Web Resource on Health News

[Guest guest]

Here is an interesting resource on the web - Health Care Journal. It has

city specific health care news.

http://www.amcity.com/journals/health_care/

here is an example of one of the articles in today's edition:

Any comments?

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Shift to Medicare HMOs Strains Health System

A new health care dynamic is developing that will put aging Americans at

the mercy of providers and payors.

Many of the 65-plus population are joining Medicare managed care plans at

a time when the government is trimming Medicare costs. The result: HMOs

and managed care plans will come up with more strategies to cut the cost

and increase the savings associated with caring for their elders,

according to area experts addressing a seminar hosted June 4 by

Coordinated Care, the Buffalo-based service that links seniors with

long-term care options.

The trend is being fueled by a continuing shift of Americans from

traditional Medicare to Medicare HMOs at a national rate of 80,000 each

month. Some estimate that 25 percent of all Medicare recipients will be

in a managed care plan by 2002.

This creates a Medicare market that's four times the size of the

commercial health insurance market and a veritable magnet for large

companies that compete for the 65-plus group with price, benefits and

services, said Dennis Horrigan, assistant vice president of health care

services for the HMO Independent Health.

Working this market, however, will be a challenge now that the government

has contained Medicare costs by retrenching reimbursements to hospitals,

physicians and other providers by $115 billion over five years, via the

Balanced Budget Act of 1997, Horrigan said.

HMOs and other managed care companies that accept Medicare recipients

agree to care for the older person for discounted payments from the

government. These companies believe they can make up the cost through

various cost containment measures. But as a result of the constraints in

Washington, the managed care plans will look for even more areas to save

money and cut expenses.

An obvious area of savings is keeping patients healthy and less dependent

on expensive services. Prevention must be embraced by both patients and

providers, said Dr. Peer, clinical associate professor of surgery

at the University at Buffalo medical school and a physician with the

Buffalo Medical Group.

Plans could further save money if they ran interference between patients

and the media commercials touting brand name pharmaceuticals, Peer said.

Patients are being pressured by national drug company advertising

campaigns -- valued at $2 billion, Peer said -- to request certain

allergy and other medicine by name. He said other, less expensive brands

can do the same job but patients are reluctant to switch.

" If we could educate patients, we could save $10 a week times 2,000

patients or $1 million a year, " Peer said, using a hypothetical

situation.

Meanwhile, plans might put off spending money on members by postponing

care, said Szczygiel, who focuses on health care as a clinical

associate professor of law at UB.

Knowing that Medicare HMOs have a 5 percent to 7 percent turnover of

members each month, plan officials could delay care because, " next

month they're not going to be on my watch any more. If I hold off, I'd be

doing a good thing for my organization, " Szczygiel said.

R. Kovacek, MSA, PT

KovacekManagementServices, Inc.

The FOCUS Group, Inc.

20225 Danbury Lane

Harper Woods, MI 48225

Fax

Email Pkovacek@...

<http://www.theFOCUSgroup.net>

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