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Tuesday, April 24, 2012

Health Care Reform Articles-April 24, 2012

Insurers Alter Cost Formula, and Patients Pay More




Despite a landmark settlement that was expected to increase coverage for out-of-network care, the nation’s largest health insurers have been switching to a new payment method that in most cases significantly increases the cost to the patient.
The settlement, reached in 2009, followed New York State’s accusation that the companies  manipulated data they used to price such care, shortchanging the nation’s patients by hundreds of millions of dollars.
The agreement required the companies to finance an objective database of doctors’ fees that patients and insurers nationally could rely on. Gov. Andrew M. Cuomo, then the attorney general, said it would increase reimbursements by as much as 28 percent.
It has not turned out that way. Though the settlement required the companies to underwrite the new database with $95 million, it did not obligate them to use it. So by the time the database was finally up and running last year, the same companies, across the country, were rapidly shifting to another calculation method, based on Medicare rates, that usually reduces reimbursement substantially. 
APRIL 23, 2012, 4:00 PM

The Confusion of Hospital Pricing

Wesley Bedrosian
When Augie Hong awoke with severe abdominal pain nearly two years ago, he went to the hospital emergency room closest to his home in San Francisco. The diagnosis was acute appendicitis, and doctors removed his inflamed appendix.
Mr. Hong had health insurance, so he wasn’t too worried about paying. Then the bills started to arrive.
“That’s when I got nervous,” said Mr. Hong, 36, who has insurance through his job at an investment firm.
The Consumer
Advice on money and health.
In all, Mr. Hong was charged $59,283, including $5,264 for the doctors. According to the Healthcare Blue Book, that amount is six times the fair price for an appendectomy in Northern California, which is $8,309 (including a four-day admission) for the hospital and an additional $1,325 for the doctor. Even after Mr. Hong’s insurer paid the hospital $31,409 and Mr. Hong paid the doctors $4,034, the bills kept coming.
A new study suggests that Mr. Hong’s experience is not unusual. Hospital charges are all over the map: according to the report published Monday in the Archives of Internal Medicine, fees for a routine appendectomy in California can range from $1,500 to — in one extreme case — $182,955. Researchers found wide variations in charges even among appendectomy patients treated at the same hospital.
http://well.blogs.nytimes.com/2012/04/23/the-confusion-of-hospital-pricing/?pagemode=print


Posted:Today
Updated: 12:46 AM

For removal of appendix, hide wallet

Study finds 'madness' pricing with a huge swing in patients' bills, from $1,500 to $180,000.

By LINDSEY TANNER/The Associated Press

CHICAGO — What do hospitals charge to remove an appendix? The startling answer is that it could be the same as the price of a refrigerator -- or a house
http://www.printthis.clickability.com/pt/cpt?expire=&title=For+removal+of+appendix%2C+hide+wallet&urlID=476786211&action=cpt&partnerID=561087&cid=148611025&fb=Y&url=http%3A%2F%2Fwww.pressherald.com%2Fnews%2Ffor-removal-of-appendix-hide-wallet_2012-04-24.html


California's working poor would lose a lot if health reform law dies

A bill to create a federally funded Basic Health Plan for about 720,000 low-income residents would go for naught if the Supreme Court tosses out the law.

David Lazarus
April 24, 2012

If the healthcare reform law is thrown out by theU.S. Supreme Court — as many fear could happen based on the comments of conservative justices — more than 700,000 low-income Californians could lose a once-in-a-lifetime chance to obtain affordable health insurance.

At stake is what's known as a Basic Health Plan. This is a system provided for by the reform law, fully funded by the federal government, that would extend coverage to people who may not be able to afford conventional insurance policies but don't qualify for Medi-Cal.

Doctors falling short helping seniors to avoid medical problems, poll finds — Health — Bangor Daily News — BDN Maine

By Judith Graham, Kaiser Health News
Posted April 24, 2012, at 8:41 a.m.

Large numbers of seniors aren’t receiving recommended interventions that could help forestall medical problems and improve their health, according to a new surveyfrom the John A. Hartford Foundation.

Trustees Issue Warnings On Medicare, But Make No Changes To Solvency Projections

APR 23, 2012
Trustees of the Medicare program today forecast increased financial troubles as a result of an aging population and rising health care costs, increasing the visibility of an issue that is already proving divisive in the 2012 presidential and Congressional campaigns.
"Both programs took a turn for the worse this year," trustee Charles Blahous III, a senior research fellow at George Mason University in Virginia, said of Medicare and Social Security.
Overall, the outlook for the Medicare program which covers nearly 50 million elderly and disabled people was only slightly worse than findings from last year. Once again, trustees forecast that Medicare’s hospital fund would begin to run out of money beginning in 2024, but many experts place little importance on the trustees' projection since the program’s insolvency has been forecast from as little as two years away to as many as 28 years since 1970.
Today’s report emphasized that Medicare costs in both the short term and long term would rise higher than previously reported, but that these costs would be offset by 2 percent cuts to the program agreed to in last year’s deficit reduction agreement, unless Congress passes an alternative cost-cutting plan.

Health insurer CEOs' big paychecks are latest target of outraged shareholders

By Wendell Potter
The Huffington Post, April 23, 2012

One of my responsibilities when I was head of corporate communications at Cigna was to help ensure that the company's annual meeting of shareholders ran smoothly and, if at all possible, attracted no negative publicity.
I always dreaded the annual meeting because you really never knew if one or more disgruntled shareholders might show up and ask rude questions of the CEO. But during all of my years of helping plan those meetings, we had an unblemished string of non-events. We considered the meetings marathons if they lasted more than 15 minutes. Most of them were over-long before then. Over the course of 10 years, I only recall two reporters who felt compelled to attend, and one of them got stuck in traffic and missed the whole thing.
Some of my peers at other health insurers were not that lucky, but relatively few of the big-profit insurers have had to cope with contentious shareholder meetings.
It is clear those days are over.
http://www.pnhp.org/print/news/2012/april/health-insurer-ceos-big-paychecks-are-latest-target-of-outraged-shareholders




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