The Health Care Waiting Game
Long Waits for Doctors’ Appointments Have Become the Norm
ONE small consolation of our high-priced health care system — our $2.7 trillion collective medical bill — has been the notion that at least we get medical attention quickly.
Americans look down on national health systems like Canada’s and Britain’s because of their notorious waiting lists. In recent weeks, the Veterans Affairs hospitals have been pilloried for long patient wait times, with top officials losing their jobs.
Yet there is emerging evidence that lengthy waits to get a doctor’s appointment have become the norm in many parts of American medicine, particularly for general doctors but also for specialists. And that includes patients with private insurance as well as those with Medicaid or Medicare.
Merritt Hawkins, a physician staffing firm, found long waits last year when it polled five types of doctors’ offices about several types of nonemergency appointments including heart checkups, visits for knee pain and routine gynecologic exams. The waits varied greatly by market and specialty. For example, patients waited an average of 29 days nationally to see a dermatologist for a skin exam, 66 days to have a physical in Boston and 32 days for a heart evaluation by a cardiologist in Washington.
The Commonwealth Fund, a New York-based foundation that focuses on health care,compared wait times in the United States to those in 10 other countries last year. “We were smug and we had the impression that the United States had no wait times — but it turns out that’s not true,” said Robin Osborn, a researcher for the foundation. “It’s the primary care where we’re really behind, with many people waiting six days or more” to get an appointment when they were “sick or needed care.”
Supplemental healthcare policies may relieve some worries
Nicholas Lazzarini has a pretty good health insurance policy. But as a self-employed dancer, he says he worries about becoming sick or injured and incurring extra costs. "Unless you're on a TV show, you don't have coverage," says the 29-year-old from Van Nuys.
For extra protection against unforeseen medical costs, Lazzarini decided to buy two additional policies to supplement his health insurance plan. He bought a critical illness plan, which will pay a lump sum if he becomes sick with a serious ailment like cancer or a severe burn, and an accident plan that will put cash in his pocket should he injure himself.
"If I'm working at a dance studio where I have to cover myself, it's smart to have that extra protection in case I can't work," he says.
When it comes to buying supplement policies for accidents and critical illnesses, experts urge consumers to shop around, make sure they're getting only what they need and know how the policy works. Every insurance plan is different.
By far, the largest and best-known seller of this kind of insurance is AFLAC — thanks to its huge marketing campaign fronted by a talking duck.
These supplemental policies are among a growing menu of voluntary benefits offered by employers and insurers to help consumers pay their bills in case of a catastrophic medical event. And they can be used to offset the cost of out-of-pocket medical expenses.
Unlike health insurance that pays medical bills, supplemental policies may be used for a variety of expenses such as baby-sitting, car payments, mortgages and transportation.
Critical illness plans offer a set cash benefit that is triggered by a diagnosis such as cancer or heart attack. The cost of an average individual plan is about $25 per month and cash benefits commonly range from $5,000 to $50,000.
If you have a heart attack, for example, you might receive a lump-sum payment of $20,000.
A mid-range accident plan costs $21 per month for an average individual. Policyholders could receive $350 for each day of hospitalization and $150 for an ambulance ride required by an accident. The loss of fingers could yield a lump-sum payout of $5,000.
Many accident plans also have a life insurance benefit: If a policyholder dies because of an accident, a payout of, say, $50,000 may be made to his or her family.
Sales are on the rise. "Accident and critical illness are two areas of growth," says Anita Potter, research director with LIMRA, an insurance and financial services research organization. Her firm estimated that sales of critical illness plans jumped 28% and accident plans rose 14% in 2013 over the year before.
Need for ballot measure on health insurance rate regulation debated
Kicking off a major ballot fight this year, California lawmakers pressed the state's insurance commissioner to defend a proposal that would grant his agency sweeping new authority over health insurance rates.
