Tag Archives: Hospital Charges

How to Negotiate Down Your Hospital Bills – The Atlantic

Negotiate hospital bills? Why not negotiate drug costs, insurance premiums, co-pays, deductables, etc.?

Instead of playing this game, why not Improved Medicare for All. This way, no one will get sick paying for health care that is too damn expensive.

Read on.

Doctors’ bills play a role in 60 percent of personal-bankruptcy filings.

Source: How to Negotiate Down Your Hospital Bills – The Atlantic

Hospital prices, not physicians, drive cost growth, Health Affairs says | Healthcare Dive

Here’s another article about prices from last Tuesday that should be read in conjunction with today’s article on prices.

If we keep doing the same things over and over again to make things better, and they don’t work, that is a sure sign we are crazy, so ideas like antitrust enforcement, while a good idea in general business, and the incentivizing of more cost-efficient physician referrals, only scratches the surface.

The real problem is how health care in the US is just another revenue stream for investors and stockholders of insurance companies, pharmaceutical companies, and hospitals and hospital systems, as I reported also today in Hospital Mergers Improve Health? Evidence Shows the Opposite – The New York Times

So here is last Tuesday’s article:

The report suggests measures aimed at cutting healthcare costs focus on issues like antitrust enforcement and incentivizing more cost-efficient physician referrals.

Source: Hospital prices, not physicians, drive cost growth, Health Affairs says | Healthcare Dive

One Implant, Two Prices. It Depends On Who’s Paying. | Kaiser Health News

Here is another example of our broken health care system and the way in which health care has become a cash cow for hospitals, physicians, medical device manufacturers, which includes implant manufacturers, and pharmaceutical companies.

The following article from Kaiser Health News is eerily familiar to a piece I wrote a while back about a man who needed a hip replacement, and went to Belgium to get it, and discovered that the hip they gave him was made near his home in the US, but was considerably cheaper in Belgium than in the US, even though it was the same hip he would have gotten if he had the surgery locally.

That the same implant should come with two different costs, either because it is implanted in the US, or in a foreign country, or in the case below, because of the type of surgeries performed, is illogical and a symptom of a dysfunctional, profit-driven health care system that is out of control.

Here is the article link:

Breast implants — used for both cancer and cosmetic surgeries — give a glimpse into how hospitals mark up prices of medical devices to increase their bottom lines.

Source: One Implant, Two Prices. It Depends On Who’s Paying. | Kaiser Health News

Midterm Mashup

Well, the 2018 Midterm elections are over, and the analysis is beginning as to what this all means.

For those who wanted to send a message to the Russian puppet in Washington, the election meant that the House of Representatives will be controlled for the next two years starting in January by the Democrats.

For the Republicans, it means a greater control of the Senate, with at least one race, the one in my current state of Florida undecided and headed for a recount, as per state law.

However, there were many defeats for the party of Obama, Bill Clinton, Jimmy Carter, LBJ. JFK, Truman and FDR. Andrew Gillum lost to a nobody for governor of Florida who is connected to the Orangutan by an umbilical cord. Beto O’Rourke made a valiant, if futile effort against the worse person to hold a Senate seat, Lyin’ Ted Cruz. And a few Democratic senators lost seats in Indiana, Missouri and North Dakota.

But as far as health care is concerned, the change in the leadership of the House of Representatives means that the ACA is safe for another two years. and Medicare and Medicaid will not be cut, as the Senate Majority Leader has indicated he wanted to do.

Medicaid, in particular, came out of the Midterms a little better than expected before the election, as the following posts from Healthcare Dive, Joe Paduda, and Health Affairs reported this morning.

First up, Healthcare Dive, who reported that Red states say ‘yes’ to Medicaid . Idaho, Utah, and Nebraska said yes to expansion; Montana said no.

Joe Paduda echoed that in his post, “And the big winner of the 2018 Midterms is…Medicaid“. However, Joe stated that results in Montana were not final; yet, they had decided to expand Medicaid two years ago, but the vote was temporary, and yesterday’s vote was to make it permanent.

And lastly, Health Affairs reported in “What the 2018 Midterm Elections Means for Health Care” that besides blocking repeal of the ACA, Democrats may tackle drug prices, preexisting conditions protections, Opioids, Medicare for All, Surprise bills (unexpected charges from a hospital visit). regulatory oversight, extenders such as MACRA, Medicaid Disproportionate Share Hospital (DSH) payments, and Medicaid expansion, especially since gubernatorial wins in Maine, Kansas, and Wisconsin will make expansion more likely in those states.

