California Health Insurers to Raise Premiums 8 to 14%
Thursday, February 23rd, 2012
California’s largest health insurers are raising average rates by about 8% to 14% for hundreds of thousands of consumers with individual coverage, outpacing the costs of overall medical care.
The cost of goods and services associated with medical care grew just 3.6% over the last 12 months nationally, government figures show. But insurance premiums have kept climbing at a faster pace in California.
Insurers defended their rate hikes, saying they are based on their claims experience with the customers they insure and not just the broader rate of medical inflation. They also say that healthier members dropped out of the individual market as premiums rose and the economy worsened in recent years, leaving behind a group of policyholders who have higher average costs.
“We will continue to examine the fundamental issues at the heart of rising healthcare costs, including the prevention of chronic disease, increasing the quality of care and reducing unnecessary health expenses,” said Darrel Ng, spokesman for Anthem Blue Cross, the state’s largest for-profit health insurer.
Consumer advocates and others are skeptical, however, questioning whether insurers are doing enough to hold down costs. These latest increases follow years of 20% to 30% rate hikes for families that are at the center of a looming fight between the insurance industry and its critics over a proposed ballot measure seeking tougher rate regulation.
“Consumers should be outraged that premiums continue to grow faster than underlying costs,” said Gerald Kominski, director of the UCLA Center for Health Policy Research. “There’s help on the horizon for millions of Californians from health reform, but things may get worse before they get better.”
Anthem has proposed raising premiums 9.6% to 13.8% on average, effective May 1 or July 1, for about 700,000 individual policyholders and their family members. The rate increases are under review by state officials.
Nonprofit Kaiser Permanente increased premiums 9% on average for nearly 300,000 customers last month.
Blue Shield of California, also a nonprofit, is boosting average rates by 7.9% for 265,000 members and by 8.9% for 56,000 members, both effective March 1.
Insurers in California must submit proposed rate hikes for review to determine whether they meet certain state requirements, but state officials don’t have the authority to reject rate hikes for being unreasonable. But regulators have been challenging insurers’ arithmetic in calculating rates.
Officials at the Department of Managed Health Care persuaded Blue Shield to lower a proposed 14.8% increase to the 8.9% boost. The agency said it disagreed with Blue Shield’s projection for future medical expenses. The California Department of Insurance convinced Aetna, based in Hartford, Conn., to lower a 13.7% increase to 9.3% for 50,000 members last month.
“Many of the health insurance carriers have projected significant increases in medical costs and utilization, but those projections have not been borne out by experience,” said Janice Rocco, the insurance department’s deputy commissioner for health policy. “Therefore the rate is higher than it needs to be.”
Rocco said some consumers may receive rebates in August. That would occur based on an upcoming state review of 2011 claims to determine whether insurers met a new federal requirement for spending at least 80% of premiums on medical care for individual policies.
Tom Epstein, a spokesman for Blue Shield, said the company consented to the change in its rates sought by managed health care officials because “we want to keep medical care more affordable for our members.” In its filings to regulators, Blue Shield said “the cost of hospital services, physician services and prescription drug coverage for our individual members continues to rise.”
In recent years, the rising cost of medical care and rate hikes for health insurance have been a major political issue that prompted congressional approval of President Obama‘s healthcare overhaul, much of which takes effect in 2014, and calls in California for tougher state regulation of health premiums.
Anthem tried to raise rates by up to 39% in 2010, sparking national outrage and helping Obama win support for his healthcare overhaul. The Woodland Hills company, a unit of WellPoint Inc., was forced to back down and accepted maximum rate increases of 20%. Last year, Anthem raised premiums 9% to 16% on average for individual policyholders.
Starting in October 2010, Blue Shield raised premiums by 23% to 35% on average for about 325,000 policyholders, a result of two separate rate hikes that spanned two years. Blue Shield also began issuing credits to customers if its net income exceeded 2% of revenue. The company said it returned about $450 million to individual policyholders last year as a result, which reduced members’ rates by about 7%.
