News In Healthcare

Can you believe that health­care is fol­low­ing the lead of appli­ance man­u­fac­tur­ers?  Well, one med­ical group in Penn­sy­la­nia is doing just that in an effort to encour­age hos­pi­tals and doc­tors to ren­der high qual­ity care and minimizing/eliminating costly mis­takes.  The New York Times reports that Geisinger Health Sys­tem is exper­i­ment­ing with a flat fee for surgery approach.  With that flat fee, the patient has 90 days of follow-up treat­ment for free — even if the patient suf­fers com­pli­ca­tions.  Geisinger is only test­ing this with one insurer at this point — which just hap­pens to be its own insur­ance unit.   After one year, Geisinger reported a reduc­tion in patients return­ing to ICU and fewer days in the hos­pi­tals.  While it still remains to be seen whether there is any merit to this approach, it is def­i­nitely one to watch.

Med­ical tech­nol­ogy is ter­rific.  Today, physi­cians can order a scan of a patient’s body part and obtain detailed images on a com­puter screen of malig­nan­cies or abnor­mal­i­ties.  And the image capa­bil­i­ties of today are even bet­ter than they were just 2–3 years ago.  But as the Baltimore-Sun reports,  not every­one is thrilled with the increased use of diag­nos­tic imag­ing.  The cost of this tech­nol­ogy has caused imag­ing to be the fastest grow­ing com­po­nent of med­ical costs — esti­mated cost is over $100 bil­lion annu­ally in the United States.  And as one would expect, as the costs for imag­ing increases, so does the scrutiny insur­ance com­pa­nies place on these pro­ce­dures prior to pay­ing for them.   The arti­cle details sev­eral sit­u­a­tions where patients had prob­lems get­ting their insur­ance com­pa­nies to pay for the nec­es­sary tests.  On the flip side, the arti­cle also explains why the insurer’s scrutiny is nec­es­sary - unnec­es­sary tests being ordered by physi­cians con­cerned about pos­si­ble mal­prac­tice claims.   

Blue Cross of Cal­i­for­nia and their poli­cies on rescind­ing patients’ cov­er­age has been the sub­ject of arti­cles for the past sev­eral months (see entries on 09/28/06 and 04/20/07).  Well, now in an effort to avoid any ongo­ing lit­i­ga­tion, Blue Cross of Cal­i­for­nia has agreed that it will only can­cel a member’s cov­er­age in the case of mem­ber decep­tion.  What does this mean?  As explained by the L.A. Times, Blue Cross will no longer rescind cov­er­age for a pol­icy holder’s hon­est mis­take or inad­ver­tant error in com­plet­ing their med­ical his­tory on the insur­ance appli­ca­tion.  This is good news for all Cal­i­for­nia res­i­dents who are human, and there­fore make mistakes.

On Decem­ber 6, 2006, we reported on the ini­tial effects states were feel­ing as a result of the new doc­u­men­ta­tion require­ments for Med­ic­aid enroll­ment man­dated by the Deficit Reduc­tion Act of 2005 (DRA).  The George Wash­ing­ton Uni­ver­sity Depart­ment of Health Pol­icy recently issued a Pol­icy Brief detail­ing the find­ings of a sur­vey of 300 health cen­ters and the impact the doc­u­men­ta­tion require­ments have had on their facil­i­ties.  In brief, the sur­vey found:

 a.  Almost 90% of all health cen­ters reported enroll­ment dif­fi­cul­ties for patients of all ages, includ­ing new­born children;

b.  For those health cen­ters report­ing a decline in their Med­ic­aid pop­u­la­tion, two-thirds of the respon­dents cited the doc­u­men­ta­tion process as the rea­son for the decline;

c.  One-third of the respon­dents have had to increase staff to han­dle the addi­tional admin­is­tra­tive chal­lenges with the appli­ca­tion and enroll­ment process; and

d.  Ini­tial find­ings esti­mate that the doc­u­men­ta­tion require­ments will elim­i­nate Med­ic­aid cov­er­age for between 105,000 to 320,000 pedi­atric and adult patients.

A dis­cus­sion about this Pol­icy Brief was held and is avail­able for view­ing.

America’s Health Insur­ance Plans (AHIP) released the results from its sur­vey of insur­ance plans and noted that 4.5 mil­lion peo­ple have enrolled in health insur­ance plans with health sav­ings accounts as of Jan­u­ary 2007.    The Amer­i­can Med­ical News report explains that the increase of 1.3 mil­lion over the pre­vi­ous year (43% growth) is sig­nif­i­cant but far less than the increase in enroll­ment between Jan­u­ary 2005 and Jan­u­ary 2006.  Dur­ing that time period, enroll­ment increased by 220%.