At a legislative hearing Wednesday, backers and opponents of the statewide ballot measure on health insurance rate regulation called Proposition 45 squared off for the first time in a public debate. Before the hearing, supporters of Proposition 45 rallied in Sacramento and accused health insurers of putting profits ahead of patient care.
As medical costs keep climbing, California Insurance Commissioner Dave Jones and consumer groups are pushing for more authority on health premiums for about 6 million Californians who are covered by individual and small-business policies.
In November, voters will decide whether to give the insurance commissioner veto power over rate increases.
For now, state regulators have limited power over rates. They can deem health insurance increases unreasonable, but they can't stop health plans from imposing them.
One major point of contention Wednesday was whether Proposition 45 will be a help or hindrance to making the Affordable Care Act work for consumers. California was a leader nationally in signing up 1.4 million people in Obamacare coverage during the first year of the health law rollout.
Jones said Proposition 45 is fully compatible with the federal health law and essential to shield consumers from rising premiums.
"This is the missing piece of the Affordable Care Act," Jones told lawmakers at the hearing. "Without health insurance rate regulation, we will continue to see excessive rates."
Obama awaits another court ruling that could deal blow to health law
President Obama's healthcare law could be dealt a severe blow this week if a U.S. appeals court rules that some low- and middle-income residents no longer qualify to receive promised government subsidies to pay for their health insurance.
The case revolves around a legal glitch in the wording of the Affordable Care Act, which as written says that such subsidies may be paid only if the insurance is purchased through an "exchange established by the state."
That would seem to leave out the 36 states in which the exchanges are operated by the federal government.
A ruling could come as early as Tuesday.
The administration has argued that Congress intended to offer the subsidies nationwide to low-and middle-income people who bought insurance through an exchange, without making a distinction.
Lawyers and congressional staffers who worked on the 2010 law have described the problem as a classic wording glitch in a long and complicated piece of legislation.
In one part of the law, it says that states, which normally regulate insurance, could create exchanges that would help consumers and small businesses shop for coverage. The law also said if a state failed to establish an exchange, the federal government could step in and run one in its place.
A second part of the law described the subsidies that could be offered to low- and middle-income people to cover the cost of the insurance. This part of the law said these subsidies--or tax credits--would be offered for insurance bought on an exchange "established by the state."
2 Maine Hospitals Could See Medicare Payment Reduction in Wake of Report
by Patty Wight
This fall, Medicare will penalize hospitals with the worst rates of patient injury. Two Maine hospitals are on the preliminary list.
Maine Medical Center in Portland and St. Mary's Regional Medical Center in Lewiston scored among the worst in the nation for criteria such as infections and avoidable complications like bed sores, blood clots, and lung punctures. If their rankings still stand this fall, both hospitals face a one percent reduction in Medicare payments. Betsy Shew of St. Mary's says the data doesn't tell the whole story of very sick patients who underwent complex procedures.
"Yes. There was a complication that was recorded during the course of the procedure, however these patients have had very positive outcomes after their procedure," Shew says.
The chief medical officer of Maine Medical Center, Peter Bates, issued a written statement saying Medicare's methodology is imbalanced. Bates points out that as an urban teaching hospital, Maine Medical Center takes in some of the most complex and diverse patients in northern New England.
The Medicare penalty stems from a program under the Affordable Care Act designed to incentivize hospitals to improve care. Both Maine Medical Center and St. Mary's say they constantly strive to achieve the highest level of safety.
Tracking Medicare Over-Billing: Is the Cost Worth the Return?
by Patty Wight
No one likes paying medical bills, much less being over-billed. About five years ago, the federal government created a program to guard against overpayments in Medicare. It's called the Recovery Audit Contractor - or RAC - program. So far, it's identified about $5 billion in overpayments. But many hospitals say that's little return for the enormous administrative cost that's required to comply, and that the program does nothing to improve patient care. Patty Wight reports on what the RAC program means for Maine hospitals.
Patty Wight reports on a federal program Maine hospitals are complaining about that's intended to reduce Medicare over-billing.
