Washington, DC, United States (KaiserHealth) – As the federal government pumps billions of bonus dollars into private Medicare health plans to encourage better care, the quality rating system used to award the bonuses is coming under increasing fire.

Critics, including the Government Accountability Office and the Medicare Payment Advisory Commission (MedPAC), question whether the $8 billion-plus program is mostly rewarding mediocre patient quality. The latest attack came in a report last week from the American Action Forum, a conservative think tank, which argued that some standards are difficult to measure, and that it’s hard to score well when plans don’t always know the criteria in advance.

Supporters defend the program as part of a broad initiative to boost the quality of patient care and point to demonstrable improvements – for instance, a San Diego physicians’ group that discovered 700 Medicare patients with diabetes who were not getting annual eye exams, even though failure to get early treatment can result in blindness.

“Change a compensation system, and priorities shift,” said Dan Mendelson, CEO of Avalere Health, a consulting and research firm. “You can see the numbers going up.”

The federal government created the star rating system in 2007 as a guide to help seniors compare the quality of private health plans in the Medicare Advantage program. One quarter of older and disabled people now opt out of the traditional, government-run Medicare program in favor of private, mostly managed care plans, that often have lower premiums and extra benefits such as coverage of hearing aids and eye glasses.

Ratings Ignored In Past

Until recently, though, health plans and their enrollees all but ignored the ratings. Only about a third of Medicare beneficiaries knew about the star ratings, and only half of that group considered the scores when choosing a health plan, according to a survey that Harris Interactive conducted last September for insurer Kaiser Permanente. (Kaiser Health News is not affiliated with Kaiser Permanente.).

Comparing Medicare Advantage Plans

Consumers can look up the ratings of Medicare Advantage plans in their area on Medicare.gov

The downloadable spreadsheet files below include ratings data for all plans from all insurers in all 50 states and D.C.

Alabama – Montana (.xls file)

Nebraska – Wyoming (.xls file)

Source: Centers for Medicare & Medicaid Services

But insurance executives made them a priority after the 2010 healthcare law attached large financial rewards to them. The first round of ratings last fall showed that most have a long way to go. Only 12 earned a perfect score of five, on a scale of one to five, and about 9 percent were below average. The majority received scores of three, or three and a half stars– enough to get them bonus money this year.

After 2014, plans will need four or five stars to get bonuses. And if they have fewer than three stars, they won’t be allowed to enroll beneficiaries through Medicare’s website, and risk being booted from Medicare altogether, according to HHS spokesman Tony Salters.

Already, five-star plans don’t have to wait until open season to enroll new customers. Poor performers are branded with an icon on Medicare’s website.

“You basically can’t operate a profitable Medicare Advantage plan without strong star ratings,” said Mendelson. “For some health plans, the bonus money accounts for as much as 7 percent of revenues, which can translate into a couple of billion dollars for a large health plan in a large state. Compensation of senior managers in Medicare Advantage has now been oriented around achieving star ratings.

Bonuses Offset Health Law Cuts

The money is particularly attractive to Medicare Advantage plans as the health law gradually reduces payment rates to bring them in line with what the government spends on beneficiaries in the traditional government-run program. This year, they will lose $6 billion in federal payments, and the bonus money is estimated to offset that reduction by about half.

Douglas Holtz-Eakin, president of the American Action Forum, and Tom Miller, resident fellow at the American Enterprise Institute, argue the larger bonuses were a political calculation by the Obama administration to head off an exodus of health plans — and a backlash from angry seniors — before the November election.

The GAO and MedPAC, meanwhile, question the strategy of rewarding plans with average ratings. Bonuses are now going to plans that cover 93 percent of enrollees “at a time when Medicare already faces serious problems with cost control and long-term financing,” according to a March MedPAC report.

Jonathan Blum, deputy administrator for Medicare, says the incentives were made available to average-rated plans to spur rapid improvements. “The higher the plan rates, the larger the payment it can get and that is turned back to providing a more generous package of benefits,” he said.

