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U.S. health system: Built by the haves, disadvantaging the have-nots

Posted by on August 7, 2016
Published on Flickr by 401(K) 2012, via Wylio

Published on Flickr by 401(K) 2012, via Wylio

Summary: Well-to-do and wealthy people think differently about health care pricing than people of more modest means. This may seem obvious, but it’s a big problem: if the system is built by the haves and services the have-nots, and also takes advantage of them, then big issues will inevitably arise. For an example of this in recent history, look no further than the financial crisis, where the banking industry treated the entire nation as its personal piggy bank.


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Pa. hospitals lag in charity care for the poor: Pittsburgh Post-Gazette

Posted by on August 4, 2016

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.

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What journalists should know about ratings: Health journo blog

Posted by on July 30, 2016

Summary: “Journalists should take hospital ratings with a healthy dose of skepticism, according to experts at a recent AHCJ New York chapter event,” Liz Seegert writes on the blog of the Association of Health Care Journalists, examining the pluses and minuses of different ratings in the context of the overall discussion about ratings systems. “Simply looking at an institution’s overall rating is just the start. Reporting that without understanding what’s being rated and how ‘success’ is measured does a disservice to your audience. Ratings are far from perfect and are ever evolving. That leaves journalists in kind of a quandary, noted chapter president Trudy Lieberman. ‘What do we do about the ratings, how do we judge them, how do we use them in our stories and which ones should we use?’ Moderator Charles Ornstein, senior reporter at ProPublica, said he views hospital ratings like new chocolate studies. There’s never a long stretch between studies, and journalists never really know what to do with them. ‘You don’t want to confuse people, but you feel like you need to report on something.'” Liz Seegert, “What journalists should know about hospital ratings,” Association of Health Care Journalists.

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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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Hospitals Close for Many Reasons: North Carolina Health News

Posted by on July 27, 2016

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.

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

Posted by on July 21, 2016

ambulance

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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