What it means for Jessica Hibbard is a new job title, because dealing with RAC requests is a full-time gig. Hibbard is the audit coordinator at Franklin Memorial Hospital in Farmington.
"It wasn't my job at all to begin with. And then all of a sudden it began, and we realized that someone had to take that role over," she says.
The point of the RAC program is to make sure hospitals bill appropriately for the services they provide. Sometimes hospitals get money back if they under-billed. More often, it's the U.S. government that gets money back from over-billing.
Here's how it works: A RAC contractor, hired by the government, will ask a hospital for patient records. They'll check these out to see what was billed and why. It's Hibbard's job to compile, review, and send the requests. She's gotten as many as 100 at a time, and she keeps track of the mountains of records and charts in a gray filing cabinet that reaches as high as her shoulders.
"These accounts in the bottom three drawers are - as you can see, they're even packed quite tight," Hibbard says.
Compiling and sending the paperwork is only the beginning. As soon as a RAC request is made, it sets in motion a series of timeframes that Hibbard needs to keep track of. She juggles multiples of these at once. Some days, she says, the sounds emanating from her office reveal just how tedious and maddening it all is.
Medicare for all simplifies health care
By William D. Clark, M.D.
Portland (Maine) Press Herald, Letters, July 3, 2014
In his June 22 articles (“When college athletes get hurt, whose wallets should feel the pain?” and “USM ‘doing responsible things’ for athletes”), Mark Emmert explores the questions “Who pays?” and “Is it fair?” for injured University of Maine athletes. He interviews UMaine officials, caregivers, injured athletes and outside experts.
Any uninsured student entering UMaine must pay $3,000 for health care coverage, in addition to tuition. For serious injuries, like those Emmert describes, the athlete pays $10,000 for deductibles that generate seemingly endless mountains of bills.
UMaine buys insurance that kicks in after the deductible, paying $124,000 for it. UMaine pays $340,000 to provide injured athletes “free rehabilitation services.” Is UMaine doing enough for its athletes? Is it fair to other UMaine students to add a share of the $464,000 to their tuition?
We could establish a less complex, fairer and cheaper option than the one Emmert describes at UMaine. Health policy experts, economists, physicians and Congress people urge us to provide everyone with “improved Medicare for all.” Medicare for All is simple – from your first breath to your last one, you have access to private care, with choice of physician, hospital and rehabilitation facility.
Everyone pays when working (not when sick!), and everyone has the same comprehensive benefit package. It’s cheaper, and experts say more than $350 billion would be saved by changing from a profit-oriented system to a patient care-oriented one. The savings more than offset the $110 billion experts estimate would be required for health care for the currently uninsured.
Do you know that more than $30 million went to Aetna’s CEO in 2013? Why not offer what every other developed country does, and provide taxpaying citizens, UMaine athletes and other students a simpler, equitable and less costly health care option?
http://www.pnhp.org/print/news/2014/july/medicare-for-all-simplifies-health-care
Portland (Maine) Press Herald, Letters, July 3, 2014
In his June 22 articles (“When college athletes get hurt, whose wallets should feel the pain?” and “USM ‘doing responsible things’ for athletes”), Mark Emmert explores the questions “Who pays?” and “Is it fair?” for injured University of Maine athletes. He interviews UMaine officials, caregivers, injured athletes and outside experts.
Any uninsured student entering UMaine must pay $3,000 for health care coverage, in addition to tuition. For serious injuries, like those Emmert describes, the athlete pays $10,000 for deductibles that generate seemingly endless mountains of bills.
UMaine buys insurance that kicks in after the deductible, paying $124,000 for it. UMaine pays $340,000 to provide injured athletes “free rehabilitation services.” Is UMaine doing enough for its athletes? Is it fair to other UMaine students to add a share of the $464,000 to their tuition?