Ratings Drove Change In San Diego

The ratings drove significant changes in care by one large San Diego physicians group which contracts with a Medicare Advantage plan run by UnitedHealthcare.

Jorge Pelayo-Garcia, director of innovations at Sharp Rees-Stealy Medical Group, found 700 Medicare patients with diabetes who were not getting annual eye exams. Most diabetics have retinopathy, a blood vessel weakness in the eye, but early detection and treatment cuts in half the risk of vision loss, according to the American Diabetes Association.

Pelayo-Garcia quickly organized staff calls, and within two months last fall, the screening rate jumped from 30 to 73 percent. The doctors found 163 eye problems that had never been diagnosed, and 21 were severe. Five patients, for example, had vitreous hemorrhage, where blood from damaged vessels leaks into the eye, and two had severe non-proliferative diabetic retinopathy, where the creation of weak blood vessels can destroy the retina.

“I’m proud of what we did and the outcome,” he says, noting that diabetic patients now also must slip off their shoes for foot exams every time they walk through the door, even if they’re only there for a flu shot.

Scores for diabetic eye exams and osteoporosis screenings are now fives, and Pelayo-Garcia attributes the improvement to aggressive data collection. “I thought I was a good physician, but the data showed me I wasn’t properly following patients with retinopathy,” he said.

But others point out what they see as flaws in the system.

Wells Shoemaker, medical director of the California Association of Physician Groups, suggested the ratings are a better indicator of a plan’s ability to collect data than of performance. He said that health plans in California generally rely on the same physicians, so their scores should be similar. But they aren’t – and Shoemaker contends that’s because some plans are more aggressive about capturing data. “Plans have close to zilch influence on the actual delivery system dynamics, as those duties have been delegated to locally organized …medical groups,” he said.

Pelayo-Garcia says that his group was able to collect and analyze data because it is a large physician practice, but that smaller groups might be at a disadvantage. “To have proper data, you need proper investment in computers, analysts. A lot of groups, especially solo practices, don’t have enough money to pay for it.”

‘Like Checking For Sunscreen In Winter’

Another complaint about the rating system is that the government sometimes scores plans on measures they learn about too late to change what they do – in some cases, months after care has been delivered.

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Medicare Advantage Quality Scores

Washington D.C. Area Plans

Insurer

Score

Kaiser Permanente

4.5

Aetna

3.5

Humana

3

Bravo

2.5

Universal

Too New To Be Measured

Plans are scored on a scale of 1-5. All of these insurers offer multiple plans. Not all plans offered by an insurer have enough data to have been scored.

Source: Centers for Medicare & Medicaid Services

“None of us is able to time travel,” said Rhonda Medows, chief medical officer for UnitedHealthcare’s programs.

The Centers for Medicare and Medicaid Services “published criteria in October 2011 to be applied to plan performance between January 2010 and June 2011,” according to Holtz-Eakin’s report. “There is simply no way that [a Medicare Advantage] plan can adjust its plan offerings, plan design, or performance in any way to improve its performance in the dimensions CMS chooses to evaluate,” the report concluded.

“They had a measurement for flu vaccines, but didn’t do it in flu season,” he said. “What value is that? It’s like checking for sunscreen in the winter.”

Some health plans also complain that certain measures are hard to evaluate, such as customer satisfaction.

When patients respond to surveys about their mental health status, for example, “if you’re one of the sickest beneficiaries, if you’re an individual who has very low income, if you have had problems with housing, there may be a range of socioeconomic factors that affect how you might answer that question,” said Karen Ignagni, president of America’s Health Insurance Plans, the industry trade group.

Gale Arden, a consultant who used to run the Medicare Advantage program for BlueCross BlueShield of Tennessee, worries the pressure to please customers “forces health plans into a situation where they can never say no to any treatment or to any customer because it impacts the rating. They’re afraid to ever say no to an MRI.”

