Billing dispute leads to blocked patient data in Maine
Vendor’s action may point to broader risks
When staffers at a ti1ny medical practice in far-northern Maine arrived at work one July morning and tried to view medical records for that day’s patients, they got an unsettling response from their computer.
“Access denied.’’
The staff called a technician, who confirmed what had happened. As part of a billing dispute, the vendor for the clinic’s electronic health records — a German corporation with US headquarters in Boston — took the unusual step of blocking the staff’s ability to look up medical histories on its 4,000 patients.
Nurses and physicians could no longer use the system to review diabetes records, blood pressure logs, medication histories, allergy reports, lab results. Nothing.
The company’s aggressive action poses what specialists in the field of digital health records say is a serious safety hazard for patients.
“It creates patient risk. It is dangerous, in my view,’’ said Dianne J. Bourque, a health care lawyer at Mintz Levin in Boston who specializes in regulatory and contract matters and is not involved in the case. “It’s a horrible, horrible remedy.’’
But the German health technology company, called CompuGroup, likens the situation to a utility customer who stops paying bills, saying a medical provider should similarly expect its medical records to go dark. A couple of weeks after the July morning when the records were shut down, a CompuGroup lawyer at its US headquarters in Boston delivered an ultimatum, via e-mail: Until the medical office, Full Circle Health Care, paid $20,000 in overdue charges, the electronic health records would remain locked.
“I’m incredulous they think it is OK to hold us hostage like that,’’ said E. Victoria Grover, the physician assistant who owns and operates Full Circle. The financially struggling practice, with about 10 employees, is located in Presque Isle, a city that has its own hospital but is located in a rural region that lacks easy access to medical care.
Grover acknowledged that Full Circle stopped paying CompuGroup $2,000 monthly fees about 10 months before the shutoff. But she said that was after months of fruitless haggling over what she considered exorbitant, unexpected maintenance fees and charges for hardware that was never delivered — disputed billings that she said CompuGroup refused to acknowledge or correct.
In Context, Health Premium Increases Don’t Actually Look Like Increases
In the Affordable Care Act marketplaces, which now serve 7.3 million Americans, some premiums are going up while others are going down. Based on data available so far, we reported last week that the average premiums for last year’s most popular plans would rise 8.4 percent, but thatpeople willing to switch plans could get much better deals — an average 1 percent increase, and even decreases in some markets.
But is 8.4 percent an alarming increase or a good deal for a plan you like? Is a 1 percent increase a disappointment or a terrific bargain? To put both increases in context, we’ve assembled some historical data on insurance markets that existed before the Affordable Care Act.
None are a perfect comparison group — there are many reasons the new marketplaces and the people shopping there are different from customers in the older markets. But, taken together, they can give us some sense of whether the health law is giving customers a good deal on insurance.
The overall assessment: By nearly any comparison, the average 1 percent premium increases available to consumers willing to switch plans is remarkably low. We are in a period of record-low health-care spending growth. But even in this period, premium increases lower than inflation are unusually good news.
Premium Increases in the Individual Insurance Market
Before the Affordable Care Act, big annual increases in individual market premiums were the norm.
+9.9%
+10.8%
+11.7%
Even the average 8.4 percent increase for people who renew in the most popular plans falls within the range of historical increases in the individual market. It’s not on the low end, but it’s not in the category of runaway premium growth that many critics of the Affordable Care Act warned might be coming.
Recall that back before January, when the marketplace plans launched, the individual insurance market was a very different place. Insurance companies were free to exclude customers with previous illnesses. People tended to cycle in and out of coverage very frequently as their income and employment status changed.
And regulations in some markets limited the amount that insurers could vary premiums by age, making products unaffordable for many young, healthy customers.
But the old individual market still remains the best comparison group for the new individual market — the Affordable Care Act marketplaces. By that standard, even an 8.4 percent annual increase looks pretty good.
A Commonwealth Fund study conducted by the M.I.T. economist Jonathan Gruber this summer found that, before the Affordable Care Act passed, premiums were rising by higher rates: 9.9 percent in 2008, 10.8 percent in 2009 and 11.7 percent in 2010. Those are average rates. As in the current marketplaces, there was a lot of local variation in price increases.
The employer market has seen smaller recent increases, but that market has not seen an average 1 percent increase in recent memory. The Kaiser Family Foundation recently published its 16th annual survey of employer health plans. It found that 2014 was a year with a record-low premium increase for family plans: 3 percent. That number makes 8.4 percent look less rosy. But the 1 percent available to marketplace switchers looks good.
By Medicare standards, an 8.4 percent increase seems absurdly high. Medicare, the public insurance program for those 65 and over and the disabled, is enjoying a period of unusually slow growth. In that program, per capita spending is quite flat, and looks to be going down over the next few years.
