[…] I can see how awareness is a good thing if it encourages people (men and women) to be in tune with their health and current on the screening exams that they and their doctor feel they need. And it’s a reminder to all of us to do whatever we can to provide support to those who have cancer. But what about the people who know that their cancer is terminal? What about those with metastatic breast cancer? Or with another form of advanced cancer like my friend? The people who know that there is almost no chance they will beat the disease, and that their life will almost certainly be cut short by it? Do all the pink ribbons trivialize their deaths? […]
[…] David also points out that the amounts allowed by his Blue Cross Blue Shield carrier don’t seem to have anything to do with the amounts billed by his physical therapies – the lowest allowed amount on his EOB was for the service that was billed with the highest price tag. We’ve also seen little rhyme or reason (that we can detect, anyway) in terms of how billed amounts and allowed amount correlate. […]
[…] The healthcare providers make recommendations, order tests, perform surgeries… and in general, the patient does what the doctor recommends. And really, isn’t that the way it probably ought to be? Most of us have not been to medical school. When something seems amiss with our health, we need to feel that we can rely on our doctors to tell us the best course of action. Increased cost-sharing tends to increase the number of people who skip healthcare in general – including very necessary care like keeping diabetes and blood pressure under control.
[…] Denying arbitrary “non-emergent” ED claims for Medicaid patients doesn’t seem like a way to actually reduce ED overutilization. Instead, it seems like a way to cut Medicaid costs by increasing the number of unpaid claims that EDs have to write off each year. In order to cover their costs, hospitals will have to further increase prices for privately insured patients. That in turn causes health insurance premium hikes, which leads to calls for negotiations to artificially lower premiums. Where does it end?
[…] She specifically addresses Medicare costs, but it stands to reason that the same cost-saving strategies and paradigm shifts will also help to lower healthcare costs that are being reimbursed by private health insurance carriers. Not only do private carriers tend to follow Medicare’s lead, but the focus on value over volume from a provider perspective will benefit everyone, as it’s unlikely to be applied only to Medicare patients.
[…] How would it help to have health insurance exchange boards negotiating with health insurance carriers to try to lower premiums – without addressing the root problem, which is the ever-increasing cost of healthcare? […] Much of the focus of the healthcare reform rhetoric has been on health insurance (availability, premiums, etc.), and some important issues have been addressed in the process. But we cannot continue to focus primarily on the cost of health insurance (or try to artificially lower it) without reducing the cost of healthcare.
[…] Insuring the entire population isn’t going to solve all of our healthcare woes. For starters, even with health insurance, healthcare can still be unaffordable. And even if we were to make health insurance more comprehensive than it is now, with lower out-of-pocket costs (not likely, as the trend over the last decade has been towards higher out-of-pocket costs in order to keep premiums from increasing even faster than they already do), there would still be more than one in five people without realistic access to care – for reasons that aren’t directly related to paying for care. […]
[…] Those are a few of the thoughts that come to mind when I think about direct-pay medical care. I can see pros and cons to the idea, and I’m sure that there are many PCPs who would love the chance to focus more on medicine and less on administration/payer issues. But I think that most PCPs also want to make sure that everyone – regardless of financial status – has realistic access to medical care. And I’m just not sure that would be the case if more PCPs started pulling out of the health insurance networks – especially the networks that serve low income populations.
[…] The Dartmouth study results might seem counter-intuitive, since we often assume that as long as people are getting regular care by a PCP, they will be more able to avoid expensive hospitalizations. That appears to be true, but the lower cost office visits and outpatient treatments add up faster than one might expect, and would actually exceed the cost of the hospitalizations that they would prevent. […]
[…] He tackles the question of whether Medicare beneficiaries have to wait longer than privately insured patients for a routine appointment, and finds that they do not. In fact, it appears that the opposite is true, with more privately insured patients reporting that they had to wait longer than they wanted to get an appointment (although most insureds, regardless of whether they had Medicare or private health insurance, were able to get appointments within the time frame they wanted).[…]
[…] If the goal of CMS is to reduce the number of “never events” – but not to discourage doctors from treating high-risk patients who may be more likely to suffer complications – it would seem to make more sense to evaluate reimbursement for “never events” on a case-by-case basis. Zero-tolerance policies rarely make sense when you consider all of the possible scenarios, and the “never events” list basically amounts to a zero-tolerance policy.
As of April 1, 2011, CoverColorado will be switching to a new fee schedule for reimbursing providers. In the past, CoverColorado has used the Rocky Mountain Health Plans provider network, and doctors were paid according to the RMHP network-negotiated rates when they treated CoverColorado members. The new CoverColorado-specific fee schedule applies to any provider who treats a CoverColorado member, regardless of whether that provider is part of the RMHP network or not. […]
[…] Over the last several years, most of the major health insurance carriers in Colorado have increased the out of pocket portion that an insured has to pay for prescriptions. Most individual policies now have prescription deductibles, and a lot of carriers have designated very expensive drugs as a separate tier that requires a percentage copay from the insured, rather than a flat amount. And of course, premiums continue to climb. The Makena story is an example of why this happens, and it has nothing to do with health insurance carrier profits. When insureds see their health insurance premiums skyrocket again, where do you think they will point their finger?