Such complaint calls are counted toward star results even if they are unjustified, she said. “If a customer doesn’t pay his premiums and we dis-enroll him and he calls CMS to complain, then we’ve got a problem because it shows up as a complaint. Do we leave people enrolled? Do we pay their claims?”

This article was produced by Kaiser Health News with support from The SCAN Foundation.

– Provided by Kaiser Health News.

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Arlington, VA, United States (AHN) – Mortgage rates fell to new lows again for the week ended May 10, with the 30-year averaging 3.83 percent.

Freddie Mac said in a statement Thursday, “Following April’s weaker than expected employment report and the French and Greek election results raising concerns over the stability of the eurozone, long-term Treasury bond yields declined, allowing fixed mortgage rates to ease to new all-time lows this week.”

The rate for the 30-year averaged 3.84 percent in the prior week and 4.63 percent in the same period a year ago.

Rates on the 15-year fixed mortgage averaged 3.05 percent in the latest week, down from 3.07 percent last week and 3.82 percent a year ago.

According to Freddie Mac, average interest rates on five-year Treasury indexed hybrid adjustable mortgages averaged 2.81 percent, down from 2.85 percent last week and 3.41 percent from a year ago.

Rates for 30-year conforming mortgages also fell to a record low in the Mortgage Bankers Association weekly survey released Wednesday.

The MBA also reported that mortgage applications increased 1.7 percent in the current period, a hopeful sign for the ailing housing market.

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New York, NY, United States (AHN) – U.S. stocks fell on the open Tuesday as political uncertainty in Greece kept investors wary and on edge.

Just after the opening bell on Wall Street, the Dow Jones Industrial Average slumped 83 points, the Standard & Poor’s 500 Index slid 8 points and the NASDAQ suffered a 20-point drop.

Market participants were keeping a close eye on developments in Europe, one day after Greece’s main central-right party failed to form a coalition government. The left-wing coalition, opposed to austerity measures as a means to close Greece’s mounting debt gap, has just three days to form a new government.

These new developments have raised fears that Greece might be forced to drop out of the eurozone and have investors on edge.

While various parties move to form a new coalition government in Greece, new elections will most likely be held come June. The imposing question is whether Greece will be forced to renegotiate its bailout funding.

In world markets Tuesday, European stocks faltered in morning trading and Asian markets ended mixed.

U.S. markets shrugged off early jitters Monday following weekend elections in Greece and France and recovered somewhat. But stocks tumbled Tuesday on the open on renewed European debt fears.

In corporate news, McDonald’s reported same-store sales increased 3.3 percent globally and in the U.S. While the fast food chain’s sales rose 3.5 percent in Europe, it recorded just a 1.1 percent gain in its Asia Pacific, Middle East and Africa regions. Those numbers failed to impress, sending McDonald’s shares lower by 2.6 percent.

Rival Wendy’s also reported and also disappointed, falling short of analysts’ expectations. Shares slipped some 4 percent in morning trading.

After the close Tuesday, Dow component Disney will report,. The studio had a blockbuster weekend with ‘The Avengers,” but also had a major bomb with “John Carter” early in the year.

In currencies and commodities, the dollar gained against the euro and British pound, but dropped against the Japanese yen.

Oil continued its slide, falling 85 cents to $97.09 a barrel.

Gold for June delivery gave back $10.30 to $1,628.80 a troy ounce.

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New York, NY, United States (AHN) – Mortgage rates fell in the week ending April 12.

Fixed mortgage rates slid a full tenth of a percent in the latest week, and mark the third consecutive week of declines, mortgage giant Freddie Mac reported Thursday

The 15-year fixed rate average hit a new record low of 3.11 percent. That was down from 3.21 percent last week, and way lower than the 4.12 percent one year ago. The previous low for the 15-year was set in March when the average hit 3.13 percent.

The 30-year also headed near its record low of 3.87 percent (set in February), averaging 3.88 percent this week. It has lingered just below 4 percent the last two weeks. At this same period a year earlier, the 30-year averaged 4.91 percent.

