lower my healthcare costs

No Easy Answers on Financing Long – Term Care

Doug

By JUDITH GRAHAM, NY Times

This article points out the difficulty in financing long term care for the elderly.  Experts believe more focus should be on finding ways to provide affordable care within the efforts to reform Medicare and Medicaid.  For now, families continue to bear the brunt of the cost associated with caring for the elderly.

The federal Long-Term Care Commission published its full report on Wednesday, but it did little to change the perception that substantial relief for caregivers will be a long time coming.

The commission had endorsed a package of 28 recommendations late last week, prior to the release of the full report. Among other measures, the recommendations call for recognizing caregivers as members of “care teams,” including information about caregivers in patient records, assessing caregivers’ need for support, and making services like respite care more widely available.

But this group of 15 experts couldn’t agree on how to pay for long-term care services needed by frail older adults or people with disabilities. The full report doesn’t change that.

Currently, only those who are impoverished and qualify for Medicaid get significant assistance from the government for long-term care. For the most part, middle-class families are left to bear the burdensome expenses: $18 an hour on average for homemaker services, $19 an hour for home healthcare aids, $3,405 a month for assisted living, $230 a day for a private nursing home room, according to the latest report from Genworth Financial.

How to ease this financial burden was the most important issue facing the commission. In the end, the report proposed two alternatives: some kind of government insurance program for long-term care, or some kind of private insurance option. Then commission members essentially threw up their hands, admitting they couldn’t agree.

When my colleague Paula Span wrote about the commission earlier this year, she asked whether its work would elicit a yawn or a cheer. For many, the answer is neither. Even some commission members feel a sharp sense of frustration and disappointment.

One is Judy Feder, a professor of public policy at Georgetown University, who voted against the commission’s final recommendations on the grounds that they didn’t fulfill Congress’s charge to come up with a comprehensive solution. I asked her about a statement from six of her fellow commissioners insisting that any new long-term care program not enlarge public budgets.

“The current system has a budgetary implication,” Dr. Feder said. “It sticks it to families.”

Another disappointed member is Judith Stein, executive director of the Center for Medicare Advocacy. “The vision in the majority report is not much more than we have now,” she said. “It is, ‘Plan, understand, think about savings and insurance, and provide for those who are impoverished.’ That kind of approach doesn’t meet our long-term care needs now, and it won’t meet them in the future.”

While several of the commission’s recommendations are welcome, they will make a difference only “around the margins,” Ms. Stein said.
Families will bear the consequences, said Ms. Stein and other experts. Elderly spouses will continue to struggle to care for each other, and adult children will strain to balance jobs and the needs of frail parents and their own children. Untold numbers of aging Americans won’t get enough care, and caregivers will suffer from stress and depression, endangering their own health.

If a public insurance program is unaffordable, as several commission members claimed, might the private market supply a solution to the aging population’s need for affordable long-term care? That seems unlikely. Premiums for private long-term care insurance have been rising dramatically, policies are becoming more restrictive, insurers have been exiting the market, and bureaucratic red tape makes it difficult for many individual and families to receive expected benefits.

Financially, the only way to make private insurance work is to spread risk over a wide base of policy holders. But the cost of long-term care coverage makes it unlikely that millions of healthy people will purchase policies. This was the economic calculus that doomed the Class Act, the voluntary long-term care insurance program that was originally part of the Affordable Care Act.

Is there a way forward? The long-term care commission recommended two options: convening a White House conference on aging to consider long-term care policies, and establishing yet another advisory committee to continue its work. But, said Dr. Joanne Lynn, a geriatrician who directs the Center for Elder Care and Advanced Illness at the Altarum Institute, “The administration has shown no interest in having that happen, and here we are on the cusp of the largest generation in history growing old.”

She believes that it’s a mistake to separate long-term care from broader reforms of Medicare and the health care delivery system. The two systems of caring for people with disabilities and older adults need to be much more tightly integrated, Dr. Lynn said. Savings from eliminating inappropriate medical care — by some estimates, as much as one-third of all care — could be used to finance the expansion of long-term care services, she suggested.

As for another commission, is there any reason to hope it will be more successful in tackling critical issues when advocates of smaller government are committed to standing against a new federal insurance program for long-term care that might rely, at least in part, on public financing?

“I think this will be a hard discussion, but it is one that we as a country will have to grapple with,” said Dr. Bruce Chernof, the commission’s chairman and president of the SCAN Foundation in California. He sees the seeds of a potential compromise embedded in the commission’s report. The two primary financing options considered by the commission share “some commonalities,” he said, including agreement on the need for strong public programs and a role for the private sector.

