A $1 million grant to the University of Arkansas for Medical Sciences (UAMS) from Arkansas Blue Cross and Blue Shield will enable the UAMS Institute for Digital Health & Innovation to advance digital health statewide to provide more streamlined access to healthcare for patients, reports UAMS News. The first phase of the plan will focus on urgent care, in which patients will be able to consult with a medical professional by voice or video call to determine whether they need immediate care and how to obtain follow-up care. The second phase will develop digital approaches to providing primary care and certain specialized care, such as gynecology, ophthalmology, gastroenterology, oncology and orthopedics. Digital health approaches can reduce the cost of healthcare and improve access for patients, especially in a largely rural state like Arkansas.
California is facing a growing shortage of primary care physicians, according to Cal Matters. By 2030, the state could be short as many as 10,000 primary care professionals, including nurse practitioners and physician assistants. Some areas—the Central Valley, Central Coast and Southern Border region—will be hit especially hard. So too will be remote rural and inner-city residents, communities of color, the elderly, people with mental illness or addiction and those without health coverage. This could result in longer wait times and travel distances for doctor visits, as well as a reduction in preventative care and care for chronic conditions.
California hospitals provide significantly less free and discounted care to low-income patients since the Affordable Care Act (ACA) took effect, according to Kaiser Health News. As a proportion of their operating expenses, in 2017 general acute-care hospitals spent less than half as much on charity care as they did in 2013. Experts believe that the ACA is largely responsible for the reduction in charity care spending–with fewer uninsured patients, fewer patients seek financial assistance through the charity care programs. Currently, neither the state nor federal governments impose minimum requirements for charity care spending by hospitals, although the California Attorney General has created standards for a few nonprofit hospitals that have changed ownership in recent years.
California’s 2017 law addressing surprise medical billing for out-of-network (OON) non-emergency physician services at in-network hospitals is effectively protecting patients from surprise medical bills, according to a study in The American Journal of Managed Care. However, the law is also exacerbating provider consolidation, as a result of increasing insurers’ bargaining power in their negotiations with physicians. Specifically, an OON payment standard set at payer-specific, local average negotiated rates give insurers leverage to lower or cancel contracts with rates higher than their average as a means of suppressing OON prices. California’s experience demonstrates that OON payment standards can influence the payer–provider bargaining landscape, affecting network breadth and negotiated rates.
Though high prices at specific Colorado hospitals may correlate with higher quality for some services, price does not appear to predict or even reflect quality on balance, according to an analysis by the Colorado Business Group on Health and the Colorado Consumer Health Initiative. The report notes that hospital quality varies nearly as much within hospitals as it does across hospitals. Furthermore, hospital prices for routine healthcare procedures in Denver varied by more than 800 percent in 2017. The hope is that “Hospital Value Reports” such as this one will incentivize value by examining price and quality measures in concert.
Data from Colorado’s all-payer claims database show wide variation in the facility fees charged by hospitals and freestanding emergency departments, according to Modern Healthcare. For example, the Center for Improving Value in Health Care reports that for the highest severity level, the facility fees commonly ranged from $1,990 (25th percentile) to $4,700 (75th percentile), but can go as high as almost $48,000.
Connecticut’s Office of Health Strategy launched a free, online tool intended to help consumers, businesses and healthcare providers navigate the state’s vast system of care, reports The CT Mirror. The website’s two key elements–a quality scorecard and a cost estimator–will allow users to compare the quality and cost of medical care at 19 of the state’s healthcare organizations. Organizations are also evaluated on patient experience in four categories: office staff, provider communication, timely care and overall patient experience. In addition, users can compare the overall performance rating of provider networks across all quality measures. Connecticut is one of the first states to create a rating system that evaluates the performance of provider networks rather than individual providers.
The Center for Disease Control & Prevention recommends that Iowa spend $30 million annually on tobacco prevention efforts, but the state spends just $4 million, according to the Telegraph Herald. A report by the American Cancer Society shows that about 5,100 adults die in Iowa each year due to smoking and that Iowa has a relatively low tobacco tax rate: just $1.36 per pack, while the national average is $1.81.