The 5-year and 1-year hybrid adjustable rate averages remained relatively unchanged from last week at 2.85 percent and 2.80 percent respectfully.

The drop in mortgage rates was spurred by a disappointing report on jobs growth for the month of March. News that the U.S. economy added just 120,000 jobs renewed fears of whether the economic recovery has legs.

Worries over the mounting and ongoing European debt crisis, coupled with warnings for slowing growth in corporate earnings, also helped push mortgage rates down.

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Delray Beach, FL, United States (AHN) – The S&P is up 10 percent already in the first quarter of 2012. We have had steady growth in the economy and in employment. The markets and the fed have discounted 2.5 percent to 3 percent growth for 2012. Although, we are still bullish on U.S. equities, there are risks to this strategy. Ironically, the largest risk may be growth that is beyond the expectations of the Fed and the markets. Before I explain, I would like to discuss the some of the other risks to this.

It seems that oil prices are of much concern to the continued equity rise. Getting beyond the politics and rhetoric of news coverage, oil is probably underpriced relative to geopolitical risks, which currently exist. What affects the equity markets are “oil shocks” not just generally higher oil prices. What is an oil shock? Oil would need to rally 80 to100 percent in less than a year to create an oil shock. Higher oil prices alone, will not cause equity price breakdowns. Europe has learned to live with much higher gasoline prices. The fact is that without this type of shock, equity prices will remain ambivalent and the trend of oil consumption relative to GDP and the oil curve will continue down.

The weak dollar in 2011 has led to good U.S. export growth. However, can a strong dollar in 2012 derail the economic growth? A 15 percent rally in the trade weighted dollar would pose problems, the question becomes just how realistic is that possibility. Canada, Asia, and Mexico are our largest trading partners. Thus, it would take a large rally in the USD/Euro to reach the strength in the trade weighted dollar to affect growth.

Bond yields are a risk. The Fed has carefully crafted a protracted period of extremely low yield on the long end of the curve by keeping the short end at or below 0 percent. Bond yields should be over 3.5 percent relative to GDP growth and inflation. This has also fueled investors to take on more risk and look to equities for alpha. The FED has designed this bubble of protection. However, the reality is that this is a very fragile correlation which is being maintained. Eventually this will have to be unwound. If the market dictates a premature unwinding, then we are sure to see a very sharp decline in the equity markets.

This revelation is the path to my original statement; our own worst enemy may be our excessive growth. We are currently in equilibrium. Government debt is offset by private savings growth. A near term disruption to this balancing act anywhere in the economy would dislodge this equilibrium in a large way. In the end, free markets will always trump intervention even the FED could not successfully continue this orchestration.

Current FED policy is fitted to avoid deflation and avoid economic weakness. This is the driving force for the higher equity prices. As long as the FED keeps building its balance sheet, all is well.

Thus, what could derail this is growth which is certainly beyond the predicted path. This could prompt the market to change their view of future policy. This may cause bond yields to spike higher. This will create great stress on the economy, which has now become addicted to 0 percent short-term rates and low bond yields. This will have a devastating effect on the equity markets. In the end, the greatest risk may be the result of our success!

Steven A. Michael is the founder, principal and chief investment officer of Stonehenge Asset Management LLC, a multi-strategy alternative investment manager based in Delray Beach, Florida. He has over 25 years experience in the alternative management space. His extensive financial career began in 1985 on the trading floor of the Chicago Board of Trade (CBOT). He is also a member of the Chicago Mercantile Exchange (CME).

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New York, NY, United States (AHN) – U.S. stocks were little changed on the open Wednesday after a dismal report on durable goods orders. Investors are hoping for big quarterly gains three days before the close of the first quarter of 2012.

Just after 10 a.m. on Wall Street, the Dow Jones Industrial Average was up less than a point, the Standard & Poor’s 500 Index was lower by 1 point and the NASDAQ was up about 3 points.

Markets in the U.S. finished lower Tuesday after disappointing news showed that home prices in 20 major cities fell to the lowest levels since 2002. A disheartening report on consumer confidence further rattled already shaky investors.

