New ED drama? Hospitals demand upfront fee for nonemergencies
More are charging patients up to $180 for problems deemed nonemergent. Some doctors say the policy could backfire and harm patients.
By KEVIN B. O'REILLY, amednews staff. Posted Dec. 3, 2012.
Physicians who take after-hours calls from patients often face a difficult decision: Which symptoms can wait for an office visit, and which ones require a trip to the emergency department? Now doctors find these decisions complicated by a troubling, rising trend: Will a trip to the ED mean an upfront charge for a patient if the problem is deemed nonemergent?
At least half of hospitals are making efforts to collect patient co-pays, deductibles or other charges at the time of service in the emergency department, said Richard Gundling, vice president of health care financial practices at the Healthcare Financial Management Assn. The organization has 39,000 members, including chief financial officers and other professionals in health care financing.
Gundling said a smaller but growing number of hospitals give patients whose problems are deemed nonemergent a choice: Pay an initial fee to get the problem treated in the ED, or seek care elsewhere. The fees range from $100 to $180 for uninsured patients, or the relevant co-pay or deductible for insured patients. He said it is unclear how many hospitals are charging ED patients up front for nonemergency care, but he added that hospitals financially squeezed by uncompensated care increasingly are opting for this collections model.
Extended Use of Breast Cancer Drug Suggested
By ANDREW POLLACK
The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.
In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.
“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.
Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs as well might be taken for a longer duration.
“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”
Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.
Portland free health clinic running out of money, may be forced to close
Posted Dec. 04, 2012, at 3:19 p.m.
PORTLAND, Maine — More than 500 people could lose their only source of health care if an India Street clinic can’t soon find a way to pay its bills.
The Portland Community Free Clinic, at 103 India St., offers primary and some specialized medical care to low-income Cumberland County residents without health insurance. For nearly two decades, the clinic was supported by a partnership between Mercy Hospital and the city.
But Mercy stopped its contribution of about $200,000 a year in 2011, and city funds dried up at at the end of September.
“We’re living on fumes,” said Caroline Teschke, Public Health Department program manager and administrator of the clinic. “Our need is urgent.”
Mercy and the city both continue to provide in-kind support. The hospital donates diagnostic, lab and referral services, while the city’s Public Health Department provides office space, liability insurance and other help.
“We want to be supportive, because the clinic is really an asset for Portland,” Health and Human Services Director Doug Gardner said.
But after picking up the cost of clinic staff salaries during the first quarter of its 2013 fiscal year, the city didn’t have the money to help past September.
“The hope there was that the three months would give us some breathing room until we found another strategy,” Teschke said. “But three months is not very long.”
Both Mercy and the city had hoped the clinic’s population could be served through other programs, including the federally qualified health center at 180 Park Ave. But the clinic’s patient load continues to remain above 500.
One of the reasons is that its after-work hours and lack of red tape often make it the only option for patients, Teschke said.
It’s not profit that is destroying our health; it’s the private insurance business model
By Samuel Metz, M.D.
Firedoglake, Dec. 3, 2012
Many Europeans use private health insurance companies, a few of them for-profit. These Europeans enjoy better care for more people at lower cost than we do. But the European business model differs radically from that in the U.S. In fact, American insurance companies find the European model not only alien, but intolerable. Imagine American insurance companies playing by these European rules:
* You can set any price on your policy, but you must sell it at the same price to everyone, regardless of health.
* You must sell a policy to anyone who applies, no exceptions.
* No policy can be cancelled for any reason, not even failure to pay (the government will step in). Patients, however, can change companies without notice.
* Every policy must cover all treatable diseases. No matter what policy they purchase, patients will never risk destitution (or death) if they suffer a treatable condition.
* Your company must pay every claim from every licensed provider within 30 days. You can protest the payment, but only after you pay the bill.
* Every provider receives the same payment for the same service, regardless of patient or their insurance.
* Your records are an open book. Every dollar (or Euro) that passes through your hands is open to the public. There are no proprietary secrets.
* If you still manage to cherry pick healthier patients, the government will impose a premium to subsidize other companies with sicker patients.
With this model, European companies compete with lower prices, extra benefits, and better customer service. Isn’t that a refreshing change?