More than 110 rural hospitals have closed nationwide since 2010, with profound consequences for the communities they served, according to Kaiser Health News. In Fort Scott, Kansas, ambulances responded to more than 80 calls for service and drove more than 1,300 miles for patients to get care in other communities during an 18-day period when the local emergency department was closed. In addition to delaying treatment for patients needing emergency care, the travel time prevented the crews from serving local needs and caused emergency vehicles to wear out faster. Increased reliance on air ambulances also causes problems for rural communities–though they can transport patients quickly, the dispatch system is not coordinated in many states and regions across the country. Moreover, many air ambulance companies do not participate in insurance networks, which can cost patients dearly.
Kansas has threatened to cancel insurer Aetna’s Medicaid contract if the company fails to resolve a number of long-running problems, reports KCUR. The state’s written complaint to Aetna in July stated that doctors and others struggle to secure provider credentials from the insurer, and that discrepancies in Aetna’s records mean Kansas can’t judge the adequacy of the company’s provider network for the state’s 100,000 Medicaid recipients. Additionally, providers claim they sometimes don’t get paid because Aetna demands advance permission for certain basic procedures and that the company hasn’t put together a complete directory of physicians and specialists. Aetna has reported that it has fixed several issues and that many of the other problems “are well on their way to compliance.”
Poplar Bluff Regional Medical Center has filed more than 1,100 lawsuits for unpaid bills in a rural corner of Southeast Missouri, where emergency medical care has become a standoff between hospitals and patients, according to The Washington Post. Three nearby hospitals closed for financial reasons in the past few years, leaving Poplar Bluff Regional as the last full-service hospital to care for five rural counties, treating more than 50,000 patients each year. As a result, the hospitals’ uncompensated care costs have risen from about $60 million to $84 million. Community residents are similarly at-risk of financial ruin. Over 35 percent have unpaid medical debt on their credit report, about double the national rate. The resulting lawsuits have become so routine that some people derisively refer to it as the “follow-up appointment.”
A new law in New Hampshire would give the director of the New Hampshire Charitable Trusts Unit the specific authority to ask merging health care organizations how the transaction will affect the community’s access to quality and affordable physical and mental health care services, according to Valley News. The law also increases the time the director has to review these proposed transactions and requires more than one public hearing on the proposals. Mergers have become more commonplace in New Hampshire and the U.S., though their value to consumers has been questioned, as exemplified in a 2018 analysis that found hospital mergers can eliminate competition and cause price increases.
The Centers for Medicare and Medicaid Services approved North Dakota’s request to develop a state-based reinsurance program under Section 1332 of the Affordable Care Act, according to a Health Affairs blog post. North Dakota’s reinsurance program will operate through 2024 and is expected to reduce 2020 premiums by 20 percent. The North Dakota Insurance Department waiver application stated that this program will encourage additional insurers to write business in North Dakota’s individual market, improve consumer access and lower rates.
A looming physician shortage in Ohio could make it difficult for patients to see a primary care physician, increase health disparities and raise costs as people are forced to turn to emergency room care, according to The Plain Dealer. By 2025, Ohio is projected to be short 1,200 primary care physicians (those in family medicine, internal medicine or pediatrics), estimates the U.S. Department of Health and Human Services. Recruiting primary physicians can be challenging due to pay inequities (primary care physicians make 30 percent less than specialists) and increased workload. Medical schools such as Case Western Reserve University School of Medicine are changing their recruitment and curriculum strategies to encourage more students to choose primary care.
Dozens of Oklahoma hospitals have filed more than 22,000 lawsuits against their former patients over unpaid medical bills since 2016, according to Oklahoma Watch. These billing practices highlight a heated debate in the medical community across the country. Consumer advocates argue that hospitals, especially those that are nonprofits, sue too often and should prioritize their moral obligation to their patients. Hospital officials say they already offer millions of dollars in charity care for those who meet certain income standards and that they only take legal action when necessary. Patients sued are at a disadvantage in court, because few people in these situations can afford a lawyer or know what steps to take.
Pennsylvania ranks 45th in the nation for per-capita public health spending, slightly ahead of Ohio, Kansas and Mississippi. The state spends $12 per capita on public health, according to data from the State Health Access Data Assistance Center (SHADAC). The data also show that state healthcare spending has been declining, going from $29 in 2005 to $13 per-capita in 2017. Though the state has made strides in fighting opioid and heroin abuse, funding for the public health component has remained flat. Other programs that enable people to live healthy and productive lives, such as General Assistance, were eliminated entirely, reports the Pennsylvania Capital-Star.
