News/Blog

Healthcare Data

The next big battle in healthcare will almost certainly be about costs!

Posted by | Healthcare Cost Savings | No Comments

Mounting frustration from employers and employees will put cost controls on the table faster than you might think, making the next big battle in healthcare almost certainly about costs!

Right now frustration over healthcare costs is starting to percolate, particularly over the concern that the industry already maxed out the existing tools for cost control.

California, for example, has proposed moving the state to an all-payer system, to give the state more control over doctors and hospitals insurance plan charges (only Maryland has an all-payer system). Are we really going to have a debate about all-payer? Is this one of those times when California is the wacky outlier state, or one of those times when it’s a trendsetter?

Once employers reach the end of their rope on healthcare costs, the cost-control debate is going to ratchet into a higher gear. That is the prelude to a debate over all-payer in every state, but government intervention will probably be on the table, at least in some states. The cost-containment debate is coming because policymakers are not going to put too much new revenue on the table, and that means that both the private sector and Medicare will be paying the most.

Costs have risen modestly over the past few years, and private insurance has responded, in large part, by shifting more of those costs onto consumers through higher copays, deductibles, and coinsurance. But we’re at the end of what the market will bear on cost-sharing.

This is a scary position for providers. If employees are at their breaking point on cost-sharing, and employers reach their breaking point on cost growth, expect political systems to get serious about cutting those costs themselves. The question remains … are healthcare organizations and doctors ready for real changes in reimbursement?

 

The dramatic increase in deductibles, especially within employer-based coverage

Posted by | Health News, Healthcare Cost Savings | No Comments

In employer-based health plans, the average deductible for a SINGLE person is over $1,500, according to Kaiser — 3 times higher than it was a decade ago. The trend toward increasingly high deductibles means families struggle to afford their care, even with insurance.

Now, experts are starting to reconsider whether high cost-sharing — once conceived as a way to turn employees into more discerning healthcare consumers — is working.

“High-deductible plans do reduce health-care costs, but they don’t seem to be doing it in smart ways,” USC professor Neeraj Sood told Bloomberg.

This frustration with existing cost-shifting tools — and the growing sense that we’ve basically maxed out their utility — is contributing to the renewed focus on underlying health care prices.

  • Many employers don’t feel they can shift any more costs onto their workers, but that’s largely how they’ve kept premiums in check for the past several years. And they certainly don’t want to shoulder higher bills themselves.
  • As that frustration mounts, expect to see a greater political appetite for real cost controls.

The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid

Posted by | Healthcare Data | No Comments

While the Medicaid expansion was intended to be national, the June 2012 Supreme Court ruling essentially made it optional for states. As of June 2018, 17 states had not expanded their programs.

Medicaid eligibility for adults in states that did not expand their programs is quite limited: the median income limit for parents in these states is just 43% of poverty, or an annual income of $8,935 a year for a family of three in 2018, and in nearly all states not expanding, childless adults remain ineligible. Further, because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults fall into a “coverage gap” of having incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits (Figure 1).

This KFF brief presents estimates of the number of people in non-expansion states who could have been reached by Medicaid but instead fall into the coverage gap, describes who they are, and discusses the implications of them being left out of ACA coverage expansions. An overview of the methodology underlying the analysis can be found in the Methods box at the end of the report, and more detail is available in the Technical Appendices available here.

 

The Cost of Chronic Diseases in the U.S.

Posted by | Health News, Healthcare Data | No Comments

Chronic disease management is a must when shifting to value-based care! The Milken Institute reported that the total costs in the U.S. for direct health care treatment for chronic health conditions totaled $1.1 trillion in 2016—equivalent to 5.8% of the U.S. GDP.

Chronic diseases also lead to indirect costs—lost income and reduced economic productivity—for the individuals suffering from the conditions, their family caregivers, and the overall economy. When the indirect costs of lost economic productivity are included, the total costs of chronic diseases in the U.S. increased to $3.7 trillion, equivalent to 19.6% of 2016 GDP—i.e., one-fifth of the U.S. GDP.

This trend is expected to get worse as an estimated 83.4 million people in the US will suffer from 3 or more chronic diseases in 2030 compared to 30.8 million in 2015.

The number of uninsured Americans is rising

Posted by | Health News, Healthcare Data, Uncategorized | No Comments

The cold war on Obamacare is having an effect. The uninsured rate has begun to creep back up since Trump became president. After several years of major declines under Obama, the uninsured rate has grown from 10.9 percent to 12.2 percent, according to Gallup. It’s not hard to imagine, in just one Trump term, that we could see half of the gains made under the ACA, which led to 20 million Americans being newly covered, erased.

Poll after poll shows the public wants this assault on the ACA to stop. After all this time, the program remains at a record level of popularity. Fifty percent approve, even as the administration badmouths and undercuts it.

