Hospital charges bring a backlash
Patients objecting; state adds scrutiny
Patients, angered by surprise surcharges that hospitals tack on bills for doctor visits, are increasingly challenging these fees — sometimes even refusing to pay.
Hospitals say the charges cover their overhead, but the fees are sometimes added to the bill even when patients are treated in offices miles away from the medical centers.
The fees can reach hundreds of dollars, and some resistant patients end up being pursued by collection agencies. Others, such as Wendy Frosh, are dropping longtime caregivers in favor of physicians not employed by hospitals.
Tufts Medical Center charged Frosh a $500 “facility fee’’ for a routine 20-minute exam in an adjacent office building — on top of roughly $250 a surgeon billed for his services, she said. After complaining in vain to Tufts, Frosh switched to a new doctor.
G.O.P. in Arizona Is Pushed to Expand Medicaid
By FERNANDA SANTOS
PHOENIX — In the battle to get the Medicaid expansion being championed by Gov. Jan Brewer approved by the state’s legislators, her closest advisers are hanging their hopes on the number eight. That is how many of the 17 Republicans in the State Senate they believe they can get on their side.
They were working on an equally modest tally in the State House of Representatives, an unusual state of affairs for a staunchly conservative governor: her most reliable supporters on this issue are on the other side of the aisle, in the Legislature’s usually powerless Democratic minority.
“It is not often we agree with her,” said Representative Bruce Wheeler, the minority whip, “but we certainly do on this issue.”
Indeed, the governor has won respect in conservative circles for her outspoken criticism of President Obama and for her support of Arizona’s strict immigration legislation.
Last week, Ms. Brewer took her fight from conference rooms and the halls of the Senate and House to the steps of the State Capitol, surrounding herself with health care professionals in a public show of force before the Legislature, where the Medicaid bill she endorses will be unveiled on Tuesday.
In the meantime, a coalition of business leaders began running television advertisements promoting Ms. Brewer’s plan as a lifeline to hospitals, particularly in rural areas, where the number of Medicaid recipients is large, as is the number of uninsured seeking care in emergency rooms.
But in their push to win over Republicans, the governor’s advisers have found that they have no single persuasive argument, and at times, no chance at all for persuasion.
To make their case, they are pressing the idea that expanding Medicaid, the federal and state program that provides health care to poor and disabled people, is the best way to stabilize the state’s health care system, already buckling under the weight of caring for uninsured patients. They invoke the burden borne by the insured, whose high premiums cover, in part, the cost of treatment that goes unpaid. They remind legislators that to back the plan is to honor the choice of voters, who overwhelmingly passed ballot measures, in 1996 and 2000, expanding coverage for childless adults with incomes up to 100 percent of the federal poverty level.
For good measure, they warn of the perils of bad press just as the 2014 campaign season is getting started. If the state got hammered in 2010 for cutting Medicaid coverage forcertain organ transplants, affecting 94 patients, the thinking goes, imagine the reaction if the expansion does not go through and thousands of childless adults are dropped from the rolls just days after Christmas. (The waiver that has allowed for their coverage expires on Jan. 1.)
The high costs of Medicare’s low prices
By David Goldhill, Published: March 10
David Goldhill is chief executive of GSN, a media company, and the author of “Catastrophic Care: How American Health Care Killed My Father – and How We Can Fix It.”
Steven Brill’s recent Time magazine cover story, “Bitter Pill: Why Medical Bills Are Killing Us,” is an extraordinarily well-reported look at medical pricing, demonstrating that high health-care prices have little relationship to underlying cost. For many commentators, the much lower prices paid by Medicare suggests an obvious solution to our health-care problems — “Medicare for all.” There’s only one problem with this “obvious” solution: Medicare has been a primary driver of the explosion of health-care costs in the United States despite — and perhaps because of — the low prices it pays.
Over the past decade, Medicare’s spending per beneficiary has risen at roughly the same rate as spending for privately insured patients. Medicare’s supporters have a simple explanation: Americans are living longer, and this is driving up the program’s costs. But Medicare’s own data say that a much more important factor is the growing intensity of use: more demand for care at every age.
In the mainstream of our health-care debate, this growth in seniors’ demand is considered organic — a need to be fulfilled. But this extraordinary growth in volume is better understood as a provider reaction to the perverse incentives of low prices. Faced with buyers focused on volumes — such as private insurers — the health-care industry prices high; when dealing with buyers focused on prices — such as Medicare and Medicaid — the focus shifts to raising volumes, especially of more-costly procedures. Both strategies demonstrate the industry’s enormous market power.
Medicare beneficiaries get a lot of health care, and these amounts grow every year. In 10 years, the number of CT and MRI scans per beneficiary more than doubled; hip replacements increased by 36 percent between 1997 and 2007. One out of three Medicare beneficiaries now has at least one surgery in the year of his or her death; even 20 percent of 90-year-olds do! The average 75-year-old is on five prescription drugs. Here’s a fact you rarely hear about Medicare: Annual spending just on those in excellent or very good health was an astonishing $5,437 per person in 2008.
If you have relatives who are Medicare beneficiaries, you’ve probably experienced the medicalization of senior years — the perverse fate of the healthiest generation of seniors in history. But although the past years have seen a slew of insider accounts discussing the rise in unnecessary tests, diagnoses and even treatments far beyond any benefit to the patient, little awareness of the harm inflicted by growth in medical volume has seeped into policy debates.
Democrats to add hospital repayment to their liquor bill; LePage testifies on his own plan
By Matthew Stone, BDN Staff
Posted March 11, 2013, at 9:25 a.m.
AUGUSTA, Maine — Democratic legislative leaders unveiled a plan Monday morning to repay Maine’s $484 million hospital debt while tying the repayment to an expansion of the state’s Medicaid program and other health-care system reforms.
The announcement came as a legislative committee holds hearings to consider Gov. Paul LePage’s plan to repay the state’s hospitals using increased revenues from a renegotiated wholesale liquor contractand a competing proposal from Democratic Senate Leader Seth Goodall that sets out criteria for renegotiating the liquor contract, but doesn’t address the state’s hospital debt.
The Democrats are proposing an amendment to Goodall’s liquor renegotiation plan, whose original form requires a $20 million or $200 million upfront payment from the contractor who wins the bid to operate the state’s wholesale liquor business.
Democrats now propose to use the upfront payment to pay Maine’s share of the debt — $186 million, which would trigger a $298 million matching payment from the federal government — by Sept. 30. Under LePage’s plan, the state would sell a revenue bond to pay back the hospitals and use future liquor proceeds to pay back the revenue bond.
“We’re asking private industry to assume the risk, not the taxpayers,” Senate President Justin Alfond, D-Portland, said at a Monday morning news conference. “By getting this upfront payment by Sept. 30, the state will save $5 million in interest payments.”
Alfond and House Speaker Mark Eves, D-North Berwick, said their plan gets around constitutional concerns Democrats have raised about LePage’s plan. Citing a 2009 opinion from Attorney General Janet Mills, Democrats have questioned whether it’s constitutional to use a revenue bond to pay down the state’s hospital debt.
In addition to repaying the state’s hospital debt, Eves and Alfond on Monday outlined health-care system reforms that they plan to press for through separate legislation. Those measures would require more transparency in medical billing and shift the state’s health-care system to one in which patients and insurers pay for positive outcomes, rather than the number of procedures provided.
“We are really missing the boat if we don’t take this moment to address the high cost of health care in Maine,” Eves said.
They also pressed for Maine to participate in an expansion of the state’s Medicaid program next year as part of the federal Affordable Care Act, a move that LePage has opposed.
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