Kerry Abukhalaf, a 37-year-old who owns a small technology services firm with her husband in Alameda, has seen her family’s Blue Shield premiums more than double in the last three years to $544 per month. Her latest increase of 9% “is especially hard for ourselves and others we know due to the hard economy right now,” she said. “I feel like my family is being penalized for doing the responsible thing and having insurance.”
Last month, Blue Shield notified Tom and Dana Richardson, who run a pool-cleaning business in San Diego, that their premium would rise 15% to $1,905 per month. The Richardsons chose to nearly triple their deductible to $11,000 from $4,000 to cut their monthly premium to $1,090.
“It’s like a kick in the teeth,” said Tom Richardson, who’s 63. His wife turns 60 next month. Because of their age and medical history, he said, they can’t find a cheaper policy.
These increases would affect many of the 2.2 million Californians who buy individual policies, but not the majority of working Californians who are insured through employer group plans.
Businesses and employees covered by group health insurance are seeing premiums rise too. Nationwide, the annual premium for family coverage through an employer increased 9% last year, according to the Kaiser Family Foundation.
The proposed ballot measure would give the California insurance department the same authority to approve or reject health insurance rate increases that the department now has over property and auto policies. Consumer Watchdog, the Santa Monica group that championed California’s Proposition 103 in 1988 that enacted rate controls on auto insurance, is leading the drive to get 505,000 valid signatures by May 1 to qualify the ballot measure for the November election.
Consumer groups have failed to win approval for similar measures in the state Legislature the last five years, encountering intense opposition from the insurance industry and other medical groups.
“In California, nobody can say no to an insurance company, and we’re paying the price for it with rate hikes every year,” said Doug Heller, executive director of Consumer Watchdog.
The insurance industry says the ballot initiative is unnecessary because health reform has brought extra scrutiny to premiums and company practices.
“Rate regulation might sound appealing,” said Steve Shivinsky, a spokesman for Blue Shield. But “it will layer in another complex bureaucratic level of rate review that will gum up the system.”
http://www.latimes.com/business/la-fi-0223-health-insurance-rate-hikes-20120223,0,7634380.story
Accredited teams with Cedars Sinai Medical Center to curb readmissions
Wednesday, February 22nd, 2012
Accredited Home Health Services worked with Cedars Sinai Medical Center to reduce hospital admissions. The project details and summary can be found at this site – http://enewsletter.csmc.edu/Pulse/2012/February-17/A-novel-way-to-curb-readmissions-taking-healthcare-home.aspx
As the national Healthcare agenda continues to focus on quality outcomes with reduced spending, Accredited remains committed to these goals for patients in the community. Visit www.medicare.gov to view Accredited’s Quality Outcomes which has helped us achieve Home Care Elite Status for 4 of the last 5 years.
Home Health Providers Fight Minimum Wage Rule
Thursday, February 16th, 2012
USA Today published an article on Obama’s Proposal to ensure home care agencies pay minimum wage. http://www.usatoday.com/news/washington/story/2012-02-15/home-health-care-minimum-wage/53110228/1
Here is an analysis of the article from Joe Hafkenschiel, CAHSAH’s President.
This article does not present a very balanced picture of the issue. First, it is not about minimum wage for home health workers. The federal companion regulation is an exception to the general rule to pay minimum wage and overtime for workers who are serving as companions to the elderly and disabled. By the nature of the work, the worker must often work more than 8 hours per day. The regulation provides a balance between paying the worker a living wage and keeping the care affordable for the client. In California, which requires all workers to be paid the minimum wage of $8 per hour, a live-in companion working 24 hours is paid between $128 and $192 per day. If the exemption is eliminated, that same worker would have to be paid $304 per day resulting in a charge to the client of $500 to $600 per day. Home care would no longer be less expensive than assisted living or a nursing home and many people would be institutionalized. Most importantly, the workers would not benefit. Their shifts would be reduced to 8 hours to avoid overtime (which most clients cannot afford) and their pay would fall to $64 per day. The Department of Labor has done a very poor analysis of this proposal and we should all be wary of the unintended consequences.
