Healthcare Business Week in Review: End-of-Life Care, Hospital Costs, New Medicare Plan

Tuesday, May 14th, 2013
This post was written by Cheryl Miller


However difficult, end-of-life care issues need to become an integral part of the public health agenda, according to a new article from the American Journal of Public Health by two Johns Hopkins Bloomberg School of Public Health faculty, and advance directives are a critical part of this agenda.

Despite being free, legally binding and readily available, however, too few Americans have completed an advance directive. They need to become routine parts of the conversation between doctors, nurses, and other key health providers and their patients, and viewed as another aspect of preventive care, the authors note.

End-of-life care consumes an estimated 30 percent of Medicare expenditures, and the impact on Medicaid and commercial insurance costs is substantial as well. Increasing the rate of completion of advance directives could conceivably lower these expenses and would do so by respecting patients’ values and wishes.

Want to know what your hospital bill is really charging you for? CMS has now launched a new Web site with detailed information on the charges for services that may be provided during the 100 most common Medicare inpatient stays. The data shows significant variations across the country and within communities in what hospitals charge for these services, CMS officials warn. Even within the same geographic area, hospital charges for similar services can vary significantly. The Web site is part of a new three-part program from the agency to give healthcare consumers more price transparency.

Today’s Medicare patients are sicker and have more chronic illnesses, and are driving up the costs of emergency department (ED) care, according to a new report by the American Hospital Association (AHA).

Between 2006 and 2010, the severity of illness of beneficiaries receiving services in the ED increased, as did the rate of use, driving up the intensity of ED care and resources. The report outlines a number of factors that are contributing to this trend, and are detailed in our story.

A proposed Medicare plan that combines hospital, physician, and prescription drug coverage with private supplemental coverage into one health plan could produce savings of $180 billion over a decade and improve care for beneficiaries, according to a new study by researchers at The Johns Hopkins Bloomberg School of Public Health and The Commonwealth Fund.

Under the proposed plan, called “Medicare Essential,” Medicare beneficiaries could save a total of $63 billion between 2014 and 2023, with total premium and out-of-pocket costs for beneficiaries estimated to be 17 percent to 40 percent lower than current costs.

According to the article, Medicare Essential would create financial incentives for beneficiaries to select high-quality, cost-effective healthcare services — also known as value-based benefit design. Beneficiaries would be encouraged to choose a primary care physician and providers who meet standards of high value. Beneficiaries selecting such providers would pay lower deductibles and co-pays.

Achieving real cost containment or quality improvement is difficult unless patients and consumers become more active, informed and engaged. How to achieve this? Tailoring your approach towards your low-activation patients and understanding their needs is one way to monitor and create better patient engagement, explains Dr. Judith Hibbard, the professor of health policy at the University of Oregon and the developer of PAM, the Patient Activation Measure.

And lastly, don’t forget to take our latest e-survey, Healthcare Case Management 2013. Care coordination by healthcare case managers is helping to drive clinical and financial outcomes in population health management and bolster emerging models of care such as the patient-centered medical home and the accountable care organization. Share your organization’s case management strategies by May 17 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

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