Monday, May 2, 2016

Healthcare costs vary from town to town, state to state

"The National Chartbook of Health Care Prices 2015" using data from the Health Care Cost Institute (HCCI), and the report, "Prices For Common Medical Services Vary Substantially Among The Commercially Insured," released by HealthAffairs, show price differences for common medical procedures across the same areas and across the states.

The study used data from the Health Care Cost Institute to assess national commercial claims and compare 242 medical services prices across 41 states and the District of Columbia between Jan. 1, 2012, and Dec. 31, 2013. Prices were standardized to reflect costs in September 2015. The study also looked at city data. No state data was available for Alabama, Arkansas, Hawaii, Idaho, Montana, Michigan, South Dakota, Vermont and Wyoming.

National Public Radio, in "That Surgery Might Costs You A Lot Less In Another Town," offers a way to select your state for comparing to the national average for three common procedures.

Congressional Quarterly reported that Alaska, along with Wisconsin, North Dakota, New Hampshire, and Minnesota in their respective order, had the highest average health care prices.  Residents in Alaska paid twice the costs of the national average.  See "Health Costs Differ in States and Cities, Report Finds". Only 15 states had health care costs below the national average. Florida, Arizona, Tennessee, Maryland and Nevada had the lowest in the country.

USA Today reports in "Huge health care price differences even within same area, by state" (April 25) that prices can differ within an single urban area, showing disparities in MRI costs within a 100-mile radius of San Francisco.  While some residents in different cities in the same state could see significant price differences, in other states, differences between cities were minimal.

The USA Today article also indicates the amount of out-of-pocket for the patient also shows wide disparities, pointing to several explanations, including the fact that some insurance policies require consumers to pay the insurer's negotiated rate, while others require the insured person or the insurers and the consumer to pay the entire sticker price.

In San Francisco, that left one person facing out-of-pocket costs of more than $1,900 for that same lower back MRI that cost less than $500 in the same area. Insurers also often need to include certain expensive hospitals in their networks to get contracts with some employers. Then they will  sometimes put those hospitals in a pricing tier that requires higher out of pocket costs.

Explanations for the variation in healthcare costs vary.  The HCCI report points to wages, rent, market power and the lack of transparency as reasons for wide disparity in prices in its new report. USA Today notes a 2013 report on health care spending by the Institute of Medicine (IOM), which reported about 70% of the variation in spending in the commercial insurance market is due to differences in price markups by doctors and hospitals, which it said most likely reflects these providers' regional market power.

Friday, April 29, 2016

CMS backs away from two-midnight rule

A NAMAH member shared this with NAHAM News, found in Modern Healthcare (Monday, April 18). 

The CMS will not continue to impose an inpatient payment cut to hospitals under the two-midnight rule following ongoing industry criticism and a legal challenge. It will provide a onetime bump to hospitals to offset the cuts. 

The original rule may be found in the CMS Fact Sheet: Two-Midnight Rule.

The agency imposed the cut because it estimated the two-midnight policy would increase Medicare spending by approximately $220 million because of an expected increase in inpatient admissions. 

Hospitals will also see a temporary increase of 0.6% in fiscal 2017. That would make up for the 0.2% reduction to the rates the past three years.

This addition, plus other increases outlined in the proposed rule, will result in a net increase of approximately $539 million to hospital inpatient prospective payment systems providers in 2017.

The decision to drop the proposed cut came after a September ruling in Shands Jacksonville Medical Center v. Burwell. A federal judge partially sided with the American Hospital Association and scores of other hospitals around the country, ordering HHS to better justify the cut and re-open the policy to comments.

As reported by Modern Healthcare, hospitals had challenged a 0.2% reduction for inpatient services meant to offset estimated costs to Medicare associated with the two-midnight rule. The rule directs CMS payment contractors to presume hospital stays are appropriately billed as inpatient admissions rather than outpatient observation visits if they span two midnights.

The policy was intended to reverse a trend toward higher rates of observation stays, which experts attributed to defensive billing practices by hospitals wary of having their admissions challenged by Medicare's audit contractors.

Even though September's ruling didn't outright demand the CMS rescind the pay cut, the agency felt it was the best thing to do given the industry's apprehension.

CMS explains its adjustment in its Fact Sheet: Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Proposed Rule Issues for Fiscal Year (FY) 2017 -

"CMS is proposing to take action regarding the -0.2 percent adjustment it implemented in the FY 2014 IPPS/LTCH PPS final rule to account for an estimated increase in Medicare expenditures due to the Two Midnight Policy.  Specifically, in the FY 2014 IPPS/LTCH PPS final rule, CMS estimated that this policy would increase expenditures and accordingly made an adjustment of -0.2 percent to the payment rates.  CMS believes the assumptions underlying the -0.2 percent adjustment were reasonable at the time they were made.  Additionally, CMS does not generally believe it is appropriate in a prospective payment system to retrospectively adjust rates.  However, in light of recent review and the unique circumstances surrounding this adjustment, for FY 2017, CMS is proposing to permanently remove this adjustment and also its effects for FYs 2014, 2015, and 2016 by adjusting the FY 2017 payment rates.  The impact of this proposal is to increase FY 2017 payments by approximately 0.8 percent."