“If you look carefully at these two perspectives, you can begin to see a way forward.”

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Three Ways to Slash Your Medical Bills

J Roberts

Medical Cost Advocate’s CEO Derek Fitteron was recently interviewed for Fox Business. Read the following BLOG post to learn more about reducing medical costs. Dont forget to negotiate your medical bills and save money. It’s worth the effort. In these difficult economic times, why pay list price when you may be able to save.

By: Donna Fuscaldo

FOXBusiness

Published July 10, 2012

Many things in life are negotiable, including medical bills.

“More and more billing offices, whether it’s a hospital or doctor’s office, are much more receptive to bargaining,” says Nancy Fase Guernon, director of operations at CareCounsel, an health advocacy firm. “There’s definitely ways to negotiate the bill.”

 According to a survey of Angie’s List members who asked for discounts from their doctors, 74% said they were successful. “We’ve heard some great success stories from members who have successfully negotiated with their health care provider,” says Angie Hicks, founder of the peer-review website. “It doesn’t hurt to ask. You’ll be amazed at what you can save and still get great care.”

 From making sure your bill is correct to negotiating ahead of a procedure there are ways to get as much as 40% off your medical bill. Here’s how:

Step One: Check the accuracy of the bill

Medical billing mistakes are common, so review the invoice carefully before submitting payment.  Experts say it’s common for a procedure to be coded wrong by the doctor’s office and lead to excess charges.

 Patients should review their health insurance plan to know what is and is not covered. “You want to make sure if it’s the insurance company’s responsibility to pay it, it’s paying what it should according to the plan,” says Fase Guernon.

 If you don’t have insurance or are going out of network and are paying out of pocket, Derek Fitteron, founder and CEO of Medical Cost Advocate, advises getting a full cost estimate of the procedure upfront to avoid any surprises at the end and you avoid getting overcharged.

 Fitteron also suggests asking for an itemized bill so you can review the charge for every procedure. “Sometimes there are mistakes and those mistakes might include bills for the wrong procedures or procedures that didn’t happen.”

 Step Two: Negotiate Up Front

Think of negotiating health care like shopping for a car. A dealership wants your business and will working with you—same idea applies to a doctor. For instance, many times doctors will reduce their price if you pay in cash or pay for the procedure ahead of time.

 According to Hicks, some hospitals and doctors will cut a health-care bill by as much as 50% if you pay in cash on the day of service. “We had a member from Washington D.C. who saved $9,000 on his mother’s in-home care by bargaining ahead of her treatment.”

 To negotiate ahead of time, experts say it pays to do your homework. Procedure prices vary be region, so know what know what is common in your area before negotiating. “Do the research so you are not throwing out numbers. That can be insulting,” says Fitteron.

 Step Three: Be honest about your financial situation

 If you get hit with a medical bill that you can’t afford, the best thing to do is call your doctor or hospital and honestly explain your financial situation. Often times the medical facility will be willing to reduce the bill as long as you agree to pay something.

 “If you ask the billing office for a discount and you are willing to pay something right then more times than not they will knock down the bill 30% to 40%,” says Fase Guernon.

 Some providers will set up interest-free payment plans. Hicks points to one member who saved $4,000 by talking to her doctor about her financial concerns. The member couldn’t afford the costs that weren’t covered by the insurer so the doctor agreed to collect just the insurance portion, she says.

 “Too many consumers aren’t aware of just how much power they have to negotiate their health-care costs. There are many great doctors, dentists and other health-care specialists out there who are willing and eager to work with their patients to provide them with high quality, affordable care,” says Hicks.

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NJ lawmakers seeking to control insurance costs

J Roberts

Looking for greater transparency on how insurers calculate and charge for premiums? The state of NJ is intending to provide just that. A recent measure adopted by the state legislature would require all insurers to gain approval by the state’s regulatory agency before they can raise premiums.

THE ASSOCIATED PRESS

TRENTON  — Health insurance carriers who serve individuals and small businesses in New Jersey may soon have to gain state approval before implementing rate increases.

These firms currently can set and increase rates just by filing the information with the state. But a measure planned by three state lawmakers would require that the firms gain approval for such actions from the state Department of Banking and Insurance.

It also would expand the jurisdiction of the state’s Division of Rate Counsel, which now has no say over health insurance rates, to create a watchdog for residents and small businesses.

