Cost Shifting

Study says US cancer costs almost double in 20 years – but not because of pricey treatments

J Roberts

Here’s some news that’s probably not too surprising: Cancer costs have doubled over the past twenty years. As with any serious disease, usually the drugs and the various treatment associated with fighting the disease are expensive; however in this study researchers conclude that rising cost were the direct result of the increased number of cancer patients.

ATLANTA (AP) —

The cost of treating cancer in the United States nearly doubled over the past two decades, but expensive cancer drugs may not be the main reason why, according to a surprising new study.

The study confounds conventional wisdom in several respects. The soaring price of new cancer treatments has received widespread attention, but the researchers conclude that rising costs were mainly driven by the growing number of cancer patients.

The study also finds cancer accounts for only 5 percent of total U.S. medical costs, and that has not changed in the last few decades.

“I will say I’m a bit surprised,” said Dr. Len Lichtenfeld of the American Cancer Society, who said he would have expected the proportion of cancer costs to rise.


The researchers also found that private insurers now cover a greater share of cancer treatment costs — about 50 percent — while patients’ out-of-pocket costs have fallen over the past two decades.

Though taken aback by some of the findings, Lichtenfeld and other experts did not dispute the study, which compared medical cost data from the late 1980s to that of the early 2000s. But they said the picture surely has changed in the last several years.

The study is being called the first to combine national cancer costs for all types of payers and see how they’ve changed over time. The figures are reported in 2007 dollars.

It found that cancer treatment costs rose from nearly $25 billion in 1987 to more than $48 billion by the end of 2005.

The rise in costs is mainly due to an increase over 20 years in how many cancer patients there are, said the study’s lead author, Florence Tangka of the U.S. Centers for Disease Control and Prevention.

The researchers used data from national telephone surveys done in 1987 and from 2001 through 2005, which gathered information on medical conditions as well as who paid the bills. More than 164,000 people were surveyed.

The study did not offer precise estimates of how the number of people treated for cancer changed from the late 1980s to the early 2000s. But it showed dramatic increases in the number of cancer cases covered by the government’s Medicare and Medicaid programs. Medicare, which covers the elderly and disabled, has consistently covered about a third of the nation’s cancer costs. Medicaid accounts for only 3 percent.

The U.S. population is aging, and older people tend to get cancer at higher rates, Tangka noted.

Better and more advanced treatments mean more people with cancer are remaining alive, so the spending increases represent money well spent, said Kenneth Thorpe, a health policy researcher at Emory University who has focused on the cost of health care.

“It seems like we’re buying increases in survival,” Thorpe said.

The study is being published in Cancer, a medical journal of the American Cancer Society.

The researchers also found:

—The percentage of cancer costs from inpatient hospital care fell from 64 percent to about 27 percent. A shift to less expensive outpatient care, along with cost containment efforts by large health insurers, helped keep down increases in the costs per patient, the authors said.

—The proportion of cancer costs paid by private insurance rose from 42 to 50 percent.

—The proportion of costs paid out of pocket by patients — including copayments and deductibles — dropped from 17 percent to 8 percent.

Those last two findings surprised some experts.

Recent government reports have found that the percentage of Americans with private health insurance has been shrinking and recently hit its lowest mark in 50 years. Yet the study found that the proportion of cancer treatment costs paid by private insurance rose.

And companies have been tightening or cutting employee benefits, causing out-of-pocket costs to go up for many patients. Yet the study found that the proportion of bills paid by patients declined.

That last finding in particular was striking, said Lichtenfeld, the cancer society’s deputy chief medical officer.

He alluded to widely reported increases in personal bankruptcies prompted by medical bills. “There’s no question that the out-of-pocket costs for some patients have risen dramatically,” Lichtenfeld said.


The rising price of certain treatments also should be acknowledged, he said.

The challenge of rising prices was recognized by American Society of Clinical Oncology (ASCO), which last year released its first guidelines counseling cancer doctors on how to talk to patients about deciding between less expensive chemotherapy drugs made more sense than newer, more expensive products.