Monday, April 25, 2016

Help Inform the Department of Health and Human Services’ (HHS) Measurement of Interoperability

The ONC asking for your input on ways to measure the progress toward a future where health information is flowing between providers and patients to supports a health system that provides better care, smarter spending, and healthier people. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) declares it a national objective to achieve the widespread exchange of health information through the use of interoperable certified electronic health records and directs HHS to establish metrics in consultation with you – the health IT community – to see if that objective has been met.

The Federal Health IT Strategic Plan is a collaboration with over 35 federal partners and the public which focuses federal offices that use or influence the use of health information technology on person-centered care, advancement of science, and overall health. The central theme of the Strategic Plan is ensuring health data flows seamlessly and securely to create a learning-based, person-centered health system.

Similarly, the Nationwide Interoperability Roadmap was an effort by the Office of the National Coordinator for Health Information Technology (ONC) in collaboration with the private sector, states, and federal partners to identify near-term actions to advance an interoperable health system.

Combined with the recent announcements of private sector market leaders to make EHR information flow more efficiently, these efforts all help to support the flow of health information when and where it is needed for patient care. (See our 3/1/16 post “Health Groups Aim to Make Medical Records Easier to Access” here.)

The ONC is issuing a request for information for your thoughts on how to measure interoperability and ensure HHS is keeping pace with the objectives laid out in the Roadmap and the Federal Health IT Strategic plan to measure the broad health information ecosystem, including individuals and non-health settings. Specifically, the ONC is asking for input on:

1.       What populations and elements of information flow should we measure?
2.      How can we use current data sources and associated metrics to address the MACRA requirements?
3.      What other data sources and metrics should HHS consider to measure interoperability more broadly?

The public comment period closes on June 3, 2016. View and download the request for information here and view the original posting here

Thursday, April 21, 2016

What Yelp Can Tell You About a Hospital That Official Ratings Can’t

Yelp is home to reviews on everything from restaurants to salons, and now hospitals too. If you've ever taken the time to give Yelp your two cents about a hospital, you'll be happy to know that someone's listening and that they've deemed the crowdsourced information not only useful — but unique.

In what is believed to be the first large-scale analysis of such data, researchers from the University of Pennsylvania looked at 17,000 Yelp reviews of 1,352 hospitals from consumers. The researchers found that the Yelp reviews provide more and broader information than the stalwart U.S. government created survey that costs millions of dollars to implement every year.

The Hospital Consumer Assessment of Healthcare Providers and Systems Survey or HCAHPS has been used since 2006 and involves asking discharged patients questions about their stays. It consists of 11 categories ranging from communication with medical staff, to staff responsiveness, pain management, and hospital hygiene.

Yelp offers consumers the ability to rate hospitals on a scale of one to five stars and write a review to accompany that rating. The U-Penn researchers used natural language processing to take apart the narratives and put them into buckets that were similar to the categories used by the HCAHPS. They gave as an example a post that had words such as "pain," "nurse," "medication," "gave" and how that might be assigned to the pain category.

Their paper, published in the April issue of Health Affairs, found that Yelp reviews encompassed only about seven of the 11 categories covered by the HCAHPS.

But, the data still proved surprising. The Yelp reviews had information about 12 additional categories that weren't addressed in the government survey. Those include the cost of the hospital visit, insurance and billing, ancillary testing, facilities, amenities, scheduling, compassion of staff, family member care, quality of nursing, quality of staff, quality of technical aspects of care, and specific type of medical care.

For positive reviews they included caring doctors, nurses and staff; comforting; surgery/procedure and peri-op; and labor and delivery. And for negative reviews, they included insurance and billing and cost of hospital visit.

The publication of the paper comes at a key time for Yelp when the social media site is trying to transform itself from a social, whimsy, and casual review website to a more serious player in other consumer domains.

The original article by  Ariana Eunjung Cha can be found at the following address:

Monday, April 18, 2016

Studies Find High Rates Of Errors In Medical Billing

In 2013, the America Medical Association estimated that 7.1% of paid claims in 2013 contained an error and a 2014 NerdWallet study found mistakes in 49% of Medicare claims. Groups that review bills on patients' behalf, including Medical Billing Advocates of America and CoPatient, put the error rate closer to 75% or 80%.

To that end, experts suggest reviewing medical bills closely before paying them. "Don't pay it until you understand it," said Sara Taylor, health solutions and strategies manager for benefits administrator Aon Hewitt.

For some consumers, spotting and correcting medical billing problems is getting easier. A forthcoming Aon Hewitt survey of 800 large and mid-size employers found that 45 percent offer advocacy services to help workers manage their health-care benefits; 43 percent are considering adding those services within five years.

