Healthcare system costs continue to be in the centre of political debate, despite some irreconcilable differences over the Obama-era Affordable Care Act. The last news from the Capitol seemed to leave some hope for the near future, concerning at least some healthcare system related issues. Lawmakers in both chambers of Congress are working towards reaching a bipartisan agreement on lowering costs for people who are already insured.
According to CNN and the Associated Press, there has been shown a willingness to work together on a few health care issues that directly affect Americans.
After the Fourth of July recess, the Senate and House are making efforts to elaborate legislation that should put an end to surprise medical bills, restrain high drug prices, and set limits to prescription copays for people insured in Medicare.
A sign that things are going in the desired direction is the fact that the House recently voted in favor of making generic drugs more available for people, after bipartisan efforts in recent weeks concerning surprise billing and drug prices.
Previous efforts to prevent surprise medical bills
The stakes are high, since medical bills weigh heavily on American families: lowering prices and reducing unknown billing are of utmost importance. President Trump has spoken out since January against surprise medical bills that patients often cannot afford, calling upon administration officials HHS Secretary Alex Azar and Labor Secretary Alex Acosta to investigate how to prevent surprise medical bills.
Then, in March, a bipartisan Senate health care price transparency working group released draft legislation that it hopes will protect patients from surprise medical bills.
In a statement, the group of Senators said the draft bill was intended to jumpstart discussions in Congress about how to best stop the use of balanced billing to charge patients for emergency treatment or treatment provided by an out-of-network provider at an in-network facility.
Meanwhile, overbilling patients has not been without consequences for some companies. uBiome, for instance, suspended clinical operations în May, following an FBI investigation regarding their billing practices, following complaints from customers who allegedly have been billed multiple times for tests.
Where are we now with the new legislation?
More than three months later, we might be getting closer to a satisfactory form of the needed legislation. The Alexander-Murray discussion draft on surprise billing has elements of legislation presented to the House and Senate last week. The idea is basically one representatives have been working on for a while now, ensuring that patients who need out-of-network emergency care would only be responsible for their in-network costs. Even more important, any patient needing follow up services and further treatment would have to be informed beforehand if any of the medical care providers are not part of their insurance plan. Patients would then be able to make informed decisions about their care, and not be taken by surprise when the final bill is issued.
The draft legislation includes more options for paying the difference between what the patient pays, and what the provider bills. The provider will be paid the median in-network rate for the services rendered, and the insurer and provider can even have recourse to arbitration in case of need. The law would also impose a 30-day rule requirement for providers to send the bills, otherwise patients would not be required to pay them. Insurers would be obliged to keep their directories of in-network providers up-to-date.
The bipartisan legislation draft tackles the problem of overpriced generic drugs, by introducing “biosimilars”, less expensive versions of complex and high-priced biologic medications. The idea is to give people access to complete information concerning the whole range of drugs and their respective prices, impeding the ability of providers and insurers to make agreements such as banning gag clauses, to hide cost and quality information. Insurers and providers would be obliged to supply an estimated out-of-pocket cost for certain services, so patients can make truly educated decisions about the care they want or can afford to receive and pay for.
Medicare for All, a question of “whether” or “when”?
The legislation draft was presented only a day after the House Budget Committee hearing on establishing a single, government-run health insurance system in the US, such as Medicare for All.
Last month, experts from the Congressional Budget Office released a report, at the lawmakers’ request, about what Congress would be forced to take into account when elaborating a viable plan for Medicare for All: how it would be financed,how much patients would have to contribute out-of-pocket and the ratio at which providers would be reimbursed. The estimated costs for a 10 year period are of $32 trillion, a number which prompted insurers, doctors, hospitals and pharma industry representatives to strongly oppose any legislation.
Lawmakers at the hearing tried to strike political points during the debate. Republicans declared the system to be costly, and were against limiting choice for Americans, in a healthcare plan which would lengthen the waits for care. On the other side, Democrats reiterated the need to offer access to healthcare to the estimated 30 million people who are now uninsured, and focused on the ability for a government-run plan to lower administrative costs and be able to conclude better deals with providers.