“Residents deserve a watchdog, someone with the knowledge to advocate on their behalf when it comes to the complicated issue of rising health care premiums,” said Assemblyman Dan Benson, D-Hamilton Township (Mercer County), who said he will sponsor the measure with fellow Democrat Valerie Vainieri Huttle of Englewood.

Democratic Senate Majority Leader Barbara Buono plans to sponsor identical legislation, with both measures likely to be introduced by year’s end.

“This legislation will provide far greater transparency,” Benson said.

Ed Rogan, spokesman for the banking and insurance department, declined to comment on the proposal. As a matter of policy, the department does not discuss proposed or pending legislation.

Besides requiring the banking and insurance department commissioner to approve any rate increase, the proposed bill also would give the commissioner authority to reject proposed rate changes deemed discriminatory or excessive.

The commissioner and rate counsel would also have to jointly hold public hearings on any proposed premium increases for insurance contracts or policies in the Individual Health Coverage Program or New Jersey Small Employers Health Benefits Program market.

Information about premium increases, including an explanation of how carriers report and calculate health insurance premiums, also would have to be posted on the department’s website.

Currently, insurers in these plans are required to spend no more than 20 percent of the premiums paid on administrative expenses.

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Cut Costs by Reducing Redundant or Inefficient Activity

J Roberts

What’s the parallel between the world’s largest car manufacturer -Toyota – and the American Healthcare System?  Read on to learn how total quality management and improved operational efficiencies can reduce waste and decrease spending in our healthcare system.

By Mark Graban and Rob Harding August 09, 2011

Enlist your employees to help find and eliminate waste in your organization’s processes.

Many hospital CEOs, including John Toussaint, M.D., the former CEO of ThedaCare, and thought leaders, including Donald Berwick, M.D., M.P.P., administrator for the Centers for Medicare & Medicaid Services, estimate that 30 to 50 percent of all health care spending can be described as waste — activity that provides no benefit to patients. This adds up to more than $1 trillion a year in the United States. Instead of merely slashing reimbursements or providing less care, there is a clear opportunity to do more — and provide the right care — with less waste and less spending.

The word “waste,” or muda in Japanese, is one of the most commonly used terms in Lean management, which is based on the Toyota Production System. According to Toyota, there are eight types of waste, each of which can be translated directly into health care:

Lean’s Eight Types of Waste

Examples of Waste Found in Hospitals

Defects

Lost or mislabeled laboratory specimens

 

Overproduction

Medications sent to inpatient units in 24-hour batches, leading to wasted medications if orders

Change

Transportation

Moving patients a long distance from the operating room to recovery

Waiting

Patients waiting weeks for an appointment, or waiting hours to be seen in the emergency department, resulting in exacerbated conditions

Inventory

Expired supplies due to overstocking and poor rotation of inventory

Motion

Staff walking in excess because high-use surgical instruments and packs are not grouped together in perioperative services

Processing

Staff writing or entering the same patient information into multiple forms or software screens

Human potential

Nurses dragging bags of dirty linen down the hallway; staff members unengaged in improvement activities

In health care, Lean teaches us to engage all staff members in a never-ending search for waste, making quality and process improvements that benefit patients, leading to lower costs. Reducing waste is very different, in mindset and practice, from traditional cost cutting, as Lean waste reduction looks at how the actual work is performed rather than focusing on spreadsheets, budgets and financial benchmarks. Reducing errors, improving throughput, reducing staff frustration — all of these tactics reduce costs.

A Lean Perspective on Waste

Traditional organizations might see that 60 percent or 70 percent of their expense is direct labor cost. This realization often leads to the idea that the clearest path to cost reduction is to eliminate people (again, often based on benchmarks). Lean methodology takes a different view: Waste reduction cannot be used to drive layoffs, as that would put an end to staff engagement in the improvement process — a core Lean principle.

Leading health care organizations that actively employ Lean tactics, including ThedaCare, Denver Health and Avera McKennan, all have “no layoffs due to Lean” commitments with employees. Engaging people to reduce waste through process improvement has led to significant savings at these organizations — more than $54 million at Denver Health, for example — along with quality and access improvement, thanks to a culture of collaboration. (more…)

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Insurance mandates again hike costs

J Roberts

Recent government mandates in the state of Connecticut raise the cost of insurance for all. While the act aims to offer more comprehensive services, it may, in actuality prove as a disservice by raising the overall cost of insurance to the states residents.  Read on to learn more.

By Greg Bordonaro

While tax increases, paid sick leave and union concessions took up most of the attention during the recent legislative session, lawmakers passed a flurry of new health insurance mandates that will raise the cost health insurance for employers.