The study did not add in the cost of diagnostic tests and scans, which are cost drivers. And the data does not include the last five years, which saw some extremely pricey cancer drugs come on the market.

The picture may have changed since the study’s data was collected and the U.S. economy deteriorated, said Dr. Neal Meropol, a Case Western Reserve University cancer expert who worked on the ASCO guidelines.

Newer treatments along with wider testing are driving up the overall cost of cancer care, Meropol said.

“My concern is that costs are getting shifted to patients and there is a potential for increasing disparities” in cancer care, he added.

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Family Practitioner’s Say Recession Taking a Big Toll on Patients

J Roberts

Healthcare Financial Management Association On-line News

Even physicians are worried about the current recession and the impact it is having on patients ability to pay for healthcare. The below article details the outcomes of a recent survey by the American Academy of Family Physicians over this very issue. To read the survey go to the American Academy of Family Physicians at www.aafp.org and click on the News and Publication section.

Nearly 90 percent of family physicians say that their patients are worried about being able to pay for their health care, according to a new survey of 505 physicians by the American Academy of Family Physicians. Fifty-eight percent of respondents said appointment cancellations have increased and 54 percent reported seeing fewer total patients. But 73 percent said they had seen an increase in uninsured patients visiting their offices and 64 percent reported a decrease in the number of insured patients. In addition, 60 percent said that their patients are forgoing preventive care, which has led to health problems. And nearly 90 percent of respondents have noted a significant increase in patients with major stress symptoms since the beginning of the recession. Two-thirds of the family physicians who responded said they were taking specific actions, such as discounting their fees, increasing charity care, providing free screenings, and moving patients to generic prescriptions, to help their patients manage health care.

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Tallying the Cost to Bring Baby Home

Doug

Another informative article from the Wall Street Journal about the lack of pricing transparency and how difficult it is for consumers to get an estimate of charges, understand the cost, and their portion of the payment.

By ANNA WILDE MATHEWS

Bringing my newborn son home was a joy. Figuring out the hospital bill wasn’t.

Cedars-Sinai Medical Center in Los Angeles provided excellent care and thoughtful treatment during my uncomplicated traditional delivery in December. Then the invoices started coming. The hospital sent one for me, and another for my baby. The doctors billed separately. The total charge for three days: $36,625.

People lucky enough to have good health insurance, including me, don’t have to come up with such sums. Insurers typically pay a lower, negotiated price for hospital care, and patients pay a portion of that amount. Even people without insurance often get sharp discounts from list prices on their hospital bills.

Still, consumers have a big financial stake in the cost of care. People who get health insurance through their workplaces have been paying higher premiums in recent years, and more people have been enrolling in plans that include very high deductibles. A recent survey by the International Foundation of Employee Benefit Plans found that two-thirds of employers are increasing, or considering an increase in, workers’ deductibles, co-insurance and co-payments.

It’s important for patients to get good information about what they have to pay and why. That’s not easy. Before my son was born, it was difficult to figure out what I was going to owe. And I struggled after the birth to learn whether the amounts I was told to pay were appropriate. I could have done a better job at calculating some of my costs. But often, information wasn’t available, or was hard to decipher.

My own health plan is a so-called PPO, or preferred-provider organization, which means I pay less when I use doctors and hospitals that have contracts with Aetna Inc., the insurer that administers my employer’s coverage. For hospital and surgery services from these providers, I am on the hook for 15% of Aetna’s negotiated price. I also have a $400 annual deductible. Fortunately, there is a $2,000 cap on how much I might have to spend out of pocket each year for my in-network care.

From the Wallet

    Having a Baby? How to Prepare for the Hospital Bill

My research started before my due date, with a call to Aetna. I asked the customer-service representative how much the birth would cost me, and she didn’t answer the question directly. She did confirm that Cedars-Sinai was in my network. Aetna’s Web site offered typical maternity costs for other Los Angeles-area hospitals, but there was no such listing for Cedars-Sinai.

