In addition, The Senior Citizens League has “seen no reports to indicate whether savings [with the ACO program] will be financially advantageous for beneficiaries as well. Will ACOs slow the rate of increase in base Medicare Part B premiums (currently at $170.10) or pricey supplemental Medigap insurance premiums that currently average $235 a month for beneficiaries?” writes Mary Johnson, the advocacy group’s Social Security and Medicare policy analyst, in its May newsletter.

However, some proponents of the new program stated that “criticism against the [ACO] model are misleading and flat out false,” in a February letter from the National Association of ACOs, which was signed by 200 various health care organizations.

“Traditional Medicare patients maintain their freedom of choice to see any willing provider. They keep all of their rights and protections, and in fact, get more benefits and lower cost care through the model,” they stated. “This is not the end of traditional Medicare … but a way to provide additional beneficial and provider tools as part of the whole-person approach.”

Private Equity and SPACs

But the fear of having ACOs become a key part of traditional Medicare is that the owners are not necessarily health care organizations, such as large physician practice groups. Indeed, there has been a “surge” in investment in ACO groups by private equity firms and insurance companies.

This has become a ripe investment area as the US population ages. And as Miller noted, “most of the investment activity is coming from special-purpose acquisition companies or SPACs, private equity firms and health insurance companies already dominant in the Advantage business.”

And though an AARP spokesperson said in an email to ThinkAdvisor that it had not “commented specifically on the ACO Reach program,” in its letter regarding MA programs, it said that it shares the concern by CMS on third-party marketing of MA programs and a “rise in marketing-related complaints from beneficiaries.”

They note that in 2021 there were 33 different plan options, and determining which is best is a “daunting process for even the most knowledgeable consumers. This challenge has been exacerbated by the MA program’s history of marketing abuses involving enrollment.”

Further, they “strongly” support the proposal to “restore network adequacy review standards when an MA plan applies for a new or expanded service area,” stating that per the previous administration’s rules, a network had to only “attest that it has an adequate network.”

Even the HHS inspector general had some concerns with MA programs, stating in an April report that it found a 13% to 18% rate of denied prior authorization and payment requests that met Medicare coverage rules.

Fixing Medicare

Many practitioners have advocated keeping Medicare as is, with some tweaks to strengthen it. dr Ed Weisbart, chair of the Missouri chapter of PNHP and assistant professor of clinical medicine at Washington University in St. Louis, told Healthcare Innovation in March 2022:

“There’s a school of thought that drives Medicare Advantage, and drives a lot of the innovation out of Medicare Innovation Center, which says that the root problem is [traditional Medicare] fee for service. And so, they want to move everything over to capitation. And that to me is, on its face, just ridiculous,” he said.

“We really should eliminate [or] greatly reduce the copays and deductibles of traditional Medicare. … This could fix the personal finance aspects of traditional Medicare and then other things could be experimented with like adding in hearing, vision, and dental. These are things that improve health outcomes and should be inexpensive to offer. So, improve traditional Medicare and stop giving an unfair advantage to Medicare Advantage.”

Likewise, Dr. Ana Malinow, past president of PNHP and professor of pediatrics at the University of California-San Francisco, told Healthcare Innovation that “traditional Medicare is working pretty well. … we should be looking at what it is that traditional Medicare is doing better than Medicare Advantage. The profit motive there is not making things better.”

ThinkAdvisor contacted several members of Congress and health organizations who had signed the various letters, as well as the CMS and HHS. They had not responded by deadline.

But as Miller stated: “The ACO model has important implications for the future of one of our most important social insurance programs. It shouldn’t be implemented without a robust discussion — and without the approval of Congress.”

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COVID cases and hospitalizations across the Bay Area are increasing at a pace not seen since the biggest spike began in November.

Dr. Bob Wachter, Dean of the University of California, San Francisco School of Medicine, said:

Related: CDC is reversing course on interior masks in some parts of the U.S.

“This virus does its job twice as well.”