We could establish a less complex, fairer and cheaper option than the one Emmert describes at UMaine. Health policy experts, economists, physicians and Congress people urge us to provide everyone with “improved Medicare for all.” Medicare for All is simple – from your first breath to your last one, you have access to private care, with choice of physician, hospital and rehabilitation facility.
Everyone pays when working (not when sick!), and everyone has the same comprehensive benefit package. It’s cheaper, and experts say more than $350 billion would be saved by changing from a profit-oriented system to a patient care-oriented one. The savings more than offset the $110 billion experts estimate would be required for health care for the currently uninsured.
Do you know that more than $30 million went to Aetna’s CEO in 2013? Why not offer what every other developed country does, and provide taxpaying citizens, UMaine athletes and other students a simpler, equitable and less costly health care option?
http://www.pnhp.org/print/news/2014/july/medicare-for-all-simplifies-health-care
U.S. doctors migrating north
By Wendy Glauser
CMAJ (Canadian Medical Association Journal), June 19, 2014
TORONTO -- With the prospect of greater pay, fewer bureaucratic headaches and the opportunity to provide better care for patients, the number of American doctors migrating north is rising, according to Canadian recruiters and Canadian Medical Association data.
Susan Craig, president of the Toronto-based physician recruiter, Susan Craig Associates, said that Canada is becoming "increasingly attractive," while John Philpott, the Halifax-based chief executive director of Can-Am Recruiting, noted "interest is doubling each year for American doctors" seeking to move north.
Increased pay is the main driver of this interest. Philpott said family physicians, pediatricians and psychiatrists can make $100,000 more in Canada, on average, compared to the U.S.
According to data from the Canadian Medical Association, the number of U.S.-trained physicians grew less than 3% from 1996 to 2005 (up from 493 to 506), but jumped 42% from 2006 to 2014 (508 to 721).
The increase would be much higher, however, if estimates distinguished between specialists and family doctors, as the majority of U.S. physicians crossing the border are in family medicine, said Philpott.
In the U.S., thanks to insurance company loopholes and technicalities, American family physicians aren't paid up to 30% of the time, whereas under a single-payer system, only about 2% of his billings don't covered, explained Dr. Sajad Zalzala, a U.S.-trained family physician who moved to Windsor, Ont., in 2012.
Communicating with insurance companies and filing claims is so bewilderingly bureaucratic, in fact, that while "a family physician in Canada can manage with one or two secretaries, in the U.S., one doctor could need 10 secretaries," said the recruiter Susan Craig.
Even referrals are a headache as insurance companies often only pay for specific hospitals and specialists, added Zalzala.
The introduction of Obamacare isn't stemming the tide of U.S. physicians heading North. Quite the opposite, in fact.
"For every problem that Obamacare solves, it creates two to three other problems," said Zalzala. For example, the Blue Cross plan under the Affordable Care Act is different from the Blue Cross employer-paid plan, so doctors will have double the paperwork.
Canadian registration constraints
Depending on the regulations of the provincial Colleges of Physicians and Surgeons, U.S. doctors have to undergo a period of supervision (usually several months to a year) or must complete the Medical Council of Canada exams, or both, to obtain a full license to practice in Canada.
There are numerous procedural delays and doctors often have to show they have a job before they can start the process, which can lead to a period of unemployment, said Dr. Bridget Reidy, who moved north two years ago and has worked as a locum doctor in Prince Edward Island, as a full time physician in Ontario, and is about to start a job in BC.
"I think a lot more doctors would want to work in Canada if [the licensing process] was easier," she said, adding that the barriers are a shame as most provinces "desperately need doctors."
Since the credentials of U.S.-trained doctors are recognized by the Canadian College of Family Physicians (CCFP), Philpott doesn't understand why the provincial colleges put barriers up.
"The provincial colleges are slapping the CCFP in the face," said Philpott. "I guess they feel they have a greater understanding of certification than our own national bodies."
