Las Vegas hospital doesn’t contract with any payers

https://www.beckershospitalreview.com/payer-issues/las-vegas-hospital-doesn-t-contract-with-any-payers.html?origin=cfoe&utm_source=cfoe

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Elite Medical Center, a Las Vegas-based acute care hospital that some experts say is operating similarly to a 24/7 freestanding emergency room, doesn’t contract with any payers, according to the Milbank News.

EMC is a state-licensed hospital. It is an unaccredited hospital that has no agreements with insurers, meaning patients have to pay out-of-network prices for care. Under state law, EMC isn’t required to be accredited by CMS or accept public or private insurance.

On EMC’s website, the medical center states, “This facility is not a participating provider in any health benefit plan provider network. However, under the [ACA], your health insurance company is required to process your emergency visit at in-network benefit levels. The physician providing medical care at this facility may bill separately from the facility for the medical care provided to you.”

While Nevada doesn’t provide licenses for freestanding ERs — though hospitals can open satellite ERs at other locations — EMC obtained a state license to operate as a hospital. As a result, it has to be able to admit patients for 48 hours.

Bill Welch, president and CEO of the Nevada Hospital Association, told Milbank News: “We think that Elite Medical Center, if they want to operate as a hospital in the state, that they should operate as a CMS-certified center and they should be accredited and Medicare participating. Without those things, we’re concerned.”

EMC CEO Butch Frazier defended the hospital in an emailed statement to the publication, saying it often has higher online patient ratings than University Medical Center in Las Vegas.

“EMC tries hard to make sure that the ultimate charges paid by the patients and by the insurers to EMC are in line with what they are paying for the same services at other hospitals in the area,” Mr. Frazier said. He added that EMC is seeking CMS accreditation.

 

Millions already lose or change health plans every year

https://www.axios.com/newsletters/axios-vitals-1ef6e02e-18e5-4a57-9dd2-891aadfbcaf1.html

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Millions of Americans lose their health insurance plans every month, by leaving the job through which they got that coverage, Axios’ Bob Herman reports.

Why it matters: Critics and skeptics of “Medicare for All” worry about eliminating people’s existing coverage because most people are relatively satisfied with their employer-based plans.

  • But millions of workers and their families already switch or lose their insurance from their jobs.

By the numbers: More than 66 million Americans voluntarily quit their jobs, were laid off or otherwise separated from their employers in 2018, and that high turnover rate has continued into 2019, according to data from the Bureau of Labor Statistics.

Details: The BLS data does not measure whether separated jobs offered health insurance.

  • However, close to half of all private employers provide coverage to their workers, and more than 90% of companies with at least 100 employees offer health benefits.
  • It’s therefore reasonable to estimate that at least 2 million workers and their families lose or transfer to new commercial health plans every month.

The bottom line: Behavioral economics teaches that people don’t like to lose what they have, a concept known as “loss aversion.”

Go deeper:

 

 

 

 

Healthcare Triage News: Why Do Insulin Prices Keep Rising?

Healthcare Triage News: Why Do Insulin Prices Keep Rising?

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Frederick Banting discovered insulin in 1921 and didn’t want to profit off of such a life-saving drug. Fast forward to 2019, and the price of insulin continues to increase year over year. Why is that?

 

 

 

 

Insurers, hospitals, physicians united in stance on ACA lawsuit

https://www.healthcarefinancenews.com/news/insurers-hospitals-physicians-united-stance-aca-lawsuit?mkt_tok=eyJpIjoiWldGbU16WmxOak00TmprMiIsInQiOiIzeGkycUpwcmtPUk42Z2R0b1k4RHd0NUVoY0k3UmE5TktUSkhMUzVtNVVWOWtWY3BhWkdUbjcrZndNS0tZRnA1cWFSajhWdmlZcUc4VE5DbFB4VEZNNkJyYTkyXC9XK3hxZVMwVzhSaVF2ZjZIdUFjbzZwcnF6aGE0UmowZ2w1eHcifQ%3D%3D

Hospitals, physicians and insurer groups are united in wanting to preserve the Affordable Care Act and have defended it in briefs filed with the Fifth Circuit Court of Appeals.

The American Hospital Association, the American Medical Association and America’s Health Insurance Plans are among groups that are fighting a lower court ruling in Texas that struck down the law.

