Uninsured

Hospital Charges Surge for Common Ailments, Data Shows

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This excellent NY Times article is based on Medicare data on over 3,000 hospitals nationwide for what they charged in 2012. The data shows that the prices that hospitals charge is highly variable and has risen across the board. The article correctly points out that these increases in charges do not necessarily affect what Medicare pays because Medicare is so large that they tell hospitals what they are going to pay them independent of what they bill.

By JULIE CRESWELL, SHERI FINK and SARAH COHEN –  JUNE 2, 2014

Charges for some of the most common inpatient procedures surged at hospitals across the country in 2012 from a year earlier, some at more than four times the national rate of inflation, according to data released by Medicare officials on Monday.

While it has long been known that hospitals bill Medicare widely varying amounts — sometimes many multiples of what Medicare typically reimburses — for the same procedure, an analysis of the data by The New York Times shows how much the price of some procedures rose in just one year’s time.

Experts in the health care world differ over the meaning of hospital charges.

While hospitals say they are unimportant — Medicare beneficiaries and those covered by commercial insurance pay significantly less through negotiated payments for treatments — others say the list prices are meaningful to the uninsured, to private insurers that have to negotiate reimbursements with hospitals or to consumers with high-deductible plans.

“You’re seeing a lot more benefit packages out there with co-insurance amounts that require the holders to pay 20 percent of a lab test or 20 percent of an X-ray. Well, 20 percent of which price?” asked Glenn Melnick, a professor who holds a Blue Cross of California endowed chair at the University of Southern California. “Some hospitals will charge 20 percent of what Blue Cross Blue Shield will pay; others will play games.”
Data released by the federal government shows that hospitals across the country charge Medicare differing amounts for the same types of cases. The data includes bills submitted in 2012 by 3,300 hospitals nationwide for the 100 most commonly performed treatments and procedures like hip replacement, heart operations and gallbladder removal, among hospitals that reported at least 11 cases.

Charges for chest pain, for instance, rose 10 percent to an average of $18,505 in 2012, from $16,815 in 2011. Average hospital charges for digestive disorders climbed 8.5 percent to nearly $22,000, from $20,278 in 2011.

In 2012, hospitals charged more for every one of 98 common ailments that could be compared to the previous year. For all but seven, the increase in charges exceeded the nation’s 2 percent inflation rate for that year, according to The Times’s analysis.

Experts say the increase in the price of some of the most common procedures may be offsetting rising technology or drug costs, declines in the number of patients being admitted to hospitals and a leveling out of reimbursements from Medicare. Between 2011 and 2012, Medicare increased payment rates by only 1 percent for most inpatient stays.

The number of patients admitted for chest pain under Medicare’s fee-for-service plans plummeted more than 28,000, to 107,224 in 2012, and inpatients with digestive disorders decreased more than 29,000, to 217,514.

Over all, the number of Medicare patients discharged from hospitals for the comparable 98 most common diagnoses dropped from 7.5 million to 7.2 million. The total amount Medicare paid for their care also declined somewhat between 2011 and 2012, from $62.8 billion to $61.9 billion.
In an effort to reduce overall health care costs, hospitals have been encouraged to admit fewer patients for conditions like asthma, for example, in favor of less expensive outpatient care.

(more…)

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Americans don’t know what’s in Obamacare, do know they don’t like it

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By Sarah Kliff, Washington Post

Fifty percent of Americans now say they oppose the Affordable Care Act. This is the highest number that Kaiser Family Foundation’s poll has seen since October 2011, when Republicans were in the midst of a primary cycle and lots of anti-Obamacare rhetoric was in the air. The easiest explanation for the recent upswing in negative sentiment would be that lots of Americans tried, but failed, to buy insurance through HealthCare.gov. They ran into technical barriers that plagued the site in October and November. But Kaiser’s data don’t really bear out that thesis. There’s actually only been a tiny uptick in the number of Americans who say the health-care law has affected their lives over the past three months. A full 59 percent of Americans still report no personal experience with the law. 

Most Americans don’t know that Obamacare has, at this point, pretty much fully taken effect. When surveyed in January, after the insurance expansion began, 18 percent said they thought “all” or “most” provisions of the Affordable Care Act had been put into place.

There’s lots of confusion, too, about what policies are and aren’t part of the health-care law. Most Americans know there’s a mandate to purchase health insurance. A lot fewer are aware that the law provides financial help for low- to middle-income Americans (the tax subsidies) or gives states the option of expanding Medicaid.

For many Americans – particularly the 68 percent who get coverage through their work, Medicare and Medicaid — the launch of the exchanges probably doesn’t affect their coverage situation. They’ll continue getting insurance in 2014 just the same way they did in 2013. For them, an expansion of Medicaid or an end to the denial of coverage for people with pre-existing conditions isn’t a big change (unless, of course, they lose their current coverage).

So what’s driving the negative opinions of Obamacare? The Kaiser survey does point to one potential culprit: negative news coverage. More Americans say they’ve seen stories about people having bad experiences with the Affordable Care Act than good ones.

Politico’s David Nather had a great line on this recently, in a story about the very high bar for success stories about the Affordable Care Act.