Often, billing errors result in an out-of-pocket cost that's bigger than expected, either from a charge that shouldn't be there or a coding error that affected how your insurer processed the claim. Or, a bill is sent before payment is received from an insurer.

For those patients who do not have access to health concierge and patient advocacy services, asking for an itemized detailed statement is the best option. For those patients who are facing a big or complex bill, hiring a billing advocate is a solution.

Typically, review of the bill is free, with the service taking a cut of whatever savings it successfully secures for you. (MBAA takes a 25 percent cut; CoPatient, 35 percent.) Outsourcing the process can also save you time spent trying to get the bill corrected.

However, waiting too long to pay (or officially dispute) a medical bill is not recommended. Some providers are fast to take action on unpaid balances — resulting in 20 percent of consumers having an unpaid medical debt on their credit report, according to a 2014 Consumer Financial Protection Bureau study. The average amount owed: $579.

The original article by Kelli Grant can be found at the following address:

Thursday, April 14, 2016

Health IT Interoperability Remains Elusive

To assess the state of HIT, Modern Healthcare conducted a survey in 2015, known as the 25th annual Modern Healthcare Survey of Executive Opinions on Key Health Information Technology Issues. The results on interoperability of EHRs were disappointing. Only 11% of respondents to the survey said their organizations were able to routinely exchange electronic patient information with other providers across the country.

That meager showing comes 11 years after President George W. Bush created the Office of the National Coordinator for Health In-formation Technology with a mandate to implement a “nationwide interoperable health information technology infrastructure.

Only 17% of respondents to the 2015 survey indicated their hospitals and physician offices can move patient records around their home states. Just 21% reported they can exchange records within their regions. In contrast, 21% of respondents said they aren't exchanging electronic information at all, either within or outside of their organizations.

Still, an overwhelming majority of respondents (71%) were optimistic they'll be able to exchange a “core data set” of patient information nationally by the end of 2017 in keeping with a goal set in the ONC's “interoperability road map” released in January 2015. And 72% of those taking our survey opined that achieving nationwide interoperability would be of either high value (23%) or moderate value (49%) to their organizations. The road map signaled a shift in emphasis by federal health IT policymakers away from EHR adoption and toward health information exchange.

The original article by Joseph Conn can be found at the following address:

Monday, April 11, 2016

Electronic Health Records: Top 10 Healthcare Milestone of the Past 40 Years

In a recent article, Modern Healthcare named the top healthcare milestones of the past 40 years.  The top 10 milestones include electronic medical records, as called for by President George W. Bush in his 2004 State of the Union address. President Bush called for universal, portable, electronic health records within a decade.

On April 26, 2004, President George W. Bush formally launched the federal drive to widely disseminate health information technology to improve patient care. The next day, by executive order, Bush created the Office of the National Coordinator for Health Information Technology within HHS. A few days later, HHS Secretary Tommy Thompson named Dr. David Brailer the first ONC leader.

Bush said the ONC should work with private sector healthcare organizations as well as all federal agencies with a hand in healthcare. The goal of the newly-created ONC was to begin work on a national HIT strategy to promote the adoption and use of interoperable electronic health records to enhance clinical decision-making, improve quality, lower costs, reduce errors, improve coordination of care and ensure the privacy and security of patient data.

However, the Bush years of the ONC did not provide funding for the agency. Instead, the ONC was financed by reshuffling HHS' administrative funds. Despite this, adoption of EHRs has tripled in the first 10 years of the ONC and the concept health information exchange is now commonplace.

The second era of the ONC is the big-money Obama era starting with the 2009 American Recovery and Reinvestment Act, with its $2 billion for ONC grant programs. The incentive payment program for adoption of EHRs has paid out $21.6 billion so far.

There are critics of the strong federal role in HIT development, calling the EHR incentive program a market-disrupting “Frankenstein.”

Ross Koppel, a professor of sociology at the University of Pennsylvania medical school, said federal policymakers erred in thinking that “more HIT equals better care and safer care. That assumption has been defeated by their desire to push the technology long before it was ready.” What has resulted, he said, “is a captured market in which vendors create inferior products that the clinicians are obliged to purchase.”

Yet, EHR has still come a long way. Before the ONC, caveat emptor ruled for EHR buyers. Today, virtually all EHR systems sold are tested and certified against a list of functional criteria developed by the ONC. Before the ONC and the EHR incentive program, fewer than 4% of nonfederal U.S. hospitals had EHR systems with computerized physician-order entry. Today, 90% of hospitals have CPOE. Previously, less than 20% of office-based physicians had any kind of an EHR; today, more than 78% do.

Though ONC has had several previous directors and initiatives, Dr. Karen DeSalvo, the current Coordinator, succinctly sums up the ONC’s overarching goal: “Everyone is trying to solve these same three issues—capturing data, freeing it appropriately and then putting it to use.”

The original article by Joseph Conn can be found at the following address: