The Medical Bill Mystery
By ELISABETH ROSENTHAL
MAY 2, 2015
CONFESS I filed this column several weeks late in large part because I had hoped first to figure out a medical bill whose serial iterations have been arriving monthly like clockwork for half a year.
As medical bills go, it’s not very big: $225, from a laboratory. But I don’t really want to pay it until I understand what it’s for. It’s not that the bill contains no information — there is lots of it. Test codes: 105, 127, 164, to name a few. CPT codes: 87481, 87491, 87798 and others. It tells me I’m being billed $29.90 for each of nine things, but there is an “adjustment” to one of $14.20.
At first, I left messages on the lab’s billing office voice mail asking for an explanation. A few months ago, when someone finally called back, she said she could not tell me what the codes were for because that would violate patient privacy. After I pointed out that I was the patient in question, she said, politely: “I’m sorry, this is what I’m told, and I don’t want to lose my job.”
I have spent the last two and a half years reporting and writing about medical costs, and during that time I have pored over hundreds of patients’ bills. And while I’ve become pretty adept at medical bill exegesis, I continue to be baffled by how we’ve come to tolerate the Kafkaesque stream of nonexplanations that follow health encounters.
Income Inequality Is Costing the U.S. on Social Issues
Eduardo Porter
Thirty-five years ago, the United States ranked 13th among the 34 industrialized nations that are today in the Organization for Economic Cooperation and Development in terms of life expectancy for newborn girls. These days, it ranks 29th.
In 1980, the infant mortality rate in the United States was about the same as in Germany. Today, American babies die at almost twice the rate of German babies.
“On nearly all indicators of mortality, survival and life expectancy, the United States ranks at or near the bottom among high-income countries,” says a report on the nation’s health by the National Research Council and the Institute of Medicine.
What’s most shocking about these statistics is not how unhealthy they show Americans to be, compared with citizens of countries that spend much less on health care and have much less sophisticated medical technology. What is most perplexing is how stunningly fast the United States has lost ground.
The blame for the precipitous fall does not rest primarily on the nation’s doctors and hospitals.
The United States has the highest teenage birthrate in the developed world — about seven times the rate in France, according to the O.E.C.D. More than one out of every four children lives with one parent, the largest percentage by far among industrialized nations. And more than a fifth live in poverty, sixth from the bottom among O.E.C.D. nations.
Among adults, seven out of every 1,000 are in prison,more than five times the rate of incarceration in most other rich democracies and more than three times the rate for the United States four decades ago.
The point is: The United States doesn’t have a narrow health care problem. We’ve simply handed our troubles to the medical industry to fix. In many ways, the American health care system is the most advanced in the world. But whiz-bang medical technology just cannot fix what ails us.
Almost 40% of California hospitals graded C or lower for patient safety
By CHAD TERHUNE AND DOUG SMITH
By CHAD TERHUNE AND DOUG SMITH
Nearly four in 10 California hospitals received a grade of C or lower for patient safety in a new national report card aimed at prodding medical centers to do more to prevent injuries and deaths.
The Leapfrog Group, an employer-backed nonprofit group focused on healthcare quality, issued its latest scores Wednesday, it said, so consumers and employers can be aware of poorly performing hospitals before using them.
"There is absolutely room for improvement," said Leah Binder, Leapfrog's president and chief executive, of figures showing that 37% of California hospitals received a C, D or F grade.
Grades were issued Wednesday to 2,523 U.S. hospitals, including 248 in California.
The Times has published an interactive map of California hospital scores online in addition to other helpful hospital resources for consumers.
Since 2012, Leapfrog has been analyzing information it collects as well as data reported to Medicare.
The results indicate improvement in safety processes related to surgery and the use of computerized prescribing systems to avoid mistakes. But hospital performance on reducing infections, accidents and errors hasn't significantly improved, according to Leapfrog.
In Wednesday's data, 43% of California hospitals received an A rating — the seventh-highest rate among states nationwide. That's up from 40% three years ago.
Twenty-nine California hospitals have achieved straight A's on patient safety since Leapfrog began issuing ratings in spring 2012.
Healthcare giant Kaiser Permanente has 17 of its hospitals on that list, including its medical centers in West Los Angeles and Riverside.