Seattle’s City Council adopted the Sweetened Beverage Tax in June 2017 to improve the health of the city’s residents, and address persistent health and education inequities, reports The Seattle Times. Evidence to-date shows the tax is funding programs that increase healthy food access, support child health and aid in early learning. However, its impact on reducing sales of sugary beverages is currently unknown. Nevertheless, evaluations of similar taxes imposed in Berkeley and Philadelphia revealed that sales of taxed beverages dropped substantially — by 9.6% and 38%, respectively.
Wyoming’s 1115 waiver application proposes to treat air ambulances like a public utility, with high fixed costs and universal service, and rely on free-market principles like competitive bidding and price transparency. Under the plan, Medicaid would: issue competitive bids; set up a centralized call center; make periodic flat payments to air ambulance providers; and articulate clear and transparent cost-sharing requirements. Though the state will assume short term risk to pay for this system, it will ultimately be self-funded. Health insurers would continue to cover air ambulance through up-front subscriptions or get billed by a state contractor on a fee-for-service basis. However, a Center on Health Insurance Reforms blog notes that the federal government still needs to approve the waiver proposal, after which Wyoming’s legislature would have to enact state-level legislative changes to enact the program.
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According to a study in JAMA, out-of-network (OON) billing is becoming more common and costly in both the emergency department and inpatient settings. A retrospective analysis using data from the Clinformatics Data Mart database (Optum), which includes private health insurance claims for individuals from all 50 states, examined inpatient admissions and emergency department visits. The mean OON amounts billed appear to be sufficiently large that they may create financial strain for a substantial proportion of patients.
UnitedHealthcare only spent 40 cents out of every dollar collected in premiums though short-term health plans, according to the National Association of Insurance Commissioners' 2018 Accident and Health Policy report. The average loss ratio, or the percentage of premiums spent on medical claims, of the five health insurers that bring in the most premiums from short-term insurance policies was 39 percent in 2018. Comparatively, the average loss ratio for ACA-compliant comprehensive plans purchased by individuals was 73 percent. Short-term plans provide fewer benefits as ACA-compliant plans. These plans can also deny coverage based on pre-existing conditions, according to Modern Healthcare. Approximately 86,600 people enrolled in 2018 and that number is slated to grow due to the Trump administration’s rule allowing insurers to extend the duration of short-term policies.
For the second year in a row, the percentage of large companies offering only high-deductible health plans has decreased to a quarter of employers—down from 30 percent in 2019 and 39 percent in 2018, reports Modern Healthcare. Evidence has demonstrated that high-deductible health plans have not resulted in workers being more informed and engaged with their care, as once predicted. Employers, whose healthcare costs grew slowly in 2018 compared to previous years, are starting to offer more plan options. To cut down on costs and improve healthcare quality, they are turning their attention to improving primary care. About half of companies surveyed said they will have at least one advanced primary-care strategy in place in 2020 with another 26 percent considering one for later.
In 2018, an average family of four with an employer plan spent $4,706 on premiums and $3,020 on cost-sharing, according to the Kaiser Family Foundation, with families contributing 67 percent more to their health benefits compared to a decade ago. During the same time period, wages and inflation increased by 31 percent and 21 percent, respectively. An analysis in FierceHealthcare, finds that in 2003 deductibles accounted for 20 percent of out-of-pocket spending—a number that grew to 51 percent by 2017.
As Americans continue grappling with rising healthcare costs, research indicates that a sizable group of people with employer healthcare are still spending a ton on their medical bills, reports Yahoo Finance. An estimated 23.6 million Americans with employer coverage had high premium contributions, high out-of-pocket costs, or both, according to a report published by the Commonwealth Fund.
The frequency of and price tags for surprise medical bills for emergency and inpatient services at in-network hospitals are on the rise, according to a study published in JAMA Internal Medicine, reports Healthcare Dive. The percentage of emergency department visits resulting in a surprise bill jumped from 32 percent in 2010 to 43 percent in 2016, while the increase for inpatient admissions went from 26 percent to 42 percent. The cost of the bill in both categories nearly doubled, with the top 10 percent of ED visits resulting in a patient bill of more than $1,000, and the top 10 percent of inpatient visits costing more than $3,000. The research adds to the growing evidence that surprise billing is becoming more prevalent.
