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Big-name hospitals fail to get 5 stars in new Medicare ratings: Kaiser

Posted by on July 28, 2016

Summary:The federal government released its first overall hospital quality rating on Wednesday, slapping average or below average scores on many of the nation’s best-known hospitals while awarding top scores to dozens of unheralded ones,” Jordan Rau writes over at Kaiser Health News. “The Centers for Medicare and Medicaid Services rated 3,617 hospitals on a one- to five-star scale, angering the hospital industry, which has been pressing the Obama administration and Congress to block the ratings. Hospitals argue the ratings will make places that treat the toughest cases look bad, but Medicare has held firm, saying that consumers need a simple way to objectively gauge quality. Medicare does factor in the health of patients when comparing hospitals, though not as much as some hospitals would like. Just 102 hospitals received the top rating of five stars, and few are those considered as the nation’s best by private ratings sources such as U.S. News & World Report or viewed as the most elite within the medical profession. Medicare awarded five stars to relatively obscure hospitals and at least 40 hospitals that specialize in just a few types of surgery, such as knee replacements. There were more five-star hospitals in Lincoln, Neb., and La Jolla, Calif., than in New York City or Boston. Memorial Hermann Hospital System in Houston and Mayo Clinic in Rochester, Minn., were two of the  nationally known hospitals getting five stars.” The original CMS report page is here.  Jordan Rau,
“Many Well-Known Hospitals Fail To Score 5 Stars In Medicare’s New Ratings,” Kaiser Health News.

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Us! Us! Us! CEO Jeanne Pinder is interviewed on GotAGirlCrush.com

Posted by on July 21, 2016

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Summary: The remarkable Meg Wachter of “GotAGirlCrush.com” interviewed me. Here’s the piece. Also, I love this .gif by the excellent Amanda Stosz. Some quotes from me: “There’s no easy way to know prices, or to make smart decisions with your money and your health. We’re working to change that.” and “It’s a national embarrassment: Our health care system takes advantage of people who are ill, or who don’t have gold-plated insurance, or who don’t have the time to fight through the murk and the bureaucracy and the active attempts to keep you in the dark about prices.’ GotAGirlCrush is is a blog & print magazine made by women, about women, for everyone. I’m incredibly honored to be in the company of these amazing women. Bonus: now I know how to make a .gif play in WordPress. Go, read!

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Advice on getting a cash price: Ask up front, and get it in writing

Posted by on July 14, 2016

Summary: We’re often asked how to get a cash price. Here’s one suggestion, from John R. Graham at the National Center for Policy Analysis, a “free-market reform” think tank: “I, myself, went deeper at a hospital a few years ago, when I was scheduled for an operation. I called and asked for the cash price and received a quote by fax. When I subsequently received a bill after my health insurer had processed the claim, the amount the insurer paid the hospital was more than the cash price quoted to me; yet the hospital wanted still more! I sent that bill back, unpaid, along with the fax, explaining that the hospital had already received more from the insurer than it would have from me if I had paid cash. That was the last I heard of it.” John R. Graham, More Evidence Against Health Insurance,” Health Policy Blog, NCPA.org.

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How bad are providers’ network lists? Really, really bad.

Posted by on July 11, 2016

Summary: “Provider directories for some health plans sold through Covered California and in the private market are so inaccurate that they create an ‘awful’ situation for consumers trying to find doctors, according to the lead author of a new study published in the journal Health Affairs,” Emily Bazar writes at California Healthline. “In the study, ‘secret shoppers’ posing as patients were able to schedule an appointment with a primary care physician less than 30 percent of the time. The callers contacted 743 doctors in five different regions of California who were listed as primary care physicians in their health plans’ online directories. They focused on Blue Shield of California and Anthem Blue Cross plans sold to individuals and families through the state health insurance exchange and in the open market. ‘We were a little bit surprised at how bad the numbers were,’ said the study’s lead author, Simon Haeder, an assistant professor of political science at West Virginia University.” Emily Bazar, “Inaccurate Provider Lists A Major Barrier To Care, Study Finds,” California Healthline.

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What does quality mean? How do you find it? Dr. Jay Parkinson tells all

Posted by on July 10, 2016

Summary: How do you pick a doctor? Here’s a great handbook by Dr. Jay Parkinson, who’s a co-founder of Sherpaa. “During my preventive medicine residency at Hopkins I worked in Dr. Peter Provonost’s Institute for Patient Safety and Quality,” Jay writes on his blog. “In addition to leading all safety and quality issues at Hopkins, he’s also credited with creating the concept of the surgical checklist, a tool that’s proven to save a significant number of lives and best described in Atul Gawande’s book, The Checklist Manifesto. Peter taught me that everything is a process, and if you don’t design the process with intention and outcome in mind, the process evolves into the easiest, rather than the safest. That being said, in healthcare, I deify process mostly because the data on individual physicians isn’t plentiful enough to be statistically significant … For example, a surgeon who does 32 tonsillectomies a year isn’t enough data to be scientific. It’s meaningful because it’s common sense that you almost always want to go to the surgeon/facility who does the most of the exact thing you need. But, you need much, much more volume than that for the outcomes to be scientifically statistically significant. Physicians are also always taught that the practice of medicine changes every 5 years. New evidence comes out and gold standards change. This also throws a wrench in the concept of studying doctor quality. …It’s also relatively common knowledge that the older the physician, the further they are from state of the art training. … Older physicians, unless they take it upon themselves to learn new procedures through curiosity and continuing medical education, will likely be doing an exceptional job with out of date procedures. Younger physicians will be doing state of the art procedures with less experience.” Dr. Jay Parkinson, “What does quality mean in healthcare and how do you find it?” his blog.

