, he says, they’re trying to get as much of their cancer treatment covered by Part A as possible.\u003c/p>\n\u003cp>Unfortunately, they face major out-of-pocket expenses. “This is costly,” he warns. “It can be a real crusher.”\u003c/p>\n\u003cp>If you’re someone in this category who needs advice, or if you have other Medicare questions, there’s free, one-on-one Medicare counseling available through the Health Insurance Counseling and Advocacy Program, or HICAP. You can find HICAP offices in your county by visiting the \u003ca href=\"https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html\" target=\"_blank\">California Health Advocates website \u003c/a> or call 800-434-0222.\u003c/p>\n\u003cp>HICAP appointments can be hard to get during open enrollment. You can also call 1-800-MEDICARE for help.\u003c/p>\n\u003cp>\u003cem>Questions for Emily:\u003ca href=\"http://AskEmily@usc.edu\" target=\"_blank\"> AskEmily@usc.edu\u003c/a>\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://centerforhealthreporting.org\" target=\"_blank\">The CHCF Center for Health Reporting\u003c/a> partners with news organizations to cover California health policy. Located at the \u003ca href=\"http://annenberg.usc.edu\" target=\"_blank\">USC Annenberg School for Communication and Journalism\u003c/a>, it is funded by the nonpartisan \u003ca href=\"http://www.chcf.org\" target=\"_blank\">California HealthCare Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Every year, open enrollment runs from Oct. 15 to Dec. 7. Premiums are going up for many people. You could save money by shopping around.","status":"publish","parent":0,"modified":1448385482,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":48,"wordCount":1336},"headData":{"title":"What You Need to Know About Medicare Open Enrollment | KQED","description":"Every year, open enrollment runs from Oct. 15 to Dec. 7. Premiums are going up for many people. You could save money by shopping around.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"What You Need to Know About Medicare Open Enrollment","datePublished":"2015-11-24T16:30:50.000Z","dateModified":"2015-11-24T17:18:02.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"111557 http://ww2.kqed.org/stateofhealth/?p=111557","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/11/24/what-you-need-to-know-about-medicare-open-enrollment/","disqusTitle":"What You Need to Know About Medicare Open Enrollment","source":"CHCF Center for Health Reporting","sourceUrl":"http://centerforhealthreporting.org/project/answers-consumer-questions-about-obamacare","nprByline":"Emily Bazar","path":"/stateofhealth/111557/what-you-need-to-know-about-medicare-open-enrollment","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003ca href=\"http://kff.org/medicare/state-indicator/total-medicare-beneficiaries/\" target=\"_blank\">More than 5 million Californians\u003c/a> get their health insurance from \u003ca href=\"https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-medicare.html\" target=\"_blank\">Medicare\u003c/a>, the federal health insurance program for people 65 and over, and for people under 65 who have certain disabilities.\u003c/p>\n\u003cp>There’s a lot going on with Medicare right now. Premiums will rise next year for about one-third of its Part B enrollees. (I’ll help you decipher some of Medicare’s alphabet soup below.)\u003c/p>\n\u003cp>And premiums will increase for other Medicare coverage, such as some prescription drug plans.\u003c/p>\n\u003cp>“The standalone prescription drug plans will have the most dramatic changes next year,” says Margaret Reilly, program manager for a \u003ca href=\"http://www.hicapservices.net/new/html/contact_us.htm\" target=\"_blank\">Medicare counseling service\u003c/a> in Northern California.\u003c/p>\n\u003cp>Now through Dec. 7 is a critical time for many of you with Medicare because it’s open-enrollment season. I’ll provide some tips on what to look out for.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Premium Increases\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html\" target=\"_blank\">Part B \u003c/a>is known as the “medical insurance” portion of Medicare, and helps pay for outpatient medical care such as doctor visits, lab tests and durable medical equipment.\u003c/p>\n\u003cp>Next year, about 30 percent of Part B enrollees will pay $121.80 (or more) instead of $104.90.\u003c/p>\n\u003cp>\u003ca href=\"http://kff.org/medicare/issue-brief/whats-in-store-for-medicares-part-b-premiums-and-deductible-in-2016-and-why/\" target=\"_blank\">Here’s who will pay the higher premiums\u003c/a>:\u003c/p>\n\u003cp>• People who are dually eligible for Medicare and Medicaid (called Medi-Cal in California). But Medicaid pays their premium – and the increase – on their behalf.\u003cbr>\n• Medicare beneficiaries who made more than $85,000 as an individual or $170,000 as a couple. This group also has to\u003ca href=\"https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html\" target=\"_blank\"> pay a surcharge \u003c/a>depending on their income. For example, an individual who made $200,000 would have to pay a total of $316.70 per month.\u003cbr>\n• New Medicare enrollees in 2016.\u003cbr>\n• Part B enrollees who are not receiving Social Security benefits.\u003c/p>\n\u003cp>\u003cstrong>Medicare Advantage and Part D Open Enrollment\u003c/strong>\u003c/p>\n\u003cp>If you have a Medicare Advantage or Part D plan, now’s the time to make changes through Dec. 7. First, a few definitions.\u003c/p>\n\u003cp>Unlike “\u003ca href=\"https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/original-medicare/how-original-medicare-works.html\" target=\"_blank\">Original Medicare\u003c/a>,” which is administered by the federal government, \u003ca href=\"https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/how-medicare-advantage-plans-work.html\" target=\"_blank\">Medicare Advantage\u003c/a> plans are offered by private companies. Medicare pays them to cover your benefits. In addition to your monthly Medicare premium, you may need to pay a premium for your Medicare Advantage plan.\u003c/p>\n\u003cp>They usually include prescription drug coverage.\u003c/p>\n\u003cp>\u003ca href=\"https://www.medicare.gov/sign-up-change-plans/get-drug-coverage/get-drug-coverage.html\" target=\"_blank\">Part D\u003c/a> plans allow you to add prescription drug benefits primarily to Original Medicare.\u003c/p>\n\u003cp>If you already have a Medicare Advantage or Part D plan and don’t want to explore other options for next year, it could cost you.\u003c/p>\n\u003cp>Consider that 22 of the 28 standalone Part D plans in California next year \u003ca href=\"http://www.cahealthadvocates.org/news/drugs/2015/review-coverage-options-2016-and-save.html\" target=\"_blank\">will have higher premiums\u003c/a>, says Elaine Wong Eakin, executive director of \u003ca href=\"http://www.cahealthadvocates.org/index.html\" target=\"_blank\">California Health Advocates\u003c/a>, a Medicare advocacy and education group.\u003c/p>\n\u003cp>The premium hikes range from 90 cents per month to – gulp – $98.70, she says. Five plans will have premium reductions and one stays the same.\u003c/p>\n\u003cp>To find out what’s happening to your plan’s premium, look at your “\u003ca href=\"https://www.medicare.gov/forms-help-and-resources/mail-about-medicare/plan-annual-notice-of-change.html\" target=\"_blank\">Annual Notice of Change\u003c/a>,” which you should have received in the mail earlier this fall. (If you didn’t receive it, call your plan.)\u003c/p>\n\u003cp>This document also should include the plan’s drug formulary, which can add or drop medications from year to year.\u003c/p>\n\u003cp>“If the drugs you take this year are not going to be on next year’s formulary, you want to know that,” Reilly says.\u003c/p>\n\u003cp>Unfortunately, the formularies can be difficult to navigate, she says, so you can also call 1-800-MEDICARE with a list of your medications, and a customer service rep can help you.\u003c/p>\n\u003cp>Another option is to go to the \u003ca href=\"https://www.medicare.gov\" target=\"_blank\">Medicare.gov \u003c/a>website. From the home page, click on the “\u003ca href=\"https://www.medicare.gov/find-a-plan/questions/home.aspx\" target=\"_blank\">Find health & drug plans\u003c/a>” link. You’ll be able to enter the names of your drugs, as well as the dosage and frequency. In return, you’ll be told which Part D plans cover your medications most economically, Reilly says.\u003c/p>\n\u003cp>\u003cstrong>Dental and Vision\u003c/strong>\u003c/p>\n\u003cp>Original Medicare \u003ca href=\"https://www.medicare.gov/what-medicare-covers/not-covered/item-and-services-not-covered-by-part-a-and-b.html\" target=\"_blank\">does not cover most dental care,\u003c/a> including dentures. It also doesn’t cover eye exams related to prescription glasses.\u003c/p>\n\u003cp>Some Medicare Advantage plans may offer limited vision and dental coverage, but it may cost you extra. Check with your plan.\u003c/p>\n\u003cp>If you want these benefits and have Original Medicare, or don’t get them from your Medicare Advantage plan, you’ll need to buy a standalone dental or vision plan.\u003c/p>\n\u003cp>And that can be expensive. “There are very limited options for people on Medicare,” says Jeff Album, a vice president at \u003ca href=\"https://www.deltadental.com/Public/index.jsp\" target=\"_blank\">Delta Dental\u003c/a>, California’s largest dental insurer.\u003c/p>\n\u003cp>Album offers some tips for Medicare beneficiaries looking for dental coverage:\u003c/p>\n\u003cp>• If you’re eligible for AARP, then you’re also eligible for the \u003ca href=\"https://www.deltadentalins.com/aarp/index.html\" target=\"_blank\">dental insurance products it sells \u003c/a>(including Delta Dental). Call 866-583-2085 for more information.\u003cbr>\n• \u003ca href=\"https://www.deltadentalins.com/plans_costco/\" target=\"_blank\">Costco\u003c/a> sells a Delta Dental plan to its members.\u003cbr>\n• You can search for dental insurance and discount dental plans on \u003ca href=\"http://www.dentalplans.com\" target=\"_blank\">Dentalplans.com\u003c/a>.\u003c/p>\n\u003cp>You can enroll in standalone dental plans any time of year, Album says, but you often have to commit to the plan for a year and/or face a one-year waiting period for some major services.\u003c/p>\n\u003cp>\u003cstrong>Part B Open Enrollment\u003c/strong>\u003c/p>\n\u003cp>Most people sign up for \u003ca href=\"https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html\" target=\"_blank\">Medicare Part A\u003c/a> (known as the “hospital insurance” portion) when they turn 65 because\u003ca href=\"https://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html\" target=\"_blank\"> it’s usually free.\u003c/a>\u003c/p>\n\u003cp>But not everyone signs up for Part B right away because some may have job-based insurance. Others don’t want to pay the Part B premium.\u003c/p>\n\u003cp>If you’re over 65 and have job-based insurance, \u003ca href=\"https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html\" target=\"_blank\">you can sign up for Part B\u003c/a> without penalty when you retire or otherwise lose your (or your spouse’s) employer-sponsored coverage. (There are \u003ca href=\"http://www.aarp.org/health/medicare-insurance/info-03-2011/ask-ms-medicare-question-94.html\" target=\"_blank\">some different rules\u003c/a> for people who work for small businesses with fewer than 20 employees.)\u003c/p>\n\u003cp>But if you didn’t have insurance and elected not to sign up at age 65, you get dinged for waiting. You have to pay a premium penalty for every year you delayed enrolling, you can only sign up for Part B from \u003ca href=\"https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-up-parts-a-and-b.html\" target=\"_blank\">January through March each year\u003c/a>, and your coverage won’t be effective until July 1 that same year.\u003c/p>\n\u003cp>(By the way, there are l\u003ca href=\"https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html\" target=\"_blank\">ate enrollment penalties for Part D \u003c/a>as well.)\u003c/p>\n\u003cp>The point is to discourage people from waiting until they’re sick to enroll.\u003c/p>\n\u003cp>“Sometimes people will say, ‘I don’t want to spend the money. I’m not sick’,” Reilly says. “But when they need it, they find out the effective date isn’t until July 1.”\u003c/p>\n\u003cp>Tom Freker, an insurance broker in Fountain Valley, came across two women this year who have cancer, but neither had signed up for Part B when they were originally eligible.\u003c/p>\n\u003cp>They plan on enrolling in January. While they wait for their coverage to kick in, he says, they’re trying to get as much of their cancer treatment covered by Part A as possible.\u003c/p>\n\u003cp>Unfortunately, they face major out-of-pocket expenses. “This is costly,” he warns. “It can be a real crusher.”\u003c/p>\n\u003cp>If you’re someone in this category who needs advice, or if you have other Medicare questions, there’s free, one-on-one Medicare counseling available through the Health Insurance Counseling and Advocacy Program, or HICAP. You can find HICAP offices in your county by visiting the \u003ca href=\"https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html\" target=\"_blank\">California Health Advocates website \u003c/a> or call 800-434-0222.\u003c/p>\n\u003cp>HICAP appointments can be hard to get during open enrollment. You can also call 1-800-MEDICARE for help.\u003c/p>\n\u003cp>\u003cem>Questions for Emily:\u003ca href=\"http://AskEmily@usc.edu\" target=\"_blank\"> AskEmily@usc.edu\u003c/a>\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://centerforhealthreporting.org\" target=\"_blank\">The CHCF Center for Health Reporting\u003c/a> partners with news organizations to cover California health policy. Located at the \u003ca href=\"http://annenberg.usc.edu\" target=\"_blank\">USC Annenberg School for Communication and Journalism\u003c/a>, it is funded by the nonpartisan \u003ca href=\"http://www.chcf.org\" target=\"_blank\">California HealthCare Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/111557/what-you-need-to-know-about-medicare-open-enrollment","authors":["byline_stateofhealth_111557"],"categories":["stateofhealth_2442"],"tags":["stateofhealth_105"],"featImg":"stateofhealth_113028","label":"source_stateofhealth_111557"},"stateofhealth_98970":{"type":"posts","id":"stateofhealth_98970","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"98970","score":null,"sort":[1445975975000]},"guestAuthors":[],"slug":"low-income-elderly-reject-calif-managed-care-experiment-cite-fear-of-change","title":"Low-Income Elderly Reject Calif. Managed Care Experiment, Cite Fear Of Change","publishDate":1445975975,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{},"content":"\u003cp>Nearly half of low-income elderly Californians have opted out of a statewide managed care experiment because they feared losing their doctors and were reluctant to make any changes to their health care, according to \u003ca href=\"http://www.thescanfoundation.org/sites/default/files/field_research_medicare_medi-cal_polling_results_102715.pdf\" target=\"_blank\">survey data released Tuesday\u003c/a> by the Field Poll.