Summary: It’s been busy over here at ClearHealthCosts. Here’s some news: We have been chosen for the beta of IFundWomen, a new crowdfunding platform for women-owned businesses. They liked our mission: revealing health care costs. Our ask: We’ll be raising moolah to make our home site mobile first, or easier to use on smartphones, iPads, etc. — as have Google, Apple and others, to better serve our community. We get about 60 percent of our visitors on mobile, so this is past due, and it will help us a lot!
Your Source for Finding Health Care Prices
Cash or self-pay prices and Medicare pay rates. Our metro areas: NYC, SF, LA, Philadelphia, Miami, Tampa-St. Petersburg, Dallas-Fort Worth, Houston, San Antonio, Austin. Others soon!
Summary: Not everyone who comes to our data uses it in the same way — some people are cheering us on and offering to help just because they think transparency is the right thing. Here are some voices from our Florida partners’ survey of their community members: ‘This will be a valuable tool & may serve to keep facilities on their toes re prices they charge. Or maybe not, current system so entrenched & Insur co drive the costs, too. *sigh*” … “I think this is a great idea and needs to happen. Please keep it going” … “I know nothing about health care, and almost never use it. So I don’t know what I could contribute. But I believe in what you guys are doing, so I’ll help where I can.” … “Keep growing the data base- could be a great resource” … “This is such important work. I hope you spread the word to other public radio stations so the information can go national.” Thanks to our community: We believe in you, too!
Summary: How do people use our information? We’re often asked who our visitors are and what they’re looking for. Sometimes a picture is worth a thousand words. We have a system of Web analytics that lets us see, in some cases, where you’re coming from, depending on your internet configuration. It will also let us see what you’re doing here — though of course it doesn’t give us your name, address and phone number. We wouldn’t want them anyway. So: How do people use our information? Here’s a snapshot in time, from a couple of hours on a Wednesday afternoon (New York time).
Summary: “In 2015, the U.S. Department of Health and Human Services announced a goal of linking at least 50% of Medicare spending to value-based payment models such as accountable care organizations,” Leemore S. Dafny, Christopher J. Ody and Matthew A. Schmitt write in the New England Journal of Medicine. “Health care providers are now scrambling to reorganize in a way that delivers value while preserving or enhancing commercial success. … Value-based plan design — a term that describes payers’ efforts to align consumer cost sharing with the value generated by a service or drug — may sound like a new development in health care, but it’s old news for prescription drugs. For years, insurers and pharmacy benefits managers have steered consumers toward generic and other high-value drugs by categorizing drugs into ‘tiers’ and requiring lower copayments for preferred drugs. By 2000, roughly three quarters of consumers enrolled in employer-sponsored health plans had prescription plans with two or more drug tiers. Today, a similar proportion have plans with at least three tiers. Tiering not only encourages consumers to use high-value drugs, it also gives insurers leverage during price negotiations with manufacturers.Under tiering, insurers offer manufacturers favorable tier placement in exchange for better discounts. … In recent years, drug manufacturers have counterattacked by offering ‘copayment coupons.’ These coupons or discount cards — distributed by physicians’ offices, through the mail, and online — enable the manufacturer to pay some or all of a consumer’s copayment for a prescription. By severing the link between cost sharing and the value generated by a drug, copayment coupons can undo the beneficial effects of tiering. With such coupons, consumers’ cost sharing may actually be lower for higher-tier brand-name drugs than for lower-tier therapeutic substitutes or generic bioequivalents. Since insurers typically cover about 80% of the total price of a prescription, however, the combined amount that the insurer and the consumer spend for higher-tier drugs remains substantially greater. If coupons shift spending toward these higher-priced drugs, the net effect will be higher pharmaceutical spending and, ultimately, higher health insurance premiums.” Leemore S. Dafny, Christopher J. Ody and Matthew A. Schmitt, “Undermining Value-Based Purchasing — Lessons from the Pharmaceutical Industry,” New England Journal of Medicine.