Tuesday’s decline came after a big run-up Monday after Fed Chairman Ben Bernanke made comments on the job market and hinted that low interest rates will be around for some time.

Stocks have rallied in 2012 on improving economic data and easing concerns about the sovereign debt crisis that has plagued the eurozone region. As the first quarter of the year winds down, the Dow has climbed 18 percent, the S&P 500 has gained almost 13 percent and the NASDAQ is better by more than 20 percent.

In world markets Wednesday, Asia ended lower and European markets were down in afternoon trading.

Weighing on investors’ minds is the price of gas. The price of an average gallon of regular gas surpassed the $3.90 mark on Wednesday, according to AAA. Prices are now within a dime of the $4 threshold after 19 consecutive increases.

Making its debut on Wednesday is organic food maker Annie’s Inc. Known particularly for its mac & cheese, the company will trade under the ticker BNNY. The IPO was priced at $19, above the estimated range of $16 to $18. Annie’s sold 5 million shares for its initial public offering.

In currencies and commodities, the dollar lost ground against the euro and the yen, but strengthened against the pound.

Oil for May delivery slumped $1.24 to $106.09 a barrel, and gold futures for April delivery gave back $11.30 to $1,673.60 a troy ounce.

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New York, NY, United States (AHN) – The rate on a 30-year fixed mortgage climbed above 4 percent for the first time since October, Freddie Mac reported Thursday.

In its weekly report, the mortgage giant noted the average rate on the 30-year fixed rate mortgage increased to 4.08 percent in the week ending March 22. That was up from 3.92 percent in the prior week. A year earlier, the rate rested at 4.81 percent.

The 15-year-fixed rate mortgage rose to 3.30 percent in the latest week. That was up from 3.16 percent in the previous week.

Economists say that mortgage rates are inching higher along with improved economic data, and are catching up with increases in U.S. Treasury bond yields.

The housing market has been showing mixed signs of recovery, and the unemployment situation appears to be improving.

However, higher rates slow mortgage activity.

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New York, NY, United States (AHN) – Stock index futures point to extended gains for Wall Street Friday as traders remain upbeat on the U.S. economy.

Shortly before the opening bell, the Dow Jones Industrial Average rose 38 points to 13,209, the Standard & Poor’s 500 futures eked up 3.3 points and the NASDAQ futures climbed 8.8 points.

The closely watched S&P benchmark, because of its diversity, surpassed the 1,400 threshold Thursday for the first time since before the 2008 financial crisis. All three indexes have made impressive gains in recent trading sessions.

The markets in general have gotten a lift from optimistic data on the recovering U.S. economy, coupled with easing fears about the European debt crisis.

Market participants will be eyeing three key economic reports on Friday.

Before the open, a report on Inflation at the consumer level showed an increase of 0.4 percent in February, in line with estimates, with a spike in gas prices accounting for almost 80 percent of the rise. Excluding the food and energy components, prices were up 0.1 percent, slightly less than the 0.2 percent forecast.

Later on Friday, data from the Federal Reserve is expected to show production in the U.S. industrial sector grew at 0.4 percent in February from the prior month. Two regional manufacturing reports came in ahead of expectations on Thursday.

Also expected is a report on consumer sentiment which is expected to show a very slight, but positive, rise in early March. Rising gasoline prices may have also taken its toll here, too.

In premarket trading, oil rose 40 cents to $105.51 a barrel, and gold gave back $13,00 to $1,646 a troy ounce.

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New York, NY, United States (AHN) – The U.S. trade deficit surged to the widest imbalance in more than three years in January as imports hit an all-time high, the Commerce Department reported Friday.

The increase in imports reflects the growing demand for foreign made cars, computers and food products.

Meanwhile, U.S. exports to Europe fell, raising concerns that the debt crisis in the region could hamper and dampen U.S. economic growth.

