Posts Tagged ‘health policy’

Hospital Medicare Charges: You Don’t Always Get What You Want

Monday, June 8th, 2015

In early June of this year, the Centers for Medicare and Medicaid Services (CMS) let loose a treasure trove of data. One data set lists inpatient charges of 3,000 hospitals for the 100 most frequently billed diagnoses of 2013. The differences between what the hospitals billed and what Medicare paid are eye-popping, as are the differences between what hospitals within just a few miles of each other charged.

The inpatient data shows Medicare paid about $62 billion to cover more than 7 million discharges. Our good friends at Modern Healthcare have analyzed the data. This, from Modern Healthcare’s Bob Herman:

Hospitals have been under intense scrutiny for their billing practices, often triggered by extremely high charges—or sticker prices—for common procedures. Consumer groups and patient advocates argue hospital pricing is shrouded in secrecy, which has put patients on the hook for costly bills. But hospitals have said the listed charges are irrelevant because they only serve as a starting point for negotiations with insurers and that patients rarely, if ever, pay those prices.

The CMS data is shining a light on the process. The agency has now released data from 2011, 2012 and 2013. Charges for various inpatient and outpatient procedures differed significantly again in 2013 as they did in prior years. In many instances, charges fluctuated greatly among hospitals in the same region.

A Modern Healthcare analysis of the inpatient payment data shows Philadelphia, Los Angeles and Newark, N.J., had the largest gulfs in charges between the top and bottom hospitals. For example, in Philadelphia, the average difference in average hospital charges across all procedures was $123,847. In Los Angeles—an area rife with academic medical centers such as Cedars-Sinai Medical Center—the average difference between the highest-charging hospital and the lowest-charging hospital was about $112,000.

Did you catch the part about the listed charges being irrelevant, because they’re only starting points for negotiations? Reminds me of the last time I bought a car.

You might be tempted to say, “That’s crazy! Why do hospitals do that?” Let me answer with a little story.

A few years ago, I was a Trustee at a major teaching hospital in Massachusetts, a tertiary care facility, one of the biggies. At one Board meeting early on in my trusteeship I asked the CEO how the hospital was compensated for uninsured people who were indigent. His answer? “We charge them the moon.” Note to reader: he’s talking about the indigent patient, here. “Then, when the state’s uncompensated care pool gets around to paying us, we’ll get a lot more than if we just charged them what the procedure cost, in which case we’d get a lot less than what the procedure cost.” I never forgot that lesson in hospital economics.

So, you see, when hospitals say their charges are “starting points,” they’re telling the truth. And that is one spooky scary example of what a first-class horrendoma the American healthcare system (if you can call it that) has become.

Health Wonk Review, “Football Is Here” Edition at Colorado Health Insurance Insider

Thursday, September 13th, 2012

Check out a fun and smart Health Wonk Review – “Football Is Here” Edition posted by Louise Norris at Colorado Health Insurance Insider.
We don’t want to step on her toes here, just go read the whole edition, which is a pretty full one — Louise always does a very thoughtful job in framing each entry — but we would echo her recommendation to be sure to visit the post from Amy Berman – the first one in this edition. It’s so very worth reading and thinking about. Thank you Amy, and best to you!

Health Wonk Review, medical costs, price hikes, joint & several liability, and more

