This short article in Forbes on-line summarizes concerns with compliance to — and related costs — updates in HIPAA (Health Insurance Portability and Accountability Act). As noted, security and privacy are getting more serious with each iteration.
This is no small concern:
The Department of Health and Human Services estimates that the cost of compliance with the final rule will be somewhere between $114 and $225 million (first year) and about $14 million for each year thereafter… the rule qualifies as an “economically significant” one under Executive Order 12866.
The reason for this new level of security is pretty fundamental. Healthcare has had some serious deficiencies through the years and it’s a prime target for identity theft. Not so much for the actual healthcare information but for financial fraud – which is a companion problem in healthcare (to the tune of about $70 billion a year in Medicare fraud alone).
It is not often that a reader contribution column from The New York Times called—“Modern Love”—has something of relevance to the work that we do at MCN.
In this column, the writer, Sarah Kishpaugh eloquently conveys the impact of a work injury on her husband, herself and their lives together. Rarely does one have the opportunity to hear from a fine writer how a significant injury can impact their life, as well as an interaction with the workers’ compensation system. Read more…
This recent New York Times article focuses on the impact of hospital mergers in Washington State, where increasingly, Catholic systems are taking over hospitals both small and large. The Church has a venerable history of leadership in providing health to the region since pioneer days, and what started as small missions, have evolved into very large systems.
The responsiblity to serve all people with compassionate care underscores the Catholic health mission and in so many ways inspires all, regardless of background – especially those who decry the increasingly profit-driven nature of the system.
While the vast majority of the work done in these hospitals are unaffected by the ownership structure, positions on procedures including abortion and assisted suicide between the hospitals and many patients and practitioners are at odds. Concerns exist that a physician working at such institutions on the medical staff is specifically precluded from a full discussion of legal options, when such options run counter to Catholic teachings, regardless of the personal beliefs of the physician or the patient. As a source in the article notes:
“If you go to a Catholic medical institution, you’re going to get medical advice that is in keeping with the moral norms of that institution”…“We think Catholic medical advice is the best medical advice to give.”
When a Catholic institution takes over the only hospital in a rural region, physicians and patients have little choice but to adhere to the dictates and restrictions imposed by the institution, unless they choose to travel a long distance to another facility. In many cases, the institutions have been supported with public funds via bonding, tax treatment and other benefits. Expect this conflict to widen in the context of individual cases where a clash of values conflicts with care desired vs. care available.
Every once in a while an editorial catches our eye here at MCNTalk because it captures a certain aspect of the work that we do. This thoughtful New York Times op ed piece by Bruce Marchart does just that — reminds us both of the human side of the injuries and disabilities we work with every day, and gives us pause to ponder how we view each life, each incident of “lost time” from work.
In Marchart’s past work in Houston he came across — and confesses to a larger fascination with — many industrial accidents. He contemplates some of the moments of tragedy juxtaposed against the backdrop not just of the recent explosion at a fertilizer plant in West, Texas but also of the terrorist incident at the Boston Marathon, two incidents which resulted in over 200 injuries and multiple deaths.
Marchart muses, “We tend to discount that which is accidental as somehow less tragic, less interesting, less newsworthy than the mayhem of agency. Lives have been ‘lost’ in Texas, but in Boston, by God — lives have been ‘taken.’
“But this distinction means nothing to the victims or, I imagine, to their families. In Boston, in West, whether by sinister design or by accident, whether on a television-ready stage or hidden away in a rural factory, when people are hurt, when lives are lost, the essential human cost shouldn’t be lost on the living.”
As this New York Times article details, data being released for the first time by the government on Wednesday shows that hospitals charge Medicare wildly differing amounts — sometimes 10 to 20 times what Medicare typically reimburses — for the same procedure, raising questions about how hospitals determine prices and why they differ so widely.
The data for 3,300 hospitals, released by the federal Center for Medicare and Medicaid Services, shows wide variations not only regionally but among hospitals in the same area or city. For instance, in Saint Augustine, Fla., one hospital typically billed nearly $40,000 to remove a gallbladder using minimally invasive surgery, while one in Orange Park, Fla., charged $91,000. A hospital in Livingston, N.J., charged $70,712 on average to implant a pacemaker, while a hospital in nearby Rahway, N.J., charged $101,945.
Hospitals submitted bills to Medicare that were, on average, about three to five times what the agency typically pays to treat a condition, an analysis of the data by The New York Times indicates. And variations between what hospitals charge may be even greater.