Other straight-A performers across the Southland include Saint John's Health Center in Santa Monica, Long Beach Memorial Medical Center and Desert Valley Hospital in Victorville.
Cedars-Sinai Medical Center earned a B grade and UCLA's Ronald Reagan Medical Center received a C.
Nationwide, medical experts say about 400,000 lives are lost annually to hospital errors. One in every 25 hospital patients will contract a new infection during their stay, according the U.S. Centers for Disease Control and Prevention.
California's individual health insurance market grows 64% to 2.2 million
By CHAD TERHUNE
The number of Californians buying individual health insurance soared 64% to nearly 2.2 million as Obamacare took full effect last year, a new report shows.
In California, 843,607 people joined the individual market both inside and outside the Covered California insurance exchange, as of Dec. 31, 2014.
California and three other states -- Florida, Texas and Georgia -- accounted for about half of the enrollment growth nationwide for individual policies, according to the Kaiser Family Foundation report released Wednesday.
Nationally, 15.5 million people had purchased their own individual health policy by year's end. That's up 4.8 million, or 46%, from December 2013.
The Affordable Care Act triggered a major overhaul of the health insurance market by guaranteeing people coverage regardless of their medical conditions and providing financial subsidies to lower-income consumers.
The healthcare law also requires most Americans to purchase health insurance or pay a penalty.
Nearly half of Californians continue to get their health benefits through their employer, but the percentage of California firms offering coverage to workers has been falling in recent years.
Fifty-eight percent of California employers offered coverage to their workers last year, compared with 69% in 2010, according to the California HealthCare Foundation.
The analysis of the individual market published Wednesday by the Kaiser Family Foundation relied on insurers' state regulatory filings as of Dec. 31. The figures don't include the entire open enrollment period, which ended in February.
Survey: 42% of Texans support single payer
Health care survey yields surprises for the medical community
By Jenny DeamThe Houston Chronicle, April 27, 2015
Not only do the vast majority of Texans think having insurance is important for them and their families, seven in 10 also want health coverage for everyone else.
And they are willing to dig into their pockets to pay for it.
The results of a first-of-its-kind survey measuring attitudes of state residents on health care and insurance coverage elicited surprise and some dismay among the scores of medical professionals gathered Monday at the start of a conference in downtown Houston.
Earlier this year the Texas Medical Center commissioned Nielsen to poll 1,000 Texans over 18 on a variety of topics surrounding the shifting landscape of health care, including how important insurance was to them, whether everyone should have insurance, who should pay for it and what role patients and doctors have in decision making.
Half of those surveyed said having health insurance for themselves and their family was "absolutely essential," and another 33 percent said it was "very important." Only 5 percent said coverage was not important at all.
In addition, 70 percent said they thought it important that the nation have universal health care coverage, with 36 percent calling it "extremely important." Thirteen percent said coverage for all was "not important at all."
But the answer to who should pay for coverage seemed to take the doctors and health care executives in the audience by surprise.
Before Dr. Arthur "Tim" Garson Jr., director of the Health Policy Institute for the Texas Medical Center, presented the finding, he asked the audience to guess the result. Many signaled they assumed people wanted insurance to come from employers or the marketplace.
But in fact, the survey showed that 42 percent of Texans favored a tax-supported single-payer plan, something akin to Medicare for everyone. Twenty-seven percent of those polled thought it should come from employer plans and 12 percent answered it should come from the marketplace.
Still, residents did not expect the government to foot the whole bill, the survey showed. Eighty-one percent, including those who earn the least amount of money, were willing to pay at least something out of pocket to guarantee universal coverage.
That lowest-income group, making less than $25,000 per year, said they would pay an average of $47 a month for universal coverage.
"I think that's a lot," said Garson, adding that he found it significant that those whose budgets are stretched thinnest were still willing to pay to guarantee coverage for others.
Also stumping the audience was a question about whether patients want everything medically possible done for them at the end of their lives. Nearly two in three survey respondents answered yes, much to the surprise of the gathered medical professionals, who assumed otherwise.