\u003c/p>\n\u003cp>California is in the middle of a three-year pilot project aimed at nearly 500,000 of the state’s most costly patients -- so-called dual eligibles. The beneficiaries receive both Medicare, the health insurance program for seniors and the disabled, and Medicaid, called Medi-Cal in California, which provides coverage for the poor.\u003c/p>\n\u003caside class=\"pullquote alignright\">But once they are enrolled, less than 10 percent have decided to leave the program.\u003c/aside>\n\u003cp>The state program, known as Cal MediConnect, has had a high rate of people opting out -- about 47 percent, according to the state Department of Health Care Services.\u003c/p>\n\u003cp>“Resistance to change is not surprising,” said Mark DiCamillo, senior vice president of the Field Research Corp. “It is an older population. ... The status quo is the easiest course.”\u003c/p>\n\u003cp>In some cases, DiCamillo said, their fears were valid. Nearly 30 percent of those enrolled in the new managed care program ended up with a different personal doctor, according to the survey. About the same percentage of enrollees in the program said they had been seeing their doctor for one year or less.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But once they are enrolled, less than 10 percent have decided to leave the program, according to the state. About 80 percent of enrollees said they were very or somewhat confident they could get their questions answered and that they know how to manage their health conditions, the poll found.\u003c/p>\n\u003cp>The experiment, which has about 117,000 enrollees, is designed to provide more coordinated care and to improve enrollees’ health, reduce their costs and help keep them in their homes. The participants typically have multiple chronic diseases and, until now, have bounced between two government systems. Medicare pays for most doctor visits and hospitalizations and Medicaid covers nursing homes and long-term care.\u003c/p>\n\u003cp>The fact that people who enroll in the program stay enrolled is encouraging, said Jennifer Kent, director of the Department of Health Care Services. “The reason they are staying in the program is that they are satisfied with, and in some cases, really pleased with the care,” she said.\u003c/p>\n\u003cp>Kent said it continues to be a challenge, however, to get the message out to beneficiaries about the advantages of being in a more coordinated program. “A lot of individuals think they are losing benefits,” she said. “We are working really hard to assure people that is not the case.”\u003c/p>\n\u003cp>Kent also said the state is evaluating the program to ensure that it is doing what it was intended to do -- save money and improve care.\u003c/p>\n\u003cp>William Averill, a cardiologist in Torrance who treats many dual beneficiaries, said he doesn’t believe that the program is accomplishing that goal and that many people have been automatically enrolled without being aware of the change.\u003c/p>\n\u003cp>“The most vulnerable people were the ones who weren’t in a position to understand their choices,” he said. “I think the whole thing is going to collapse under its own weight.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The survey was the first of four planned polls in 2015 and 2016 of 2,502 dual eligibles in California. This first round included 1,394 enrollees in the Cal MediConnect program in five California counties and 678 who opted out. Surveyors also interviewed 430 people in counties where the program is not being implemented. The survey research was funded by the SCAN Foundation and done in conjunction with the California Department of Health Care Services.\u003c/p>\n\n","blocks":[],"excerpt":"The program, called Cal MediConnect, aims to provide better care for some of the state's most vulnerable patients. ","status":"publish","parent":0,"modified":1445992159,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":15,"wordCount":626},"headData":{"title":"Low-Income Elderly Reject Calif. Managed Care Experiment, Cite Fear Of Change | KQED","description":"The program, called Cal MediConnect, aims to provide better care for some of the state's most vulnerable patients. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Low-Income Elderly Reject Calif. Managed Care Experiment, Cite Fear Of Change","datePublished":"2015-10-27T19:59:35.000Z","dateModified":"2015-10-28T00:29:19.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"98970 http://ww2.kqed.org/stateofhealth/?p=98970","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/10/27/low-income-elderly-reject-calif-managed-care-experiment-cite-fear-of-change/","disqusTitle":"Low-Income Elderly Reject Calif. Managed Care Experiment, Cite Fear Of Change","source":"Kaiser Health News","nprByline":"Anna Gorman","path":"/stateofhealth/98970/low-income-elderly-reject-calif-managed-care-experiment-cite-fear-of-change","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Nearly half of low-income elderly Californians have opted out of a statewide managed care experiment because they feared losing their doctors and were reluctant to make any changes to their health care, according to \u003ca href=\"http://www.thescanfoundation.org/sites/default/files/field_research_medicare_medi-cal_polling_results_102715.pdf\" target=\"_blank\">survey data released Tuesday\u003c/a> by the Field Poll.\u003c/p>\n\u003cp>California is in the middle of a three-year pilot project aimed at nearly 500,000 of the state’s most costly patients -- so-called dual eligibles. The beneficiaries receive both Medicare, the health insurance program for seniors and the disabled, and Medicaid, called Medi-Cal in California, which provides coverage for the poor.\u003c/p>\n\u003caside class=\"pullquote alignright\">But once they are enrolled, less than 10 percent have decided to leave the program.\u003c/aside>\n\u003cp>The state program, known as Cal MediConnect, has had a high rate of people opting out -- about 47 percent, according to the state Department of Health Care Services.\u003c/p>\n\u003cp>“Resistance to change is not surprising,” said Mark DiCamillo, senior vice president of the Field Research Corp. “It is an older population. ... The status quo is the easiest course.”\u003c/p>\n\u003cp>In some cases, DiCamillo said, their fears were valid. Nearly 30 percent of those enrolled in the new managed care program ended up with a different personal doctor, according to the survey. About the same percentage of enrollees in the program said they had been seeing their doctor for one year or less.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But once they are enrolled, less than 10 percent have decided to leave the program, according to the state. About 80 percent of enrollees said they were very or somewhat confident they could get their questions answered and that they know how to manage their health conditions, the poll found.\u003c/p>\n\u003cp>The experiment, which has about 117,000 enrollees, is designed to provide more coordinated care and to improve enrollees’ health, reduce their costs and help keep them in their homes. The participants typically have multiple chronic diseases and, until now, have bounced between two government systems. Medicare pays for most doctor visits and hospitalizations and Medicaid covers nursing homes and long-term care.\u003c/p>\n\u003cp>The fact that people who enroll in the program stay enrolled is encouraging, said Jennifer Kent, director of the Department of Health Care Services. “The reason they are staying in the program is that they are satisfied with, and in some cases, really pleased with the care,” she said.\u003c/p>\n\u003cp>Kent said it continues to be a challenge, however, to get the message out to beneficiaries about the advantages of being in a more coordinated program. “A lot of individuals think they are losing benefits,” she said. “We are working really hard to assure people that is not the case.”\u003c/p>\n\u003cp>Kent also said the state is evaluating the program to ensure that it is doing what it was intended to do -- save money and improve care.\u003c/p>\n\u003cp>William Averill, a cardiologist in Torrance who treats many dual beneficiaries, said he doesn’t believe that the program is accomplishing that goal and that many people have been automatically enrolled without being aware of the change.\u003c/p>\n\u003cp>“The most vulnerable people were the ones who weren’t in a position to understand their choices,” he said. “I think the whole thing is going to collapse under its own weight.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The survey was the first of four planned polls in 2015 and 2016 of 2,502 dual eligibles in California. This first round included 1,394 enrollees in the Cal MediConnect program in five California counties and 678 who opted out. Surveyors also interviewed 430 people in counties where the program is not being implemented. The survey research was funded by the SCAN Foundation and done in conjunction with the California Department of Health Care Services.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/98970/low-income-elderly-reject-calif-managed-care-experiment-cite-fear-of-change","authors":["byline_stateofhealth_98970"],"categories":["stateofhealth_11"],"tags":["stateofhealth_99","stateofhealth_105","stateofhealth_2519"],"featImg":"stateofhealth_98974","label":"source_stateofhealth_98970"},"stateofhealth_63598":{"type":"posts","id":"stateofhealth_63598","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"63598","score":null,"sort":[1439925551000]},"guestAuthors":[],"slug":"medicare-says-doctors-should-get-paid-to-discuss-end-of-life-issues","title":"Medicare Says Doctors Should Get Paid To Discuss End-Of-Life Issues","publishDate":1439925551,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Remember the so-called death panels?\u003c/p>\n\u003cp>When Congress debated the Affordable Care Act in 2009, the legislation originally included a provision that would have allowed Medicare to reimburse doctors when they meet with patients to talk about end-of-life care.\u003c/p>\n\u003cp>But then Sarah Palin argued that such payments would lead to care being withheld from the elderly and disabled. Her comment ignited a firestorm among conservatives and helped fuel the opposition to the legislation.\u003c/p>\n\u003cp>Her assertions greatly distressed Dr. Pamelyn Close, a palliative care specialist in Los Angeles.\u003c/p>\n\u003cp>“It did terrible damage to the concept of having this conversation,” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Amid the ensuing political uproar, Congress deleted the provision. And the lack of payments and concerns about the controversy further discouraged doctors from initiating these talks, according to Close.\u003c/p>\n\u003cp>“We just are not having these conversations often enough and soon enough,” Close said. “Loved ones who are trying to do always the right thing, end up being weighed with tremendous guilt and tremendous uncertainty without having had that conversation.”\u003c/p>\n\u003cp>When done right, according to Close, these counseling sessions often delve into end-of-life treatment options and legal documents, such as advance directives and living wills. The issues to be covered are complex and typically require a series of discussions.\u003c/p>\n\u003cp>Right now, Medicare only pays doctors for this sort of advanced care planning if it happens during the first visit for new Medicare enrollees. But the government recently has again proposed that Medicare reimburse doctors for including these conversations in their practice, whenever they occur.\u003c/p>\n\u003cp>Already, some private insurance companies are starting to do just that.\u003c/p>\n\u003cp>Meanwhile, the Alliance Defending Freedom, a conservative Christian organization, has formally opposed Medicare’s proposal.\u003c/p>\n\u003cp>“By paying doctors for these conversations, what we’re doing is opening the door to directive counseling and coercion,” said Catherine Glenn Foster, an attorney with the group. Foster says her organization supports end-of-life counseling and planning, but not in a doctor’s office.\u003c/p>\n\u003cp>“A doctor is not really the person you’d want to be having it with – particularly not a general practitioner who would not be able to advise on the nuances of end-of-life care in the first place,” she says.\u003c/p>\n\u003cp>But patients seem to want these talks.\u003c/p>\n\u003cp>Many doctors who initiate the discussions often do so on their own dime. More often, they don’t have them at all, said Dr. Daniel Stone, an internist with Cedars-Sinai Medical Center in Los Angeles.\u003c/p>\n\u003cp>“When a doctor has patients scheduled every 15 minutes, it’s difficult to have a face-to-face conversation about values and goals related to the end of life, which is one of the most sensitive topics that you can possibly discuss with a patient,” Stone said.\u003c/p>\n\u003cp>Dr. Susan Tolle, an internist with the Center for Ethics in Health Care at the Oregon Health and Science University in Portland, says the informality with which such conversations are held now means that family members may not be included. Having the discussion as part of a formal doctor’s appointment can change that, she said.\u003c/p>\n\u003cp>“What it does is, it gives this really important conversation dignity and standing,” she said.\u003c/p>\n\u003cp>In Oregon, doctors have been squeezing end-of-life discussions into regular medical appointments for decades, under less-than-ideal circumstances. Over the last five years a quarter of a million Oregonians filed their wishes with a state registry. They use what’s known as a POLST form, which stands for Physician Orders for Life Sustaining Treatment. A version of it has been adopted by some other states, including New York and West Virginia.\u003c/p>\n\u003cp>Jo Ann Farwell, a retired Portland social worker who was recently diagnosed with a brain tumor, completed the form after talking to her doctor.\u003c/p>\n\u003cp>“I had surgery and had a prognosis of four to six months to live,” she said, after she was diagnosed with a brain tumor.\u003c/p>\n\u003cp>She did it, she said, to make sure her last hours are as comfortable as possible.\u003c/p>\n\u003cp>“I wouldn’t want to be on tube-feeding,” she said. “I wouldn’t want to be resuscitated, or have mechanical ventilation, because that would probably prolong my dying, rather than giving me quality of life.”