The data covers bills submitted from virtually every hospital in the country in 2011 for the 100 most common treatments and procedures performed in hospitals. Medicare does not actually pay the amount a hospital charges but instead uses a system of standardized payments to reimburse hospitals for treating specific conditions.
Private insurers do not pay the full charge either, but negotiate payments with hospitals for specific treatments. Since many patients are covered by Medicare or have private insurance, they are not directly affected by what hospitals charge.
Experts say it is likely that the people who can afford it least — those with little or no insurance — are getting hit with extremely high hospitals bills that may bear little connection to the cost of treatment.
After TIME Magazine featured the report “Bitter Pill: Why Medical Bills Are Killing us,” Cleveland Clinic CEO Dr. Toby Cosgrove argues that one potential cause of out-of-control healthcare costs may be that doctors often have no idea how much medical procedures actually cost. He argues that by informing doctors about the specific costs of health care procedures, doctors may try to find more cost-effective alternatives.
And in a new study by Johns Hopkins published in the journal, JAMA Internal Medicine, researchers showed that informing doctors of the cost of tests, services, and supplies they use actually can lead to hefty medical savings.
The researcher split physicians into two groups over the six-month experiment to see if showing the tests prices would change a physician’s decision about services. One group was given the tests with prices on them, while the other group’s tests did not have a price.
The researchers compared the buying behavior of the physicians and found that showing the pricing information resulted in a 9% cut in use of the tests overall and a savings of over $400,000 over the six months. By comparison, there was a 6% increase in the use of the tests without pricing information over the same time period. Read More…
The researchers say the savings can be largely credited to the simple principles behind comparison shopping.
To challenge this theory, CEO Dr. Toby Cosgrove decided to make it a point to deconstruct the costs of their top three procedures, record the price of sutures, the number of instruments uses and record how long patient’s spend in post-anesthesia care.
“Take, for example, nitric oxide, a drug commonly used in heart, lung and chest surgeries to keep tissues well-supplied with oxygen during the operation. When it’s effective, it’s very effective, but it doesn’t help all patients. When we realized we were spending $2 million a year on the drug, we drilled down to see who was using it and why.
We found that doctors and OR staff did not have a standard protocol to guide them on when and how much to rely on nitric oxide; we had to educate them that if the drug didn’t work within a half hour of being administered, it won’t work at all, so repeated doses were wasteful. The result: nitric oxide use dropped by half, saving $1 million without any adverse effect on patient care,” Dr. Cosgrove said.
When his team saw where they could easily cut costs, they made a goal to save $100 million in a year by focusing on what and how they use equipment and supplies they purchase. Within a year, they topped their $100 million goal and after three years have saved $155 million.
And while it’s crucial that quality of health care services always comes before price, it is equally important to realize that even the smallest cost saving practices create a monumental difference in our costly health care system.
New York City may be facing a predicament as the prevalence and popularity of social adult day care centers is on the rise, especially in the Brooklyn area.
With the largest Medicaid budget in the country at $54 billion, the city is trying to find a way to balance spending for institutional care with less expensive care methods that allow people to remain in their communities.
These spending concerns arise as the number of social adult day care centers has grown from eight programs to 192 centers across the city.
Why has the number grown so much so quickly? The answer lies within their aggressive marketing tactics. To entice people, a facility may offer $50 for a referral, money each week, free food to take out, a grocery coupon, or an unlimited MetroCard.
Medicaid indirectly pays for the cost of attendance. Managed care companies pay the adult day care centers to provide services to its clients. In return, the centers refer new clients to these companies.
“Centers collected $25 million for managed care plans in the first nine months of 2012.” The rate per month for each member is about $3,800 or $93 per session. Read More…
Furthermore, these care centers are fairly inexpensive to operate because they are minimally regulated, do not require a license and only require a staff of two people, one of whom can be a volunteer.
Those who receive treatment are supposed to be impaired enough to need at least 120 days of help with everyday tasks. However, the The New York Times article,“Day Centers Sprout Up, Luring Fit Elders and Costing Medicaid,” reports that healthy individuals may be reaping the benefits of a superfluous Medicaid budget.
“The idea that people are bicycling home from managed long-term care is a complete misnomer…The idea that they’re playing Ping-Pong — I guess they could be wheelchair-bound Ping-Pong players, but otherwise it’s fraud and they are not eligible,” said Jason Helgerson, the state’s Medicaid Chief.