Mostly, Americans want this assault on their ability to care for their families to end so we can begin the process of building back what has been allowed to erode. Americans want to pay less, not more, for health insurance. They don’t want insurance companies to be given unlimited authority again.

They want to see Medicaid strengthened, not weakened. They want the basic dignity of being able to afford medication and an end to the constant fear that grips so many that if they get sick, they will lose everything.

Americans didn’t want last year’s war on Obamacare, and they don’t want this new cold war either.

 

 

 

 

 

 

Sources: Gallup, KFF and  Vox – The Republican cold war on the Affordable Care Act

Under the hood on hospital pricing

Posted by | Health News, Healthcare Data | No Comments

The actual prices hospitals charge private health insurers are closely guarded trade secrets. But a widely circulated health economics paper, which received some new updates, uses actual claims data from three national insurers to show the inner workings of how hospitals get paid.

The bottom line: Hospitals make a lot of money off patients who get their health coverage through their jobs, and hospitals with little or no competition have the power to set their rates at will.

Show less

Why it matters: The amount Americans spend just on hospital care represents 6% of the entire economy, so it’s important to understand how hospitals price their services and to determine if patients and taxpayers are getting a good deal.

The backdrop: This paper builds on previous work that shows Medicare spending is almost entirely driven by the quantity of services, whereas private insurance spending is driven heavily by the prices and market power of hospitals — an increasing concern as more systems merge into dominant regional and national players.

Updates to the paper and thesis include:

  • “Insurers pay substantially different prices for the same services at the same hospitals,” the economists wrote.
  • “Prices at monopoly hospitals are 12 percent higher than those in markets with four or more rivals.”
  • “If private prices were set at 120 percent of Medicare rates rather than at their current levels, inpatient spending on the privately insured would drop by 19.7 percent.”
  • Many hospitals get paid based on percentages of their charges instead of fixed amounts, and that system “places them under less pressure to reduce costs.”

Sources AxiosThe Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured

Electronic Health Records Were Supposed to Cut Medical Costs. They Haven’t!

Posted by | Health News, Healthcare Cost Savings, Healthcare Data, Hospital Finance | No Comments

Despite the promise that electronic health records would cut billing costs, savings have yet to materialize, according to a major new study by researchers at Harvard Business School and Duke University.

The study, published in the February 20 issue of the Journal of the American Medical Association, looked at five types of visits: primary care visits, ER visits resulting in a patient discharge, general medicine hospital stays, outpatient surgical procedures, and inpatient surgeries.

Findings included:

– A primary care visit necessitated 13 minutes in billing and insurance-related activities, costing $20. The time and cost ramped up to 100 minutes and $215 for an inpatient surgery.
– Just the physicians’ portion of the time and cost spent on billing amounted to 3 minutes and about $6 for a primary care visit, up to 15 minutes and $51 for surgery.
– Physicians, who cost between $3 and $8 per minute, are doing administrative tasks that ascribe costing 50 cents a minute could do better, Kaplan says.

The hospital systems buying physician practices say vertical integration will facilitate care coordination and lower costs… Where’s the evidence?

Posted by | Health News, Healthcare Cost Savings | No Comments

Contrary to physicians claims caught up in the consolidation wave, hospital administrators continue to grant most specialties pay hikes that outpace inflation by a healthy margin.

Modern Healthcare’s Physician Compensation Database, which tracks average salaries based on a survey of a dozen compensation consulting firms and organizations, shows the average pay for 22 specialties, including the relatively low-paying fields of family practice, pediatrics, and internal medicine, rose 10.8% between 2012 and 2017. Average physician pay now stands at $386,000 a year, up 10.9% from $348,000 in 2012.

In percentage terms, that pay hike is 4 percentage points more than the national inflation rate over the same period. In other words, despite consolidation, doctors in recent years have consistently pulled down steady, inflation-adjusted pay increases—something that has eluded most American workers.

Staffing Plans – What to Share with Staff and the Public

Posted by | Healthcare Data, Healthcare Transparency, Nurse Patient Ratios, Nursing, Nursing Staff, Patient Care, Patient Census, Patient Experience, Patient Safety, Patient Satisfaction, Patients, Staff Engagement, Staff Morale, Tracking Costs | No Comments

Once a staffing plan has been developed, how do we monitor our compliance to the plan?   How do we share these results with our staff and patients, in order to demonstrate our commitment to patient safety and staff satisfaction?

Read More

International Transitions Homeward – A Different Approach to Healthcare Costs and Patients

Posted by | Health News, Healthcare Cost Savings, Healthcare Data, Hospital Finance | No Comments

International Transitions Homeward

Undocumented, uninsured immigrants make up a significant portion of the uninsured patient population. These patients pose huge financial burdens for health systems today. Many of these patients  become trapped in the U.S. Healthcare system for years, even when that is not their intention.

Read More