Medicare’s spending numbers are helped by demographic changes. The baby boomers began aging into the program in 2011, pulling down the average age of beneficiaries and making the population in the program healthier. Since 2006, when the Medicare Part D prescription drug benefit went into effect, annual per capita spending growth has been less than 5 percent — and in the last two years, it’s been less than 1 percent.
A Cancer Battle We Can Win
THE war against cancer can be confusing, with providers, insurers and policy makers debating the effectiveness of treatments, prevention programs and research. But there is one significant victory within our grasp. There is, increasingly, a consensus that CT screening for lung cancer can save thousands of lives each year.
Lung cancer, the No. 1 cancer killer, claims the lives of approximately 435 people in the United States every day. In fact, more women die of lung cancer each year than breast, ovarian and uterine cancers combined. While lung cancer is curable with surgery in its early stages, most people are given diagnoses of lung cancer after symptoms develop, when the disease is often advanced and resistant to treatment.
Now, however, there is good evidence that we can reduce the number of people who die of this devastating disease. A recent study called the National Lung Screening Trial proved that we do that by using a low-dose CT scan to detect early stage lung cancer. The study showed that in older people, both current and former heavy smokers, annual screening reduced the number of deaths from lung cancer by 20 percent.
How to help ensure you die on your own terms
Earlier this year, Gary Spivack and his sister Betsy Goodkin lost their mother to cancer. Between her first diagnosis and her death in April, her children say, their mother was determined to overcome her illness.
"She was a very stubborn and proud person who fought this and had a lot of support from immediate family and a lot of friends," says Spivack, 49, a music industry executive who lives in Pacific Palisades.
"She was going to live out her final minutes as healthy and fighting it as much as she could," adds Goodkin, 51, who describes herself as a "full-time mom" in the Cheviot Hills neighborhood of Los Angeles.
But even as their mother fought to stay alive and healthy, her children say, she made her end-of-life wishes known: If death was imminent, she wanted no heroic measures taken to save her life. And she insisted on dying at home.
They said their mother passed away April 13 in just the manner she had hoped: She was in her own bedroom with the lights low and the mood peaceful. She held hands with loved ones as she passed.
Dr. Neil Wenger, director of the UCLA Health Ethics Center, said most patients would prefer to die that way, but few actually do. That's because they fail to put their final request in writing, he says.
Without advanced planning, he says, most people die in hospital intensive care units, "in not the most dignified circumstances, in a way most say they don't want to die."
Why the gap between what people say they want at the end of their lives and what actually happens? There are many reasons.
A recent study published in the American Journal of Preventive Medicine found that lack of awareness is the most common reason people cite for not having written instructions prepared in advance.
Denial is at play too.
"People go into a mode of thinking — and are encouraged to — that 'if I just apply enough technology I will survive it,'" says Barbara Coombs Lee, president of Denver group Compassion & Choices. They even continue "in that mode of thinking when it's perfectly obvious they are actively dying."
Health advocates eye new neighborhood-level ACA enrollment data - Bangor Daily News
Maine health advocates gearing up for a second round of health insurance signups under the Affordable Care Act are analyzing new federal figures that shed light on their initial success.
The U.S. Department of Health and Human Services released new data this week detailing health insurance enrollment under the law by ZIP code. Statewide, 44,000 people signed up for plans through Healthcare.gov, the federal insurance marketplace launched under the health reform law.
The new data show how many plans were purchased between Oct. 1, 2013, the first day of open enrollment for plans taking effect in 2014, and April 19, 2014, the final enrollment day after federal officials approved an extension for individuals who had already started the process.
Unsurprisingly, more health plans were purchased in Maine’s populous ZIP codes in the Portland area, Bangor, Brunswick and Lewiston, the data show. But due to privacy concerns, the figures omit data for ZIP codes where residents purchased fewer than 50 plans, leading to underestimates for many of Maine’s rural areas, said Emily Brostek of Consumers for Affordable Health Care.
The data account for 39,600 Healthcare.gov plans purchased in Maine, about 90 percent of the 44,000 U.S. HHS reported in May.
The Augusta advocacy group, as part of a statewide network of consumer “navigators” and assisters, is now preparing its outreach push for the second ACA enrollment period, which kicks off Nov. 15 and ends Feb. 15, 2015.
“It’s really great planning for people like us who are trying to decide, as we go toward the next open enrollment, where are the places that might need more help or might need more resources?” Brostek said.
Some rural towns could benefit from more resources to help residents enroll, she said. While more than 1,000 health plans were purchased in Bangor, Brostek said Penobscot County overall fell short of enrollment hopes. Piscataquis County could similarly benefit from more targeted outreach, which the local community action plan will provide this fall, she said.
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