\u003c/p>\n\u003cp>In the 1990s, health care workers all over Oregon recognized that the wishes of patients weren’t being consistently followed. So the health care establishment worked with the state and with ethicists to prioritize end-of-life talks; the result was the POLST form.\u003c/p>\n\u003cp>Rep. Earl Blumenauer, a Democrat from Portland, has introduced the Medicare reimbursement legislation every session since 2009. Until now, he says, the federal government hasn’t placed any value on helping people prepare for death, and he finds that ironic.\u003c/p>\n\u003cp>“The Medicare program will pay for literally thousands of medical procedures, many of them very expensive and complex, even if the person is at the latest stage of life and it may not do any good,” Blumenauer says.\u003c/p>\n\u003cp>From a purely financial point of view, the change could save money. But Blumenauer says that’s not what’s driving him.\u003c/p>\n\u003cp>“I don’t care what people decide,” he says. “If they want to die in an ICU with tubes up their nose, that’s their choice. What we want is that people know what their choices are.”\u003c/p>\n\u003cp>Farwell, the brain tumor patient, well remembers when her sister was dying from cancer.\u003c/p>\n\u003cp>“She never talked about death or dying,” Farwell said, “never talked about what she wanted at the end. It was very, very difficult for me to try to plan and give her care.”\u003c/p>\n\u003cp>Farwell wants her sons to be in a better position when it comes to carrying out her wishes.\u003c/p>\n\u003cp>The federal government is now accepting public comment on the Medicare reimbursement proposal. It’s expected to make a decision in November.\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes \u003ca href=\"http://www.opb.org/news/\" target=\"_blank\">Oregon Public Broadcasting\u003c/a>, \u003ca href=\"http://www.scpr.org/\" target=\"_blank\">Southern California Public Radio\u003c/a>, \u003ca href=\"http://www.npr.org/sections/news/\" target=\"_blank\">NPR\u003c/a> and Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KHN’s coverage of aging and long term care issues is supported in part by a grant from The SCAN Foundation.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Remember the so-called \"death panels\"?","status":"publish","parent":0,"modified":1440091284,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":36,"wordCount":1066},"headData":{"title":"Medicare Says Doctors Should Get Paid To Discuss End-Of-Life Issues | KQED","description":"Remember the so-called "death panels"?","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Medicare Says Doctors Should Get Paid To Discuss End-Of-Life Issues","datePublished":"2015-08-18T19:19:11.000Z","dateModified":"2015-08-20T17:21:24.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"63598 http://ww2.kqed.org/stateofhealth/?p=63598","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/08/18/medicare-says-doctors-should-get-paid-to-discuss-end-of-life-issues/","disqusTitle":"Medicare Says Doctors Should Get Paid To Discuss End-Of-Life Issues","nprByline":"Kristian Foden-Vencil, Oregon Public Broadcasting\u003cbr>and Stephanie O'Neill, Southern California Public Radio","path":"/stateofhealth/63598/medicare-says-doctors-should-get-paid-to-discuss-end-of-life-issues","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Remember the so-called death panels?\u003c/p>\n\u003cp>When Congress debated the Affordable Care Act in 2009, the legislation originally included a provision that would have allowed Medicare to reimburse doctors when they meet with patients to talk about end-of-life care.\u003c/p>\n\u003cp>But then Sarah Palin argued that such payments would lead to care being withheld from the elderly and disabled. Her comment ignited a firestorm among conservatives and helped fuel the opposition to the legislation.\u003c/p>\n\u003cp>Her assertions greatly distressed Dr. Pamelyn Close, a palliative care specialist in Los Angeles.\u003c/p>\n\u003cp>“It did terrible damage to the concept of having this conversation,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Amid the ensuing political uproar, Congress deleted the provision. And the lack of payments and concerns about the controversy further discouraged doctors from initiating these talks, according to Close.\u003c/p>\n\u003cp>“We just are not having these conversations often enough and soon enough,” Close said. “Loved ones who are trying to do always the right thing, end up being weighed with tremendous guilt and tremendous uncertainty without having had that conversation.”\u003c/p>\n\u003cp>When done right, according to Close, these counseling sessions often delve into end-of-life treatment options and legal documents, such as advance directives and living wills. The issues to be covered are complex and typically require a series of discussions.\u003c/p>\n\u003cp>Right now, Medicare only pays doctors for this sort of advanced care planning if it happens during the first visit for new Medicare enrollees. But the government recently has again proposed that Medicare reimburse doctors for including these conversations in their practice, whenever they occur.\u003c/p>\n\u003cp>Already, some private insurance companies are starting to do just that.\u003c/p>\n\u003cp>Meanwhile, the Alliance Defending Freedom, a conservative Christian organization, has formally opposed Medicare’s proposal.\u003c/p>\n\u003cp>“By paying doctors for these conversations, what we’re doing is opening the door to directive counseling and coercion,” said Catherine Glenn Foster, an attorney with the group. Foster says her organization supports end-of-life counseling and planning, but not in a doctor’s office.\u003c/p>\n\u003cp>“A doctor is not really the person you’d want to be having it with – particularly not a general practitioner who would not be able to advise on the nuances of end-of-life care in the first place,” she says.\u003c/p>\n\u003cp>But patients seem to want these talks.\u003c/p>\n\u003cp>Many doctors who initiate the discussions often do so on their own dime. More often, they don’t have them at all, said Dr. Daniel Stone, an internist with Cedars-Sinai Medical Center in Los Angeles.\u003c/p>\n\u003cp>“When a doctor has patients scheduled every 15 minutes, it’s difficult to have a face-to-face conversation about values and goals related to the end of life, which is one of the most sensitive topics that you can possibly discuss with a patient,” Stone said.\u003c/p>\n\u003cp>Dr. Susan Tolle, an internist with the Center for Ethics in Health Care at the Oregon Health and Science University in Portland, says the informality with which such conversations are held now means that family members may not be included. Having the discussion as part of a formal doctor’s appointment can change that, she said.\u003c/p>\n\u003cp>“What it does is, it gives this really important conversation dignity and standing,” she said.\u003c/p>\n\u003cp>In Oregon, doctors have been squeezing end-of-life discussions into regular medical appointments for decades, under less-than-ideal circumstances. Over the last five years a quarter of a million Oregonians filed their wishes with a state registry. They use what’s known as a POLST form, which stands for Physician Orders for Life Sustaining Treatment. A version of it has been adopted by some other states, including New York and West Virginia.\u003c/p>\n\u003cp>Jo Ann Farwell, a retired Portland social worker who was recently diagnosed with a brain tumor, completed the form after talking to her doctor.\u003c/p>\n\u003cp>“I had surgery and had a prognosis of four to six months to live,” she said, after she was diagnosed with a brain tumor.\u003c/p>\n\u003cp>She did it, she said, to make sure her last hours are as comfortable as possible.\u003c/p>\n\u003cp>“I wouldn’t want to be on tube-feeding,” she said. “I wouldn’t want to be resuscitated, or have mechanical ventilation, because that would probably prolong my dying, rather than giving me quality of life.”\u003c/p>\n\u003cp>In the 1990s, health care workers all over Oregon recognized that the wishes of patients weren’t being consistently followed. So the health care establishment worked with the state and with ethicists to prioritize end-of-life talks; the result was the POLST form.\u003c/p>\n\u003cp>Rep. Earl Blumenauer, a Democrat from Portland, has introduced the Medicare reimbursement legislation every session since 2009. Until now, he says, the federal government hasn’t placed any value on helping people prepare for death, and he finds that ironic.\u003c/p>\n\u003cp>“The Medicare program will pay for literally thousands of medical procedures, many of them very expensive and complex, even if the person is at the latest stage of life and it may not do any good,” Blumenauer says.\u003c/p>\n\u003cp>From a purely financial point of view, the change could save money. But Blumenauer says that’s not what’s driving him.\u003c/p>\n\u003cp>“I don’t care what people decide,” he says. “If they want to die in an ICU with tubes up their nose, that’s their choice. What we want is that people know what their choices are.”\u003c/p>\n\u003cp>Farwell, the brain tumor patient, well remembers when her sister was dying from cancer.\u003c/p>\n\u003cp>“She never talked about death or dying,” Farwell said, “never talked about what she wanted at the end. It was very, very difficult for me to try to plan and give her care.”\u003c/p>\n\u003cp>Farwell wants her sons to be in a better position when it comes to carrying out her wishes.\u003c/p>\n\u003cp>The federal government is now accepting public comment on the Medicare reimbursement proposal. It’s expected to make a decision in November.\u003c/p>\n\u003cp>\u003cem>This story is part of a partnership that includes \u003ca href=\"http://www.opb.org/news/\" target=\"_blank\">Oregon Public Broadcasting\u003c/a>, \u003ca href=\"http://www.scpr.org/\" target=\"_blank\">Southern California Public Radio\u003c/a>, \u003ca href=\"http://www.npr.org/sections/news/\" target=\"_blank\">NPR\u003c/a> and Kaiser Health News.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>KHN’s coverage of aging and long term care issues is supported in part by a grant from The SCAN Foundation.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/63598/medicare-says-doctors-should-get-paid-to-discuss-end-of-life-issues","authors":["byline_stateofhealth_63598"],"categories":["stateofhealth_15","stateofhealth_14"],"tags":["stateofhealth_38","stateofhealth_40","stateofhealth_105","stateofhealth_365"],"featImg":"stateofhealth_63602","label":"stateofhealth"},"stateofhealth_53405":{"type":"posts","id":"stateofhealth_53405","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"53405","score":null,"sort":[1438102346000]},"guestAuthors":[],"slug":"happy-50th-birthday-medicare-your-patients-are-getting-healthier","title":"Happy 50th Birthday, Medicare. Your Patients Are Getting Healthier","publishDate":1438102346,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Here's a bit of good news for Medicare, the popular government program that's turning 50 this week. Older Americans on Medicare are spending less time in the hospital; they're living longer; and the cost of a typical hospital stay has actually come down over the past 15 years, according to a\u003ca href=\"http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2015.8035\" target=\"_blank\"> study\u003c/a> in the \u003cem>Journal of the American Medical Association\u003c/em>.\u003c/p>\n\u003cp>Doctors, hospitals and government administrators have put a lot of effort into making Medicare more efficient in the past 15 years. \u003ca href=\"https://medicine.yale.edu/intmed/people/harlan_krumholz.profile\" target=\"_blank\">Dr. Harlan Krumholz\u003c/a> and colleagues at Yale University took on a study to see whether that effort has paid off.\u003c/p>\n\u003cp>[contextly_sidebar id=\"d6fBr9xMRQXiy0cpNzqihfUmFxAiuvKG\"]\"The results were rather remarkable,\" says Krumholz, a cardiologist and leading health care researcher. \"We found jaw-dropping improvements in almost every area that we looked at.\"\u003c/p>\n\u003cp>The researchers looked at the experience of 60 million older Americans covered by traditional Medicare between 1999 and 2013. They found that mortality rates dropped steadily during that time, and people were much less likely to end up in the hospital.\u003c/p>\n\u003cp>\"If the rates had stayed the same in 2013 as they had been in 1999, we would have seen almost 3.5 million more hospitalizations in 2013,\" Krumholz says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"People who were being hospitalized were having much better outcomes after the hospitalization,\" he says. \"They had a much better chance of survival.\"\u003c/p>\n\u003cp>And the average cost of a hospital stay dropped too, he says, from $3,290 to $2,801 in inflation-adjusted dollars over the 15-year-period for patients in the traditional Medicare program. (Researchers couldn't quantify the experience in Medicare Advantage, the managed-care alternative to Medicare).\u003c/p>\n\u003cp>Krumholz attributes the improvement to a wide variety of measures designed to boost patients' health, from prevention programs to advances in medical care. He says some of the savings also came about because medical care shifted from hospitals to less expensive outpatient clinics.\u003c/p>\n\u003cp>\"They're pointing out a very good thing in the medical system,\" says economist \u003ca href=\"https://www.kellogg.northwestern.edu/faculty/directory/garthwaite_craig.aspx\" target=\"_blank\">Craig Garthwaite\u003c/a> at the Kellogg School of Management at Northwestern University. He says the recession, which helped slow rising health care costs overall, apparently played a minor role in this story of Medicare.\u003c/p>\n\u003cp>Costs really are being contained, Garthwaite says. One other reason that's happening is that the federal government is reimbursing hospitals and doctors less for treating Medicare patients.\u003c/p>\n\u003cp>\"That's an easy way to get control of medical spending in Medicare,\" Garthwaite says, but \"it's just not something we can do in the private market, and we have to worry about how sustainable it is for the Medicare program overall.\"\u003c/p>\n\u003cp>With the post-World War II baby boom now reaching retirement age, more and more people are turning 65 and becoming eligible for Medicare. That growth continues to drive up the overall cost of the program, even as that average cost per illness or hospitalization comes down. And as older Americans live longer lives, they use Medicare for more years than previous generations did.