“Here’s the challenge the White House faces in telling Obamacare success stories: Try to picture a headline that says, ‘Obamacare does what it’s supposed to do,’ ” Nather writes. “Somehow, the Obama administration and its allies will have to convince news outlets to run those kinds of stories — and to give the happy newly insured the same kind of attention as the outraged complainers whose health plans were canceled because of the law.”

We don’t have a great sense yet of what type of experience Obamacare’s new enrollees are having — whether they’re disproportionately bad or if the bad stories are just more interesting to cover. But the more negative news coverage does seem to have played some role in the recent uptick in negative opinions about the new law.

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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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Too Little on What Controls Costs

J Roberts

Robert Reich’s comment stating the President’s speech should have been clearer about how his plan will contain future costs was right on the mark. See his blog posting below.

More than a week after the Presidential speech to Congress there still has not been any indication or revelation on how the administration intends to reign in the high cost of care that continues to grow at an unacceptable level.  While President Obama wasted no time bashing insurance companies for their unjust practice of dropping coverage for preexisting conditions or other catastrophic illnesses, he failed to touch upon or address the crux of healthcare reform: containing cost.

At no point was there mention concerning the myriad of components that contribute to the rise in health care costs such as physicians, hospitals, pharmaceutical companies and other entities all entrenched in our current health care system. It is true that insurance bureaucracies contribute to the rise in health care costs, they themselves are not the lone culprit. The fact is, there are so many moving parts to this byzantine system, all of which contribute to rise in costs. This is a fact that can’t be ignored by the Administration, Congress or anyone wanting to promote real change to the system. Without controlling the increasing rise in costs, any plan is doomed for failure.

Robert Reich, a professor at the Goldman School of Public Policy at the University of California at Berkeley, was secretary of labor in the Clinton administration. He is the author, most recently, of “Supercapitalism,” and he blogs at Robert Reich’s Blog.

The president’s rebuttal of the fear-mongers was strong and he made a compelling case for preventing insurers from denying coverage because of pre-existing conditions or dropping coverage because of a serious illness and for requiring all Americans to have health insurance. He clarified his goal of full coverage and his support for a public insurance option.

He should have been clearer about how he intends to pay for the coverage of Americans who can’t otherwise afford it.

But I thought he should have been clearer about how he intends to pay for the coverage of Americans who can’t otherwise afford it, and how he’ll contain future costs. A commission to look at health outcomes is a fine idea but how are its findings to be used and enforced?

Taxing high-cost insurance plans is worthwhile but won’t raise much money or dramatically reduce future costs. An optional public insurance plan that’s open to all would put competitive pressure on private plans to reduce costs while also pressuring drug companies and providers to do the same, but his version of a public option would be available only to a relatively small number of Americans who lack employer-provided care.

The proposed health care exchange could generate real savings if the federal government acts as gatekeeper and limits access only to private insurers that offer low prices and high quality, but he didn’t explain the government’s role.

Still, he recaptured the initiative on health care and provided some cover for conservative and Blue Dog Democrats who need it in order to vote for the plan — which, I assume, were his most immediate political goals.

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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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In California, Pricey Insurance Plans Get Pricier

J Roberts

Buyer beware! Americans are feeling the squeeze of rising health care costs including insurance. It’s no news that the number of uninsured continues to rise as health insurance becomes unaffordable. The below article depicts two California Health Plans that excessively overcharged premiums to those subscribers who were the sickest and likely the most in need of coverage.

Health Blog – Wall Street Journal Blogs

Two California health insurers have been overcharging patients for a special type of coverage for people with pre-existing health problems, the Los Angeles Times reports .

The federal law known as HIPAA, often cited in the health-care industry for its health-privacy provisions , also helps sick patients get health coverage. When somebody loses a job, for instance, they first get Cobra coverage. When that expires, if they’re too sick to get insurance on the open market, they can continue with so-called HIPAA-plans.

But, as you might imagine, with pools of sick patients, the plans are often enormously expensive. This explainer we wrote a while back showed HIPAA premiums for one individual were around $1,000 a month, compared with at most $400 a month for non-HIPAA plans.

California in 2001 passed a law that attempted to control the plans costs by capping them at the “average premium paid” in the state’s high-risk pool, another option for sick patients, but Blue Shield of California’s rates are as much as 55% higher, and Anthem Blue Cross’s have been as much as 36% higher, LAT reports.

Here are two examples the newspaper cites: Blue Shield’s monthly premium for a family of four in Los Angeles with a 40-year-old primary policyholder is $1,461. That’s $401 a month, or $4,812 a year, above the cap. Anthem’s 2009 monthly premium for the same family was $1,356 — $296 a month, or $3,552 a year, above the cap.

After hearing from the paper, Anthem reviewed and found overcharges for enrollees age 60 to 64 since 2006. The company, which is owned by WellPoint, said it would reimburse policyholders for overpayments, with interest. Blue Shield denied that its rates were incorrect and added that it lost about $7 million in its HIPAA coverage last year.

The Times said Aetna and Health Net priced their plans according to state law.

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