But Craig thinks the supervision is a "wise thing." There are billing practices and different drug names to be learned, and American doctors often feel the need to order more tests — a practice known as defensive medicine — to avoid lawsuits, she said. "In the U.S., they practice fairly intensive defensive medicine and in Canada we don't encourage that."
Another attraction for family doctors is that their work is more valued in Canada, said Reidy, who explained that U.S. patients tend to go to walk-ins or straight to specialists. "There's just not that understanding of the need for someone to be the captain of the outpatient care. Doing proper care becomes more difficult as a result," she said.
Dr. Jack Lucas, who works in forensic psychiatry in New York City and commutes to Owen Sound, Ont., to practice psychiatry two weeks every month, said he appreciates that his Canadian patients can access psychiatric services much more easily than in the U.S., and are supported through social programs rather than being "criminalized" like they are south of the border.
And Zalzala appreciates that the lack of a "defensive medicine" culture. "If I'm worried about missing something, it's because I'll feel terrible for the patient, not because the patient will come back and sue me," he said
http://www.pnhp.org/print/news/2014/june/us-doctors-migrating-north
CMAJ (Canadian Medical Association Journal), June 19, 2014
TORONTO -- With the prospect of greater pay, fewer bureaucratic headaches and the opportunity to provide better care for patients, the number of American doctors migrating north is rising, according to Canadian recruiters and Canadian Medical Association data.
Susan Craig, president of the Toronto-based physician recruiter, Susan Craig Associates, said that Canada is becoming "increasingly attractive," while John Philpott, the Halifax-based chief executive director of Can-Am Recruiting, noted "interest is doubling each year for American doctors" seeking to move north.
Increased pay is the main driver of this interest. Philpott said family physicians, pediatricians and psychiatrists can make $100,000 more in Canada, on average, compared to the U.S.
According to data from the Canadian Medical Association, the number of U.S.-trained physicians grew less than 3% from 1996 to 2005 (up from 493 to 506), but jumped 42% from 2006 to 2014 (508 to 721).
The increase would be much higher, however, if estimates distinguished between specialists and family doctors, as the majority of U.S. physicians crossing the border are in family medicine, said Philpott.
In the U.S., thanks to insurance company loopholes and technicalities, American family physicians aren't paid up to 30% of the time, whereas under a single-payer system, only about 2% of his billings don't covered, explained Dr. Sajad Zalzala, a U.S.-trained family physician who moved to Windsor, Ont., in 2012.
Communicating with insurance companies and filing claims is so bewilderingly bureaucratic, in fact, that while "a family physician in Canada can manage with one or two secretaries, in the U.S., one doctor could need 10 secretaries," said the recruiter Susan Craig.
Even referrals are a headache as insurance companies often only pay for specific hospitals and specialists, added Zalzala.
The introduction of Obamacare isn't stemming the tide of U.S. physicians heading North. Quite the opposite, in fact.
"For every problem that Obamacare solves, it creates two to three other problems," said Zalzala. For example, the Blue Cross plan under the Affordable Care Act is different from the Blue Cross employer-paid plan, so doctors will have double the paperwork.
Canadian registration constraints
Depending on the regulations of the provincial Colleges of Physicians and Surgeons, U.S. doctors have to undergo a period of supervision (usually several months to a year) or must complete the Medical Council of Canada exams, or both, to obtain a full license to practice in Canada.
There are numerous procedural delays and doctors often have to show they have a job before they can start the process, which can lead to a period of unemployment, said Dr. Bridget Reidy, who moved north two years ago and has worked as a locum doctor in Prince Edward Island, as a full time physician in Ontario, and is about to start a job in BC.
"I think a lot more doctors would want to work in Canada if [the licensing process] was easier," she said, adding that the barriers are a shame as most provinces "desperately need doctors."
Since the credentials of U.S.-trained doctors are recognized by the Canadian College of Family Physicians (CCFP), Philpott doesn't understand why the provincial colleges put barriers up.
"The provincial colleges are slapping the CCFP in the face," said Philpott. "I guess they feel they have a greater understanding of certification than our own national bodies."
