0 Medicares Expenses Increased by 0 4 Really And Its All Because of the Affordable Care Act

If youre the head of Google and you want to teach about the internet, North Korea is a swell place to visit.  If your goal is air travel safety, the 787 Dreamliner is the plane for you.  If you would like to get the puck from an opposing professional hockey player, saying "please" helps.  And if Medicare costs dip, the Affordable Care Act (ACA) obviously deserves the credit.

Writing on an HHS website, Richard Kronick and Rosa Po announce that 2012 Medicare expenditures per beneficiary grew only by 0.4% over the 2011 baseline.  They credit the ACAs value-based payment (VBP) system, attacks on fraud and abuse, reduced payments to Medicare Advantage plans, cutting hospitals payments and "innovation."

The Disease Management Care Blog isnt too sure about that.

1. This Kaiser Health News article notes the VPB program withholds 1% of hospital payments and uses that fund to award bonuses in what is really a zero sum game.  And this Health Affairs article suggests the overall financial impact of VPB on hospitals is quite minimal anyway. 

2. While there have certainly been some big fraud and abuse busts, theres plenty of reason to still be skeptical about the ability of Medicares ossified bureaucracy to catch up with the sophisticated criminal enterprises that are routinely fleecing billions from the U.S. taxpayer.

3. As for the one-time payment cuts to providers and insurers, the DMCB is confident that theyll figure out ways to get their money back.  They always do.

4. The innovations are in demonstration phase.  Its too early to tell.

In addition, the DMCB is surprised that Medicares 2012 insurance claims were ready to be rolled up and quantitated in early 2013. Check out this telling quote from the website:

"2010 and 2011 statistics are calculated on a calendar year incurred-basis. 2012 statistics are calculated on a fiscal year cash-basis, because calendar year incurred-basis data are not yet available." (bolding from the DMCB).

Last but not least, the DMCB believes the lackluster economy has probably had the biggest impact on consumers willingness to use their Medicare benefit.  While Kronick and Ro state" Medigap" insurance benefits have protected the beneficiaries from the financial pain of Medicares out-of-pocket expenses, the expense of using a hospital or seeing a doctor is more than the sum of all those medical bills.

Is the DMCB being too skeptical?  Perhaps, but this particular HHS spin is built on assumptions that are backed by associations that are biased by partisan loyalty.  Taxpayers deserve better.

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0 The Dilemma of Medicare Coverage of Reasonable and Necessary Care and Why Its Important

If you get sick, health insurance should cover all the "stuff" necessary to make you better, right?

While that sounds good in principle, Uncle Sam has made it a lot more complicated than that.  As we continue to struggle with health orm, this New England Journal article on "Medicares Enduring Struggle to Define Reasonable and Necessary Care" is very timely.

According to Drs. Neumann and Chambers, Medicare has always covered medical services that are "reasonable and necessary." As new approaches, drugs and medical technologies have been released, youd think coverage would be based on an objective analysis of outcomes and cost effectiveness.

Youd be wrong.

Years of differing interpretations, patient advocacy, Congressional meddling, regulatory carve-outs and case law have generated a miasma of bureaucratic complexity that will guarantee the incomes of thousands of lawyers for years to come.

Not that CMS hasnt tried to be reasonable about "reasonable and necessary." According to the article, in 1989 CMS specifically proposed that the words "cost effective" could be used to assess new technology. That proved too controversial. It later tried "least costly alternative language" for coverage of durable medical equipment and Part B medications.  This too was dismantled by the courts when plaintiffs argued that the term "reasonable and necessary" could only be applied to medical services, not to the costs of those services.

How ironic. Even though CMS is making "value-based purchasing" judgements for hospital payments and costs can be factored in the coverage of preventive services, that still doesnt apply to new technologies and drugs.

The latest dysfunction is CMS pretzel logic of "coverage with evidence  development" approach to medical devices, essentially agreeing to coverage that is conditional on CMS evaluation of additional outcomes data.  Unfortunately, CMS ability to collect and interpret these kinds of data in the current political environment remains an open question.