The Aetna representative did say that I had $1,370 remaining before I reached my out-of-pocket maximum for the year. So I decided to set aside $1,370 toward maternity costs, and hoped that I’d have some of that left over for a crib.

It didn’t turn out that way. In fact, I owed a total of $2,118.90, a sum I arrived at only after adding figures from five separate documents. Why the difference? Along with dark hair and blue eyes, my son was born with his own $400 deductible. Also, the maximum annual out-of-pocket charge for the two of us was $4,000, double what mine alone had been. I should have re-read the fine print of my plan.

Before paying the bills, I wanted to double check them to make sure I’d actually received the services I was billed for. At my request, Cedars-Sinai sent itemized invoices, with 14 items listed for my baby and 34 items for me, not including doctors’ fees.

Those charges I could decipher seemed stunningly high. A “Tray, Anes Epidural” cost $530.29. (After inquiring, I learned this was the tray of sterile equipment used to give me an epidural anesthetic injection.) An “Anes-cat 1-basic Outlying Area” was billed at $2,152.55. (I was told this was the cost of the hospital’s resources related to the epidural.) These items were in addition to the separate anesthesiologist’s charge of $1,530 for giving the epidural. Even though the pain-killing epidural shot felt priceless during my 20 hours of labor, I was amazed that its total cost could run so high.

To decipher other items, I decided to check out consumer services that advise people about medical bills. Candy Butcher, chief executive of Medical Billing Advocates of America, wondered why the hospital listed a price of $2,382.92 for my recovery, when I hadn’t had a Caesarean section. It turned out the charge was for the 90 minutes I spent in the birthing room after my delivery. I recalled lying exhausted there while a kind nurse checked my vitals and cleaned me up. Important help, for sure, but was it really worth that much money?

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Recession Will Cause More Health Cost Shifting

J Roberts

> Workforce Management

According to the below article more employers are looking to shift the cost of care to their employees in 2009.

The recession likely will boost group health care costs higher than employers anticipated, leading more organizations to shift more costs to employees and adopt lower-cost consumer-driven health plans, according to a survey released Thursday, April 30.

Employers surveyed by benefit consultant Mercer of New York now expect . That compares with a 6 percent average increase employers predicted in a 2008 Mercer survey. , according to the survey. In fact, 15 percent of the 428 responding employers said medical plan utilization has been higher than expected.

Mercer consultants said . More employees, fearful of being laid off, want to get medical tests and have health care services completed while they still have employer-based coverage, said Beth Umland, Mercers director of research for health and benefits in New York.

With costs going up at a time when many employers can least afford it, many intend to shift more costs to employees next year.

For example, 47 percent of respondents said they are likely to increase the percentage of premium employees pay in 2010.

In addition, 22 percent of employers say they are likely to add consumer-driven health care planseither a CDHP linked to a health savings account or a health reimbursement arrangementin 2010. This will be a boon to CDHPs, said Linda Havlin, Mercers global leader for research and knowledge management in Chicago.

Increased employer interest in CDHPs during a recession is not surprising, given that this type of plan costs much less than other health care plans, according to Mercer.

In 2008, Mercer found that HSA-based CDHPs cost an average of $6,027 per employee, compared with an average of $7,815 per employee for more traditional preferred provider organization plans.

The survey also found that more employers were in favor of broad health care reform legislation that would require employers to offer a health care plan or pay a fee to help fund coverage for the uninsured, and a requirement that all individuals be covered in a health care plan.

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A Healthcare System Out of Balance

J Roberts

Why is the price of healthcare for the same procedure dramatically different from one hospital to the next? Why aren’t American’s aware of this? To find out more read the article from The Boston Globe about difference in pricing at Massachusetts Hospitals.