Wachter says he is confident that when San Francisco gets vaccinated it will be in “good shape”, a model for the whole country, by the time it reaches 70-75% of the population.

“If we were dealing with an old virus, it would have been true,” he said. “But we are not.”

In the past three weeks, new infections with COVID in the Bay Area have increased fivefold on average and hospital admissions more than doubled.

Another blockage?

Stephanie: “Do you think it is possible?”

Wachter: “It depends on what we do, but we discover it early enough and the proportion of those vaccinated is high enough that there is an increase that could overwhelm the hospital. I think it’s very unlikely to be seen .. But it’s not zero. “

Video: what to do and what not to do after vaccination

Wachter is cautiously optimistic, but does not rule out another blockade. He says the UCSF Medical Center changed from zero inpatient COVID patients six weeks ago to 25 Tuesday morning.

“If we go back to the worst of the pandemic, when there are 100 to 150 people in the hospital, I think we have to do more than we do now,” he said.

Will Maskman Date be back?

Stephanie: “Do you think the entire bay will again require masking indoors?”

Wachter: “Oh, I think it’s 100 percent likely … I think the health authorities have to be pretty close to triggering this.”
Dr. Wakta says it would be surprising if the Bay Area didn’t have a mask requirement within a week.

Related: California State University requires all students and staff to receive the COVID-19 vaccine

4th wave

According to ABC7 data analysis, the 7-day moving average of new daily COVID cases in the Bay Area increased from 231 on July 1 to 1,335 on July 23. The average increased more than five-fold in just three weeks.

“If you look at what we’ve seen so far, the increase usually takes months,” said Wachter. “The delta seems to be a little shorter than the other waves.”
Even if a significant part of the population is vaccinated today, Wachter said, the situation will still be difficult in a month or two.

“Delta is not the end, so everyone has to be vaccinated,” said Wachter. “A new variant will come out.”

When do I need a booster vaccination?

Wachter says certain groups will need to start taking booster shots within the next few months. He hopes that it will gradually be phased out in groups like the first vaccination.

Who is in group 1? Once approved, Wachter will be used by immunocompromised patients, people over the age of 70, people who received their first injection in December or January, and even people vaccinated with Johnson & Johnson. Protected because the single dose is slightly lower.

Vaccine Tracker: The Situation in California When the Coronavirus Vaccine Can Be Administered

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COVID-19: Will the San Francisco Bay Area Be Closing Again? Not If Mask Mandate Is Reintroduced, Doctors Say Source Link COVID-19: Will The San Francisco Bay Area Be Closing Again? Not if a mask requirement is reintroduced, doctors say

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(KPIX 5) – Special filters for your stove and air purifiers for selected rooms will certainly help make your home feel more comfortable, but do they also protect you from the novel coronavirus?

Some doctors suggest that COVID-19 could be spread through much smaller particles than the droplets that are caught by some face masks. There are dozens of air purifiers on the market that claim to filter and remove dust, pollen, mold, and even viruses from the air.

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Experts say they are better than none other than retired Air Force colonel, and Stanford infectious disease specialist Dr. Dean Winslow, be careful.

“I would be concerned that just having a few air purifiers in the room in a large, crowded room with lots of people would give a false sense of security,” said Winslow.

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The virus is extremely small and is unlikely to be caught in standard filters. “I think the most important place to have filters is part of a high-efficiency HVAC system,” said Winslow.

Your home heating and cooling system gives you options. There are filters that claim to remove viruses down to 5 microns. That is a tenth of the average diameter of a human hair.

“Filters used for this purpose generally work very well against 5 micron droplets, but some of the viral material can be contained in droplets as small as 1 micron,” said Dr. William Nazaroff, Distinguished Professor of Engineering Emeritus at the University of California, Berkeley.

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Both doctors agree that the volume of air exchanged is just as important as using the correct filter.

The post Medical doctors Warning In opposition to Relying On Air Filters, Purifiers To Assist Cease COVID-19 – CBS San Francisco appeared first on Los Gatos News And Events.