The results of a Waystar survey reveal that consumers remain confused and frustrated when it comes to navigating the process of paying for their healthcare, reports Healthcare Innovation. The Waystar press release noted, “Waystar’s study finds patients between the ages of 18 and 39 are hardest hit, with more than one in three choosing to delay or forgo care to keep bills at bay. ‘Surprise billing’ plays a significant role here: when asked about their last medical procedure, one in three patients said the amount of the bill they received was more than expected.”
ACA Medicaid expansion has reduced the uninsured rate and uncompensated care costs in expansion states, while increasing affordability and access to care and producing state budget savings, according to a comprehensive review of research conducted by the Kaiser Family Foundation. The review found that Medicaid expansion has had a particularly large impact on uninsured rates in rural areas. Additionally, several studies show that people in expansion states have experienced reductions in unmet medical need because of cost, with national and multi-state studies showing those reductions were greater than reductions in non-expansion states. Multiple studies found that expansion was associated with significantly greater increases in overall or Medicaid-covered cancer diagnosis rates and/or early-stage diagnosis rates, decreases in smoking rates and improvements in access to mental health medications and services. However, studies show inconsistent findings about how Medicaid expansion affected ED use. Budget savings, revenue gains and overall economic growth occurred despite Medicaid enrollment growth initially exceeding expectations.
A report from Rutgers University’s Center for State Health Policy examines the implementation of Medicaid housing support demonstrations in four early-adopter states: California, Maryland, Illinois and Washington. The report describes preliminary observations regarding program design and characteristics of each state’s Medicaid housing support waiver and highlights the unique approaches these states are taking to address homelessness-related healthcare costs in Medicaid. Evidence suggests that states are off to a promising start, but more research is needed.
In rural communities, greater broadband access is associated with greater telemedicine use, according to a study published in JAMA. Counties with low broadband availability had 34 percent fewer telehealth visits per capita compared with counties with high broadband availability. Though the FCC’s Connect America Fund has provided billions in subsidies to expand broadband, the report’s authors note that they did not observe an association between broadband availability and telemedicine use in funded counties. Thus, more targeted funding to fully rural counties could help alleviate disparities in healthcare access.
A fiscal map and accompanying brief of funding sources for early childhood services in two areas (state of Maryland and Hennepin County, Minnesota) was released by the Center for Health Care Strategies. The fiscal mapping for these two sites revealed implementation considerations that include: identifying the goals of mapping, understanding how to capture key data, strategically considering staff resources, developing cross-sector collaboration, and establishing support from leadership. Both locations’ fiscal mapping is ongoing, though Maryland hopes to use its insight to inform future policy decisions that recognize social determinants of Health and Hennepin County hopes to consider how two-generational approaches are being implemented across programs that support children and families.
Accountable Care Organizations (ACOs) participating in shared savings contracts and serving rural and underserved areas was associated with lower Medicare spending compared to non-ACO providers, according to a study published in the New England Journal of Medicine. The study, funded by the Centers for Medicare and Medicare Services, also suggested that ACO participation in the CMS Accountable Care Organization Investment Model (AIM) was associated with reduced Medicare spending per beneficiary per month in its first year.
Care management and coordination activities by Accountable Care Organizations (ACOs) were not associated with improved outcomes for patients who were frail or had multiple chronic conditions, according to an AHRQ-funded study in JAMA Network Open, reports AboutHealthTransparency.org. Researchers reviewed survey responses from 244 ACOs with claims data from 1.4 million Medicare patients and found patients in the best-performing ACOs for care management and coordination activities did not have different outcomes as measured by hospital readmissions, hospital or emergency department visits, visits for evaluation and management services in outpatient settings, or healthcare spending compared with patients in lower-performing ACOs.
According to the AJMC, it appears that hospital participation in value-based programs encourages adoption and spread of care coordination activities. Hospital participation in an Accountable Care Organization (ACO) was associated with the adoption of slightly more than 3 more care coordination activities on average, and 0.16 more points on the scale of spread of care coordination activities compared with hospitals that were not in an ACO. Meanwhile, hospital participation in a bundled payment program was associated with the adoption of 1.84 more care coordination activities, but not greater spread.