Outside of Medicares cost travails, why is all of this important?

1) Medicares price tag was $509 billion in 2010, taking 12% of the federal budget. While there are other drivers of cost, such as aging, coverage arrangements, income, pricing, administrative costs and defensive medicine, technology could account from 38% to more than 65% of the current growth (inflation) in spending.  Medicares historic inability to control this does not bode well for future cost projections.

2) This is not a partisan issue and there are no partisan solutions.

3) Commercial insurers generally use Medicares coverage criteria to define their own benefit structure.  Medicares problems are everyone elses.

4) This is another reason why Medicare is banking on ACOs.  By delegating management and the associated risk of all these thorny coverage issues, theyre hoping ACOs can do within three years what CMS couldnt do in three decades. Well see.

0 Different Milk Different its nutritional

Different Milk, Different its nutritional - Formerly we only know th cow milk, but now we have many milk choice. include the milk that come from plants, like soya milk or almond peanut. We also can choose the organic milk that we drink direct from cow, without any process.

Many kind of milk, actually also contain different nutrient. "some product have enriched with vitamin D. Also available non milk product tha enriched by nutrient like cow milk, so can be the alternative for them whom suffer from laktosa intolerance.

To know the advantages and disadvantages of each milk, Gazzaniga see explanation below.

Cow Milk

Plus: Cows milk is very rich in calcium and has two times more protein than other types of milk. Although there are currently several types of cows milk, non fat or low-fat, each of which has almost the same nutritional content.

Minuses: For people suffering from lactose intolerance, cows milk can cause problems such as diarrhea, abdominal bloating or discomfort. But according to the National Digestive Diseases Information Clearinghouse, the actual people who intorelan lactose can drink up to 4 ounces of milk each day without suffering symptoms.

Soy milk

Plus: Milk is made by soaking and refine soybean seeds are rich in protein and calcium and has no saturated fat. Another advantage is low in calories and have a variety of flavors.

Minus: Soy products can inhibit the absorption of protein and minerals. Several studies of soy against breast cancer is still controversial, in part mentions soy consumption increases the risk of breast cancer.

Goat milk

Plus: Goats milk is very easy to digest because the protein molecules of different shapes with cows milk protein. Besides the calcium content in goat milk with cows milk is not less, plus contain more tryptophan, an essential amino acid.

Minus: Goats milk also contains lactose, so just like cows milk can cause a complaint to the lactose intolerant. In addition, not everyone likes the taste is a combination of salty and sweet, the smell is quite overpowering.

Almond milk

Plus: According to Gazzaniga, in recent years, this almond milk is quite popular in America. Milk prepared from almonds mixed with water and sweetener also contains vitamins, minerals, and less fat content. It was also more comfortable and rich.

Minuses: Only a little protein, about 1 gram per cup, much less than soy milk or cows milk containing 7-8 grams per cup. This type of milk is also not recommended for people allergic to peanuts and deficiency of vitamin B. "Some almond milk products are also given an additional sweetener," said Gazzaniga.

Rice milk

Plus: Made from rice, milk of this type contain less fat and calories. Also available in vanilla or fresh, and free of lactose and soy.

Minuses: The nutrients, according to Gazzaniga rice milk-dairy milk is inferior to others. In addition to not contain vitamins A and C, rice milk also have little protein. Raw milk

Plus: Milk taken directly from the cow, according to Gazzaniga is a gift from nature is good because it is not processed.

Minus: Fresh milk is not on-pasteurisation can contain harmful bacteria such as salmonella, E. coli or listeria. According to prevention and disease control centers in the U.S., in the last 13 years more than 800 people suffering from illness due to consumption of fresh milk and cheese.

organic milk

Plus: The organic food advocates say organic milk produced from cows not fed hormones, antibiotics, pesticides or synthetic fertilizer.

Minus: The price is twice more expensive than non-organic milk. But according to Gazzaniga, organic milk has nutritional and health benefits the same as conventional cows milk.