Tag: "Health Care Costs"

This Will Teach Little Old Ladies to Brush Up On Medicare’s Rules

So here’s a sad story about medicine and the law. Sarah Mulcahy was 96 years old when she suffered a bad fall. The pain was so severe that she became incontinent and nauseous. After going to the emergency room, she was hospitalized and spent three nights at Manchester Memorial Hospital in Connecticut. While there, she was X-rayed, CT scanned, hooked up to an IV, treated with an incentive spirometer, and given compression cuffs to prevent deep vein thrombosis. After being discharged, she went to a skilled nursing facility (SNF) to recuperate. She stayed there for more than three months at a price tag of about $30,000.

Fortunately, Medicare covers the costs of SNF care for patients who first spend at least three days as a hospital inpatient. (This is known in the lingo as the “three-midnight rule.”) Unfortunately for Ms. Mulcahy, however, she was never technically admitted as an inpatient to Manchester Memorial. Instead, the hospital had put her on “observation status,” an ill-defined halfway house for a patient who’s too sick to go home but who might not be sick enough to need the full range of hospital services. Because Ms. Mulcahy wasn’t ever an inpatient, Medicare wouldn’t cover her subsequent SNF stay.

So she sued and lost. And then there is this:

The bad news for Ms. Mulcahy is that financial incentives have recently been pushing hospitals to put more and more patients on observation status. (More from the Incidental Economist)

Oct 03, 2013 | 10 comments | by

Wide Variation in Doctor Fees

0928_doctor-money_390x220The researchers analyzed more than 40 million claims filed in 2007 for nearly a dozen types of service ranging from five-minute check-ups to comprehensive exams. The most common claim filed was for a “problem-focused” exam lasting about 15 minutes with a patient the physician already knew.

The lowest-paid 5 percent of doctors received $47 or less for the visit while the highest-paid 5 percent received $86 or more. The average reimbursement amount was $63.  For more complex, yet identical, office visits lasting longer and involving a new patient, the reimbursements ranged from $103 or less to $257 or more.

Reuters story. Health Affairs study.

Oct 03, 2013 | 11 comments | by

Headlines I Wish I Hadn’t Seen

familyBetween 2014 and 2022, the increase in national health spending (which the Medicare actuaries specifically attribute to ObamaCare) amounts to $7,450 per family of four.

NBER study: There is no statically significant relationship between hospital prices and quality (as measured by colon cancer surgery mortality).

An internal Senate memo warns lawmakers and their staff not to sign up for ObamaCare’s health insurance exchanges just yet.

Government regulation may prevent personalized medicine from reaching its potential.

HHS: Individual health insurance premiums will rise by 99% for young men and 62% for young women.

Sep 25, 2013 | 15 comments | by

Cancer Care

As outlined by Thomas Smith and Bruce Hillner in a now-classic piece, too many patients are subjected to punishing and futile treatments. Too much costly imaging is performed, for too little therapeutic benefit. Too often, costly supportive therapies, such as Epogen, that raise red blood cell counts are provided when they are not needed. The lack of easily used electronic health records aggravates fragmentation of care and perpetuates miscommunication and medical errors.

This isn’t an issue of rationing. America can amply afford the $125 bCancer-Careillion we devote to cancer care. Cancer accounts for only about 5 percent of our nation’s $2.8 trillion health-care economy. Yet particularly in the case of advanced cancers, both patients and the wider society could receive greater value for what is spent. Many patients require care delivered with greater thoughtfulness: less-toxic treatment regimes that relieve suffering and protect quality of life when curative care is not possible.

Proper care also requires greater clarity and candor upfront — particularly when the prognosis is not what patients are hoping to hear. According to one recent survey of patients with metastatic cancer, “69% of patients with lung cancer and 81% of those with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer.” False hope provides temporary comfort. It cannot provide the basis for a realistic or humane treatment plan, much less confidence and trust in the providers.

Full piece by Harold Pollack worth reading.

Sep 24, 2013 | 14 comments | by

Benefit Shock

As Robert Laszewski has observed, the health care media has been obsessed with whether or not premiums in the ObamaCare exchanges will produce “rate shock.” They have completely ignored the more likely source of discomfort — especially for people used to employer plans that allow access to almost any doctor or hospital.

The big surpriseOB-UE291_goodma_G_20120814172119 here will be that in many states that second-lowest cost plan [the one that qualifies for a full subsidy] will be a narrow-network plan with significant limits on which providers the consumer can go to. In fact, in many cases, the narrow-network plan will look very much like a Medicaid network.