Home Health Spared from 10% Medi-Cal Reduction
Wednesday, January 11th, 2012
In October 2011, the Centers for Medicare & Medicaid Services approved the state’s proposed 10% reduction to Medi-Cal rates for all provider types except three: physician/clinic services for children, home health services, and distinct part subacute facilities. This was a crucial victory for Medi-Cal beneficiaries!
Neil’s Spin: The Medi-Cal Home Health Rates are already sub-standard and less than 1% of licensed home health agencies routinely accept Medi-Cal referrals. A 10% reduction would have been devastating to patients currently using Home Health and it would have created an access to care crisis in California.
SB411 Would Cost Thousands
Wednesday, January 11th, 2012
Included in the SB411 language, a Home Care Agency would be required to pay an annual licensing fee of $3900 plus $165 for each employee. The $165 would be used to pay for administrative taks associated with the certification of home care aides and for maintaining the online public registry of home care aides employed by each agency. The $165 doesn’t include agency costs for completing 13 hours of initial & ongoing training or the LiveScan background check fees.
Neil’s Spin: This bill counteracts job creation as it leaves employers with a disincentive to hire. The more you hire, the more it costs. That’s counterproductive to the State’s economic goals. Additionally, Home Care Agencies will experience a dramatic increase in operating costs. To compensate, home care fees will have to increase. Many seniors and disabled individuals are having difficulty affording care at its current prices.
Face to Face Requirements Clarified
Wednesday, January 11th, 2012
CMS Clarified that if a physician’s visit note, referral documentation, or hospital discharge summary contained all of the required elements, the physician could use that documenation to satisfy the F2F encounter.
CMS also stated they will not accept the use of checkboxes and forms with pre-printed statements that describe homebound status and the need for skilled services.
Neil’s Spin: From experience, we know that the physician’s documentation rarely contains all of the required elements. To no fault of physicians as CMS has not properly educated them on F2F requirements. So, F2F continues to frustrate physicians and home health providers but enables CMS to deny or delay payment for services.
Best Job Opportunities in 2012 – 2 of the Top 10 are home care related
Friday, December 16th, 2011
According to an article posted on MSN, two of the top 10 jobs in 2012 will be Home Health Aides and Registered Nurses. As the population in the US continues to live longer and the baby boomers come of age, the need for healthcare workers will continue to soar. One of the fastest growing business industries in America is Home Health Care.
Additionally, home health agencies are already experiencing a shortage of physical therapists, occupational therapists, and speech therapists. Typically, these clinical disciplines are working in private practice or in a hospital, where the pay can be better. In the hospital, however, the demands are much greater than working one to one in a patient’s home environment.
Here is a link to the article posted on MSN http://msn.careerbuilder.com/Article/MSN-2854-Job-Info-and-Trends-Best-bets-for-jobs-in-2012/?SiteId=cbmsnhp42854&sc_extcmp=JS_2854_home1
Obama proposes Overtime Initiative for Home Care Workers
Thursday, December 15th, 2011
WASHINGTON – Nearly 2 million home care workers could qualify for federal wage and overtime protections under a rule being proposed today by the Obama administration.
By Carolyn Kaster, AP
The effort — the 18th initiative in Obama’s “We Can’t Wait” campaign against Congress — would overcome legislative inertia and a 2007 Supreme Court ruling that upheld home care workers’ exclusion from wage-and-hour standards.
Once classified as companions for the elderly and people with disabilities, most home care workers today are part of a growing $70 billion industry that has doubled in size during the past decade. The nation’s over-65 population is projected to grow from 40 million to 72 million by 2030; 27 million Americans will need home care by 2050, the government estimates.
At the same time, the duties of home care workers have evolved to include health care services, such as managing medications and monitoring vital signs. Yet they average $17,000 to $20,000 a year — more than the $7.25-per-hour minimum wage, but low enough to put many beneath the poverty line and enable them to qualify for public assistance.
More than 90% of home care workers are women, and nearly 50% are minorities. About four in 10 rely on public benefits such as Medicaid and food stamps.
“The care provided by in-home workers is crucial to the quality of life for many families,” Labor Secretary Hilda Solis says. “The vast majority of these workers are women, many of whom serve as the primary breadwinner for their families.”
