Summary: Patient satisfaction is a big deal in health care these days. I talked about the topic with Randi Redmond Oster, the head of Help Me Health and the multi award winning author of “Questioning Protocol,” which details her journey with her son, who has Crohn’s disease, and his multiple operations. “What I discovered was this: the process of health care could be improved,” Randi said. “I have an aerospace engineering background and that combination of the insight to safety, communication and keeping things working. Plus seeing the reality of what was happening in the hospital helped me, and propelled me to become an agent of change.” Here’s our interview, lightly edited for clarity.
Summary: “Before Luke Whitbeck began taking a $300,000-a-year drug, the 2-year-old’s health was inexplicably failing. A pale boy with enormous eyes, Luke frequently ran high fevers, tired easily and was skinny all over, except his belly stuck out like a bowling ball,” Sarah Jane Tribble and Sydney Lupkin write at NPR in a piece about orphan drugs. “‘What does your medicine do for you?’ Luke’s mother, Meg, asked after his weekly drug treatment recently. ‘Be so strong!’ Luke said, wrapping his chubby fist around an afternoon cheese stick. Luke now spends days playing with his big brother, thanks to what he calls his ‘superhero’ medicine, a drug called Cerezyme, which has saved his life. For the Whitbecks, finding a way to pay for the drug has been a nerve-wracking struggle. Their family business and its insurer cough up hundreds of thousands of dollars per year, spreading the cost across the people it insures. Cerezyme is an orphan drug, which means it was created to treat a rare disease, one that affects fewer than 200,000 people in the U.S. The orphan drug program overseen by the Food and Drug Administration is loaded with government incentives and has helped hundreds of thousands of patients like Luke feel better or even stay alive. But the 34-year-old program has opened the door to almost unlimited price tags and created incentives for drugmakers to cash in, and to cash in repeatedly, a Kaiser Health News investigation shows. The explosion has burdened insurers as well as government programs like Medicare and Medicaid with drugs that cost up to $840,000 a year that they have almost no choice but to pay for.” Sarah Jane Tribble and Sydney Lupkin, Orphan Drug Bounty Comes At Steep Price,” Shots – Health News, NPR.
Summary: “The House of Representatives just passed HR-7, an anti-abortion bill that expands the Hyde Amendment (a 1976 bill which prohibits the use of federal funds for abortions) to exclude the use of insurance for abortion coverage,” Noor al-Sibai writes over at Bustle, in a piece that cites us for our statistics. “The bill is titled ‘No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2017,’ and this language is misleading, given that no federal funding has gone to abortion coverage in over 40 years. Instead, the bill will expand Hyde Amendment provisions to make them permanent, and will in effect bar tax funding to insurers who provide abortion. According to the Center for Reproductive Rights, this amendment will be particularly hard on women who won’t be able to pay full price for an abortion — members of low-income families, millennial women, and women of color in particular. HR-7 was passed in spite of the fact that there are already 10 states that don’t allow insurance-covered abortions and 15 more that bar Affordable Care Act recipients from getting covered abortions.” Noor al-Sibai,“The House Just Passed An Anti-Abortion Bill That Will Badly Hurt Millennials,” Bustle.com
Published on Flickr by Parker Knight, Creative Commons attribution license
Summary: If one were to survey the public, it is not obvious whether being sick would rank as more frustrating than dealing with health insurance —- especially in these times of health reform and uncertainty. Doctors also sometimes find dealing with health insurance difficult —- especially when their patients don’t understand their responsibilities. Here is a list of some of the things doctors wish patients knew about health insurance.
Summary: “Physician organizations, hospitals and health systems are under increasing pressure to deliver transparent, competitive pricing,” writes Kelly Gooch over at Becker’s Hospital Review. “This pressure is coming from multiple sources, according to Igor Belokrinitsky, principal with Strategy&, PricewaterhouseCoopers’ strategy consulting business, and with PwC US. Federal and state governments are demanding more transparency, while consumers are asking for more affordable healthcare options. Additionally, payers are working on improving member engagement to keep members out of hospitals. These efforts include getting more members to utilize retail health clinics and telemedicine options rather than hospital emergency departments. As a result, some business is being diverted away from hospitals and toward retail clinics, standalone surgical centers and urgent care facilities that advertise their prices and services, according to a new report from PwC’s Health Research Institute.” The report documents efforts at Adventist Health System (Altamonte Springs, Fla.), Integris Health (Oklahoma City), St. Clair Hospital (Pittsburgh) and Geisinger Health System (Danville, Pa.). Kelly Gooch, “How health systems across the US are improving price transparency,” Becker’s Hospital Review.