\u003c/p>\n\u003cp>Medicare is still running a bit of a deficit, but the situation is improving. The program's trustees say its trust fund will be solvent through 2030. Some adjustments would be needed to keep the program in good financial health beyond that date.\u003c/p>\n\u003cp>Garthwaite says other recent trends could make matters worse, with one especially worrisome example being sharply rising drug prices.\u003c/p>\n\u003cp>\"Some of these [new cancer] products are providing only a few months of life for several hundred thousand dollars,\" he says. And the system doesn't do a good job of making difficult judgments in situations like that.\u003c/p>\n\u003cp>\u003ca href=\"https://www.aei.org/scholar/joseph-antos/\" target=\"_blank\">Joseph Antos\u003c/a>, an economist in health policy at the American Enterprise Institute, agrees that the good news from the Yale study doesn't assure a rosy future. He's concerned about the financial health of Medicare if, for example, an effective drug for Alzheimer's disease is developed.\u003c/p>\n\u003cp>\"I would argue that if anybody came up with an effective treatment for Alzheimer's today, that treatment would be hailed as a major breakthrough and we wouldn't be looking at the cost.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And that would almost certainly break the pattern that's been documented over the past 15 years, where improving health has actually helped drive down the cost of medical care.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Happy+50th+Birthday%2C+Medicare.+Your+Patients+Are+Getting+Healthier&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n","blocks":[],"excerpt":"\"We found jaw-dropping improvements in almost every area that we looked at,\" says lead author of analysis.","status":"publish","parent":0,"modified":1438102896,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":20,"wordCount":726},"headData":{"title":"Happy 50th Birthday, Medicare. Your Patients Are Getting Healthier | KQED","description":""We found jaw-dropping improvements in almost every area that we looked at," says lead author of analysis.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Happy 50th Birthday, Medicare. Your Patients Are Getting Healthier","datePublished":"2015-07-28T16:52:26.000Z","dateModified":"2015-07-28T17:01:36.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"53405 http://ww2.kqed.org/stateofhealth/?p=53405","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/07/28/happy-50th-birthday-medicare-your-patients-are-getting-healthier/","disqusTitle":"Happy 50th Birthday, Medicare. Your Patients Are Getting Healthier","nprByline":"Richard Harris","nprStoryId":"426740179","nprApiLink":"http://api.npr.org/query?id=426740179&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2015/07/28/426740179/happy-50th-birthday-medicare-your-patients-are-getting-healthier?ft=nprml&f=426740179","nprRetrievedStory":"1","nprPubDate":"Tue, 28 Jul 2015 11:15:00 -0400","nprStoryDate":"Tue, 28 Jul 2015 11:01:00 -0400","nprLastModifiedDate":"Tue, 28 Jul 2015 11:15:55 -0400","path":"/stateofhealth/53405/happy-50th-birthday-medicare-your-patients-are-getting-healthier","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Here's a bit of good news for Medicare, the popular government program that's turning 50 this week. Older Americans on Medicare are spending less time in the hospital; they're living longer; and the cost of a typical hospital stay has actually come down over the past 15 years, according to a\u003ca href=\"http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2015.8035\" target=\"_blank\"> study\u003c/a> in the \u003cem>Journal of the American Medical Association\u003c/em>.\u003c/p>\n\u003cp>Doctors, hospitals and government administrators have put a lot of effort into making Medicare more efficient in the past 15 years. \u003ca href=\"https://medicine.yale.edu/intmed/people/harlan_krumholz.profile\" target=\"_blank\">Dr. Harlan Krumholz\u003c/a> and colleagues at Yale University took on a study to see whether that effort has paid off.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\"The results were rather remarkable,\" says Krumholz, a cardiologist and leading health care researcher. \"We found jaw-dropping improvements in almost every area that we looked at.\"\u003c/p>\n\u003cp>The researchers looked at the experience of 60 million older Americans covered by traditional Medicare between 1999 and 2013. They found that mortality rates dropped steadily during that time, and people were much less likely to end up in the hospital.\u003c/p>\n\u003cp>\"If the rates had stayed the same in 2013 as they had been in 1999, we would have seen almost 3.5 million more hospitalizations in 2013,\" Krumholz says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"People who were being hospitalized were having much better outcomes after the hospitalization,\" he says. \"They had a much better chance of survival.\"\u003c/p>\n\u003cp>And the average cost of a hospital stay dropped too, he says, from $3,290 to $2,801 in inflation-adjusted dollars over the 15-year-period for patients in the traditional Medicare program. (Researchers couldn't quantify the experience in Medicare Advantage, the managed-care alternative to Medicare).\u003c/p>\n\u003cp>Krumholz attributes the improvement to a wide variety of measures designed to boost patients' health, from prevention programs to advances in medical care. He says some of the savings also came about because medical care shifted from hospitals to less expensive outpatient clinics.\u003c/p>\n\u003cp>\"They're pointing out a very good thing in the medical system,\" says economist \u003ca href=\"https://www.kellogg.northwestern.edu/faculty/directory/garthwaite_craig.aspx\" target=\"_blank\">Craig Garthwaite\u003c/a> at the Kellogg School of Management at Northwestern University. He says the recession, which helped slow rising health care costs overall, apparently played a minor role in this story of Medicare.\u003c/p>\n\u003cp>Costs really are being contained, Garthwaite says. One other reason that's happening is that the federal government is reimbursing hospitals and doctors less for treating Medicare patients.\u003c/p>\n\u003cp>\"That's an easy way to get control of medical spending in Medicare,\" Garthwaite says, but \"it's just not something we can do in the private market, and we have to worry about how sustainable it is for the Medicare program overall.\"\u003c/p>\n\u003cp>With the post-World War II baby boom now reaching retirement age, more and more people are turning 65 and becoming eligible for Medicare. That growth continues to drive up the overall cost of the program, even as that average cost per illness or hospitalization comes down. And as older Americans live longer lives, they use Medicare for more years than previous generations did.\u003c/p>\n\u003cp>Medicare is still running a bit of a deficit, but the situation is improving. The program's trustees say its trust fund will be solvent through 2030. Some adjustments would be needed to keep the program in good financial health beyond that date.\u003c/p>\n\u003cp>Garthwaite says other recent trends could make matters worse, with one especially worrisome example being sharply rising drug prices.\u003c/p>\n\u003cp>\"Some of these [new cancer] products are providing only a few months of life for several hundred thousand dollars,\" he says. And the system doesn't do a good job of making difficult judgments in situations like that.\u003c/p>\n\u003cp>\u003ca href=\"https://www.aei.org/scholar/joseph-antos/\" target=\"_blank\">Joseph Antos\u003c/a>, an economist in health policy at the American Enterprise Institute, agrees that the good news from the Yale study doesn't assure a rosy future. He's concerned about the financial health of Medicare if, for example, an effective drug for Alzheimer's disease is developed.\u003c/p>\n\u003cp>\"I would argue that if anybody came up with an effective treatment for Alzheimer's today, that treatment would be hailed as a major breakthrough and we wouldn't be looking at the cost.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And that would almost certainly break the pattern that's been documented over the past 15 years, where improving health has actually helped drive down the cost of medical care.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Happy+50th+Birthday%2C+Medicare.+Your+Patients+Are+Getting+Healthier&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/53405/happy-50th-birthday-medicare-your-patients-are-getting-healthier","authors":["byline_stateofhealth_53405"],"categories":["stateofhealth_14"],"tags":["stateofhealth_482","stateofhealth_105"],"featImg":"stateofhealth_53406","label":"stateofhealth"},"stateofhealth_41723":{"type":"posts","id":"stateofhealth_41723","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"41723","score":null,"sort":[1435598357000]},"guestAuthors":[],"slug":"undocumented-immigrants-help-keep-medicare-solvent-according-to-study","title":"Undocumented Immigrants Help Keep Medicare Solvent, According to Study","publishDate":1435598357,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Undocumented immigrants pay billions more into Medicare every year than they use in health benefits, and they subsidize care for other Americans, according to researchers.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.californiahealthline.org/~/media/Files/2015/PDFs/Immigrants%20%20Medicare%20study.ashx\" target=\"_blank\">study published in the Journal of General Internal Medicine\u003c/a> contends that undocumented immigrants generated surplus Medicare contributions of $35.1 billion from 2000 to 2011, extending Medicare's estimated life span by one full year. The study appeared earlier this month as an \"online first\" article in the Journal of General Internal Medicine and will appear in a forthcoming print edition of the journal.\u003c/p>\n\u003cp>[contextly_sidebar id=\"aO3J6Lbfz2x8WePJNBkZqrXUp6drAj7b\"]Researchers from Harvard Medical School, the Institute for Community Health and City University of New York's School of Public Health at Hunter College found that in one year alone -- 2011 -- undocumented immigrants generated an average surplus of $316 apiece for Medicare. Other Americans generated an average deficit of $106 apiece. Undocumented immigrants contributed $3.5 billion more than they received in care in 2011, according to the study.\u003c/p>\n\u003cp>Researchers concluded that restricting immigration would be bad for Medicare's financial health. They estimated that contributions from undocumented immigrants during the first decade of the century prolonged Medicare's trust fund solvency by one year. The trust fund is predicted to be insolvent in 15 years.\u003c/p>\n\u003cp>\u003cstrong>Background and Study Methodology\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Undocumented immigrants are not eligible to participate in government health programs, including Medicare and the Affordable Care Act, but they do contribute by paying taxes. Payroll taxes are the major revenue source for Medicare's trust fund, used primarily to pay hospital bills. Using an Individual Tax Identification Number or an unauthorized Social Security number, most undocumented immigrants -- the estimate in California is 90% -- pay payroll taxes.\u003c/p>\n\u003cp>Researchers examined Medicare trust fund contributions and expenditures from 2000 through 2011, comparing data from the Census Bureau's Current Population Survey to calculate tax contributions. They used the HHS Medical Expenditure Panel Survey to determine medical expenses paid by Medicare.\u003c/p>\n\u003cp>\"For years I have seen my unauthorized immigrant patients be blamed for driving up health care costs,\" lead author Leah Zallman, a faculty member at Harvard Medical School and researcher at the Institute for Community Health said in a prepared statement. \"Yet few acknowledge their contributions. Our study demonstrates that in one large sector of the U.S. health care economy, unauthorized immigrants actually subsidize the care of other Americans.\"\u003c/p>\n\u003cp>CMS officials declined to comment on the research, citing a standing policy against commenting on \"outside studies.\"\u003c/p>\n\u003cp>\u003cstrong>Implications for Medi-Cal\u003c/strong>\u003c/p>\n\u003cp>Although the research dealt exclusively with Medicare -- the federal health coverage program for seniors and those with disabilities -- the findings have implications for Medicaid -- the state-federal partnership providing health care for those with low incomes -- according to California Insurance Commissioner Dave Jones (D).\u003c/p>\n\u003cp>\"While these are two different programs with different funding sources, I think there's no question that this study lends support to the efforts to extend Medi-Cal coverage to undocumented immigrants. I think many of the same points in this research -- that undocumented immigrants contribute tax money to support government programs -- applies to Medicaid and California's Medicaid program, Medi-Cal,\" Jones said.\u003c/p>\n\u003cp>Zallman said the study's underlying message -- that undocumented immigrants' contributions should be recognized and appreciated -- applies to Medicaid, as well.\u003c/p>\n\u003cp>\"I think our study should cause us to re-examine our assumptions about the impacts of unauthorized immigrants in other sectors such as Medicaid,\" Zallman said.\u003c/p>\n\u003cp>Daniel Zingale, senior vice president at the California Endowment, said the Medicare research showed similar results to the Endowment's own efforts to secure health coverage for undocumented Californians.\u003c/p>\n\u003cp>\"These findings mirror what we found in California -- that undocumented people contribute far more than they take out,\" Zingale said.\u003c/p>\n\u003cp>As part of its Health4All campaign, the California Endowment did similar research in California and found undocumented Californians paid $3.2 billion in state and local taxes in 2012.\u003c/p>\n\u003cp>The Endowment's statistics are included in a You Tube video, California's Hidden Truth.\u003c/p>\n\u003cp>\u003cstrong>Research May Affect Immigration Reform\u003c/strong>\u003c/p>\n\u003cp>Jones and Zingale predicted the Medicare research would help advance immigration reform efforts.\u003c/p>\n\u003cp>\"I believe this may be the first study to analyze the impact of unauthorized immigrants on the national Medicare program,\" Jones said. \"The information is well researched and well documented and clearly shows they have had a very positive impact.\"\u003c/p>\n\u003cp>Jones said the study goes one step further and predicts that immigrants will continue to bolster Medicare's trust fund under President Obama's immigration reforms.