Summary: “The October 2016 issue of The Joint Commission Journal on Quality and Patient Safety, features the article ‘Consumer Rankings and Health Care: Toward Validation and Transparency,’ by Bala Hota, MD, MPH, and co-authors, Rush University Medical Center (RUMC), Chicago.” according to a press release on EurekAlert. “After RUMC received a lower than expected ranking for patient safety in the 2015-16 U.S. News & World Report’s (USNWR) ‘Best Hospitals’ rankings, the authors compared the data that USNWR used for their hospital to their own internal data. The authors found that the USNWR data showed many more patient safety events, such as pressure ulcers, almost all of which had actually been present at the patient’s admission. Suspecting a broader problem, Hota et al. analyzed data on a sample of hospitals and found that RUMC was not the only organization with discrepancies in data. False-positive event rates were common among high-transfer and high-volume hospitals. The authors conclude more transparency and validation is needed for consumer-based benchmarking methods. In response to these findings and concerns raised by others, USNWR made changes to its methodology and data sources in 2016. In an accompanying editorial, ‘The Quality Measurement Crisis: An Urgent Need for Methodological Standards and Transparency,’ David M. Shahian, MD, Elizabeth Mort, MD, MPH, and Peter J. Pronovost, MD, PhD, reflect on the Hota et al. article to conclude, ‘Just as health care providers have ethical and moral responsibilities to the public they serve, rating organizations and journalists that grade providers have similar obligations–in their case, to ensure measure validity and methodological transparency.’ RUMC further explored the importance of rating organization’s validity and methodological transparency in the following essay, ‘Hospital Rankings Have Room for Improvement.'” Study: Hospital rankings may rely on faulty data,” EurekAlert! Science News. In response, Ben Harder, head of the U.S. News and Word Report quality ranking efforts, posted a description of how “quality measurement is a journey,” which you can read here.
Summary: Following the money in prescription pricing is hard. Demystifying the topic is Julie Appleby at Kaiser Health News, with this graphic.
Summary: “It’s that time of year again. Insurance companies that participate in the Affordable Care Act’s state health exchanges are signaling that prices will rise dramatically this fall,” Christy Ford Chapin writes over at The Conversation, in a thorough, thoughtful examination of how our health care system came to be — including an explanation of the roads not taken. “And if insurance costs aren’t enough of a crisis, researchers are highlighting deficiencies in health care quality, such as unnecessary tests and procedures that cause patient harm, medical errors bred by disjointed or fragmented care and disparities in service distribution.
“While critics emphasize the A.C.A.’s shortcomings, cost and quality issues have long plagued the U.S. health care system. As my research demonstrates, we have these problems because insurance companies are at the center of the system, where they both finance and manage medical care.
“If this system is so flawed, how did we get stuck with it in the first place?
“Answer: organized physicians.
“As I explain in my book, ‘Ensuring America’s Health: The Public Creation of the Corporate Health Care System,’ from the 1930s through the 1960s, the American Medical Association, the foremost professional organization for physicians, played a leading role in implementing the insurance company model.” Christy Ford Chapin, “Why Insurance Companies Control Your Medical Care,” The Conversation.
Summary: “Public anger over the cost of drugs has burned hot for a year, coursing through social media, popping up on the presidential campaign, and erupting in a series of congressional hearings, including one last week over the rising price of the allergy treatment EpiPen,” writes Katie Thomas at The New York Times. “But one set of voices has been oddly muted — the nation’s biggest patient advocacy groups. The groups wield multimillion-dollar budgets and influence on Capitol Hill, but they have been largely absent in the public debate over pricing.To those who have closely followed the drug world, the reason is simple: Many of the groups receive millions of dollars a year in donations from companies behind the drugs used by their members. When they prod drug companies, it is generally for better — not less expensive — treatments.But critics say that by avoiding the debate over cost, they are failing in their patient-advocacy duties. ‘It is a conflict of interest, because the interests of the pharmaceutical industry, from whom they are getting support, may be different from the interests of the patients,’ said Dr. Michael Carome, the director of the Health Research Group at Public Citizen, a consumer advocacy group.” Katie Thomas, “Furor Over Drug Prices Puts Patient Advocacy Groups in Bind,” The New York Times.
Summary: Patients want to know what’s in their doctors’ records, and doctors need to tell them. While this is not common practice right now, it could be. Dr. Peter Elias, a family doctor in Maine and a fellow member of the Society for Participatory Medicine, made this mini-video telling how he does it.
Summary: Mediciaid covers 1 in 4 Americans, and 73 percent of them are covered by private Medicaid plans, according to a new report by Price Waterhouse Coopers. The report says: “The trend towards Private Medicaid Health Plans continues, but how much more growth remains? This analysis, the third annual on the State of Medicaid, offers an extensive view of the Medicaid market, including private Medicaid health plans, assesses the continuing impact of Medicaid expansion, and presents key considerations around the future growth potential of the Medicaid market, powered by the proprietary collection and analysis of state Medicaid data. In 2014, the full implementation of the Affordable Care Act powered growth in Medicaid, the government sponsored health coverage program for the low income and disabled. With over 9 million new beneficiaries, market observers questioned what year two post-ACA would bring – a tapering of the dramatic growth as coverage approached a natural ceiling or a continued upward trend as more states expanded and more Americans realized their eligibility? And, of importance for many market observers, would the unprecedented growth in private Medicaid health plans continue?” Ari Gottlieb, “The Still Expanding State of Medicaid in the United States”, PwC.