In all, seven new mandates — some of which business lobbyists have fought for years — passed the legislature and have been signed into law by Gov. Dannel P. Malloy.

A health insurance “mandate” is something for which an insurance company or health plan must offer coverage, and whose costs typically get passed onto employers.

Health mandates have been a hot political issue in Connecticut for years. The business community has long voiced opposition, citing costs. But supporters say cost concerns are overblown and that the benefits outweigh the price.

The divide illustrates a central issue in the broader health care debate. The question of how to control health care costs, while also mandating adequate coverage that prevents and treats illnesses effectively, has been difficult to answer.

New mandates passed this year:

• Expand coverage requirements for certain patient clinical trials, breast MRIs, colonoscopies and prostate cancer screenings;

• Increase the maximum annual coverage for ostomy-related supplies from $1,000 to $2,500;

• Require coverage for bone marrow testing;

• And place new restrictions on insurance companies that require the initial use of over-the-counter drugs for pain treatment.

“It is a fundamental truth that as you add benefits you increase costs,” said Keith Stover, a lobbyist for the state’s health insurance industry. “The math isn’t that complicated.”

According to a report by the Council for Affordable Health Insurance (CAHI), which is funded by the insurance industry, Connecticut had 59 mandates at the end of 2010, making it the fifth most demanding state.

While mandates make health insurance more comprehensive, they also make it more expensive, requiring insurers to pay for care patients previously funded out of their own pocket. Those expenses often get passed onto employers through higher premiums.

(more…)

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Employee wellness programs help companies deal with rising healthcare costs

J Roberts

One way corporate America is tackling the rise in healthcare costs is by offering an employee wellness program.  Many are offering incentives to employees in terms of gifts and rewards for employees who become actively engaged. The benefits are worth the investment as employers are encouraging employees to take an active role in maintaining their health.

KePRO Industry News

Many employers’ healthcare costs are soaring as a result of the high prevalence of chronic diseases. This is cutting into profit margins and making it difficult for companies to expand. In order to address the situation, many businesses are looking to employee wellness programs.

For example, a group of business leaders in Oregon and state health officials recently joined forces to form the initiative Wellness@Work, according to Oregon Business. The project provides companies with an online resource that they can use gauge their employees’ levels of wellness and consider new initiatives to improve well-being.

“We’re hoping businesses will bring together a committee of employees from all departments to make changes to their workplaces,” Dawn Robbins, the state’s worksite wellness coordinator, told the news source.

She added that despite fears over the cost of the initiatives, most businesses see a significant return on their investment in employee wellness. In fact, the Wellness Council of America estimates that most will experience a return of $3 for every $1 invested.

This could help businesses handle the dramatic rise in healthcare costs that are expected to occur this year and beyond.

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Consumer group says spending caps in national healthcare law will bring relief to people seeking medical care

J Roberts

There could be relief for out-of pocket costs under the Affordable Care Act (ACA). Under the act, out-of-pocket costs will be capped at a certain dollar amount.  Hopefully, this will protect consumers from increased debt and potential bankruptcies due to exorbitant medical bills.

Los Angeles Times

It’s a well-known complaint among consumers and healthcare advocates: The soaring cost of medical care is forcing millions of Americans to drain their savings, run up credit card bills, declare bankruptcy or lose their homes to foreclosure.

A report out Tuesday that examines the problem in California says the nation’s year-old healthcare law –- currently under assault by congressional Republicans — would help protect people in the Golden State from financial catastrophe.

In its study, the consumer group Families USA points out that the law would cap how much people with insurance must spend out of their pockets for healthcare services, starting in 2014.

If the law were to take effect this year, the group says, the caps would be $5,950 for an individual and $11,900 for a family of any size. Low-income people would pay less than higher earners.

More than 1.9 million Californians would exceed the spending caps if they were in place this year, the group reports. That extra spending would surpass the caps by more than $3 billion.

Once the new spending limits are in place in 2014, insurance companies will have to pick up the tab for essential  medical services -– including the costs for doctors, hospitals, prescription drugs and emergency care — after consumers pay their share.

“These new out-of-pocket caps will protect families from catastrophic medical costs when illness or [an] accident strikes,” the report states.

The spending caps will apply to health insurance plans sold through new insurance exchanges scheduled to open in 2014 in California and other states. The limits also will apply to new insurance plans sold to individuals and small businesses outside the exchanges.

In addition to the report on California, Families USA produced data for other states. To read the reports, go to http://www.familiesusa.org/resources/publications/reports/health-reform/out-of-pocket-caps-states.html.

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