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Negotiator Lowers Medical Bills, and You Can Too: Health News Florida

Posted by on July 8, 2016

Summary: “Medical debt is one of the leading causes of bankruptcy in the United States,” our partner Sammy Mack writes over at Health News Florida. “Having health insurance is no guarantee against being swamped by bills after an emergency or a big procedure. But one Palm Beach County man has found there’s room to negotiate. Kenneth Klein is a former attorney who now runs the business Human Health Advocates—he works with clients to renegotiate bills and resolve insurance disputes. You can hear his conversation with Health News Florida here. Sammy Mack, The Negotiator: He Lowers Medical Bills — And You Can Too,” Health News Florida.

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A discussion of drug prices from a thinkfest in Aspen

Posted by on July 2, 2016

Summary: Here’s the transcript of a thoughtful panel discussion on drug prices from the Aspen Institute, involving Zeke Emanuel, the co-founder of Blink Health, a Consumer Reports person, a hospital representative, and a pharma person, among others. Read and weep. Sample passage: “She did what thousands of Americans did and have told us that they do, when a price hike is this profound, they just walk away from the prescription. She did not fill the prescription, so as many physicians in the audience, you know that by not taking your rheumatoid arthritis treatment, not only do your symptoms get worse but the actual disease worsens. … her doctors were furious at her because that she had become debilitated from not taking her drugs. She couldn’t even do normal household chores. She finally went online and through using some coupon, discount coupon services … she was able to get the price down something closer to $300. Now that is still a profound amount for her. She said she struggles with this. Marlene and her situation, we estimate she was one of 33 million Americans just in the last 12 months who told us that their drug prices had hiked unexpectedly at the pharmacy counter for drugs they take all the time. So it’s not just high-end very expensive drugs, it was old school generics. It was branded drugs, it was everything.” Source: “Deep Dive: Drug prices and access to medicine,” The Aspen Institute, June, 2016. Participants: Kirsten Axelson, Pfizer; Geoffrey Chaiken, Blink Health; Ken Davis, Mount Sinai Health System; Ezekiel Emanuel, University of Pennsylvania; Lisa Gill, Consumer Reports; Kiah Williams, Sirum; Alan Weil, Health Affairs.

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Rising deductibles, and inadequate coverage: Drew Altman at the WSJ

Posted by on July 2, 2016

Screen Shot 2016-07-02 at 10.38.04 AMSummary:With 91% of the population now covered by some form of health insurance, and the coverage rate higher in some states, the next big debate in health policy could be about the adequacy of coverage,” Drew Altman, head of the Kaiser Family Foundation, writes over on The Wall Street Journal. That particularly means rising payments for deductibles and their impact on family budgets and access to care. This is about not just Obamacare but also the many more people who get insurance through an employer. As the chart above shows, payments toward deductibles by consumers who have insurance through large employers rose 256% from 2004 to 2014; over the same period, wages increased 32%. The chart shows what people actually paid toward their deductibles and other forms of cost-sharing, not just their exposure as deductibles climbed (which is more typically what studies and data report). Deductibles accounted for 47% of cost-sharing payments in 2014, up from 24% in 2004. During the same period some other forms of cost-sharing fell. Payments for co-pays declined by 26%. It’s no wonder that consumers say in polls that deductibles are their top health-cost concern.” [Note the coinsurance rising on this graph also.] Drew Altman, “The Next Big Debate in Health Care,” The Wall Street Journal.

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Where does it cost the most to see a doc? Madison.com

Posted by on July 1, 2016

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Summary: “Since the depths of the Great Recession, the cost of health care in the U.S. has steadily risen,” Nick Selbe writes at madison.com. “As a result, Americans are shouldering more of their health care costs than they have in recent years, according to the Washington Post. No one likes having to go to the doctor’s office, but in this climate, it’s wise to save up should the need arise. With this in mind, CareerTrends — part of the Graphiq network — found the 50 places where seeing a doctor costs the most. The data comes from the Council for Community and Economic Research’s Cost of Living Index (2015). The report is compiled by pricing the cost of a general practitioner’s routine examination of an established patient across different locations. Of the top 50 most expensive locations, the Midwest is the region with the most representation. A visit to the doctor in each location costs over $120, and the 10 most expensive places have prices over $160.” Nick Selbe,
“Where does it cost the most to see a doc? Wisconsin ranks high,” host.madison.com.

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18% of cancer patients can’t afford medication, study finds

Posted by on June 24, 2016

Summary: “Financial pressures kept cancer patients from filling prescription medications and attending their doctors’ visits, University of North Carolina Lineberger Comprehensive Cancer Center researchers found in a new study,” according to a press release from the center. “More than one-in-four cancer patients surveyed reported they had to pay more for medical care than they could afford, and 18 percent of those patients said they were unable to afford prescription medications.The findings (abstract 6624), presented Saturday, June 4, at the American Society of Clinical Oncology Annual Meeting 2016 in Chicago, raised concerns for the researchers about access to much-needed care for cancer patients – an issue they believe will only increase as the cost of treatments has climbed significantly.” “Cancer Patients Miss Appointments, Prescriptions Due to Inability to Afford Care,” University of North Carolina Health Care System.

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