On the other side is the Department of Justice, which last month reversed an earlier opinion and sided with the Texas judge who ruled that without the individual mandate, the entire ACA has no constitutional standing.

WHY THIS MATTERS

The ACA has insured millions who otherwise may not have been insured, allowing them to get care when needed instead of going to the more expensive emergency room when they have a medical crisis.

Hospitals and physicians see less uncompensated care under the ACA.

Without the ACA, patients would no longer have protections for pre-existing conditions, children would no longer have coverage under their parents’ health insurance plan until age 26, insurers would no longer be held to the 85 percent medical loss ratio, 100 percent coverage for certain preventive services would cease and individual marketplace and subsidies based on income would be eliminated.

Also, federal funding for Medicaid expansion would end.

TREND

Republicans under President Trump have tried unsuccessfully to repeal and replace the law.

The lawsuit, brought by 19 Republican governors, puts the GOP in a political bind over supporting the repeal of a law that is popular with consumers and their constituents. President Donald Trump recently said Republicans would unveil an ACA replacement after the 2020 election.

Democrats are also facing a crisis within their party over healthcare as it becomes a priority issue in the presidential election. Some of the leading candidates, such as Senator Kamala Harris, support Medicare for all. The Medicare for All Act of 2019  has been introduced in the Democratic-led House of Representatives.

Veteran politician and attorney Earl Pomeroy said he believes the Texas versus United States appeal changes the political course for 2020. The entire MFA argument will move to the back burner because of the Texas lawsuit, he said.

“The fight is going to be trying to underscore the Congressional importance of the provisions of the ACA and enhancing them,” Pomeroy said. “I do not believe that supporting Medicare for all is an advantageous position for a Democratic candidate running in a district that is not a secure Democratic seat. I believe Kamala Harris will spend much of the campaign walking back her comments on health insurance.”

Pomeroy is a former member of the U.S. House of Representatives for North Dakota’s at-large district, a North Dakota Insurance Commissioner and senior counsel in the health policy group with Alston & Bird.

“The safe political ground is defending a law people have warmed up to,” he said. “All politics is local but all healthcare is personal. There is little risk tolerance in the middle class for bold experiments in healthcare.”

BACKGROUND

The lawsuit was brought by Texas and the 19 other Republican-led states, based on the end of the individual mandate. In February, U.S. District Court Judge Reed O’Connor agreed that the federal law cannot stand without the individual mandate because if there is no penalty for not signing up for coverage, then the rest of the law is unconstitutional.

Twenty-one Democratic attorneys general appealed and the House of Representatives has intervened to defend the ACA in the case.

Either outcome in the appeals court may see the case headed to the U.S. Supreme Court.

WHAT THE PROVIDERS AND INSURERS ARE TELLING THE COURT

In a court brief filed by the AHA, the Federation of American Hospitals, The Catholic Health Association of the United States, America’s Essential Hospitals, and the Association of American Medical Colleges urged the Fifth Circuit Court of Appeals to reject a district court decision they said would have a harmful impact on the American healthcare system.

“Those without insurance coverage forgo basic medical care, making their condition more difficult to treat when they do seek care. This not only hurts patients; it has severe consequences for the hospitals that provide them care. Hospitals will bear a greater uncompensated-care burden, which will force them to reallocate limited resources and compromise their ability to provide needed services,” they said.

In a separate friend-of-the-court brief, 24 state hospital associations also urged the Fifth Circuit to reverse, highlighting specific innovative programs and initiatives for more coordinated care.

The American Medical Association, the American College of Physicians, American Academy of Family Physicians, American Academy of Pediatrics and the American Psychiatric Association filed a brief. AMA President Dr. Barbara L. McAneny said, “The district court ruling that the individual mandate is unconstitutional and inseverable from the remainder of the ACA would wreak havoc on the entire healthcare system, destabilize health insurance coverage, and roll back federal health policy to 2009. The ACA has dramatically boosted insurance coverage, and key provisions of the law enjoy widespread public support.”

AHIP said the law impacts not only the individual and group markets, but also other programs such as Medicaid, Medicare and Part D coverage.

“Since its passage in 2010, the ACA has transformed the nation’s healthcare system,” AHIP said. “It has restructured the individual and group markets for purchasing private health care coverage, expanded Medicaid, and reformed Medicare. Health insurance providers (like AHIP’s members) have invested immense resources into adjusting their business models, developing new lines of business, and building products to implement and comply with those reforms.”

