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Summary: “We’ve been hearing stories about problems with the ACA (Obamacare) insurance exchanges lately,” Dr. David Belk writes over at The Huffington Post, in a piece that should be read with the words “narrow network” in mind. “Now patients are buying the insurance, only to find that doctors refuse to see them. Why should these patients have so much trouble finding a doctor? Is it because Obamacare is terrible insurance? Is it because they’re terrible patients?”
Summary: “If you’re looking to find a smashing Obamacare success story—a place where the nation’s biggest and most controversial new law in a generation has truly lived up to its promise—you might stick a pin directly in North Carolina,” writes Paul Demko at Politico in an examination of the state of play for the ACA. “The central pledge of the Affordable Care Act was to make insurance available to people who didn’t have it, creating a new safety net for millions nationwide. And in North Carolina that’s exactly what happened. People flocked to the program: More than 600,000 people there signed up for Obamacare policies in 2016, and roughly 90 percent of those got financial help to pay their insurance bills, also through Obamacare. Thanks directly to the ACA, the number of people without health insurance in North Carolina has plummeted by 30 percent in the past three years. Far more people are covered, and far more of them can afford their health insurance. But if you’re looking for a quintessential Obamacare failure story, you might also stick that pin directly in North Carolina. For the insurance companies doing business in the state–the ones issuing policies to those 600,000 people–Obamacare has turned into a financial sinkhole.” Paul Demko, “Obamacare’s sinking safety net,” Politico.com.
Summary: “Of the state’s 170 hospitals in 2014, Pennsylvania Hospital in Philadelphia, above, and 106 others, or 63 percent of them, provided charity care equal to less than 1 percent of their net patient revenue, according to an analysis of data from the Pennsylvania Health Care Cost Containment Council,” Sean D. Hamill writes in The Pittsburgh Post-Gazette, in a thoughtful analysis you should cite next time someone starts talking about charity care or uncompensated care. “Pennsylvania Hospital, the country’s first hospital, was founded by Ben Franklin and others in Philadelphia in 1751 ‘to care for the sick-poor and insane.’ It adopted as its official seal the Good Samaritan and the motto ‘Take care of him and I will repay thee.’ But today, Pennsylvania Hospital, like most of the state’s hospitals, provides little free charity care to the poor, compared to other states, according to an investigation by the Post-Gazette using state data never previously made public. Of the state’s 170 hospitals in 2014, Pennsylvania Hospital and 106 others, or 63 percent of them, provided charity care equal to less than 1 percent of their net patient revenue, according to an analysis of data from the Pennsylvania Health Care Cost Containment Council. That same data shows that Pennsylvania Hospital, still operating out of its stately, original red brick and marble main building not far from some of the poorest neighborhoods near Center City in Philadelphia, is part of an even more troublesome category: It is one of 39 hospitals in the state — 23 percent of them — that provided less than one-quarter of 1 percent in charity care, and 10 of those said they provided no charity care at all.” Sean D. Hamill, “Pennsylvania hospitals lag other states in share of charity care for the poor,” The Pittsburgh Post-Gazette.
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.
Summary: “There’s no one reason why a rural hospital closes. But the results are often similar – reduced access to certain forms of care,” Thomas Goldsmith writes at North Carolina Health News, an issue that’s important because fewer hospitals means less access to care and more consolidation of providers. “Across the United States, 76 rural hospitals have closed since 2010, three of them in North Carolina. A new report by the Kaiser Commission on Medicaid and the Uninsured attributes rural hospital closings to a broad range of factors. They include, but aren’t limited to, corporate decisions on profitability, lack of community expertise in dealing with large health-care organizations, changes in federal reimbursement policies, and some states’ decision not to expand Medicaid. The authors interviewed dozens of people involved with the closure of three rural hospitals. Those interviewed cited a shift from ‘mission’ – a focus on care – to ‘margin’ – a focus on the bottom line – as a major factor in the hospital closures. They also cited a lack of consideration or planning for the impact on the community, according to the study’s authors.” Thomas Goldsmith, “Kaiser Study: Rural Hospitals Close for Many Reasons,” North Carolina Health News.
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!
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.
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.