In California, for example, the Blue Shield exchange offering is limited to 24,000 doctors compared to the standard Blue Shield network that covers 64,000 docs.

The lowest cost California plan comes from insurer Health Net. The LA Times is reporting that Health Net is offering, “less than half what some other companies are offering in Southern California.” The Times reports that Health Net is limiting its network to one-third its usual employer network. In San Diego, the company will only have 204 primary care physicians in its network.

In New Hampshire, the sole health plan offered on the exchange is a WellPoint plan, which will cover only 14 of 26 state hospitals and 65% of the normal physician network.

See previous posts on then race to the bottom within the exchanges here, here, here and here.

Sep 24, 2013 | 15 comments | by

Who Should Get Credit for the Slow Down in Health Care Spending?

File photo of an Obamacare pamphlet at a Tea Party rally in LittletonThe administration and not a few people in the press are fond of claiming this as a victory for President Barack Obama’s Patient Protection and Affordable Care Act, aka ObamaCare. The program is so fantastic on cost control, the argument goes, that providers have naturally started to control costs in preparation for the actual implementation. Authors Amitabh Chandra, Jonathan Holmes and Jonathan Skinner dismiss this explanation. Most of the cost controls haven’t kicked in yet, while one cost-increasing factor (the expansion of private insurance coverage to children under 26) has already taken effect. More importantly, as they note, “the downturn in health-care cost growth began in 2006, back when Barack Obama was still a relatively unknown senator from Illinois.”

Megan McArdle: Health-Care Costs Are Driven by Technology, Not Presidents.

Study: Is This Time Different? The Slowdown in Healthcare Spending.

Sep 23, 2013 | 20 comments | by

Headlines I Wish I Hadn’t Seen

ss-ltc20133Obama to baby boomers: prepare to pay more for home care.

Consumers can’t find out what drugs are covered by plans offered in the exchanges.

Revolving door is profitable for those who gave us ObamaCare.

Orszag: Doctors should be re-certified not based on what they know, but based on how they practice medicine.

Sep 19, 2013 | 15 comments | by

What Large Employers Are Doing

They’re sending their employees to private exchanges, armed with HSAs and HRAs:

Employers are raising deductibles, giving workers health savings accounts that look like 401(k) plans, mimicking the health law’s online insurance marketplaces and nudging patients to compare prices and shop around for treatments. Together the moves could eventually affect far more consumers than the law’s Medicaid expansion or health exchanges aimed at the uninsured and scheduled to open Oct. 1. (Kaiser Health News)

See Walgreen and others.

Sep 19, 2013 | 19 comments | by

Race to the Bottom

Within the ObamaCare exchange, that is:

To see the challenges awaiting some consumers, consider Woodland Hills-based insurer Health Net Inc.

health-netAcross Southern California the company has the lowest rates, with monthly premiums as much as $100 cheaper than the closest competitor in some cases. That will make it a popular choice among some of the 1.4 million Californians expected to purchase coverage in the state exchange next year.

But Health Net also has the fewest doctors, less than half what some other companies are offering in Southern California, according to a Times analysis of insurance data.

In Los Angeles County, for instance, Health Net customers in the state exchange would be limited to 2,316 primary-care doctors and specialists. That’s less than a third of the doctors Health Net offers to workers on employer plans. In San Diego, there are only 204 primary-care doctors to serve Health Net patients.

Other major insurers have pared their list of medical providers too, but not to Health Net’s degree. Statewide, Blue Shield of California says exchange customers will be restricted to about 50% of its regular physician network. (LA Times)

Sep 18, 2013 | 19 comments | by

Hospital Transparency in California

This is Jason Shafrin:

30-ways-to-cut-your-health-care-costsHow did hospitals respond to the law? Over 95 percent of all California hospitals reported that they offered free care to uninsured patients with incomes at or below 100 percent of poverty. However, higher-income uninsured patients still faced the risk of high prices based on billed charges.

Further, this policy did not help improve the accuracy of the billed charges to Medicare. Medicare billed charges are as ridiculous as ever. As shown in the figure below, Medicare payments equaled 20 percent of billed charges by California hospitals in 2010, down from 43 percent in 1997. Thus, although the uninsured are paying less for hospital care, the insured may be paying relatively more.

Health Affairs study.

Sep 16, 2013 | 11 comments | by
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