 

 

 

 

Americans’ healthcare paradox: ‘angst’ on costs, overconfidence on quality

https://www.healthcaredive.com/news/americans-healthcare-paradox-angst-on-costs-overconfidence-on-quality/551876/

Dive Brief:

  • More than three in four Americans expect healthcare costs to increase over the next few years and result in “significant and lasting damage” to the U.S. economy, according to a survey by nonprofit West Health and Gallup. And 69% were “not at all” confident policymakers will fix the situation.
  • Given the choice between a 10% increase in income or a complete five year freeze of healthcare costs, 61% of people said they’d choose the latter, in line with the almost half of Americans concerned that a major health event would lead to bankruptcy for their family. In the past year alone, 12% have borrowed money to pay for care and 10% had foregone treatment due to cost.
  • However, although just 39% of those surveyed were pleased with the U.S. healthcare system as a whole, 64% were satisfied in how it worked for their households. Roughly half believe the quality of U.S. healthcare is either the “best in the world” or “among the best.”

Dive Insight:

Frustrations faced by Americans in paying for healthcare are understandable given that the U.S. ranks first among the 36 OECD developed nations in healthcare cost per person.

But their belief in the supremacy of the U.S. healthcare system is misplaced at best.

The U.S. ranks 31st among the OECD group in terms of infant mortality, a key indicator of overall quality, and a depressing 28th in overall life expectancy.

While healthcare is more regulated in nearly every other developed country, mammoth bills pack a bigger punch because they can come out of nowhere in the U.S. Some 47% of Americans reported never knowing what a visit to the emergency room will cost before receiving care. Just 19% of respondents said they “always” knew their out-of-pocket costs before visiting the ER.

Outpatient surgery, visits to a physical therapist or chiropractor, and check-ups and physicals didn’t fare much better, with only 17%, 23% and 39% of respondents respectively saying they always knew their out-of-pocket costs at those sites of care.

Obfuscation of prices may lead to “risky and unhealthy behavior,” according to the West Health report. It found 41% of Americans surveyed reported forgoing a visit to the ER over the past year due to cost concerns.

And this fear over costs is affecting people at every rung of the socioeconomic ladder. West Health and Gallup found the concern wasn’t just unique to people struggling financially — it was consistent up to the top 10% of earners.

“Angst is a very appropriate word to use when you see the data,” Mike Ellrich, healthcare portfolio leader at Gallup said at the West Health Healthcare Costs Innovation Summit on Tuesday.

Political debate over fixing this problem has centered of late on drug prices, surprise medical billspre-existing conditions and lowering insurance premiums, which are rising faster than income. And CMS has prodded providers and payers to make out-of-pocket costs more transparent for patients.

But Americans largely don’t think politicians will be able to fix the problem, with more than two-thirds of Republicans and Democrats alike not at all confident that elected officials will be able to achieve bipartisan legislation to lower costs.

However, perceptions of quality diverged among party lines. West Health and Gallup found 67% of Republicans view the U.S. healthcare system as delivering the best or among the best care in the world. Just 38% of Democrats agreed.

“I’m all for patriotism, but this is a disconnect from reality,” Ellrich said. “This issue is not red or blue.”

 

 

 

Obamacare fight obscures America’s real health care crisis: Money

https://www.politico.com/story/2019/04/03/obamacare-health-care-crisis-1314382

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The ceaseless battle over the 2010 law has made it difficult to address the high cost of American health care.

The Obamacare wars have ignored what really drives American anxiety about health care: Medical costs are decimating family budgets and turning the U.S. health system into a runaway $3.7 trillion behemoth.

Poll after poll shows that cost is the number one issue in health care for American voters, but to a large extent, both parties are still mired in partisan battles over other aspects of Obamacare – most notably how to protect people with pre-existing conditions and how to make insurance more affordable, particularly for people who buy coverage on their own.

That leaves American health care consumers with high premiums, big deductibles and skyrocketing out-of-pocket costs for drugs and other services. Neither party has a long-term solution — and the renewed fight over Obamacare that burst out over the past 10 days has made compromise even more elusive.

Democrats want to improve the 2010 health law, with more subsidies that shift costs to the taxpayer. Republicans are creating lower-cost alternatives to Obamacare, which means shifting costs to older and sicker people.