\u003c/p>\n\u003cp>\"This study also analyzes the potential impact of the president's efforts if the courts allow him to move forward with immigration reform to enable some portion of the unauthorized population to stabilize their status and move forward on a path to citizenship. The net contributions persist even if there's a path to citizenship,\" Jones said.\u003c/p>\n\u003cp>Zingale said Medicare's national status will help broaden the immigration arguments his organization has been making in California.\u003c/p>\n\u003cp>\"This is another installment in a mounting number of facts that show how undocumented people are good for the health of our country,\" Zingale said. \"Because Medicare is a big deal, it will advance that progress toward a greater understanding.\"\u003c/p>\n\u003cp>Zingale and Jones both pointed to California's budget agreement last week that includes health coverage for undocumented children.\u003c/p>\n\u003cp>\"Clearing the way for children of unauthorized immigrants to join Medi-Cal is a good first step,\" Jones said.\u003c/p>\n\u003cp>\"We're calling that the first ever health for all kids budget,\" Zingale said. \"That shows you how far we've come. That budget received Republican votes. Indeed, we are in a very different place than we were just a few years ago. Remember Proposition 187?\"\u003c/p>\n\u003cp>In 1994, California voters approved Prop. 187, a controversial ballot measure denying public services -- including health care and education -- to undocumented immigrants. Courts declared much of the initiative unconstitutional and last year, Gov. Jerry Brown (D) signed legislation repealing unenforceable provisions of the proposition.\u003c/p>\n\u003cp>\u003cstrong>Ties to National Physicians Group\u003c/strong>\u003c/p>\n\u003cp>Physicians for a National Health Program, a national advocacy organization, is helping spread the word about the Medicare research.\u003c/p>\n\u003cp>Although the group \"had no role in conducting, financing or otherwise supporting the research, it decided to help publicize the study and its findings because they are consistent with PNHP's mission statement,\" Zallman said.\u003c/p>\n\u003cp>The organization's mission statement, in part, says:\u003c/p>\n\u003cp>\"PNHP believes that access to high-quality health care is a right of all people and should be provided equitably as a public service rather than bought and sold as a commodity.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Two of the Medicare study authors -- Steffie Woolhandler and David Himmelstein, both professors of public health at City University of New York and lecturers in medicine at Harvard Medical School, are co-founders of PNHP.\u003c/p>\n\n","blocks":[],"excerpt":"California Insurance Commissioner Dave Jones says findings have implications for Medi-Cal, as well.","status":"publish","parent":0,"modified":1438102432,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":37,"wordCount":1126},"headData":{"title":"Undocumented Immigrants Help Keep Medicare Solvent, According to Study | KQED","description":"California Insurance Commissioner Dave Jones says findings have implications for Medi-Cal, as well.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Undocumented Immigrants Help Keep Medicare Solvent, According to Study","datePublished":"2015-06-29T17:19:17.000Z","dateModified":"2015-07-28T16:53:52.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"41723 http://ww2.kqed.org/stateofhealth/?p=41723","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/06/29/undocumented-immigrants-help-keep-medicare-solvent-according-to-study/","disqusTitle":"Undocumented Immigrants Help Keep Medicare Solvent, According to Study","nprByline":"George Lauer \u003cbr>California Healthline Features Editor ","path":"/stateofhealth/41723/undocumented-immigrants-help-keep-medicare-solvent-according-to-study","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Undocumented immigrants pay billions more into Medicare every year than they use in health benefits, and they subsidize care for other Americans, according to researchers.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.californiahealthline.org/~/media/Files/2015/PDFs/Immigrants%20%20Medicare%20study.ashx\" target=\"_blank\">study published in the Journal of General Internal Medicine\u003c/a> contends that undocumented immigrants generated surplus Medicare contributions of $35.1 billion from 2000 to 2011, extending Medicare's estimated life span by one full year. The study appeared earlier this month as an \"online first\" article in the Journal of General Internal Medicine and will appear in a forthcoming print edition of the journal.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Researchers from Harvard Medical School, the Institute for Community Health and City University of New York's School of Public Health at Hunter College found that in one year alone -- 2011 -- undocumented immigrants generated an average surplus of $316 apiece for Medicare. Other Americans generated an average deficit of $106 apiece. Undocumented immigrants contributed $3.5 billion more than they received in care in 2011, according to the study.\u003c/p>\n\u003cp>Researchers concluded that restricting immigration would be bad for Medicare's financial health. They estimated that contributions from undocumented immigrants during the first decade of the century prolonged Medicare's trust fund solvency by one year. The trust fund is predicted to be insolvent in 15 years.\u003c/p>\n\u003cp>\u003cstrong>Background and Study Methodology\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Undocumented immigrants are not eligible to participate in government health programs, including Medicare and the Affordable Care Act, but they do contribute by paying taxes. Payroll taxes are the major revenue source for Medicare's trust fund, used primarily to pay hospital bills. Using an Individual Tax Identification Number or an unauthorized Social Security number, most undocumented immigrants -- the estimate in California is 90% -- pay payroll taxes.\u003c/p>\n\u003cp>Researchers examined Medicare trust fund contributions and expenditures from 2000 through 2011, comparing data from the Census Bureau's Current Population Survey to calculate tax contributions. They used the HHS Medical Expenditure Panel Survey to determine medical expenses paid by Medicare.\u003c/p>\n\u003cp>\"For years I have seen my unauthorized immigrant patients be blamed for driving up health care costs,\" lead author Leah Zallman, a faculty member at Harvard Medical School and researcher at the Institute for Community Health said in a prepared statement. \"Yet few acknowledge their contributions. Our study demonstrates that in one large sector of the U.S. health care economy, unauthorized immigrants actually subsidize the care of other Americans.\"\u003c/p>\n\u003cp>CMS officials declined to comment on the research, citing a standing policy against commenting on \"outside studies.\"\u003c/p>\n\u003cp>\u003cstrong>Implications for Medi-Cal\u003c/strong>\u003c/p>\n\u003cp>Although the research dealt exclusively with Medicare -- the federal health coverage program for seniors and those with disabilities -- the findings have implications for Medicaid -- the state-federal partnership providing health care for those with low incomes -- according to California Insurance Commissioner Dave Jones (D).\u003c/p>\n\u003cp>\"While these are two different programs with different funding sources, I think there's no question that this study lends support to the efforts to extend Medi-Cal coverage to undocumented immigrants. I think many of the same points in this research -- that undocumented immigrants contribute tax money to support government programs -- applies to Medicaid and California's Medicaid program, Medi-Cal,\" Jones said.\u003c/p>\n\u003cp>Zallman said the study's underlying message -- that undocumented immigrants' contributions should be recognized and appreciated -- applies to Medicaid, as well.\u003c/p>\n\u003cp>\"I think our study should cause us to re-examine our assumptions about the impacts of unauthorized immigrants in other sectors such as Medicaid,\" Zallman said.\u003c/p>\n\u003cp>Daniel Zingale, senior vice president at the California Endowment, said the Medicare research showed similar results to the Endowment's own efforts to secure health coverage for undocumented Californians.\u003c/p>\n\u003cp>\"These findings mirror what we found in California -- that undocumented people contribute far more than they take out,\" Zingale said.\u003c/p>\n\u003cp>As part of its Health4All campaign, the California Endowment did similar research in California and found undocumented Californians paid $3.2 billion in state and local taxes in 2012.\u003c/p>\n\u003cp>The Endowment's statistics are included in a You Tube video, California's Hidden Truth.\u003c/p>\n\u003cp>\u003cstrong>Research May Affect Immigration Reform\u003c/strong>\u003c/p>\n\u003cp>Jones and Zingale predicted the Medicare research would help advance immigration reform efforts.\u003c/p>\n\u003cp>\"I believe this may be the first study to analyze the impact of unauthorized immigrants on the national Medicare program,\" Jones said. \"The information is well researched and well documented and clearly shows they have had a very positive impact.\"\u003c/p>\n\u003cp>Jones said the study goes one step further and predicts that immigrants will continue to bolster Medicare's trust fund under President Obama's immigration reforms.\u003c/p>\n\u003cp>\"This study also analyzes the potential impact of the president's efforts if the courts allow him to move forward with immigration reform to enable some portion of the unauthorized population to stabilize their status and move forward on a path to citizenship. The net contributions persist even if there's a path to citizenship,\" Jones said.\u003c/p>\n\u003cp>Zingale said Medicare's national status will help broaden the immigration arguments his organization has been making in California.\u003c/p>\n\u003cp>\"This is another installment in a mounting number of facts that show how undocumented people are good for the health of our country,\" Zingale said. \"Because Medicare is a big deal, it will advance that progress toward a greater understanding.\"\u003c/p>\n\u003cp>Zingale and Jones both pointed to California's budget agreement last week that includes health coverage for undocumented children.\u003c/p>\n\u003cp>\"Clearing the way for children of unauthorized immigrants to join Medi-Cal is a good first step,\" Jones said.\u003c/p>\n\u003cp>\"We're calling that the first ever health for all kids budget,\" Zingale said. \"That shows you how far we've come. That budget received Republican votes. Indeed, we are in a very different place than we were just a few years ago. Remember Proposition 187?\"\u003c/p>\n\u003cp>In 1994, California voters approved Prop. 187, a controversial ballot measure denying public services -- including health care and education -- to undocumented immigrants. Courts declared much of the initiative unconstitutional and last year, Gov. Jerry Brown (D) signed legislation repealing unenforceable provisions of the proposition.\u003c/p>\n\u003cp>\u003cstrong>Ties to National Physicians Group\u003c/strong>\u003c/p>\n\u003cp>Physicians for a National Health Program, a national advocacy organization, is helping spread the word about the Medicare research.\u003c/p>\n\u003cp>Although the group \"had no role in conducting, financing or otherwise supporting the research, it decided to help publicize the study and its findings because they are consistent with PNHP's mission statement,\" Zallman said.\u003c/p>\n\u003cp>The organization's mission statement, in part, says:\u003c/p>\n\u003cp>\"PNHP believes that access to high-quality health care is a right of all people and should be provided equitably as a public service rather than bought and sold as a commodity.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Two of the Medicare study authors -- Steffie Woolhandler and David Himmelstein, both professors of public health at City University of New York and lecturers in medicine at Harvard Medical School, are co-founders of PNHP.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/41723/undocumented-immigrants-help-keep-medicare-solvent-according-to-study","authors":["byline_stateofhealth_41723"],"categories":["stateofhealth_14"],"tags":["stateofhealth_99","stateofhealth_105","stateofhealth_489"],"featImg":"stateofhealth_41750","label":"stateofhealth"},"stateofhealth_21938":{"type":"posts","id":"stateofhealth_21938","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"21938","score":null,"sort":[1412363437000]},"guestAuthors":[],"slug":"more-than-half-of-californias-hospitals-dinged-for-readmissions","title":"More Than Half of California's Hospitals Dinged for Readmissions","publishDate":1412363437,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_21944\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/sleepylovelorn/2570124734/in/photolist-4V7yxq-4E4Gyj-5SVm5E-8mdjzd-7oH4wW-5SVKJN-5SR4pR-5SRBJx-643opj-5yBvMt-eiQZN5-7u2nQK-4GT33u-4GNS8H-6wrQCt-nGpskC-63LsLt-5UN7of-5SR3Jn-8mdjHJ-8maamF-8mdjGd-4MoGw4-5SU3zA-5SU17d-fxHzp6-aH728-72v3fA-ewunU-NVHk-8xVm1-fxHxet-8mdk4u-bCDZL1-bCDZ49-8cjRC-8mdjru-8xVms-8maaBc-8xVmc-8mdjqj-8mdk2y-bRyHEt-p39tC-8mdjKQ-bCDX59-bD3Sqz-bq8WuY-bD3SQR-bD3TyM\">\u003cimg class=\"size-large wp-image-21944\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/2570124734_83c1a82847_o-640x425.jpg\" alt=\"Chinese Hospital in San Francisco received the second-highest fine of any hospital statewide. (m./Flickr)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Chinese Hospital in San Francisco received the second-highest fine of any hospital statewide. (m./Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan>The federal government is fining 64 percent of California hospitals for having too many Medicare patients return to the hospital within a month of being discharged, according to \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2014/October/02/Medicare-readmissions-penalties-2015.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2014/October/02/Medicare-readmissions-penalties-2015.aspx\" target=\"_blank\">an analysis of Medicare data \u003c/a>by Kaiser Health News.\u003c/span>\u003c/p>\n\u003cp>Sutter Surgical Hospital North Valley in Yuba City was the only facility in the state that received the maximum 3 percent fine. Chinese Hospital in San Francisco received the second highest fine: 2.16 percent of all Medicare billings in the coming year.\u003c/p>\n\u003cp>“Any little bit hurts. We will definitely feel it,” says Peggy Cmiel, chief nursing officer at Chinese Hospital.\u003c/p>\n\u003cp>The fines are meant to encourage hospitals to do a better job of caring for patients after they’re released. In the past, many hospitals benefited if a patient returned after surgery – more treatment meant more money. Now, the Medicare program that pays for those treatments wants to reverse the trend by fining hospitals that don't do a good enough job transitioning patients out of the hospital.