California lawmakers sidelined legislation that would have prohibited out-of-network hospitals from surprise billing privately insured emergency department patients, citing fierce pushback from hospitals, according to Kaiser Health News. Instead of billing patients directly, hospitals would have to work with health plans, leaving patients responsible only for their in-network copayments, coinsurance and deductibles. Hospitals’ opposition focused on a separate provision that limited the amount they could charge insurers for each service provided. An industry spokesperson criticized the provision as an unnecessary form of rate setting, however, proponents argue that protecting patients from high costs and capping what insurers pay hospitals are inextricably linked.
A survey of Virginia adults found that more than half of Virginia adults had problems affording healthcare during the last year, according to Virginia Business. Altarum’s Consumer Healthcare Experience State Survey also found that 78 percent of respondents worry about affording healthcare in the future. Data revealed that there was high support for government-led change crosses party lines. The top three healthcare priorities respondents want to see action on are addressing high costs (55 percent); preserving consumer protections (36 percent); and getting health insurance to those who cannot afford coverage (35 percent). The majority of respondents, regardless of political affiliation, indicated they supported government action to make it easier to switch insurance (89 percent); and requiring up-front patient cost estimates from healthcare providers (88 percent) and insurers (90 percent). Advocates agree that even with Medicaid expansion, healthcare affordability is still a top issue for all Virginians.
Heart attack patients treated at New Jersey hospitals with low hospital performance scores have a higher chance of having another heart attack or dying of cardiovascular causes than those treated at hospitals with high performance scores, according to NJ Spotlight. The study by Rutgers University, published in the American Journal of Cardiology, found that 3 percent of heart attack patients treated at low-scoring hospitals return to the low-scoring hospitals due to a new heart attack within 30 days. Those admitted to a teaching hospital were 25 percent less likely to be readmitted after a month than those admitted to a non-teaching hospital, and their chances of suffering cardiovascular death after a year were 10 percent lower.
New Hampshire has created a committee to study ways to help rural hospitals cope with for-profit health centers, like urgent care facilities, according to New Hampshire Public Radio. For-profit health clinics can provide more affordable health services to patients, but some hospitals have faced financial losses due to clinics opening nearby. Current law requires new health centers opening within 15 miles of a critical access hospital to be approved by the Department of Health and Human Services to avoid having an adverse impact on the essential healthcare services provided in the service area of the critical access hospital.
Both Medicaid members and commercially insured Coloradans have relatively good access to healthcare, according to a new analysis by the Colorado Health Institute (CHI). CHI’s Access to Care Index scores 25 measures of access on a scale of one to 10, with 10 being the best. Overall, Medicaid members scored 7.4 and commercially insured Coloradans scored 8.2. However, the index suggests that access to care for Medicaid members has room for improvement: those with commercial insurance have a better chance of finding a provider; the logistics of getting to the doctor are harder for Medicaid members; and that regardless of payer, obtaining preventive care remains hardest.
Using 2017 claims data available through the Colorado All-Payer Claims Database, an interactive map from the Center for Improving Value in Health Care (CIVHC) illustrates regional variation for 11 common services, according to AboutHealthTransparency.org. Though no one region had consistently high or low prices, some regions stand out. For example, the West region is the highest with respect to prices for five procedures – breast biopsy, C-section, hip replacement, knee arthroscopy and tonsillectomy.
Hawaii Medical Service Association, the Blue Cross Blue Shield of Hawaii, introduced Population-based Payments for Primary Care (3PC), a new capitation-based primary care payment system, in 2016. A study published in JAMA found that, in its first year, 3PC was associated with small improvements in quality and a reduction in primary care physician visits, but no significant difference in the total cost of care. Additional research is needed to assess longer-term outcomes as the program is more fully implemented and to determine whether results are generalizable to other healthcare markets.
A group of 10 Baltimore hospitals have pledged $2 million over two years towards a program that provides housing and medical services for people experiencing homelessness, according to the Baltimore Fishbowl. Funds from the partnership will provide homes and aid for 200 individuals and families, with medical organizations providing medical care and other services to break the cycle of homelessness. The program is designed to show that homeless individuals who receive treatment in permanent housing will ultimately see a reduction in healthcare costs.
New Jersey has passed a state law creating a state-based health insurance exchange to be funded by a 3.5 percent user fee on premiums, which currently goes to the federal government, according to Medical Daily. New Jersey estimates that the user fee will allow it to collect around $50 million a year to pay for marketing and enrollment fees. This action follows a 2018 law requiring all New Jersey residents to have health coverage or pay a penalty.
Hospitals in Wyoming charged private insurance plans more than three times what Medicare would pay for the same care in 2017, according to a national study that looked at 14 hospitals in the state and nearly 1,600 facilities statewide, according to the Casper Star Tribune. Of the 25 states studied, Wyoming had the second-highest disparity between Medicare and private insurance for outpatient services: Private plans were charged 302 percent more than Medicare, a difference of $8 million. Only Indiana had a higher disparity. SageWest Health Care in Fremont County had the highest relative price in the state: The hospital charged private insurance more than eight times what the facility was paid by Medicare. Representatives of the Wyoming Hospital Association responded to the report suggesting that Medicare “doesn’t pay the actual cost of delivering care,” and therefore should not be used as the “measuring stick.”