But let’s read this infor­ma­tion another way.  As stated in the AHIP press release, the sur­vey shows 4.5 mil­lion Amer­i­cans are now cov­ered lower-premium, high-deductible health insur­ance plans that are offered in con­junc­tion with an HSA.  Open­ing an HSA is not manda­tory and ear­lier stud­ies have shown that a large major­ity of the pop­u­la­tion does not open the HSA.  So, what we are left with is a report that states that 4.5 mil­lion Amer­i­cans now have to pay more out of their pock­ets because their deductibles are much higher.

We are not talk­ing about Pres­i­den­tial Pri­maries.   New Hamp­shire was the first state in the nation to enact leg­is­la­tion which blocked phar­ma­ceu­ti­cal com­pa­nies access to data that iden­ti­fies physi­cians and other pre­scribers for use in their sales pitches.  The Man­ches­ter Union-Leader reports, how­ever, that the law was struck down last week by a fed­eral judge on the basis that the law vio­lates the First Amend­ment.  The judge said that while the law “attempts to address impor­tant pub­lic pol­icy con­cerns,” because the state was doing so by “adopt[ing] speech restric­tions as their method, courts must sub­ject their efforts to closer scrutiny.”  The New Hamp­shire Attor­ney Gen­eral is review­ing the deci­sion and decid­ing whether the State will appeal.

Yes­ter­day, Pres­i­dent Bush cel­e­brated Cinco de Mayo in the White House Rose Gar­den with sev­eral famous and influ­en­tial Mexican-Americans.  The Pres­i­dent took the oppor­tu­nity to touch upon our need for immi­gra­tion reform.   He had spo­ken sev­eral times this week on our need for com­pre­hen­sive immi­gra­tion reform.   Since many peo­ple spec­u­late that the unin­sured cri­sis in Amer­ica is largely due to our exist­ing immi­gra­tion poli­cies, this is a topic that health­care providers should fol­low closely — despite the fact that the reform pack­age does not specif­i­cally address health­care.  The reform pack­age has five main goals:

1.  Secur­ing the Border

2.  Cre­at­ing a Tem­po­rary Worker Program

3.   Hold­ing Employ­ers Account­able for the Work­ers They Hire

4.  Resolv­ing the Sta­tus of the Mil­lions of Ille­gal Immi­grants Already in the Country

5.  Find­ing New Ways to Help New­com­ers Assim­i­late Into Our Society

Well, the state of Vir­ginia thinks so.  Vir­ginia recently amended its laws to allow chil­dren, 14-years and older, to play a part in mak­ing deci­sions about their med­ical care.  As reported in the Amer­i­can Med­ical News, the new law pro­hibits par­ents from being charged with neglect if they, together with their child, make a deci­sion to refuse med­ical treat­ment for a life-threatening condition. 

Blue Cross lost another law­suit brought against it by med­ical providers who claimed that the insur­ance giant did not pay them cor­rect.  The Jack­sonville Busi­ness Jour­nal reports that a jury ordered Blue Cross Blue shield of Florida to pay $1.5 mil­lion to hos­pi­tal pathol­o­gists.  The suit stems from a deci­sion that Health Options HMO made years ago to stop pay­ing the pro­fes­sional com­po­nent of clin­i­cal pathol­ogy med­ical ser­vices to hos­pi­tal pathol­o­gists.  The attor­ney for Florida Pathol­ogy Ser­vices said BCBS saved $4.1 mil­lion per year by not pay­ing the pro­fes­sional com­ponenet.  Blue Cross says it will appeal this decision.

Ear­lier this year, Sen­a­tor Ben­nett (R-Utah) intro­duced the Healthy Amer­i­cans Act (S. 334) which would pro­vide for health care cov­er­age for all Amer­i­cans by remov­ing employ­ers from the equa­tion.  As explained in the Desert News, peo­ple would be required to have insur­ance and it would no longer be tied to a person’s employ­ment.  Instead, the employ­ers would pay the indi­vid­u­als more so they could get cov­er­age on their own.   This bill hasn’t moved much since being intro­duced in Jan­u­ary, how­ever, sup­port­ers to the notion have recently been speak­ing out.  The inter­est­ing piece to note is that this uni­ver­sal health care cov­er­age was intro­duced by a Repub­li­can.  In response to this obser­va­tion, Ben­nett stated that his bill is not per­fect but that the time has come to get some res­o­lu­tion to this issue.