Neither approach gets at the underlying problem — reducing costs for both ordinary people and the health care burden on the overall U.S. economy.

Senate HELP Committee chair Lamar Alexander, the retiring Tennessee Republican with a reputation for deal-making, has reached out to think tanks and health care professionals in an attempt to refocus the debate, saying the interminable fights about the Affordable Care Act have “put the spotlight in the wrong place.”

“The hard truth is that we will never get the cost of health insurance down until we get the cost of health care down,” Alexander wrote, soliciting advice for a comprehensive effort on costs he wants to start by summer.

But given the partisanship around health care — and the fact there have been so many similar outreaches over the years for ideas, white papers and commissions — it’s hard to detect momentum. Truly figuring how to fix anything as vast, complex and politically charged as health care is difficult. Any serious effort will create winners and losers, some of whom are well-protected by powerful K Street lobbies.

And the health care spending conversation itself gets muddled. People’s actual health care bills aren’t always top of mind in Washington.

“Congress is looking at federal budgets. Experts are looking at national health spending and the GDP and value. And the American people look at their own out-of-pocket health care costs and the impact it has on family budgets,” said Drew Altman, the president and CEO of the Kaiser Family Foundation, which extensively tracks public attitudes on health.

But Congress tends to tinker around the edges — and feud over Obamacare.

“We’re doing nothing. Nothing. We’re heading toward the waterfall,” said former CBO director Doug Elmendorf, now the dean of the Harvard Kennedy School, who sees the political warfare over the ACA as a “lost decade,” given the high stakes for the nation’s economic health.

The solutions championed by the experts — a mix of pricing policies, addressing America’s changing demographics, delivering care more efficiently, creating the right incentives for people to use the right care and the smarter use of high-cost new technologies — are different than what the public would prescribe. The most recent POLITICO-Harvard T.H. Chan School of Public Health poll found the public basically wants lower prices, but not a lot of changes to how — or how much — they consume health care, other than spending more on prevention.

Lawmakers are looking at how to start chipping away at high drug prices, or fix “surprise” medical bills that hit insured people who end up with an out-of-network doctor even when they’re at an in-network hospital. Neither effort is insignificant, and both are bipartisan. While those steps would help lower Americans’ medical bills, health economists say they won’t do enough to reverse the overall spending trajectory.

Drug costs and surprise bills, which patients have to pay directly, “have been a way the public glimpses true health care costs,” said Melinda Buntin, chair of the Department of Health Policy at Vanderbilt University School of Medicine. “That information about how high these bills and these charges can be has raised awareness of health care costs — but it has people focused only on that part of the solution.”

And given that President Donald Trump has put Obamacare back in the headlines, the health law will keep sucking up an outsized share of Washington’s oxygen until and quite likely beyond the 2020 elections.

Just in the last week, the Justice Department urged the courts to throw out Obamacare entirely, two courts separately tossed key administration policies on Medicaid and small business health plans, and Trump himself declared he wants the GOP to be the “party of health care.” Facing renewed political pressure over the party’s missing Obamacare replacement plan, Trump last week promised Republicans would devise a grand plan to fix it. He backtracked days later and said it would be part of his second-term agenda.

Democrats say Trump’s ongoing assaults on the ACA makes it harder to address the big picture questions of cost, value and quality. “That’s unfortunately our state of play right now,” said Rep. Raul Ruiz (D-Calif.). “Basic health care needs are being attacked and threatened to be taken away, so we have to defend that.”

The ACA isn’t exactly popular; more than half the country now has a favorable view of it, but it’s still divisive. But for Republicans and Democrats alike, the new POLITICO-Harvard poll found the focus was squarely on health care prices — the cost of drugs, insurance, hospitals and doctors, in that order.

The Republicans’ big ideas have been to encourage less expensive health insurance plans, which are cheaper because they don’t include the comprehensive benefits under Obamacare. That may or may not be a good idea for the young and healthy, but it undoubtedly shifts the costs to the older and sicker. The GOP has also supported spending hundreds of millions less each year on Medicaid, which serves low-income people — but if the federal government pays less, state governments, hospitals and families will pay more.

Last week, courts blocked rules in two states that required many Medicaid enrollees to work in order to keep their health benefits, and also nixed Trump’s expansion of association health plans, which let trade groups and businesses offer coverage that doesn’t include all the benefits required under the ACA.