\u003c!--more-->\u003c/p>\n\u003cp>Nationwide, a record total of 2,610 hospitals were fined this year, according to the Kaiser analysis. Nearly 18 percent of Medicare patients who had been hospitalized were readmitted within 30 days. Officials estimate $17 billion is spent on potentially avoidable readmissions. They expect to recoup $428 million in fines over the next year.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The fines began three years ago and were applied only to patients hospitalized for heart failure, heart attack, and pneumonia. This year, Medicare added chronic lung ailments, as well as elective knee and hip replacements to the list.\u003c/p>\n\u003cp>This is the first year that Sutter Surgical Hospital North Valley is on the list. It incurred no fines in the last two years, then received the maximum this year.\u003c/p>\n\u003cp>Hospital executives declined to comment.\u003c/p>\n\u003cp>\u003cstrong>Safety Net Hospitals Say Fines Unfair\u003c/strong>\u003c/p>\n\u003cp>Chinese Hospital in San Francisco sees an unusually large proportion of low-income, immigrant patients with limited English skills. Many have congestive heart failure or chronic lung problems.\u003c/p>\n\u003cp>“I rarely have a day in here that we don’t have a patient that’s over 100 years old,” says Cmiel, the hospital's chief nursing officer.\u003c/p>\n\u003cp>She says the hospital set up a comprehensive program four years ago in anticipation of the fines for readmissions. They have a team of bilingual and trilingual nurses and social workers who meet with patients before they’re discharged and call and visit patients after they’ve returned home. They make sure patients understand and adhere to their medications and help them get to their follow-up appointments. But Cmiel acknowledges that sometimes even all of that is not enough.\u003c/p>\n\u003cp>“After a certain age, no matter how well, as medical professionals we try to manage their illness, there’s a point where it may not work anymore,” she says.\u003c/p>\n\u003cp>Many of their patients live alone and can become very frightened if they have trouble breathing for example.\u003c/p>\n\u003cp>“It’s just not shocking that they call 911 and want to go to the hospital,” she says.\u003c/p>\n\u003cp>She says the hospital has decreased its readmission rates by almost 30 percent in the last year. But Medicare doesn’t take individual hospital improvements into account in its calculations. It measures rates against a national standard that they deem appropriate.\u003c/p>\n\u003cp>It also makes no concessions for safety-net hospitals that care for a large number of low-income or immigrant patients, who face more obstacles to follow-up care and are more likely to get sick.\u003c/p>\n\u003cp>Cmiel says both of these things came into play for Chinese Hospital. She and other health care experts say that the punishments levied against such hospitals are too harsh or even unfair.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“It seems wrong to me to be making your savings based on a very vulnerable, fragile patient population,” she says. “It doesn’t make sense to me.”\u003c/p>\n\n","blocks":[],"excerpt":"Chinese Hospital in San Francisco received the second highest fine in the state.","status":"publish","parent":0,"modified":1412649385,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":21,"wordCount":676},"headData":{"title":"More Than Half of California's Hospitals Dinged for Readmissions | KQED","description":"Chinese Hospital in San Francisco received the second highest fine in the state.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"More Than Half of California's Hospitals Dinged for Readmissions","datePublished":"2014-10-03T19:10:37.000Z","dateModified":"2014-10-07T02:36:25.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"21938 http://blogs.kqed.org/stateofhealth/?p=21938","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/10/03/more-than-half-of-californias-hospitals-dinged-for-readmissions/","disqusTitle":"More Than Half of California's Hospitals Dinged for Readmissions","path":"/stateofhealth/21938/more-than-half-of-californias-hospitals-dinged-for-readmissions","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_21944\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/sleepylovelorn/2570124734/in/photolist-4V7yxq-4E4Gyj-5SVm5E-8mdjzd-7oH4wW-5SVKJN-5SR4pR-5SRBJx-643opj-5yBvMt-eiQZN5-7u2nQK-4GT33u-4GNS8H-6wrQCt-nGpskC-63LsLt-5UN7of-5SR3Jn-8mdjHJ-8maamF-8mdjGd-4MoGw4-5SU3zA-5SU17d-fxHzp6-aH728-72v3fA-ewunU-NVHk-8xVm1-fxHxet-8mdk4u-bCDZL1-bCDZ49-8cjRC-8mdjru-8xVms-8maaBc-8xVmc-8mdjqj-8mdk2y-bRyHEt-p39tC-8mdjKQ-bCDX59-bD3Sqz-bq8WuY-bD3SQR-bD3TyM\">\u003cimg class=\"size-large wp-image-21944\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/10/2570124734_83c1a82847_o-640x425.jpg\" alt=\"Chinese Hospital in San Francisco received the second-highest fine of any hospital statewide. (m./Flickr)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Chinese Hospital in San Francisco received the second-highest fine of any hospital statewide. (m./Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan>The federal government is fining 64 percent of California hospitals for having too many Medicare patients return to the hospital within a month of being discharged, according to \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2014/October/02/Medicare-readmissions-penalties-2015.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2014/October/02/Medicare-readmissions-penalties-2015.aspx\" target=\"_blank\">an analysis of Medicare data \u003c/a>by Kaiser Health News.\u003c/span>\u003c/p>\n\u003cp>Sutter Surgical Hospital North Valley in Yuba City was the only facility in the state that received the maximum 3 percent fine. Chinese Hospital in San Francisco received the second highest fine: 2.16 percent of all Medicare billings in the coming year.\u003c/p>\n\u003cp>“Any little bit hurts. We will definitely feel it,” says Peggy Cmiel, chief nursing officer at Chinese Hospital.\u003c/p>\n\u003cp>The fines are meant to encourage hospitals to do a better job of caring for patients after they’re released. In the past, many hospitals benefited if a patient returned after surgery – more treatment meant more money. Now, the Medicare program that pays for those treatments wants to reverse the trend by fining hospitals that don't do a good enough job transitioning patients out of the hospital.\u003c!--more-->\u003c/p>\n\u003cp>Nationwide, a record total of 2,610 hospitals were fined this year, according to the Kaiser analysis. Nearly 18 percent of Medicare patients who had been hospitalized were readmitted within 30 days. Officials estimate $17 billion is spent on potentially avoidable readmissions. They expect to recoup $428 million in fines over the next year.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The fines began three years ago and were applied only to patients hospitalized for heart failure, heart attack, and pneumonia. This year, Medicare added chronic lung ailments, as well as elective knee and hip replacements to the list.\u003c/p>\n\u003cp>This is the first year that Sutter Surgical Hospital North Valley is on the list. It incurred no fines in the last two years, then received the maximum this year.\u003c/p>\n\u003cp>Hospital executives declined to comment.\u003c/p>\n\u003cp>\u003cstrong>Safety Net Hospitals Say Fines Unfair\u003c/strong>\u003c/p>\n\u003cp>Chinese Hospital in San Francisco sees an unusually large proportion of low-income, immigrant patients with limited English skills. Many have congestive heart failure or chronic lung problems.\u003c/p>\n\u003cp>“I rarely have a day in here that we don’t have a patient that’s over 100 years old,” says Cmiel, the hospital's chief nursing officer.\u003c/p>\n\u003cp>She says the hospital set up a comprehensive program four years ago in anticipation of the fines for readmissions. They have a team of bilingual and trilingual nurses and social workers who meet with patients before they’re discharged and call and visit patients after they’ve returned home. They make sure patients understand and adhere to their medications and help them get to their follow-up appointments. But Cmiel acknowledges that sometimes even all of that is not enough.\u003c/p>\n\u003cp>“After a certain age, no matter how well, as medical professionals we try to manage their illness, there’s a point where it may not work anymore,” she says.\u003c/p>\n\u003cp>Many of their patients live alone and can become very frightened if they have trouble breathing for example.\u003c/p>\n\u003cp>“It’s just not shocking that they call 911 and want to go to the hospital,” she says.\u003c/p>\n\u003cp>She says the hospital has decreased its readmission rates by almost 30 percent in the last year. But Medicare doesn’t take individual hospital improvements into account in its calculations. It measures rates against a national standard that they deem appropriate.\u003c/p>\n\u003cp>It also makes no concessions for safety-net hospitals that care for a large number of low-income or immigrant patients, who face more obstacles to follow-up care and are more likely to get sick.\u003c/p>\n\u003cp>Cmiel says both of these things came into play for Chinese Hospital. She and other health care experts say that the punishments levied against such hospitals are too harsh or even unfair.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“It seems wrong to me to be making your savings based on a very vulnerable, fragile patient population,” she says. “It doesn’t make sense to me.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/21938/more-than-half-of-californias-hospitals-dinged-for-readmissions","authors":["3205"],"categories":["stateofhealth_14"],"tags":["stateofhealth_105"],"featImg":"stateofhealth_21944","label":"stateofhealth"},"stateofhealth_19113":{"type":"posts","id":"stateofhealth_19113","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"19113","score":null,"sort":[1400186701000]},"guestAuthors":[],"slug":"for-some-california-doctors-nearly-all-medicare-office-visits-are-highly-complex","title":"California Doctors Among Those Charging Medicare the Most for Office Visits","publishDate":1400186701,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_19133\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/141777516.jpg\">\u003cimg class=\"size-large wp-image-19133\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/141777516-640x426.jpg\" alt=\"Caption will go here. (John Moore/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">More complicated office visits are billed at a higher reimbursement level and can cost patients more in higher copays. (John Moore/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Lisa Aliferis, April Dembosky and Lisa Pickoff-White\u003c/strong>\u003c/p>\n\u003cp>When people think of seeing a doctor, generally the first thing that comes to mind is an office visit. But not all visits are the same. Frequently, patients have minor problems, which can be dispensed with quickly. Other problems are much more complex and require more of a doctor's time and expertise. Not surprisingly, doctors get paid more for these more complex visits. Office visits for established patients are billed across five levels.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Three California doctors are among the top five nationally in billing for the most complex office visits. \u003c/aside>\n\u003cp>Most doctors' billing patterns to the Medicare program fall in the middle ground between simple and complex.\u003c/p>\n\u003cp>In California, only 5 percent of doctors’ office visits for Medicare patients were billed at the highest level in 2012. It is unusual for doctors to determine -- and bill -- a large proportion of their office visits as complex.\u003c/p>\n\u003cp>Now an analysis of Medicare billing data -- which was \u003ca href=\"http://www.nytimes.com/2014/04/09/business/sliver-of-medicare-doctors-get-big-share-of-payouts.html?emc=edit_tnt_20140409&nlid=58462464&tntemail0=y&_r=0\">made public\u003c/a> for the first time last month -- shows that \u003ca href=\"http://projects.propublica.org/treatment/uniqservices/99215\" target=\"_blank\">three California doctors are among the top five nationally \u003c/a>in billing for the highest number of the most complex office visits. In addition, they tended to bill at the highest level significantly more frequently than peers in their specialty.\u003c!--more-->\u003c/p>\n\u003cul>\n\u003cli>In Orange County, \u003ca href=\"http://projects.propublica.org/treatment/doctors/1568540193\" target=\"_blank\">Dr. Louis VanderMolen\u003c/a>, a hematologist-oncologist, billed Medicare for 6,340 of these visits in 2012, the most of any doctor in the country and significantly more frequently than similar specialists nationwide. Almost 79 percent of his office visits were billed at the highest level, whereas other hematologist-oncologists only billed 12 percent of their office visits the same way.\u003c/li>\n\u003c/ul>\n\u003cul>\n\u003cli>In the Santa Cruz County community of Freedom nearly every one of cardiologist \u003ca href=\"http://projects.propublica.org/treatment/doctors/1861484511\" target=\"_blank\">Jeffrey Mace\u003c/a>'s patients received – and was charged for – the highest complexity visit. Mace billed Medicare for these high level visits almost 10 times more often than other cardiologists in California, and the third most in the country.\u003c/li>\n\u003c/ul>\n\u003cul>\n\u003cli>Cardiologist \u003ca href=\"http://projects.propublica.org/treatment/doctors/1932218666\" target=\"_blank\">Jay Schapira\u003c/a> ranks fifth in the country for the number of times he billed the most complex type of visit to his office in Los Angeles. His average patient received four of these visits in a year, compared to the one visit typical of other cardiologists in the state.\u003c/li>\n\u003c/ul>\n\u003cp>“That’s unusual for a doctor who’s not seeing patients in the hospital,” said Lamar Blount, a Medicare billing expert with the Health Law Network consultancy in Atlanta. “Usually cardiac patients in the hospital are the ones that are about to die.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>KQED conducted this analysis in conjunction with ProPublica, which published its \u003ca href=\"http://www.propublica.org/article/billing-to-the-max-docs-charge-medicare-top-rate-for-office-visits\" target=\"_blank\">national investigation\u003c/a> on Thursday.