Cayman Islands Hospital Delivers Lower Cost Care

This morning’s post by fellow blogger, Joe Paduda, contained a small paragraph that linked to an article in the Harvard Business Review (HBR) about a hospital in the Cayman Islands that is delivering excellent care at a fraction of the cost.

Joe’s blog generally focuses on health care and workers’ comp issues, and has never crossed over into my territory. Not that I mind that.

In fact, this post is a shoutout to Joe for understanding what many in health care and workers’ comp have failed to realize — the US health care system, which includes workers’ comp medical care, has failed and failed miserably to keep costs down and to provide excellent care at lower cost.

That the medical-industrial complex and their political lackeys refuse to see this is a crime against the rights of Americans to get the best care possible at the lowest cost.

As I have pointed out in previous posts, the average medical cost for lost-time claims in workers’ comp has been rising for more than twenty years, even if from year to year there has been a modest decrease, the trend line has always been on the upward slope, as seen in this chart from this year’s NCCI State of the Line Report.

The authors of the HBR article asked this question: What if you could provide excellent care at ultra-low prices at a location close to the US?

Narayana Health (NH) did exactly that in 2014 when they opened a hospital in the Cayman Islands — Health City Cayman Islands (HCCI). It was close to the US, but outside its regulatory ambit.

The founder of Narayana Health, Dr. Devi Shetty, wanted to disrupt the US health care system with this venture, and established a partnership with the largest American not-for-profit hospital network, Ascension.

According to Dr. Shetty, “For the world to change, American has to change…So it is important that American policy makers and American think-tanks can look at a model that costs a fraction of what they pay and see that it has similarly good outcomes.”

Narayana Health imported innovative practices they honed in India to offer first-rate care for 25-40% of US prices. Prices in India, the authors state, were 2-5% of US prices, but are still 60-75% cheaper than US prices, and at those prices can be extremely profitable as patient volume picked up.

In 2017, HCCI had seen about 30,000 outpatients and over 3,500 inpatients. They performed almost 2,000 procedures, including 759 cath-lab procedures.

HCCI’s outcomes were excellent with a mortality rate of zero — true value-based care. [Emphasis mine]

HCCI is accredited by the JCI, Joint Commission International.

Patient testimonials were glowing, especially from a vascular surgeon from Massachusetts vacationing in the Caymans who underwent open-heart surgery at HCCI following a heart attack. “I see plenty of patients post cardiac surgery. My care and recovery (at HCCI) is as good or better than what I have seen. The model here is what the US health-care system is striving to get to.

A ringing endorsement from a practicing US physician about a medical travel facility and the level of care they provide.

HCCI achieved these ultra-low prices by adopting many of the frugal practices from India:

  • Hospital was built at a cost of $700,00 per bed, versus $2 million per bed in the US. Building has large windows to take advantage of natural light, cutting down on air-conditioning costs. Has open-bay intensive care unit to optimize physical space and required fewer nurses on duty.
  • NH leverage relations with its suppliers in India to get similar discounts at HCCI. All FDA approved medicines were purchased at one-tenth the cost for the same medicines in the US. They bought equipment for one-third or half as much it would cost in the US.
  • They outsourced back-office operations to low-cost but high skilled employees in India.
  • High-performing physicians were transferred from India to HCCI. They were full-time employees on fixed salary with no perverse incentives to perform unnecessary tests or procedures. Physicians at HCCI received about 70% of US salary levels.
  • HCCI saved on costs through intelligent make-versus-buy decisions. Ex., making their own medical oxygen rather than importing it from the US. HCCI saved 40% on energy by building its own 1.2 megawatt solar farm.

And here is the key takeaway:

The HCCI model is potentially very disruptive to US health care. Even with zero copays and deductibles and free travel for the patient and a chaperone for 1-2 weeks, insurers would save a lot of money. [Emphasis mine]

US insurers have watched HCCI with interest, but so far has not offered it as an option to their patients. A team of US doctors came away with this warning: “The Cayman Health City might be one of the disruptors that finally pushes the overly expensive US system to innovate.”