Thursday, December 11th, 2008

Health Wonk Review — The “Just the Facts, Ma’am” Edition – hosted by Vince Kuraitis at e-CareManagement – Dragnet fans take note!
NCCI report on medical benefits – The medical share of total losses has grown dramatically — from just over 40% in the early 1980s to almost 60% today. NCCI takes a closer look: Analyzing the Shift in the Medical Share of Total Benefits (PDF)
Price hikes forecasted – economists at Swiss Re are predicting a deep recession and price hardening across all lines of insurance through 2010, insurance and reinsurance inclusive.
Walmart death – This topic has been making waves in the law blogs. Troy Rosasco talks about the likelihood that exclusive remedy will preempt any lawsuits in the case of the trampling death of a Walmart employee in a post-Thanksgiving sale stampede, and talks about how the retailer could face criminal investigations. Of course, that doesn’t mean that lawsuits haven’t been filed – Eric Turkewitz updates us on the family bringing suit; Walter Olson offers his perspective on “5 minute after” suits. My colleague Jon had blogged about this last week: Walmart’s Killer Bargains.
Can you say Joint & Several liability? – a recent study profiled in Risk and Insurance shows that small business owners are not fully aware of the financial risks involved in obtaining workers’ compensation insurance through self-insured groups. Despite several high-profile failures, “…85 percent of respondents indicated that they had not seen, read or heard about the closure of several self-insured groups over the past year. More than one-half (58 percent) of respondents reported that they were unaware that companies belonging to self-insured groups remain financially responsible — often for years — for the claims of all companies in their group, not just their own businesses.” See: joint & several liability.
Fumes and confined space – We noted a sad story last month about two amateur winemakers in France who died after being overcome by fumes while trampling grapes. While this might sound like unusual circumstances, the issue of confined space and the danger of fumes is a significant agricultural risk. Hydrogen dioxide-related deaths (PDF) also occur in manure pits – there have been several instances when rescuers enter the pit only to succumb to the fumes as well.

Hot off the presses: Health Wonk Review

Thursday, October 30th, 2008

David Harlow of HealthBlawg has posted the Samhain edition of Health Wonk Review. If you are like me and don’t know what Samhain refers to, go and get yourself educumated – it’s interesting! As are all the entries in this last-call edition for health policy posts before the upcoming election. David is one of our long-time participants in the biweekly wonkery. If you wonder why he calls his site a “blawg” that is a little legal pun used to signify the blogger is an attorney. While many of our regulars are consultants and physicians, David brings also his perspective as an attorney to the legal, policy and business issues facing the health care community.

Health Wonk Review: Political Convention Style

Thursday, September 18th, 2008

Jaan Sidorov’s posted the Health Wonk Review, Political Convention Style at his Disease Management Care Blog, and it’s a good one. We have three more HWR’s before the election, and I think they will be a very good source of info on the candidate’s health plans. They should be a platform for some spirited debates among some very smart people!
A few financial links:
Freakonomics has a very good, plain-speaking overview on the recent financial upheavals as explained by Douglas W. Diamond Merton H. Miller Distinguished Service Professor of Finance and Anil K. Kashyap, Edward Eagle Brown Professor of Economics and Finance, both of the University of Chicago Graduate School of Business.
Countdown to an Insurance Giant’s Collapse – Eric Dash and Andrew Ross Sorkinof the International Herald Tribune offer a close up view of events as they transpired.
Interested in how various newspapers throughout the world are playing the U.S. financial news? You might enjoy Newseum which offers front page snapshots of 690 front pages from 63 countries. It can be an interesting resource when large events occur.

Health Wonk Review, scaffold survivor update, hand protection, and potential cancer cluster

Friday, June 13th, 2008

Jane Hiebert White has posted a great edition of Health Wonk Review: Washington Week at Health Affairs – and she notes that this issue coincides with Academy Health’s Annual Research Meeting held in DC this past week, a gathering based on the concept that health policy should be informed by research. In this HWR issue, one of the major themes centers on health care reform. It’s worth your time to check it out – it may be one of our biggest and most substantive issues yet.
Survival story – at the beginning of the year, we posted about miracle survivor Alcides Moreno who lived through a NY scaffolding collapse which sent him plummeting 47 stories. Today, the New York Post features a story about Moreno entitled 47-story guy walking tall. But not all the news associated with this story is good: his brother who was also on the scaffold was killed in the fall. Earlier this week, The New York Times covered the OSHA report about the accident, which found fault with City Wide Window Cleaning, the service that employed the Morenos, and Tractel, the firm that had repaired the scaffold.

OSHA issued five citations against City Wide for what it called serious violations. Three carried proposed fines of $7,000 apiece, the highest the agency can impose. One was for lack of a system to protect against falls — cables that would have left the Morenos dangling at the top of the building when the scaffold gave way.

