Tag Archives: Hospital
Four predictions for the future of healthcare
Healthcare policy has long been a moving target, but it’s hard to remember a time when more change was cycling through the industry. Now, more than half a decade since the passing of the Affordable Care Act (ACA), the focus has shifted from expanding access to health insurance to reforming the delivery of healthcare.
In particular, policymakers have embarked on a series of experiments and initiatives to transition from the traditional fee-for-service (FFS) system to a payment-for-value delivery system, with key attention to cost containment and quality improvement.
We are in the first generation of pursuing approaches better than FFS, and expect the industry’s shift toward value-based care (VBC) to accelerate and continue to impact providers, patients, vendors, and payers in different ways.
Now a little more than halfway through 2016, we thought it would be a good time to look at trends in the industry and how they will shape the relationships among stakeholders for the years to come.
Your Health Insurance Will Cost More Next Year: Here’s What’s Driving Prices Higher
The cost of getting your health insurance through work will go up an average of 5 percent next year, according to a new survey of large employers by the National Business Group on Health.
The cost for employers will go up 6 percent. This is the third consecutive year that employers’ health costs have risen by 6 percent. While that’s still more six times the current rate of inflation, it’s likely a smaller increase than will be experienced by consumers who purchase insurance through the public exchanges.
While those plans vary widely by state, the average plan is expected to cost 10 percent more in 2017, according to Kaiser. Last year, the price of the average silver level plan on public exchanges increased 12 percent.
For employers, the biggest driver of the cost increases is the price of specialty drugs. Other factors included high-cost claims and long-term conditions, according to the NGBH survey.
In Battle Of Health Care Titans, Should Insurers Act Like Wal-Mart?
In late July, the Justice Department sued to block both insurance mergers, arguing that competition is important to keep premiums down and that the deals “would leave much of the multitrillion-dollar health insurance industry in the hands of three mammoth insurance companies.”
They also rejected the Wal-Mart argument, which is related to what economists call “monopsony,” a concentration of buying power.
Monopsony is the opposite of monopoly: Instead of using market dominance to raise prices for consumers, huge buyers force down prices from suppliers. Wal-Mart is often described as holding monopsony-like power.
But critics of the insurance deals say monopsony can go too far. If the buyer pushes prices too low, suppliers stop producing, making needed goods and services unavailable.
“As a result of the merger, Anthem likely would reduce the rates that … providers earn by providing medical care to their patients,” the Justice Department argued. “This reduction in reimbursement rates likely would lead to a reduction in consumers’ access to medical care.”
This Nurse Leader Cut LOS by 40% in the Emergency Department
Around 2012, Ajimol Lukose, DNP, RN-BC, nursing director at Swedish Covenant Hospital in Chicago, noticed a trend—more patients with behavioral health issues were seeking treatment in the emergency department. This development came on the heels of the state cutting $113.7 million in general funds from its mental health budget, and Chicago closing of six of its 12 city-run mental health clinics.
“There was a reduction in mental health clinics, so the follow-up or outpatient programs were limited. That resulted in patients showing up in the emergency department,” Lukose told me.
On any given day, there could be as many as six or seven behavioral health patients in the ED.
“Our emergency department was struggling with patients with mental health issues staying there for three and four days and waiting for state transfer, especially unfunded patients,” she said.
At the same time, Lukose needed to implement a project for the doctorate of nursing practice degree she was working toward. She has a background in psychiatric nursing and thought she could help address some of the issues around caring for this patient population by developing a safe care delivery model to improve care quality and reduce length of stay in the ED.
Her results were even better than expected.
Should Big Insurance Become Like Walmart To Lower Health Costs?
Should Big Insurance Become Like Walmart To Lower Health Costs?
Retail titan Walmart uses its market dominance to inflict “ruthless,” “brutal” and “relentless” pressure on prices charged by suppliers, business writers frequently report.
What if huge health insurance companies could push down prices charged by hospitals and doctors in the same way?
The idea is getting new attention as already painful health costs accelerate and major medical insurers seek to merge into three enormous firms.
Now that hospitals have themselves combined, in many cases, into companies that dominate their communities, insurance executives argue the only way to fight bigness is bigness.
Is UC Davis Medical Center Skimping On Care For The Poor?
For at least 20 years, Leslie Love relied on the UC Davis Medical Center’s hospital and clinics for her health care. Her children and grandchildren went to the same doctors there.
“They cared about me,” said Love, a 57-year-old teacher’s assistant who lives near the academic medical center, which is located in Sacramento. “There’s people there that I can trust.”
But that trust was recently broken: Love has been fighting for follow-up care since her knee surgery at UC Davis in 2014. Love’s current Medi-Cal managed care plan, Health Net, ended its contract with the UC Davis Health System in January 2015. As a result, Love could no longer see the physicians there who had treated her knee.
The pullout, which affected an estimated 3,700 patients at the time, means that Health Net’s now nearly 123,000 Medi-Cal managed care enrollees in Sacramento County can no longer seek primary care at UC Davis.
Ever since, tension has been building over what some critics say is limited access for Medi-Cal patients at UC Davis’ health clinics.
Because it is financed partly by state taxpayers, the UC Davis Health System — like all University of California hospitals and clinics — is considered a public institution with a mandate to care for the poor.
That’s why some patients and their advocates are frustrated. They say UC Davis is not fulfilling its mission as a public hospital because the health system generally no longer accepts primary care patients covered by Medi-Cal managed care contracts. Medi-Cal patients still can receive specialized and emergency room care, as well as in-hospital stays.
Editor’s Corner: OIG audit reveals dirty secrets about Meaningful Use
So far this year we’ve seen a shift in attention when it comes to electronic health records: less on the EHR Incentive Program, and more on the newer, more trendy issues, such as precision medicine, the Medicare Access and CHIP Reauthorization Act and ransomware.
But that old stalwart, Meaningful Use, is still a major focus, at least for the Department of Health and Human Services Office of Inspector General. And it should be for the rest of us, as well, based on what OIG has been unearthing.
The OIG issued its latest audit report on how states are paying Medicaid Meaningful Use incentives, and it isn’t pretty. The Arizona Health Care Cost Containment System made incorrect Medicaid incentive payments to 24 out of 25 hospitals reviewed, totaling almost $15 million in overpayments.
Costly ICU Stays Don’t Improve Mortality Rates
Hospitals that use ICUs frequently are more likely to perform invasive procedures and have higher costs, but without demonstrable improvement in patient survival.
Worthwhile California initiative
At a time when health care spending seems only to go up, an initiative in California has slashed the prices of many common procedures.
The California Public Employees’ Retirement System (Calpers) started paying hospitals differently for 450,000 of its members beginning in 2011. It set a maximum contribution it would make toward what a hospital was paid for knee and hip replacement surgery,colonoscopies,cataract removal surgery and several other elective procedures. Under the new approach, called reference pricing, patients who wished to get a procedure at a higher-priced hospital paid the difference themselves.
HENRY KOTULA 