The authors conclude by stating that US health care providers can afford to ignore experiments like HCCI at their own peril.

The attitude towards medical travel among Americans can be summed up by the following from Robert Pearl, CEO of Permanante Medical Group and a clinical professor of surgery at Stanford: “Ask most Americans about obtaining their health care outside the United States, and they respond with disdain and negativity. In their mind, the quality and medical expertise available elsewhere is second-rate, Of course, that’s exactly what Yellow Cab thought about Uber. Kodak thought about digital photography, General Motors thought about Toyota, and Borders thought about Amazon.”

Until this attitude changes, and Americans drop their jingoistic American Exceptionalism, they will continue to pay higher costs for less excellent care in US hospitals. More facilities like HCCI in places like Mexico, Costa Rica, the Caymans, and elsewhere in the region need to step up like HCCI and Narayana Health have. Then the medical-industrial complex will have to change.

Hospital Outpatient Payments Rising — Again

The Workers’ Compensation Research Institute (WCRI) released a study today that indicated that hospital outpatient payments were higher and growing faster in states with percent-of-charge-based fee regulations or no fee schedules.

This study is an annual study that compares hospital payments for a group of common outpatient surgeries in workers’ compensation across 35 states from 2005 to 2016.

According to WCRI’s executive vice president and counsel, Ramona Tanabe, “Rising hospital costs continue to be a focus for public policymakers and system stakeholders in many states.”

The study found that states with percent-of-charge-based fee regulations had substantially higher hospital outpatient payments per surgical episode than states with fixed-amount fee schedules.

Percent-of-charge-based states were 30 — 196% higher than median of the states with fixed-amount fee schedules in 2016.

States without fee schedules also had higher payments per episode; 38 — 143% higher than the median of fixed-amount states in 2016.

Lastly, WCRI found that hospital payments per episode in most states with percent-of charge-based fee regulations or no fee schedules, grew faster than states with fixed-amount fee schedules.

The study also compared payments for workers’ comp with Medicare rates for the most common group of surgical procedures across states. The following chart highlights the variation in the difference between average workers’ comp payments and Medicare rates. The variation was as low as 38%, or $2,012 below Medicare in Nevada, and as high as 502%, or $21,692 above Medicare in Alabama.

Source: WCRI

So, what does this mean?

It means that hospital outpatient payments for the most common group of surgical procedures in Workers’ Comp are not decreasing, and are likely adding to the slow, but steady rise in the overall total average medical cost for lost-time claims, a development I have followed for some time now with the release of NCCI’s State of the Line Reports.

This is not the first time I have discussed this topic, and probably won’t be the last, as I keep reminding you that surgical costs for most common workers’ comp surgeries are a fraction of the cost here in the US in countries that provide medical travel services.

If this study is right, wouldn’t you rather pay for a surgical procedure in Costa Rica, for example, that costs $12—$13,000, than paying $21,692 in Alabama? Eighteen out of thirty-five states listed on the above chart have higher payments than the median of 100. This represents 51.4% of all the states examined in the study. Just more than half.

And this idea of medical travel is stupid, ridiculous, and a non-starter? Ok, keep shelling out more money for hospital outpatient procedures. After all, it ain’t your money, is it?

To download this study, visit WCRI’s website at https://www.wcrinet.org/reports/hospital-outpatient-payment-index-interstate-variations-and-policy-analysis-7th-edition.

CMS’s Price Transparency Trick

Shoutout to Promed Costa Rica for the following article posted today on Facebook.

http://www.modernhealthcare.com/article/20180425/NEWS/180429939?utm_source=modernhealthcare&utm_medium=email&utm_content=20180425-NEWS-180429939&utm_campaign=am

CMS has been for decades the crux of the problem with the American health care system, Every model, program and scheme they have implemented addresses only the symptoms, but not the cause of the disease the patient is suffering from.

As I wrote yesterday, and the week before in my review of Health Care under the Knife, the real cause of the complexity, confusion, dysfunction and overall failures of the health care system is the system itself — meaning the economic system that has proletarianized physicians, commodified, corporatized, financialized, and monopolized health care in this country.

So now, this talk of price transparency, when the cost of care is already too high compared to other Western nations, is just a placebo being administered to a dying patient — the American health care system.

Remember these words:

“America’s health care system is neither healthy, caring, nor a system.”

Walter Cronkite