House Democratic leaders have not yet embraced Medicare for All, but Budget Committee Chairman John Yarmuth, a Kentucky Democrat, feels things are going along in the right direction. “It is incumbent upon us to begin to work through the opportunities and tradeoffs involved in a single-payer system, as well as other ways to achieve universal coverage, many of which have been proposed by members of this committee,” he said. “I strongly believe it’s not a matter of if we will have universal coverage, but when. The CBO report and this hearing are designed to advance that timeline.”
The voters will have the last word on the matter in next year’s elections
Yarmuth’s optimism might be based on solid grounds. Partisan disagreements about Medicare for All could make things difficult; both parties want a good outcome in the 2020 elections. Lawmakers are afraid of the voters’ verdict next year if they cannot cut drug prices, as promised. Since President Donald Trump himself promised results which have not yet become true, he also is now politically exposed. July 7th, he promised an executive order that would allow the U.S. government to pay lower prices for prescription drugs thus making sure, according to him, that the U.S. would not pay more than the lowest price charged to other nations or companies.
While different parts of proposed legislation are currently in a half-dozen committees, both in the Senate and the House, all at various stages, the power to decide what will pass seems to lay with the Senate, since Republicans and Democrats have to work together to avoid gridlock on the Senate floor that could sidetrack passing any legislation.
It remains to be seen, however, whether the solution politicians choose will be revolutionary, or more on the cautious side. “The public demand for action is high on both sides of the aisle and I’m sure these guys are feeling it,” said John Rother of the National Coalition on Health Care, an umbrella group that represents a cross section of business and consumer organizations. “They have to do something, and the question is, is that something is going to be meaningful, or is it going to be window-dressing?”
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Source: Bipartisan efforts to control healthcare costs through new legislation continue
I had the distinct pleasure working with family physician colleagues in Sweden recently. It was a similar experience to a trip I made to Britain about five years ago that I also wrote about. I got to spend some time watching one of my colleagues care for her patients in her surgery (they use the same description of a clinic as the British).
I got to spend some time watching one of my colleagues care for her patients in her surgery (they use the same description of a clinic as the British).
The infrastructure was very similar to what I saw in Britain. It was a spacious office that included a physical therapist, a counselor, and at least one chronic disease nurse. They also had a fitness center at the end of the building.
The waiting room is small, because patients don’t spend much time there. The family physicians’ offices large, much larger than the typical American office. It includes a desk and two chairs, and examination table, and other equipment such as a spirometer. The doctor stays in the same room all day and does not bounce from room to room.
There were no in MAs, no screenings, no PHQ-9 questionnaires, and often no vital signs were taken other than blood pressure in patients with pre-existing hypertension. They need fewer employees per physician. All of the patients I saw her care for were in their 80s who were there for their annual review. The interviews were in Swedish, but another Swedish physician was with me, and he was able to type out what they were saying on an iPad.
Just like in Britain, their EMR is so much easier to use than American EMRs, because they are not loaded down with all the American baggage. There are almost no buttons to click, no pop-ups, and no bill’s to fill out. After each visit, the family physician spent 30 to 60 seconds dictating a note, and that was it for her documentation. A secretary in her office typed out the note that was much shorter than an American Medicare-mandated bullet counting note bloat monstrosity. The purpose of the note was to serve as a brief reminder to the physician of what she did in the visit. That was it. The EMR included e-connections to the pharmacy. To the degree the doctor looked at the computer instead of the patient, it was almost entirely to click the prescription refill buttons after the doctor and patient it talked about the related conditions.
For further evidence that more prevention will not decrease health care costs, I found that this physician was more comfortable with higher blood pressures in her patients than American guidelines would tolerate. The other physician I was with confirmed that this is common practice. They are worried that falls will increase if the pressure gets too low. Also, there is essentially no primary prevention of cholesterol disease with statins and Sweden. The doctors said that if a patient had a really high family history of coronary disease or strokes and asked to be on a statin, they would probably prescribe it, but in general, statins are not prescribed until after someone has a heart attack, a coronary artery procedure, or a stroke.
When I talked to Swedes who were not in the health care system, they were generally very happy with their national system. There were some complaints about long waiting times for elective surgeries and a national shortage of nursing home beds. Others questioned if they were getting full value for their investment in taxes. I met several people who had spent some time in America, and they were the most vehement about how well the Swedish system cares for his people, in contrast to some horror stories they told about relatives back in the U.S.
There are many similarities in how Sweden and Britain finance their health care systems. One difference is that Sweden has a relatively small percentage of its doctors who are family physicians, which they are trying to increase. Britain has a looming shortage, but there are still many more there than in Sweden.
The biggest difference for me between the systems is that in Britain, the NHS is a national religion. It’s always in the news, and the general public thinks about it a lot. In Sweden, as another example of how prevention does not explain lower national health care costs, they only provide colonoscopy for cancer screening in Stockholm and Gothenburg. They want to expand the service to other regions, but it won’t happen soon. I saw no angst or protests about this fact.
I found the Swedish people to have a more passive acceptance than the British that the national health care system will take care of them. Someone in Stockholm is making rationing decisions, but I saw no evidence that those decisions are anywhere as public and transparent as they are in Britain. Both countries make difficult decisions to live within their means, but the Swedes just choose not to worry about it. That’s not a criticism by any means, just an observation of how they choose to spend their emotional energies. Instead of worrying about national or regional health care policy decisions, they prefer to spend their energy planning their next Fika (coffee break).
If only I liked coffee.
Richard Young is a family physician who blogs at American Health Scare.
Image credit: Shutterstock.com
Source: An American physician in Sweden. Here’s what he thought about its health care.
Healthcare costs are on the top of the most important financial problems and issues list that Americans say their families are more likely to face. The query showed that these costs deeply worry many respondents; 17 percent named healthcare related spending when asked about their main financial struggles. Healthcare costs were more important than even lack of money or low wages, which were named by 11percent of respondents. Those two issues, along with personal debt, tied for first place a year ago. In 2017, healthcare costs were the clear leader in people’s concerns. College expenses, house related costs and taxes are the next most commonly mentioned problems in this year’s survey, with 8 percent of Americans citing each factor.
Even in a positive financial situation, healthcare remains costly
Americans’ personal financial situations are among the most positive Gallup has measured in years. Underlining that, the April 17-30 survey was conducted during a high economic confidence period, when relatively few Americans say economic matters are the most important problem the country is facing.
Twenty percent of Americans, one of the highest such percentages in Gallup’s 14-year trend on the question, said they do not have a “most important financial problem.” Not since February 2005 was the percentage higher. At that time, 21 percent of Americans said they had no financial problem.
Healthcare has remained on the top of the major concerns for Americans, even in more auspicious economic periods. Americans have very good reasons to feel so, since healthcare costs remain high for both the country and individuals.
Healthcare costs are rising far faster than inflation and have become a major driver for health care reform in the United States. As of 2016, the US spent $3.3 trillion (17.9% of GDP), or $10,438 per person; major categories included 32 percent on hospital care, 20 percent on physician and clinical services, and 10 percent on prescription drugs.
Coverage is not not easy for families to cover, either. According to data gathered by eHealth, the average health insurance cost for single coverage premiums in 2018 is $440 per month. For family coverage, the cost for premiums in 2018 is $1,168 per month.
Since 2005, healthcare costs among three recurrent financial issues
Gallup has asked the “most important family financial problem” question on 48 separate occasions since 2005. Only three issues – healthcare costs, energy costs/oil and gas prices and lack of money/low wages – have been recurrent on the top of the list in every single poll.
Healthcare costs ranked first in two of the past three surveys, and have at least tied for first in each poll since 2014.
Healthcare costs were typically tied with energy costs as the top problem prior to the Great Recession, mostly because of gasoline prices. In July 2008, a record-high 29% mentioned gas prices as their top financial issue. The ensuing unemployment periods and a slow economic recovery between 2009 and 2014 situated lack of money or low wages as the top personal financial problem. Since 2005, healthcare costs (14%) and lack of money (13%) have been most frequently mentioned as financial concerns for families. Those were the highest averages for any financial problem, and the only two above 10 percent.
People have to sacrifice other commodities to pay for healthcare
Healthcare is difficult to pay for, even in better economic conditions. Millions of American families are experiencing the pressure of soaring deductibles and medical bills. All social classes feel it, from middle-class households to the poor and uninsured.
In the last 12 years, annual deductibles in job-based health plans have nearly quadrupled and now average more than $1,300.
Even insurance gotten through employers is not easily covered, since one in six Americans who get it say they’ve had to make “difficult sacrifices” to pay for healthcare in the last year, including cutting back on food, moving in with friends or family, or taking extra jobs. One in five Americans say healthcare costs have taken all or most of their savings.
Older Americans name healthcare costs as top problem
Some subgroups, for instance older Americans, are more likely to name healthcare related costs as their top financial problem. Twenty-five percent of adults between the ages of 50 and 64, and 23 percent of those aged 65 and older, say healthcare costs put the biggest strain on their family’s budget.
Lack of money, college expenses and housing costs are the greatest financial challenges for adults younger than 50, who are about as likely to name healthcare costs among these top problems. Debt and the high cost of living are the most troubling financial issues for adults under 30.
For those in the pre-retirement years (aged 50 to 64) insufficient retirement savings are the top issue, but one which is less important for young adults or senior citizens.
Different incomes do not shift people’s points of view on healthcare costs
Even though lack of money is, obviously, a greater concern for lower-income Americans, people of different income levels are about equally likely to name healthcare as the most important financial problem, with percentages varying between 17% and 19% for each income group. Upper- and middle-income Americans are more inclined to say college expenses, taxes and retirement savings as the main financial challenges they face.
Healthcare costs remain a consistent concern over time, and are now standing above all other concerns. This makes healthcare a likely candidate for becoming a major focus point in politics, national elections and the 2020 presidential election included. Since the older generation, who is more likely to need healthcare, is also the most likely to vote, its members are going to pay special attention to the candidates’ plans to manage healthcare costs.
The post Healthcare costs, among top financial problems for Americans, query finds appeared first on Healthcare Weekly.
Source: Healthcare costs, among top financial problems for Americans, query finds
(Reuters) – Health insurer Cigna Corp on Wednesday launched a program aimed at ensuring some diabetes patients pay no more than $25 for a 30-day supply of insulin in the wake of heightened public scrutiny over soaring prices of the life-saving drug.
U.S. lawmakers have pulled up healthcare companies over rising costs of medicine, with powerful committees in Congress holding hearings in January on insulin affordability.
The annual cost of insulin for treating a type 1 diabetes patient in the United States nearly doubled to $5,705 in 2016 from $2,864 in 2012, according to a recent study.
The program will be for eligible people with diabetes in participating health plans, the company said.
Cigna, which bought pharmacy benefits manager Express Scripts last year, said it was partnering with insulin manufacturers to lower copayments to $25 at the point of sale.
For users of insulin plans managed by Cigna and Express Scripts, the average out-of-pocket cost for insulin was $41.50 for a 30-day supply in 2018, the company said.
Eli Lilly last month announced plans of selling a half-price version of its popular insulin injection, Humalog.
Reporting by Ankur Banerjee in Bengaluru; Editing by Maju Samuel
Source: Cigna launches program to cap out-of-pocket insulin costs at $25/month
Photo source: shutterstock
Video telehealth rehabilitation reduced the rates that patients with chronic obstructive pulmonary disease (COPD) had to be readmitted within 30 days after they were hospitalized for a pulmonary exacerbation, according to a study.