But Craig thinks the supervision is a "wise thing." There are billing practices and different drug names to be learned, and American doctors often feel the need to order more tests — a practice known as defensive medicine — to avoid lawsuits, she said. "In the U.S., they practice fairly intensive defensive medicine and in Canada we don't encourage that."
Another attraction for family doctors is that their work is more valued in Canada, said Reidy, who explained that U.S. patients tend to go to walk-ins or straight to specialists. "There's just not that understanding of the need for someone to be the captain of the outpatient care. Doing proper care becomes more difficult as a result," she said.
Dr. Jack Lucas, who works in forensic psychiatry in New York City and commutes to Owen Sound, Ont., to practice psychiatry two weeks every month, said he appreciates that his Canadian patients can access psychiatric services much more easily than in the U.S., and are supported through social programs rather than being "criminalized" like they are south of the border.
And Zalzala appreciates that the lack of a "defensive medicine" culture. "If I'm worried about missing something, it's because I'll feel terrible for the patient, not because the patient will come back and sue me," he said
http://www.pnhp.org/print/news/2014/june/us-doctors-migrating-north
In Unhealthy Eastern Tennessee, Limited Patient Options Bring Some Of The Country’s Cheapest Premiums
by Jordan Rau
CHATTANOOGA, Tenn. -- Angela Allen’s struggle to ease her neck pain has been a huge pain in the neck.
Her regular spine doctor does not accept the new insurance she bought through the federal health marketplace. Allen, who has two slipped disks in her neck vertebrae, said the closest specialist she found who would see her and take her insurance works 34 miles away in another county. She belatedly learned that her physical therapist also is out of network and she owes $900. “It’s been a nightmare,” said Allen, a 42-year-old office manager.
Yet these restrictions carry an enviable price tag. At $187 a month, Allen’s policy is cheaper than almost any other midlevel, or silver, plan in the nation. Just a few miles across the Georgia border in Catoosa County, a similar plan would cost someone Allen’s age $348—86 percent more. “These new rates are really, really good,” said Russ Blakely, a Chattanooga insurance broker.
Chattanooga’s success in achieving bargain-priced policies offers valuable lessons for other parts of the country as they seek to satisfy consumers with insurance networks that limit their choices of doctors and hospitals. Nationwide, about 70 percent of the lowest-priced plans included narrow networks, according to the consultants McKinsey & Company.
But few places have put them into place as successfully as here in Eastern Tennessee, where BlueCross BlueShield of Tennessee, the area’s dominant insurer, cut a low price deal with one of the three big hospital systems to be the sole provider in their cheapest network. If all areas of the country had such low premiums, the federal government’s tab for subsidizing part of the cost of policies—totaling an estimated $29 billion for the fiscal year beginning Oct. 1—would be dramatically lower.
Low premiums here are striking because residents of Hamilton County, where Chattanooga is located, are more likely to be obese, smoke and suffer from hypertension than average, according to the Institute for Health Metrics and Evaluation, a Seattle-based research center. Yet premiums here are comparable to some of the nation’s healthiest regions: Minneapolis, Salt Lake City and Honolulu, where less demand for medical services allows for the nation’s least costly policies.
Though Chattanooga’s lowest cost silver plan is built around the well-regarded Erlanger Health System, some new buyers are miffed that the number of doctors is limited and their personal physicians are not included—even though that is a primary reason the premium is so low. Others view their new policies as adequately priced but nothing special. Still others who had been covered through a state program, where they only paid a third of the premiums, consider their new rates high in comparison.
Brian Taylor, a 36-year-old private investigator who had been uninsured, said he bought a $132 a month bronze plan with a $4,000 deductible because it was less expensive than being added to his wife’s employer-provided policy. “It’s probably a decent price, I guess, for what it covers,” said Taylor, who noted that he supported the insurance changes in the health law.
No comments:
Post a Comment