Summary: “Hospital and health system executives are well aware of the affects high-deductible health plans have had on hospital finances, from patient collections to bad debt,” Brooke Murphy wrote over at Becker’s Hospital Review, collecting statistics in May 2016. “To help quantify the impact of increasing patient financial obligations on the business of healthcare, here are 21 statistics to know about high-deductible health plans. 1. The Affordable Care Act has lowered the uninsured rate in the U.S., but it has not relieved the financial pressure hospitals experience from providing uncompensated care. The uninsured rate in the U.S. has fallen from 15.7 percent in 2009 to 9.1 percent in 2015, according to a report from the CDC. 2. Hospitals and health systems used to collect a majority of healthcare reimbursements from government or commercial payers. With the rise in popularity of high-deductible plans, hospitals are interfacing more than ever with patients to collect on accounts. From 2011 to 2014, the number of consumer payments to healthcare providers increased 193 percent, according to a study from InstaMed. 3. Patients with high-deductible policies are grappling with significantly greater out-of-pocket costs. Kaiser Family Foundation reports the average annual out-of-pocket costs per patient rose almost 230 percent between 2006 and 2015. 4. The same Kaiser Family Foundation study found employee deductibles on average increased 67 percent from 2010 to 2015.” Brooke Murphy, 21 statistics on high-deductible health plans,” Becker’s Hospital Review.
Summary: “Much of the recent attention on the future of the Affordable Care Act (ACA) has focused on the fate of the 22.5 million people likely to lose insurance through a repeal of Medicaid expansion and the loss of protections and subsidies in the individual insurance market,” JoAnn Volk writes over at Health Affairs (Related graphic: Andy Slavitt posts on his Twitter stream about the effects of repeal; click image to enlarge.) “Overlooked in the declarations of who stands to lose under plans to “repeal and replace” the ACA are those enrolled in employer-sponsored health plans — the primary source of coverage for people under 65. Job-based plans offered to employees and their families cover 150 million people in the United States. If the ACA is repealed, they stand to lose critical consumer protections that many have come to expect of their employer plan. It’s easy to understand the focus on the individuals who gained access to coverage thanks to the health reform law. ACA drafters targeted most of the law’s insurance reforms at the individual and small-group markets, where consumers and employers had the greatest difficulty finding affordable, adequate coverage prior to health reform. The ACA’s market reforms made coverage available to those individuals with pre-existing conditions who couldn’t obtain coverage in the pre-ACA world, and more affordable for those low- and moderate-income families who couldn’t afford coverage on their own. Less noticed, but no less important, the ACA also brought critical new protections to people in large employer plans. Although most large employer plans were relatively comprehensive and affordable before the ACA, some plans offered only skimpy coverage or had other barriers to accessing care, leaving individuals—particularly those with costly, chronic health conditions—with big bills and uncovered medical care. For that reason, the ACA extended several meaningful protections to employees of large businesses.” JoAnn Volk, “Get Health Insurance Through Your Employer? ACA Repeal Will Affect You, Too,” Health Affairs.
By Jnzl’s Photos, released on Flickr under the Creative Commons Attribution License
Summary: You may have asked yourself why health prices rise inexorably. Are escalator clauses, the automatic price increases common to many managed care contracts, the driving force behind trend factors? Bill Rusteberg, an independent insurance consultant in Texas, posted on his blog recently about escalator clauses, which he said commonly add 5 percent a year to a provider’s annual billing. I was interested, and called him to chat about it. Bill, who’s been in the health care industry for 44 years, advises and assists plan sponsors or companies in managing their health insurance, on a fee basis. He’s based near Victoria, Texas, in the south central part of the state. Here’s the text of our interview, lightly edited for clarity.
Jeanne Pinder: You posted on your blog about escalator clauses and whether they’re the driving force behind trend factors. What is an escalator clause?
Bill Rusteberg: It’s a pay raise guaranteed by the managed care contract, where providers are guaranteed an automatic increase in pay every single anniversary of the managed care contract. So if there’s a 5 percent escalator clause, that’s really a 5 percent raise every year.
Summary: Our work with PriceCheck, our health cost transparency partnerships with media and other organizations, has stretched across the nation, bringing thousands of people to our partner web sites to share and search prices — from databases, from our reporting, and from our communities. Our interactive software is placed on our partners’ sites, using pricing information from three sources. First, we pre-populate the database with our survey of cash or self-pay pricing collected from local providers on common, shoppable procedures — or, sometimes, prices of bigger-ticket items. Second, we encourage community members to come and share their pricing information, from their bills or “explanation of benefits” forms from an insurer. Third, in most partnerships, we also display the Medicare reimbursement rate for a collection of 8,400 procedures catalogued in the Healthcare Common Procedural Coding System (HCPCS) used by the government in any different geographic regions. In this way, we display a 360-degree view of pricing. We don’t have every price for every procedure at every provider across the nation — that data does not exist anywhere — but we have a “community-created guide to health costs” that informs people and gives them a sense of agency in the bewildering world of health care pricing. People can share and search the data, and we use the data to write and tell about the costs of health care.