The findings were published in the American Journal of Respiratory and Critical Care Medicine in a study titled “Video Telehealth Pulmonary Rehabilitation Intervention in COPD Reduces 30-day Readmissions.”
According to the researchers, hospitalizations as a result of exacerbations in COPD patients are linked with respiratory morbidity and high healthcare costs, and accounts for nearly two-thirds of the total COPD healthcare costs. About one in five patients with COPD are readmitted within 30 days after hospital admission.
Although several hospitals have started intervention programs to lower the number of readmissions, the attempts have had minimal to modest success. However, studies have shown that pulmonary rehabilitation (multidisciplinary services aimed at improving the quality of life in patients) managed to reduce readmissions by 56%.
Consequently, researchers at the University of Alabama at Birmingham (UAB) tested the effect of a program using video telehealth rehabilitation.
The team enrolled COPD patients that were hospitalized for acute exacerbations, and identified through a daily hospital census (hospital-admitted patients). Except for specific conditions preventing them from participating in the exercises, all patients were included regardless of disease severity.
For 12 weeks, the patients attended a real-time video-conferencing intervention with 36 exercise sessions, following guidelines for conventional pulmonary rehabilitation. A physiologist provided the exercises that were based on outpatient exercise assessments, and adapted to the patient’s baseline functions.
Through the regimen, including stretching, breathing, and aerobic exercises, the goal was to reach heart rates between 60% and 80% of the maximum baseline recorded in a six-minute walk test.
Results showed a significant decrease in the 30-day all-cause readmissions among COPD patients who participated in the telehealth intervention (6.2% readmission), compared with patients who did not participate (18.1% readmission).
“Participating in an exercise program soon after hospitalization for an acute exacerbation of COPD is associated with a substantially lower readmission rate within 30 days of discharge,” Surya P. Bhatt, MD, associate professor in the division of pulmonary, allergy and critical care medicine at UAB, stated in a university news release written by Adam Pope.
“The video telehealth pulmonary rehabilitation program, by overcoming many barriers to early initiation of pulmonary rehabilitation, can expand access to pulmonary rehabilitation, especially for patients who live in rural areas,” Bhatt added.
Furthermore, the researcher emphasized that “by reducing COPD readmissions, this intervention has the potential to substantially reduce healthcare costs.”
Apart from COPD, the intervention approach can also be applied to the rehabilitation of patients with other chronic lung diseases. However, according to the team, the results need to be confirmed through randomized clinical trials.
Source: Fewer COPD Patients Readmitted After Video Rehabilitation, Study Says
#senators, if you pass a law forbidding any healthcare healthplan from neotiating network discounts greater than 20%. People will never pay more than 20% of what an insurer pays! Prices will drop dramatically over night!
Why? Health plans contract to pay doctors 40% and hospitals 10% of billed prices. So a day in the hospital is billed at $25,000 per day and the contracted “reimbursement” pays hospitals $2,500! If you are a consumer? You pay the full rate! The effect? You must get insurance.
New models of healthcare? HSAs are great, major medical (catastrophic only coverage) and pre-tax deposits to cover outpatient services. This is much more cost effective. Future Crypto-HSA might be even better!
Today Healthplans and the government have deployed ACOs (accountable care organisations) and imagine these as smaller subcontracted HMOs of older days. The problem, insurers are delegating the risk to ACOs which are micro ecosystems of hospitals, clinics and doctors. This creates higher risks for managing smaller patient populations. Many of these are failing, hospitals going bankrupt.
None of these newer directions of healthcare are curing our $3.2 Trillion health insurance bill. 95% of payments are through insurance claims (e billing) and adjudication, repricing, authorizations, network leasing and fees. 45% of healthcare $$ are wasted!! In addition, fraud accounts for $250 billon (FBI) in losses! We need new identity management systems to AUTHENTICATE patients, doctors, facilities and insurance claims!!!
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