The January trade deficit widened to $52.6 billion, the biggest gap since October 2008, according to the report. Imports rose 2.1 percent to a record $244.4 billion. Exports were up less, at 1.4 percent to $180.8 billion. Exports to Europe dropped 7.5 percent.

Economists forecast the deficit in 2012 will widen from last year’s $560 billion imbalance, thanks in part to the ongoing economic woes in Europe, which accounts for roughly 20 percent of America’s export market. A wider deficit can depress economic growth because it usually means fewer export-related jobs.

The deficit with China rose 12.5 percent in January to $12.6 billion. In 2011, the deficit with the Asian nation hit a record $295.5 billion, the highest deficit ever recorded with a single country.

Political pressure is growing to impose economic sanctions on what critics see as China’s unfair trade practices, such as a currency regime that keeps the yuan undervalued against the dollar, making Chinese goods less expensive and more attractive to U.S. consumers, and makes American products more expensive in China.

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Dili, Timor-Leste (IRIN) – An increase in the number of suspected dengue cases in Timor-Leste in 2012, compared with the same period last year, has prompted government health and sanitation warnings.

The mosquito-borne virus causes flu-like symptoms known as dengue. If not properly treated, the more severe form of the disease, known as dengue hemorrhagic fever, has harsher symptoms and can be fatal.

As of 24 February, the Ministry of Health had received 563 reports of dengue (161 confirmed by laboratory tests) in every district except one, including 192 reports of dengue hemorrhagic fever that causes severe abdominal pain, vomiting and in worst cases, death.

This is a 36 percent increase over reports for the first two months of 2011.

As of 1 March, 10 people had died from dengue, according to the government.

“Those who died, their families brought them too late to the hospital for treatment, which includes intravenous medication,” Vice-Minister of Health, Madalena Hanjam, told IRIN.

At Guido Valadares National Hospital in the capital, Dili, Jacob Fernandes – whose family lives in a densely packed neighborhood on the capital’s outskirts, Bairo Pite – said he had never heard of dengue before his son’s diagnosis. When the two-and-a-half-year-old developed red skin patches and a bloody nose last week, a local clinic gave him aspirin.

“We tried to take him to a clinic for blood tests but the lab tests did not reveal dengue. They [health workers] said my child had a normal fever and gave him aspirin.” When his condition did not improve, Fernandes took him to the hospital where he was diagnosed with dengue and was recovering on 1 March.

There is no vaccine or specific treatment for dengue, but early detection and access to proper medical care lower death rates to less than 1 percent, according to the World Health Organization (WHO).

Too-small drains impeding water flow, litter-strewn streets and overcrowded housing that have all expanded breeding grounds for mosquitoes explain the virus’s resurgence nationwide, said Hanjam.

Dili, the country’s most populated district, has been most affected, followed by Manatuto in the north and Bobanaro in the east.

Infected mosquitoes – drawn to crowded city spaces – breed mostly in man-made containers, such as water jugs, flower pots, water tanks, tires or discarded food containers, Hanjam said.

“We will also appeal to anyone who consumes food such as rice in public places to please wrap up the container and throw it in the [rubbish] rather than tossing it just anywhere where it can become a place for mosquitoes to lay eggs.”

But even proper sanitation is no guarantee against infection, noted WHO’s representative in Timor-Leste, Jorge Mario Luna.

“Even countries/cities with good practices, such as Singapore, have difficulties controlling dengue as it is virtually impossible to identify all the places where rainwater stagnates, favoring the breeding of the mosquito,” he said.

There were 419 reported infections in Singapore as of 24 February 2012, about the same number of cases as last year. Australia has recorded a 30 percent increase.

Eliminating infected mosquitoes’ eggs is “virtually impossible”, forcing health workers to focus on reducing infections and providing healthcare to patients, said Luna.

According to the WHO, dengue is the most common mosquito-borne viral disease in humans. An estimated 2.5 billion people – two-fifths of the world’s population – are at risk, with an estimated 50 million dengue infections worldwide annually.

pt/ndc/mw

– Provided by Integrated Regional Information Networks.

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