Six of 19 low-value healthcare services were provided more frequently in the Military Health System when compared to civilian healthcare facilities, according to a study published in Health Affairs. Conversely, researchers found that 11 of the 19 services were more common in civilian care. Magnetic resonance imaging for low back pain emerged as the most common low-value service in both care environments and could represent a target for future interventions.
Shifts in cost-per-discharge and patient severity were consistent with take-up of insurance, according to a study published in Health Services Research. In states that expanded Medicaid, the rates of uninsured inpatient discharge rates across most groups decreased by 39 percent per capita, on average. In states that did not expand Medicaid, the uninsured utilization rates remained the same or increased, while inpatient costs increased for all insurance coverage classes in both states that expanded and those that did not expand Medicaid. However, the percentage increases in costs were smallest for the uninsured populations in expansion states (.2 percent) and largest for Medicaid patients in expansion states (11 percent). The change in estimated all-payer costs in expansion states was slightly higher than that of nonexpansion states for inpatient care, while the expansion states’ change in all-payer costs was slightly lower for ED visits than that of nonexpansion states.
Drug companies are still raising prices for brand-name prescription medicines, just not as often or by as much as they used to, reports the Associated Press. In the first seven months of 2019, drug makers raised list prices for brand-name prescription medicines by a median of 5 percent. That’s down from about 9-10 percent over those months in prior years. For years, many drug makers raised list prices on brand-name medicines up to three times annually, sometimes 10 percent or more each time. Now, companies are taking more of their increases in January, reaping the extra revenue all year and forgoing early summer hikes.
The Centers for Medicare and Medicaid Services announced that the marketplaces in all states will, for the first time, display quality rating data for most qualified health plans (QHPs), according to a Health Affairs blog post. The quality ratings—which reflect clinical quality data and enrollee satisfaction data—use a five-star system and will be displayed for most marketplace plans beginning on Nov. 1, 2019 (for the 2020 open enrollment period). The goal of the quality rating information is to increase transparency and help consumers make informed decisions about the plan they select. The ratings could also aid compliance oversight and help insurers improve the quality of their products.
Given that there is no gold standard for how a rating system should be constructed or perform, and no objective way to compare the rating systems, the strengths and weaknesses of four major public hospital quality rating systems were evaluated in the Rating the Ratersinitiative, reports the NEJM Catalyst. This study found several issues undermining all examined ratings systems, namely limited data and measures, lack of robust data audits, composite measure development, measuring diverse hospital types together, and a lack of formal peer review of their methods. This analysis offers guidance to stakeholders attempting to select a rating system for hospitals, and may offer existing rating systems some insights on how to improve.
Snake antivenin CroFab faces competition from another brand-name snake antivenin called Anavip. While Anavip could reduce readmissions by better controlling bleeding associated with a snakebite, few experts who study drug laws and drug prices expect this competition to reduce the cost for patients, reports NPR. The antivenin can be considered a case study of why drug prices are so high: head-to-head competition between two brand-name medicines may not meaningfully reduce prices. An analysis described in the New England Journal of Medicine in 2017 found competition only lowers prices after three or more generic drug manufacturers enter the market.
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Racism is a significant social determinant of health and has an impact not only on the children and families that are targeted, but also on those who witness it, according to the American Academy of Pediatrics. Chronic stress can lead to hormonal changes and inflammation, which set people up for chronic disease. The impact of bias starts well before a child is born, creating disparities in birth weight and maternal mortality. Studies show that mothers who report experiencing discrimination are more likely to have infants with low birth weight. Many of these outcomes could be shaped by unacknowledged biases on the part of medical professionals, according to The New York Times.
Multiple states, including Florida and Pennsylvania, have declared hepatitis A, a virus that affects the liver, a public health emergency. Though patients do recover, since 2016 the Centers for Disease Control and Prevention has reported ongoing outbreaks across 25 states affecting more than 20,000 people; 59 percent of these cases have required hospitalization. In California, a state where close to 69 percent of the homeless are unsheltered and live amid garbage and human waste, hepatitis A is rampant and difficult to control. It is difficult to achieve prevention and treatment compliance in the homeless and drug-using populations, and the problem of contaminated food and water remains unless the streets can be cleaned up and the homeless offered temporary shelter, reports The Hill. Without aggressive administration of the vaccine, and without shelters and drug treatment programs, hepatitis A will continue to surge and could soon become a national epidemic.
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