The American business model has no such rules. How do American insurance companies compete?
http://www.pnhp.org/print/news/2012/december/it’s-not-profit-that-is-destroying-our-health-it’s-the-private-insurance-business
Firedoglake, Dec. 3, 2012
Many Europeans use private health insurance companies, a few of them for-profit. These Europeans enjoy better care for more people at lower cost than we do. But the European business model differs radically from that in the U.S. In fact, American insurance companies find the European model not only alien, but intolerable. Imagine American insurance companies playing by these European rules:
* You can set any price on your policy, but you must sell it at the same price to everyone, regardless of health.
* You must sell a policy to anyone who applies, no exceptions.
* No policy can be cancelled for any reason, not even failure to pay (the government will step in). Patients, however, can change companies without notice.
* Every policy must cover all treatable diseases. No matter what policy they purchase, patients will never risk destitution (or death) if they suffer a treatable condition.
* Your company must pay every claim from every licensed provider within 30 days. You can protest the payment, but only after you pay the bill.
* Every provider receives the same payment for the same service, regardless of patient or their insurance.
* Your records are an open book. Every dollar (or Euro) that passes through your hands is open to the public. There are no proprietary secrets.
* If you still manage to cherry pick healthier patients, the government will impose a premium to subsidize other companies with sicker patients.
With this model, European companies compete with lower prices, extra benefits, and better customer service. Isn’t that a refreshing change?
The American business model has no such rules. How do American insurance companies compete?
http://www.pnhp.org/print/news/2012/december/it’s-not-profit-that-is-destroying-our-health-it’s-the-private-insurance-business
Obamacare architect leaves White House for pharmaceutical industry job
Few people embody the corporatist revolving door greasing Washington as purely as Elizabeth Fowler
When the legislation that became known as "Obamacare" was first drafted, the key legislator was the Democratic Chairman of the Senate Finance Committee, Max Baucus, whose committee took the lead in drafting the legislation. As Baucus himselfrepeatedly boasted, the architect of that legislation was Elizabeth Folwer, his chiefhealth policy counsel; indeed, as Marcy Wheeler discovered, it was Fowler who actually drafted it. As Politico put it at the time: "If you drew an organizational chart of major players in the Senate health care negotiations, Fowler would be the chief operating officer."
What was most amazing about all of that was that, before joining Baucus' office as the point person for the health care bill, Fowler was the Vice President for Public Policy and External Affairs (i.e. informal lobbying) at WellPoint, the nation's largest health insurance provider (before going to WellPoint, as well as after, Folwer had worked as Baucus' top health care aide). And when that health care bill was drafted, the person whom Fowler replaced as chief health counsel in Baucus' office, Michelle Easton, was lobbying for WellPoint as a principal at Tarplin, Downs, and Young.
Whatever one's views on Obamacare were and are: the bill's mandate that everyone purchase the products of the private health insurance industry, unaccompanied by any public alternative, was a huge gift to that industry; as Wheeler wrote at the time: "to the extent that Liz Fowler is the author of this document, we might as well consider WellPoint its author as well." Watch the five-minute Bill Moyers report from 2009, embedded below, on the key role played in all of this by Liz Fowler and the "revolving door" between the health insurance/lobbying industry and government officials at the time this bill was written and passed.
More amazingly still, when the Obama White House needed someone to oversee implementation of Obamacare after the bill passed, it chose . . . Liz Fowler. That the White House would put a former health insurance industry executive in charge of implementation of its new massive health care law was roundly condemned by good government groups as at least a violation of the "spirit" of governing ethics rules and even "gross", but those objections were, of course, brushed aside by the White House. She then became Special Assistant to the President for Healthcare and Economic Policy at the National Economic Council.
Now, as Politico's "Influence" column briefly noted on Tuesday, Fowler is once again passing through the deeply corrupting revolving door as she leaves the Obama administration to return to the loving and lucrative arms of the private health care industry:
http://www.guardian.co.uk/commentisfree/2012/dec/05/obamacare-fowler-lobbyist-industry1/print
"Elizabeth Fowler is leaving the White House for a senior-level position leading 'global health policy' at Johnson & Johnson's government affairs and policy group."
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