\u003c/p>\n\u003caside class=\"right\">\n\u003ch4>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/15/look-up-your-medicare-providers/\" target=\"_blank\">Look up your Medicare provider\u003c/a>\u003c/h4>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/15/look-up-your-medicare-providers/\">\u003cimg src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/medicareprovider.jpg\" alt=\"medicareprovider\" width=\"275\">\u003c/a>\u003c/p>\n\u003c/aside>\n\u003cp>These billing patterns raise questions for Medicare as a whole and for individual patients who pay a percentage copay. The higher level visits cost more. “Twenty percent of $200, for example, is obviously more than 20 percent of $100,” said Christina Melnykovych, president of Coding Continuum and an expert in insurance billing. “There's a direct correlation between the service level billed and the paid amount, and thus the copay impacts the patient.”\u003c/p>\n\u003cp>All established patient office visits are coded under a category called \"evaluation and management.\" These visits are billed at one of five levels, with \"5\" being the most complex. Established patients are people the provider has seen at least once before. First-time doctor appointments are coded differently.\u003c/p>\n\u003cp>The Centers for Medicare and Medicaid Services, which runs Medicare, declined to comment for this story and in a statement said they have not seen the data analysis.\u003c/p>\n\u003cp>\"Some providers have sicker patients, thus are more likely to bill at [evaluation and management] coding levels that carry higher payments. Every day we work with providers to make patient care the priority, and at the same time ensure they use [evaluation and management] codes that reflect the level of service provided,” the agency said. “It’s our assessment that it would be highly unusual for a provider to knowingly use the highest (level) code … for all or nearly all of his or her outpatient visits.”\u003c/p>\n\u003cp>Only one percent of California doctors billed Medicare at the highest level for all of their office visits for their established patients.\u003c/p>\n\u003cp>Coding experts stress that while the numbers cited for the doctors above do not by themselves indicate wrongdoing, they do raise eyebrows.\u003c/p>\n\u003cp>\u003cstrong>‘I’m Not An Average Cardiologist’\u003c/strong>\u003c/p>\n\u003cp>We tried to reach all of the doctors named in this report, with repeated phone calls plus faxes detailing our questions. Drs. VanderMolen and Schapira did not respond to our requests.\u003c/p>\n\u003cp>Dr. Mace sent us a written statement in which he vigorously defended his billing patterns. “I’m not an average cardiologist,” he wrote.\u003cstrong> “\u003c/strong>I spend a great deal of time taking care of patients. I generally spend 12-16 hours per day in the practice of medicine. I do not take any lunch breaks. I am on call 24 hours a day, seven days a week and do not take vacations. By being available and devoting a great deal of resources to the patients, I hope that this comprehensive care translates to improved quality of life for my patients and hopefully, improved quantity of life (longevity).”\u003c/p>\n\u003cp>But billing for an individual visit is not about a physician’s dedication. Experts say it is about the patient’s complaint that day. “What was it about the patient’s clinical presentation and condition that warranted billing a level 5 service?” Melnykovych said.\u003c/p>\n\u003cp>In his statement, Mace said he had been “subject to several audits” over many years in regards to this level 5 billing code. He says that Medicare “has found all of the office visits reviewed to be correctly coded.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">6,340 most-complex visits, at an estimated 40 minutes each, adds up to seeing patients 16 hours a day, every weekday.\u003c/aside>\n\u003cp>While the established office visits are not based on time, per se, as a metric for coding, the American Medical Association assigns average time that would normally go along with different visit levels. For a level 5 visits, it’s 40 minutes, Melnykovych said.\u003c/p>\n\u003cp>If VanderMolen spent the average 40 minutes during all the 6,340 visits which he billed Medicare, that would mean he saw patients 16 hours a day -- presuming he worked every weekday in 2012. Medicare paid VanderMolen nearly $750,000 for these level 5 visits in 2012. He was reimbursed another $1.6 million by Medicare for other services performed.\u003c/p>\n\u003cp>Overpayment can happen for many reasons, including simple error. “But that doesn’t preclude the federal government or any payer from coming to the (doctor) and getting their money back,” Melnykovych said.\u003c/p>\n\u003cp>Sometimes the excuse is legitimate. Blount said if a doctor is affiliated with a teaching hospital – Schapira is a professor at the school of medicine at UCLA – that could explain a higher volume of patients at higher level codes. In his statement, Mace said that he is \"currently on staff at Stanford.\" A spokesman for Stanford Hospital and Clinics said in an email to KQED that Mace is an \"\u003cspan class=\"Apple-style-span\">\u003cspan style=\"color: #000000\">independent community cardiologist who has 'courtesy admitting' privileges at Stanford Hospital & Clinics. Dr. Mace is not on Stanford’s faculty.\" \u003c/span>\u003c/span>\u003c/p>\n\u003cp>\u003cspan class=\"Apple-style-span\">\u003cspan style=\"color: #000000\">VanderMolen's\u003ca href=\"http://www.ocoh.com/about.html\" target=\"_blank\"> website\u003c/a> says that he \"\u003c/span>\u003cspan style=\"color: #022136\">has had several university, hospital, and other appointments.\" It does not indicate any current affiliations with any academic medical centers. \u003c/span>\u003c/span>\u003c/p>\n\u003cp>Problems can also arise from the billing set up at a doctor’s office. Many doctors don’t actually do their own billing, Blount says. They dictate their office notes from a visit or fill out a checklist, and then a clerk in the billing department enters a code.\u003c/p>\n\u003cp>“Many times a physician is not even aware of what their claims are or how their claims are coded,” Blount says.\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/149757159&color=ff5500&auto_play=false&hide_related=false&show_artwork=true\">\u003c/iframe>\u003c/p>\n\u003cp>He has also seen a rising trend in unintended coding errors that mirror the rise of the implementation of electronic medical record systems. Many of these systems include an automated coding function. A physician will type in medical observations and treatment protocols, and then an algorithm will determine the code.\u003c/p>\n\u003cp>“Those algorithms are subject to human error,” Blount says. “Some mistakes are being made by the electronic medical record vendors in how they designed the product that they’re selling.”\u003c/p>\n\u003cp>Regardless, according to Medicare rules the ultimate responsibility for billing always rests with the doctor.\u003c/p>\n\u003cp>\u003cstrong>Frequent visits\u003c/strong>\u003c/p>\n\u003cp>It’s not just the total number of visits that could raise red flags among auditors -- repeat complex visits by individual patients could also be a cause for concern.\u003c/p>\n\u003cp>\u003ca href=\"http://projects.propublica.org/treatment/doctors/1205954955\" target=\"_blank\">Dr. Gary Ordog\u003c/a> is listed in Medicare’s billing database as an outpatient emergency medicine doctor in Newhall, a suburb of Los Angeles. Typically, this kind of physician sees patients at an outpatient urgent care center for any range of simple, non-urgent complaints, like sore throats, to more urgent matters, like a broken wrist.\u003c/p>\n\u003cp>According to KQED's analysis, Ordog's patients received – on average -- 30 of the most complex office visits in 2012. The average for other emergency medicine doctors is 1 complex visit per patient.\u003c/p>\n\u003cp>“That’s a little suspect,” says Patrice Morin-Spatz, a medical coding expert and trainer.\u003c/p>\n\u003cp>This is not the first time questions have arisen around Ordog’s medical practices. In the mid-2000s, Ordog served numerous times as an expert medical witness in court cases arguing that mold in residential units and work environments made his patients severely ill.\u003c/p>\n\u003cp>The California Medical Board tried to revoke Ordog’s medical license in 2006 for “repeated negligent acts, incompetence, making false statements, and inadequate record keeping,” according to legal documents. He was put on probation and permitted to continue practicing medicine but prohibited from participating in any litigation. Ordog was found to have violated the terms of his probation by preparing reports for four patients in workers' compensation claims. He signed a settlement agreement in September that extended his probation until March 2015.\u003c/p>\n\u003cp>Ordog did not respond to repeated requests for comment made via phone, fax, and to his attorney.\u003c/p>\n\u003cp>\u003cstrong>How We Did This\u003c/strong>\u003c/p>\n\u003cp>KQED partnered with ProPublica to analyze provider billing patterns for regular office visits for Medicare patients. ProPublica released its national report Thursday. We used data released in April by the Centers for Medicare and Medicaid Services showing the payments made to providers in Medicare’s Part B program in 2012.\u003c/p>\n\u003cp>KQED focused its analysis only on California providers who billed Medicare for at least 100 office visits for established patients in 2012.\u003c/p>\n\u003cp>We looked at the doctors who billed Medicare at the highest level (5) for the majority of their office visits. We also looked for other unusual patterns, including providers whose patients received an unusually high number of level 5 visits, or doctors who provided level 5 visits to an unusually high percentage of their patients.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Matt Levin and Brittany Patterson contributed to this report.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Three California doctors are among the top five nationally in billing for the most complex office visits.","status":"publish","parent":0,"modified":1400529122,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":true,"iframeSrcs":["https://w.soundcloud.com/player/"],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":45,"wordCount":1893},"headData":{"title":"California Doctors Among Those Charging Medicare the Most for Office Visits | KQED","description":"Three California doctors are among the top five nationally in billing for the most complex office visits.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"California Doctors Among Those Charging Medicare the Most for Office Visits","datePublished":"2014-05-15T20:45:01.000Z","dateModified":"2014-05-19T19:52:02.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"19113 http://blogs.kqed.org/stateofhealth/?p=19113","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/05/15/for-some-california-doctors-nearly-all-medicare-office-visits-are-highly-complex/","disqusTitle":"California Doctors Among Those Charging Medicare the Most for Office Visits","path":"/stateofhealth/19113/for-some-california-doctors-nearly-all-medicare-office-visits-are-highly-complex","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19133\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/141777516.jpg\">\u003cimg class=\"size-large wp-image-19133\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/141777516-640x426.jpg\" alt=\"Caption will go here. (John Moore/Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">More complicated office visits are billed at a higher reimbursement level and can cost patients more in higher copays. (John Moore/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Lisa Aliferis, April Dembosky and Lisa Pickoff-White\u003c/strong>\u003c/p>\n\u003cp>When people think of seeing a doctor, generally the first thing that comes to mind is an office visit. But not all visits are the same. Frequently, patients have minor problems, which can be dispensed with quickly. Other problems are much more complex and require more of a doctor's time and expertise. Not surprisingly, doctors get paid more for these more complex visits. Office visits for established patients are billed across five levels.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Three California doctors are among the top five nationally in billing for the most complex office visits. \u003c/aside>\n\u003cp>Most doctors' billing patterns to the Medicare program fall in the middle ground between simple and complex.\u003c/p>\n\u003cp>In California, only 5 percent of doctors’ office visits for Medicare patients were billed at the highest level in 2012. It is unusual for doctors to determine -- and bill -- a large proportion of their office visits as complex.\u003c/p>\n\u003cp>Now an analysis of Medicare billing data -- which was \u003ca href=\"http://www.nytimes.com/2014/04/09/business/sliver-of-medicare-doctors-get-big-share-of-payouts.html?emc=edit_tnt_20140409&nlid=58462464&tntemail0=y&_r=0\">made public\u003c/a> for the first time last month -- shows that \u003ca href=\"http://projects.propublica.org/treatment/uniqservices/99215\" target=\"_blank\">three California doctors are among the top five nationally \u003c/a>in billing for the highest number of the most complex office visits. In addition, they tended to bill at the highest level significantly more frequently than peers in their specialty.\u003c!--more-->\u003c/p>\n\u003cul>\n\u003cli>In Orange County, \u003ca href=\"http://projects.propublica.org/treatment/doctors/1568540193\" target=\"_blank\">Dr. Louis VanderMolen\u003c/a>, a hematologist-oncologist, billed Medicare for 6,340 of these visits in 2012, the most of any doctor in the country and significantly more frequently than similar specialists nationwide. Almost 79 percent of his office visits were billed at the highest level, whereas other hematologist-oncologists only billed 12 percent of their office visits the same way.\u003c/li>\n\u003c/ul>\n\u003cul>\n\u003cli>In the Santa Cruz County community of Freedom nearly every one of cardiologist \u003ca href=\"http://projects.propublica.org/treatment/doctors/1861484511\" target=\"_blank\">Jeffrey Mace\u003c/a>'s patients received – and was charged for – the highest complexity visit. Mace billed Medicare for these high level visits almost 10 times more often than other cardiologists in California, and the third most in the country.\u003c/li>\n\u003c/ul>\n\u003cul>\n\u003cli>Cardiologist \u003ca href=\"http://projects.propublica.org/treatment/doctors/1932218666\" target=\"_blank\">Jay Schapira\u003c/a> ranks fifth in the country for the number of times he billed the most complex type of visit to his office in Los Angeles. His average patient received four of these visits in a year, compared to the one visit typical of other cardiologists in the state.