As his patient lies waiting in an adjacent exam room, Dr. James D. Alderman watches while an assistant reaches into a white envelope and pulls out a piece of paper that will determine where the man will be treated. Big money is on the line. of Massachusetts and Harvard Pilgrim Health Care. The gap is even more striking for many individual procedures, which can be two or three times more expensive in one hospital than in another.data shows, but now the escalating prices that hospitals and doctors charge is far more important. A recent Massachusetts study concludes that the price of inpatient care at hospitals is rising by 10 percent a year, while overall use of hospital beds is declining. obtained by the Spotlight Team. The health official who provided the information asked not to be identified for fear of professional retaliation. Though Partners’ rates are not the highest – that would be Children’s – Partners has more effect on statewide costs because its revenue is five times larger.’We were willing to take the risk of challenging payers,’ said Partners chief financial officer Peter Markell, adding that Partners should not have to apologize for a successful strategy. ‘If you are never willing to challenge them, of course they are going to jam it down your throat.’That willingness to get tough turned Partners’ main insurance contracts from money losers a decade ago to the company’s largest source of profit, Partners officials say. Extrapolating from Partners’ internal tally of its insurance revenues, the Brigham and Mass. General receive at least $500 million a year more from the three biggest insurers than if they were paid at the lower rates typical of their rivals. Likewise, Partners’ 6,000 physicians are paid 15 percent to 40 percent more than most other Massachusetts doctors, based on Blue Cross rates, while the company’s community hospitals earn at least 10 percent more than their peers., Tufts, and Harvard Pilgrim. officials discount Partners’ role, while Baker at Harvard Pilgrim says there is a meaningful but hard-to-measure ‘Partners effect’ on statewide insurance costs. And Partners officials themselves have said in the past that their goal was to ‘reset the prices’ paid to hospitals even if it drives up insurance premiums.rates obtained by the Globe.’Shouldn’t there be some correlation between what you get paid for doing something and the quality of what you do?’ asked Beth Israel chief executive Paul Levy last month in remarks at the Massachusetts Medical Society.; the two closely track. The Blue Cross data show that about 10 hospitals – four Boston teaching hospitals and six community hospitals – are paid at least 30 percent above the state average, while 12 hospitals make at least 20 percent below average, including Cambridge Hospital, which earns about half as much per procedure as the Brigham and Mass. General.

Alderman, an interventional cardiologist, plans to open the patient’s clogged coronary artery by inserting a flexible tube with a tiny balloon at the tip. Usually he does the procedure, called angioplasty, at MetroWest Medical Center in Framingham. But he sometimes operates in Boston as part of a research program. One time of every four, by the luck of the draw, Alderman and his patient go to a big teaching hospital in the city.

If the white slip of paper directs him to do the procedure in Framingham, the insurance company will pay the hospital about $17,000, not counting the physician’s fee. If Alderman is sent to Brigham and Women’s Hospital in Boston, that hospital will get about $24,500 – 44 percent more – even though the patient’s care will be the same in both places.’It’s the exact same doctor doing the procedure,’ said Andrei Soran, MetroWest’s chief executive. ‘But the cost? It’s unjustifiably higher.’Call it the best-kept secret in Massachusetts medicine: Health insurance companies pay a handful of hospitals far more for the same work even when there is no evidence that the higher-priced care produces healthier patients. In fact, sometimes the opposite is true: Massachusetts General Hospital, for example, earns 15 percent more than Beth Israel Deaconess Medical Center for treating heart-failure patients even though government figures show that Beth Israel has for years reported lower patient death rates.

Private insurance data obtained by the Globe’s Spotlight Team show that the Brigham, Mass. General, Children’s Hospital, and a few others are, on average, paid about 15 percent to 60 percent more than their rivals by insurance companies such as Blue Cross Blue Shield

This payment pattern has become a driving force in the state’s galloping healthcare costs, and it raises hard questions about why certain hospitals and physicians receive premium pay for care that is no better than that of their competitors. Until now, the growing pay gap has not been subject to public scrutiny because contracts between insurers and hospitals typically include confidentiality agreements.

But an ongoing Spotlight Team investigation of healthcare in this state found scores of payment disparities for routine procedures in which there is no obvious difference in quality. Consider:

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