About 1.6 million of the 1.8 million workers are employed by agencies that pay more than the minimum wage but not overtime. The National Association for Home Care and Hospice says the change would lead the agencies to hire more workers, rather than pay overtime rates.
“The worker is not getting anything out of it,” says Bill Dombi, the group’s vice president for law. “Instead, the employer ends up with higher costs because they have to hire more people.”
Eventually, he says, an aging society will outpace the industry’s ability to serve it, leading to cost overruns for federal and state government programs serving the elderly and disabled.
Home care costs Medicaid and Medicare about $56 billion annually. The proposed change is projected to cost about $100 million a year, mostly in overtime costs. Twenty-one states already provide minimum-wage protection for more than half the nation’s home care workers, and 15 also provide overtime protection.
The exemption from the Fair Labor Standards Act’s wage and overtime rules dates to 1974. President Clinton sought to change it shortly before leaving office in 2001, but President George W. Bush reversed that effort.
Enter Obama, who co-sponsored Senate legislation in 2007 that would have ended the exemption for most home care workers. As an Illinois state senator in 2003, he voted to raise the pay of home care workers to $9 an hour.
The effort plays into Obama’s “fair share” campaign theme, outlined in Osawatomie, Kan., last week, which echoes Theodore Roosevelt’s century-old crusade against economic inequality. It’s likely to help him with low-income and minority workers, who traditionally favor Democrats.
20 Things You Didn’t Know About Accredited
Friday, December 9th, 2011
“20 Things You Didn’t Know About
Accredited!”
- The Accredited
Family of Home Care Services is comprised of five corporations: Accredited Home
Health Services, Accredited Nursing Services, Accredited Nursing Care,
Accredited Respite Services, Accredited Financial Management Services.
- The Senior Management
Team has over 80 years of combined service with Accredited.
- Medicare statistics
show Accredited makes the most home health care visits of any private owned company
in Los Angeles County.
- Accredited Nursing
Care was the first Private Duty Agency to receive CAHSAH’s Home Care Aide
Organization Certification.
- We are obsessive
number junkies when it comes to our agency’s Medicare Scores. Check out
our Quality Outcomes on www.medicare.gov.
- In recognition of
our 25th anniversary, United States Congressman Brad Sherman
presented Accredited with a United States Flag that flew over the Capitol.
- Accredited’s
proudest accomplishment: In a time of deep recession, we provide
employment to 2,500 people weekly and 6,800 annually.
- As a 50th
birthday gift from staff, Accredited founder Barry Berger was presented with an
original Olympic Torch from the 2002 Salt Lake Games.
- Several of our
caregivers have 20+ year tenures with Accredited.
- Past Accredited ventures included; nanny services,
hospital staffing, and physician house calls.
- The most common name of our employees is Maria – We have
over 300 Marias on staff.
- More than 80% of our department managers have been
promoted from within the company.
- At our 30th Anniversary Gala in April 2010, there wasn’t
a dry eye in the house after hearing one of our patient’s amazing life story.
- Accredited makes over 500 referrals to our competitors
annually. We’re all in this together!
- Accredited has provided care to 4 generations of Neil’s
family – his daughter, himself, his parent, and his grandparent.
- Our ‘Celebrity’ List of Patients is enormous and ever
growing… I’m dying to publish the list. Alas, HIPAA prevents me!
- Receiving a patient’s handwritten note of gratitude is
our favorite type of mail.
- CEO Computers and Lazar & Co. Accounting have been
our vendors for over 25 years. We’re loyal customers!
- Accredited’s Leadership Team participated in more than 40
meetings with State & Federal Legislators last year.
- We really, really love when you respond to our E-mail
updates and like us on Facebook!
Accredited hold Sock Drive to Benefit Los Angeles’ Homeless Youth
Wednesday, December 7th, 2011
Please donate to our Sock Drive to support LAYN – Los Angeles’ Homeless Youth (www.layn.org). Donate new Medium-Large Mens and Womens Socks before December 12th. Contact Janelle Lacson at jlacson
accreditednursing
com for more information. Happy Holidays!