The survey also found a majority of Texans think foods that lead to obesity should be more expensive. Fifty-two percent said they would support a "fat tax." They also said people with poor health habits should have to pay more for health insurance.
http://www.pnhp.org/print/news/2015/april/health-care-survey-yields-surprises-for-the-medical-community
Why this U.S. doctor is moving to Canada
After five years of constant fighting with multiple private insurance companies to get paid, Dr. Emily Queenan decided to try her luck up north
By Emily S. Queenan, M.D.The Toronto Star, April 28, 2015
I’m a U.S. family physician who has decided to relocate to Canada. The hassles of working in the dysfunctional health care “system” in the U.S. have simply become too intense.
I’m not alone. According to a physician recruiter in Windsor, Ont., over the past decade more than 100 U.S. doctors have relocated to her city alone. More generally, the Canadian Institute for Health Information reports that Canada has been gaining more physicians from international migration than it’s been losing.
Like many of my U.S. counterparts, I’m moving to Canada because I’m tired of doing daily battle with the same adversary that my patients face – the private health insurance industry, with its frequent errors in processing claims (the American Medical Association reports that one of every 14 claims submitted to commercial insurers are paid incorrectly); outright denials of payment (about one to five per cent); and costly paperwork that consumes about 16 per cent of physicians’ working time, according to arecent journal study.
I’ve also witnessed the painful and continual shifting of medical costs onto my patients’ shoulders through rising co-payments, deductibles and other out-of-pocket expenses. According to a survey conducted by the Commonwealth Fund, 66 million – 36 per cent of Americans -- reported delaying or forgoing needed medical care in 2014 due to cost.
Gilead Hepatitis Drugs Brought In $4.55 Billion in First Quarter
Sales of Gilead Sciences’ drugs to treat hepatitis Creached $4.55 billion in the first quarter, far exceeding already lofty Wall Street expectations but likely to focus attention once again on the overall costs to the health care system of the medicines.
Gilead said on Thursday that its new drug, Harvoni, had overall sales in the quarter of $3.58 billion, of which $3.02 billion was in the United States. This was the first full quarter of sales for Harvoni, which was approved in October.
Sales of Sovaldi, the older hepatitis C drug, fell to $972 million in the quarter from $2.27 billion in the first quarter of 2014 because it was supplanted by Harvoni. Combined, hepatitis C drug sales in the first quarter were double that of a year earlier.
The surging sales of the hepatitis C drugs have made Gilead one of the top earners in the pharmaceutical industry, with profits exceeding that of most older and bigger rivals. Earnings per share for the quarter doubled to $2.76 from the first quarter of last year.
The company on Thursday said it expected total product sales — for hepatitis C, H.I.V. and other diseases — of $28 billion to $29 billion this year, up from a projection of $26 billion to $27 billion it made in February.
The price of Gilead’s hepatitis C drugs — $1,000 a pill or more — and their popularity have strained the budgets of various insurers, state Medicaid programs and prison systems, leading them to impose restrictions on which patients can be treated.
The IMS Institute for Healthcare Informatics reported recently that growth in spending on prescription drugs in the United States grew 13.1 percent in 2014, to $373.9 billion, the fastest annual growth since 2001, driven in part by the hepatitis C drugs.
Medicare Releases Detailed Data on Prescription Drug Spending
By KATIE THOMAS and ROBERT PEAR
The heartburn drug Nexium — whose advertisements have long been ubiquitous on television — was prescribed to 1.5 million Medicare patients in 2013, for a total cost of more than $2.5 billion, the largest amount spent on any drug prescribed through the government program, according to data released by Medicare officials on Thursday.
The data was the most detailed breakdown ever provided by government officials about the prescription claims of Medicare beneficiaries. It included information about 36 million patients, one million prescribers and $103 billion in spending on drugs under the program’s Part D in the year 2013, the most recent year available. The data did not take into account rebates that the drug manufacturers pay to the insurers that operate the Medicare beneficiaries’ drug plans.
Although the government has previously released similar data to outside entities — including ProPublica, the nonprofit news group — officials said they decided to make the information available on a public website to encourage experts to weigh in, potentially leading to new solutions for policy challenges, like how to contain costs.
“We know that there are many, many smart minds in this country,” Sean Cavanaugh, a deputy administrator at the Centers for Medicare and Medicaid Services, said in a conference call with reporters on Thursday. “We are excited to unleash those minds and see what they can find in our data.”