\u003c/li>\n\u003c/ul>\n\u003cp>“That’s unusual for a doctor who’s not seeing patients in the hospital,” said Lamar Blount, a Medicare billing expert with the Health Law Network consultancy in Atlanta. “Usually cardiac patients in the hospital are the ones that are about to die.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>KQED conducted this analysis in conjunction with ProPublica, which published its \u003ca href=\"http://www.propublica.org/article/billing-to-the-max-docs-charge-medicare-top-rate-for-office-visits\" target=\"_blank\">national investigation\u003c/a> on Thursday.\u003c/p>\n\u003caside class=\"right\">\n\u003ch4>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/15/look-up-your-medicare-providers/\" target=\"_blank\">Look up your Medicare provider\u003c/a>\u003c/h4>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/15/look-up-your-medicare-providers/\">\u003cimg src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/05/medicareprovider.jpg\" alt=\"medicareprovider\" width=\"275\">\u003c/a>\u003c/p>\n\u003c/aside>\n\u003cp>These billing patterns raise questions for Medicare as a whole and for individual patients who pay a percentage copay. The higher level visits cost more. “Twenty percent of $200, for example, is obviously more than 20 percent of $100,” said Christina Melnykovych, president of Coding Continuum and an expert in insurance billing. “There's a direct correlation between the service level billed and the paid amount, and thus the copay impacts the patient.”\u003c/p>\n\u003cp>All established patient office visits are coded under a category called \"evaluation and management.\" These visits are billed at one of five levels, with \"5\" being the most complex. Established patients are people the provider has seen at least once before. First-time doctor appointments are coded differently.\u003c/p>\n\u003cp>The Centers for Medicare and Medicaid Services, which runs Medicare, declined to comment for this story and in a statement said they have not seen the data analysis.\u003c/p>\n\u003cp>\"Some providers have sicker patients, thus are more likely to bill at [evaluation and management] coding levels that carry higher payments. Every day we work with providers to make patient care the priority, and at the same time ensure they use [evaluation and management] codes that reflect the level of service provided,” the agency said. “It’s our assessment that it would be highly unusual for a provider to knowingly use the highest (level) code … for all or nearly all of his or her outpatient visits.”\u003c/p>\n\u003cp>Only one percent of California doctors billed Medicare at the highest level for all of their office visits for their established patients.\u003c/p>\n\u003cp>Coding experts stress that while the numbers cited for the doctors above do not by themselves indicate wrongdoing, they do raise eyebrows.\u003c/p>\n\u003cp>\u003cstrong>‘I’m Not An Average Cardiologist’\u003c/strong>\u003c/p>\n\u003cp>We tried to reach all of the doctors named in this report, with repeated phone calls plus faxes detailing our questions. Drs. VanderMolen and Schapira did not respond to our requests.\u003c/p>\n\u003cp>Dr. Mace sent us a written statement in which he vigorously defended his billing patterns. “I’m not an average cardiologist,” he wrote.\u003cstrong> “\u003c/strong>I spend a great deal of time taking care of patients. I generally spend 12-16 hours per day in the practice of medicine. I do not take any lunch breaks. I am on call 24 hours a day, seven days a week and do not take vacations. By being available and devoting a great deal of resources to the patients, I hope that this comprehensive care translates to improved quality of life for my patients and hopefully, improved quantity of life (longevity).”\u003c/p>\n\u003cp>But billing for an individual visit is not about a physician’s dedication. Experts say it is about the patient’s complaint that day. “What was it about the patient’s clinical presentation and condition that warranted billing a level 5 service?” Melnykovych said.\u003c/p>\n\u003cp>In his statement, Mace said he had been “subject to several audits” over many years in regards to this level 5 billing code. He says that Medicare “has found all of the office visits reviewed to be correctly coded.”\u003c/p>\n\u003caside class=\"pullquote alignleft\">6,340 most-complex visits, at an estimated 40 minutes each, adds up to seeing patients 16 hours a day, every weekday.\u003c/aside>\n\u003cp>While the established office visits are not based on time, per se, as a metric for coding, the American Medical Association assigns average time that would normally go along with different visit levels. For a level 5 visits, it’s 40 minutes, Melnykovych said.\u003c/p>\n\u003cp>If VanderMolen spent the average 40 minutes during all the 6,340 visits which he billed Medicare, that would mean he saw patients 16 hours a day -- presuming he worked every weekday in 2012. Medicare paid VanderMolen nearly $750,000 for these level 5 visits in 2012. He was reimbursed another $1.6 million by Medicare for other services performed.\u003c/p>\n\u003cp>Overpayment can happen for many reasons, including simple error. “But that doesn’t preclude the federal government or any payer from coming to the (doctor) and getting their money back,” Melnykovych said.\u003c/p>\n\u003cp>Sometimes the excuse is legitimate. Blount said if a doctor is affiliated with a teaching hospital – Schapira is a professor at the school of medicine at UCLA – that could explain a higher volume of patients at higher level codes. In his statement, Mace said that he is \"currently on staff at Stanford.\" A spokesman for Stanford Hospital and Clinics said in an email to KQED that Mace is an \"\u003cspan class=\"Apple-style-span\">\u003cspan style=\"color: #000000\">independent community cardiologist who has 'courtesy admitting' privileges at Stanford Hospital & Clinics. Dr. Mace is not on Stanford’s faculty.\" \u003c/span>\u003c/span>\u003c/p>\n\u003cp>\u003cspan class=\"Apple-style-span\">\u003cspan style=\"color: #000000\">VanderMolen's\u003ca href=\"http://www.ocoh.com/about.html\" target=\"_blank\"> website\u003c/a> says that he \"\u003c/span>\u003cspan style=\"color: #022136\">has had several university, hospital, and other appointments.\" It does not indicate any current affiliations with any academic medical centers. \u003c/span>\u003c/span>\u003c/p>\n\u003cp>Problems can also arise from the billing set up at a doctor’s office. Many doctors don’t actually do their own billing, Blount says. They dictate their office notes from a visit or fill out a checklist, and then a clerk in the billing department enters a code.\u003c/p>\n\u003cp>“Many times a physician is not even aware of what their claims are or how their claims are coded,” Blount says.\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/149757159&color=ff5500&auto_play=false&hide_related=false&show_artwork=true\">\u003c/iframe>\u003c/p>\n\u003cp>He has also seen a rising trend in unintended coding errors that mirror the rise of the implementation of electronic medical record systems. Many of these systems include an automated coding function. A physician will type in medical observations and treatment protocols, and then an algorithm will determine the code.\u003c/p>\n\u003cp>“Those algorithms are subject to human error,” Blount says. “Some mistakes are being made by the electronic medical record vendors in how they designed the product that they’re selling.”\u003c/p>\n\u003cp>Regardless, according to Medicare rules the ultimate responsibility for billing always rests with the doctor.\u003c/p>\n\u003cp>\u003cstrong>Frequent visits\u003c/strong>\u003c/p>\n\u003cp>It’s not just the total number of visits that could raise red flags among auditors -- repeat complex visits by individual patients could also be a cause for concern.\u003c/p>\n\u003cp>\u003ca href=\"http://projects.propublica.org/treatment/doctors/1205954955\" target=\"_blank\">Dr. Gary Ordog\u003c/a> is listed in Medicare’s billing database as an outpatient emergency medicine doctor in Newhall, a suburb of Los Angeles. Typically, this kind of physician sees patients at an outpatient urgent care center for any range of simple, non-urgent complaints, like sore throats, to more urgent matters, like a broken wrist.\u003c/p>\n\u003cp>According to KQED's analysis, Ordog's patients received – on average -- 30 of the most complex office visits in 2012. The average for other emergency medicine doctors is 1 complex visit per patient.\u003c/p>\n\u003cp>“That’s a little suspect,” says Patrice Morin-Spatz, a medical coding expert and trainer.\u003c/p>\n\u003cp>This is not the first time questions have arisen around Ordog’s medical practices. In the mid-2000s, Ordog served numerous times as an expert medical witness in court cases arguing that mold in residential units and work environments made his patients severely ill.\u003c/p>\n\u003cp>The California Medical Board tried to revoke Ordog’s medical license in 2006 for “repeated negligent acts, incompetence, making false statements, and inadequate record keeping,” according to legal documents. He was put on probation and permitted to continue practicing medicine but prohibited from participating in any litigation. Ordog was found to have violated the terms of his probation by preparing reports for four patients in workers' compensation claims. He signed a settlement agreement in September that extended his probation until March 2015.\u003c/p>\n\u003cp>Ordog did not respond to repeated requests for comment made via phone, fax, and to his attorney.\u003c/p>\n\u003cp>\u003cstrong>How We Did This\u003c/strong>\u003c/p>\n\u003cp>KQED partnered with ProPublica to analyze provider billing patterns for regular office visits for Medicare patients. ProPublica released its national report Thursday. We used data released in April by the Centers for Medicare and Medicaid Services showing the payments made to providers in Medicare’s Part B program in 2012.\u003c/p>\n\u003cp>KQED focused its analysis only on California providers who billed Medicare for at least 100 office visits for established patients in 2012.\u003c/p>\n\u003cp>We looked at the doctors who billed Medicare at the highest level (5) for the majority of their office visits. We also looked for other unusual patterns, including providers whose patients received an unusually high number of level 5 visits, or doctors who provided level 5 visits to an unusually high percentage of their patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Matt Levin and Brittany Patterson contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/19113/for-some-california-doctors-nearly-all-medicare-office-visits-are-highly-complex","authors":["8344"],"categories":["stateofhealth_13"],"tags":["stateofhealth_482","stateofhealth_105"],"featImg":"stateofhealth_19133","label":"stateofhealth"},"stateofhealth_19115":{"type":"posts","id":"stateofhealth_19115","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"19115","score":null,"sort":[1400186395000]},"guestAuthors":[],"slug":"look-up-your-medicare-providers","title":"Look Up Your Medicare Provider","publishDate":1400186395,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>In April, Medicare released, for the first time, details on 2012 payments to individual doctors and other health professionals serving the 46 million seniors and disabled in its Part B program. Part B covers services as varied as office visits, ambulance mileage, lab tests, and the doctor’s fee for open-heart surgery. \u003ca href=\"http://projects.propublica.org/treatment/\" target=\"_blank\">ProPublica\u003c/a> created this application to help you find and compare providers.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/15/for-some-california-doctors-nearly-all-medicare-office-visits-are-highly-complex/\" target=\"_blank\">Read more\u003c/a> about the three California doctors who are among the top five nationally in billing for the highest number of the most complex office visits. \u003c/p>\n\u003cp>\u003ciframe class=\"alignright\" src=\"http://projects.propublica.org/treatment/widget?layout=embed\" style=\"width:630px;height: 320px;border: 1px solid #ccc\" scrolling=\"no\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n","blocks":[],"excerpt":"Find and compare details on 2012 Medicare payments to individual doctors and other health professionals.","status":"publish","parent":0,"modified":1400188632,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":true,"iframeSrcs":["http://projects.propublica.org/treatment/widget"],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":5,"wordCount":93},"headData":{"title":"Look Up Your Medicare Provider | KQED","description":"Find and compare details on 2012 Medicare payments to individual doctors and other health professionals.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Look Up Your Medicare Provider","datePublished":"2014-05-15T20:39:55.000Z","dateModified":"2014-05-15T21:17:12.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"19115 http://blogs.kqed.org/stateofhealth/?p=19115","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/05/15/look-up-your-medicare-providers/","disqusTitle":"Look Up Your Medicare Provider","path":"/stateofhealth/19115/look-up-your-medicare-providers","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>In April, Medicare released, for the first time, details on 2012 payments to individual doctors and other health professionals serving the 46 million seniors and disabled in its Part B program. Part B covers services as varied as office visits, ambulance mileage, lab tests, and the doctor’s fee for open-heart surgery. \u003ca href=\"http://projects.propublica.org/treatment/\" target=\"_blank\">ProPublica\u003c/a> created this application to help you find and compare providers.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/05/15/for-some-california-doctors-nearly-all-medicare-office-visits-are-highly-complex/\" target=\"_blank\">Read more\u003c/a> about the three California doctors who are among the top five nationally in billing for the highest number of the most complex office visits. \u003c/p>\n\u003cp>\u003ciframe class=\"alignright\" src=\"http://projects.propublica.org/treatment/widget?layout=embed\" style=\"width:630px;height: 320px;border: 1px solid #ccc\" scrolling=\"no\" frameborder=\"0\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/19115/look-up-your-medicare-providers","authors":["8344"],"categories":["stateofhealth_13"],"tags":["stateofhealth_105"],"featImg":"stateofhealth_19022","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. 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Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. 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