House Democrats last week introduced a package of bills that would boost subsidies in the Obamacare markets and extend that financial assistance to more middle-class people. The legislation would also help states stabilize their insurance markets — something that the Trump administration has also helped some states do through programs backstopping health insurers’ large costs.

These ideas may also bring down some people’s out-of-pocket costs, which indirectly lets taxpayers pick up the tab. These steps aren’t meaningless — more people would be covered and stronger Obamacare markets would stabilize premiums — but they aren’t an overall fix.

The progressive wing of the Democratic party backs “Medicare for All,” a brand new health care system that would cover everyone for free, including long-term care for elderly or disabled people. Backers say that the administrative simplicity, fairness, and elimination of the private for-profit insurance industry would pay for much of it.

The idea has moved rapidly from pipe dream to mainstream, but big questions remain even among some sympathetic Democrats about financing and some of the economic assumptions, including about how much of a role private insurance plays in Medicare today, and how much Medicare puts some of its costs onto other payers. Already a political stretch, the idea would face a lot more economic vetting, too.

The experts, as well as a smattering of politicians, define the health cost crisis more broadly: what the country spends. Health care inflation has moderated in recent years; backers of the Affordable Care Act say the law has contributed to that. But health spending is still growing faster than the overall economy. CMS actuaries said this winter that if current trends continue, national health expenditures would approach nearly $6 trillion by 2027 — and health care’s share of GDP would go from 17.9 percent in 2017 to 19.4 percent by 2027. There aren’t a lot of health economists who’d call that sustainable.

And ironically, the big fixes favored by the health policy experts — the ones that Alexander is collecting but most politicians are ignoring — might address many of the problems that keep aggravating U.S. politics. If there were rational prices that reflected the actual value of care provided for specific episodes of illness and treatment, instead of the fragmented system that largely pays for each service provided to patients, then no medical bill would be a surprise, noted Mark McClellan, who was both FDA and CMS chief under the President George W. Bush and now runs the Duke-Margolis Center for Health Policy.

“But taking those steps take time and will be challenging,” McClellan noted. “And they’ll be resisted by a lot of entrenched forces.”

 

 

 

Trump is reading the GOP base wrong on the Affordable Care Act

https://www.axios.com/trump-reading-base-wrong-aca-b6e2521c-d386-4c94-81e8-b018a6aaf3b1.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Image result for Trump is reading the GOP base wrong on the Affordable Care Act

 

The only plausible explanation for President Trump’s renewed effort through the courts to do away with the Affordable Care Act, other than muscle memory, is a desire to play to his base despite widely reported misgivings in his own administration and among Republicans in Congress.

Reality check: But the Republican base has more complicated views about the ACA than the activists who show up at rallies and cheer when the president talks about repealing the law. The polling is clear: Republicans don’t like the ACA, but just like everyone else, they like its benefits and will not want to lose them.

The big picture: About three quarters of Republicans still have an unfavorable view of the ACA, and seven in 10 say repealing the law is a top health priority for Congress — higher than other priorities such as dealing with prescription drug costs. And yes, 7 in 10 Republicans still want to see the Supreme Court overturn the law.

But as the chart shows, majorities of Republicans like many elements of the ACA —especially closing the “donut hole” in Medicare prescription drug coverage (80%), eliminating copayments for preventive services (68%), keeping young adults under 26 on their parents’ plans (66%) and subsidies for low and middle-income households (63%).

  • Nearly half of Republicans want the Supreme Court to keep the protections for pre-existing conditions (49%), and even more show general support for the pre-existing conditions protections (58%).
  • During the repeal and replace debate in 2017, even Republicans were nervous to hear that these sorts of things would go away. The 2020 campaign would drive home to the public, and to Republicans, what they have to lose — and it would become especially real to them if the 5th Circuit Court of Appeals upholds the ruling striking down the ACA.

Maybe Republicans would forget about these lost benefits if they could agree on a replacement plan they liked? But there isn’t one, and many of the ideas thought to be elements of one — such as cutting and block granting both Medicaid and ACA subsidies — are non-starters with Democrats and moderate Republicans on Capitol Hill. They’re unpopular with the public, too. 

The bottom line: It is widely accepted that a renewed debate about repeal hands Democrats a powerful new political opportunity. Deeper in the polling, it’s also clear that’s it’s more of a mixed bag for Republicans than President Trump may realize.