Tort reform has long been a contentious topic in the healthcare reform debate. Many Republican lawmakers – on both a state and federal level – have proposed tort reform as one of the major platforms of their alternative healthcare reform proposals. It’s the sort of issue that people tend to see as black and white, but is really many shades of grey. […]
[…] We seem to be caught up in a wave of screening test excitement lately, with new advanced testing available for every disease under the sun. Rather than focusing on things that can truly prevent health problems (the old, and decidedly low-tech diet and exercise ideas…), we are fixated on developing newer and better screening tests. This exacerbates the problem of over-consumption of health care and rising health care costs.
[…] But like any big project, nobody said this will be an easy transition. The government has created an incentive program to help providers with the financial aspect of transitioning from paper records to EHR, but of course there are hoops to jump through. It’s not as simple as just setting up the first EHR system you come across and then getting money from the government to help pay for it. In order to qualify for the incentive program, EHR systems must meet meaningful use criteria as laid out by the Centers for Medicare and Medicaid Services last year. […]
[…] We cannot continue to tackle the health care mess by focusing on health insurance reform. That has been a large part of the focus of debate over the last couple years, mainly because health insurance is the point at which most people interact with the financial aspects of their health care. But health care costs are what drive health insurance premiums, and there’s no getting around that. It’s refreshing to hear the President of the Colorado Medical Society talking about the need for evidence-based medicine and a general scaling back of what we spend on health care. […]
[…] But is having to wait to see a specialist for a non-emergency situation really that much of a drawback, when we consider that this sort of “rationing” might be what we need to bring our healthcare costs down to a reasonable level (and thus make healthcare more available to more Americans)? Maybe we don’t need MRI machines to be as conveniently-located as ATMs… Our current costs (and the rate at which they are increasing) aren’t really sustainable long-term, and the Healthcare Technology News article is a good reminder of how we stack up against the rest of the world.
[…] But Amy’s story is particularly important when we look at end-of-life scenarios, where doctors and hospitals will often take the approach of sustaining life at all costs, simply because it’s what we’re used to. I’m not advocating the rationing of health care in people who are terminally ill; patients should be given choices regardless of their prognosis. But honest discussions about end-of-life care and a genuine focus on quality of life might help to not only make life better for patients facing terminal illnesses, they could also result in lower health care costs.
Accountable Care Organizations (ACOs) have received a lot of buzz lately as the nation grapples with ways to reign in health care costs. But I think that there’s still a lot of confusion about how they would work. A couple of very informative posts on the topic were included in this week’s Grand Rounds, and I wanted to share them with our readers. […]
[…] I found this article by Dr. Lucy Hornstein to be particularly interesting. Dr. Hornstein takes the view that preventive care does not save money in the long run, and wonders if the provision in the PPACA to provide preventive care to everyone – with no copays or deductibles – is a wise idea. The discussion is made even more interesting with a comment from Maggie Mahar (who was referenced in the article) noting that some preventive care is more worthwhile than others. […]
[…] While these changes might not have been warmly welcomed, they will ultimately help to make the system sustainable in the long term. The same could be said for the rest of the health care industry if similar cuts are implemented in other areas. Although the physician reimbursement cuts are unpopular with most doctors, they may be the only way to keep Medicare as a viable payer for seniors’ health care needs. And ultimately, it’s in the best interest of both doctors and seniors to keep Medicare around.
[…] Time will tell, but it seems that as long as doctors, hospitals, medical device makers, and pharmaceutical companies are exempt from any rules concerning profits and administrative costs, the MLR rules might not have much long term impact on the actual cost of health insurance. Premiums will keep rising (at a pace similar to what we’ve seen over the last several years) as long as the cost of healthcare continues to climb at the same rate it has for the last decade or so.
[…] While many studies comparing health care around the world tend to look at generalized data like life expectancies and total cost of healthcare, this one was more focused on how healthcare in each country impacts individual people, and whether people are satisfied with their health insurance, personal medical costs, and access to care. […]
[…] Are we comfortable with allowing emergency services providers to turn away patients who are uninsured and cannot pay upfront for their care? If we are not, then the rest of us are paying for their care (indirectly, through higher health insurance premiums). And if we are, we find ourselves right back in the debate about whether it’s ok for firefighters to watch a house burn to the ground because the homeowner didn’t pay his fire protection fee. It seems that we all like having choices until we make the wrong choice one day.