Cystic fibrosis drug could bring millions to executives
Critics decry plan to compensate executives if costly new drug is profitable
By Robert Weisman GLOBE STAFF
Medicaid Expansion Proponents Make Their Case to Maine Lawmakers - Again
By PATTY WIGHT
AUGUSTA, Maine - Maine's Health and Human Services Committee is considering several bills that would expand Medicaid coverage under the Affordable Care Act.
From flat-out expansion, to various compromises, to putting the issue to referendum, they're the latest attempts in a now-annual battle to extend insurance coverage to about 20,000 low-income Mainers.
The idea behind these bills is to close what's known as the coverage gap. The Affordable Care Act was written to expand Medicaid coverage across the country, but a 2012 Supreme Court ruling allowed states to opt out. In non-expansion states like Maine, some low-income individuals now earn too much to qualify for Medicaid, but too little to qualify for subsidies to purchase Marketplace insurance plans.
If Maine closes that coverage gap and expands Medicaid, the federal government will reimburse at 100 percent through 2016. "Despite the fact that we have let two years slip away without expanding, the benefits remain just as pertinent, just as powerful, just as justified today, and some would say, more so," said Democratic Rep. Linda Sanborn, of Gorham, at a public hearing Thursday.
Sanborn said the federal injection of money would fuel the state economy, and expanding health coverage would lower overall health costs, not to mention provide needed healthcare. Sanborn points out that 26 other states have expanded Medicaid. "For those concerned about being an outliar, Maine is now in that category, and is the only state in the Northeast that does not help the working poor obtain coverage."
Two senators, including Republican Tom Saviello, proposed concept bills to allow lawmakers to tailor how Maine could expand Medicaid. Saviello says Maine should create a compromise plan modeled after other states, such as Tennessee or Wyoming. Those state plans require newly-eligible Medicaid recipients to pay for a portion of their insurance. "I ask you to look for the best way to do this. We have a great opportunity at hand," Saviello said.
Proponents of expansion ranged from uninsured Mainers, to a sheriff lamenting the need for coverage for mental health and substance abuse services, to providers, like Dr. Amy Madden of Belgrade. She recounted the experience of a middle-aged patient who struggled to manage his diabetes, high blood pressure, and high cholesterol without insurance. Madden says the man recently had a heart attack and had to leave his job. The irony, she says, is that his health is now so poor he qualifies for disability coverage.
Maine Attorney General Wants More Resources to Combat Medicaid Fraud
By THE ASSOCIATED PRESS • APR 23, 2015
AUGUSTA, Maine — Maine's attorney general is urging state budget writers to give her more resources to combat Medicaid fraud and elder abuse.
Attorney General Janet Mills wants to add a third attorney to the HealthCare Crimes Unit, which investigates and prosecutes Medicaid fraud and patient abuse and neglect in health care facilities.
Mills says in a statement that adding a third prosecutor will bring in a significant amount of state revenue while also improving the integrity of Maine's health care programs. She says the unit has recouped nearly $61 million in state and federal tax dollars since 2010.
The Judiciary Committee has unanimously endorsed Mills' proposal. The Appropriations Committee will now decide whether it ends up in the budget sent to lawmakers for approval.
CONTRIBUTING OP-ED WRITER
It’s Not Just About ‘Quality of Life’
Sandeep Jauhar
My patient had been having chest pains for several days before his heart stopped. Paramedics managed to revive him, but not before his lungs, kidneys and brain were severely damaged by the lack of blood flow. The prognosis was grim. A neurologist in the intensive care unit said the best possible outcome would be life in a persistent vegetative state.
Most doctors would recommend purely palliative treatment at this point, and that is what we did. There was no chance of organ recovery, little chance the patient could ever be weaned from the ventilator. However, his family members said they were willing for him to be in this state as long as he was alive. They asked us to start dialysis for his failing kidneys.
Of all the situations a doctor can encounter in a hospital, perhaps none is as nerve-racking as a so-called futility case. It has been estimated that there are at least 12,000 such cases in the United States every year, each typically costing hundreds of thousands of dollars. A vast majority are settled through discussions between doctors and patients’ families or mediation by a medical ethics team. But a large number cannot be resolved.
For most doctors, these cases present a crisis of conscience. How can we obey a central pillar of our profession — to do no harm — when we are forced to provide treatment that will only prolong suffering? Though doctors can refuse to treat patients under certain circumstances — for example, if a patient is violent or extremely intransigent — refusing to treat on the basis of conscience is controversial.
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