Another citation against City Wide was for failing to train employees in how to inspect the scaffold, and for not training them to wear “personal protective equipment” before they stepped onto the rig. The article lists other charges against both companies. Commenting about the fines imposed, the Daily News editorializes that death comes cheap, noting that, “Financial penalties like that are meaningless as a deterrent to corner-cutting by contractors.”
Hand injury prevention – According to an article on hand injuries by Don Groce in Occupational Hazards, gloves can prevent injuries and reduce costs. Recent research shows that “The cost of hand injuries in just one sector of the construction industry is six times what it would cost those employers to offer every employee appropriate hand protection.” This preventive measure represents potential to reduce pain, reduce lost productivity, and save dollars. According to the CDC, hand injuries account for more than a million emergency department visits by U.S. workers per year. Groce’s article also discusses advances in glove manufacturing and various types of safety glove alternatives.
Dupont cancer cluster? – Celeste Monforton of The Pump Handle raises the question of whether there is a cancer cluster associated with Dupont in response to 19 cases of rare carcinoid tumors among DuPont employees, with 6 of the cases surfacing among workers at the Washington Works plant in West Virginia. She reports that adverse health effects have been associated with exposure to perfluorooctanoic acid (PFOA or C8), the chemical used to make Teflon and other non-stick surfaces.

Health Wonk Review, RIMS, emergency responders, mysterious pork worker illness

Thursday, May 1st, 2008

Daniel Goldberg has posted an excellent new edition of Health Wonk Review at his Medical Humanities Blog. This week’s roundup from the brainiacs of health wonkery encompasses everything from the usual health policy debates to alcopops, including a handful of posts on legal matters and new legislation.
RIMS – Joe Paduda of Managed Care Matters has been blogging his observations from RIMS this past week. He’s posted news from the pharmacy sector, notes an emphasis on outcomes, and discusses innovation.
Emergency responders – In response to a recent reader inquiry about injury rates among police, we unearthed a 2004 Rand report on Emergency Responder Injuries and Fatalities focusing on U.S. firefighting, law enforcement, and emergency medical services personnel. While a little dated, it’s still worth a read. The report notes that while data for firefighter injuries are readily available, there are significant gaps in available data for police and EMT injuries. Line-of-duty fatalities are tracked, data on the frequency, type, and duration of injuries can be harder to come by. We’d welcome any pointers to data sources from readers.
Minnesota pork plant workers to be compensated – At least 18 workers at the Quality Pork Processors plant of Austin have come down with strange, debilitating neurological illnesses. Those affected worked at or near the “head table” where compressed air was used to blow brains out of pig skulls. The brain matter turned into a fine mist, and health authorities believe that the workers’ exposure to this mist led to progressive inflammatory neuropathy, or PIN. The workers were initially denied workers compensation, but at least one worker has been notified that her claim will be honored so it sounds as though the insurer rethought matters, perhaps in light of some pending lawsuits.
Workers compensation is relatively clear cut when it involves injuries, but illnesses can pose numerous complexities and employees bear the burden of proof for demonstrating the work relatedness of the illness. With many illnesses, such as cancer, there can be delayed onset and it is difficult to prove that work and not some outside factor was the precipitating cause. In this ghastly case, medical authorities are still puzzled but have observed cases of the illness among pork workers in other states, all of whom were engaged in similar work at the “head table.” All plants have now discontinued this practice.

Health Wonk Review and some handy new tools

Thursday, January 24th, 2008

A new edition of Health Wonk Review is being hosted by Vince Kuraitis at e-CareManagement blog, including posts about in-store clinics, physicians, problems and solutions in health systems, and cats, dogs and kangaroos. Suffice it to say that this is the first time kangaroos have surfaced in HWR, and I will leave it to you to discover why. This edition is Vince’s debut as HWR host, and he carries out his duties with style and grace. His blog focuses on issues and trends in chronic disease management and technology. While there, you might check out his take on Disease Management Megatrends for 2008, a post which is also available in a 20-minute podcast version.
New tools for our sidebar
In other matters, here are a few handy tools that have recently come to our attention – we’ll be adding them to our sidebar:
Health careHealthExecLynx is a huge compendium of links related to all things health care – an absolute must for your bookmarks. It lists thousands of links, including health care news sources, blogs, associations, governmental concerns, career resources, and more – an excellent resource.
Safety signsSafety Sign Builder 2.0 – this free service includes a number of web-based tools that facilitate the creation of custom general and safety signs. Each Sign Builder tool has unique options designed to make the creation of any custom sign quick and easy. Build Hazmat signs, ANSI signs, or OSHA-compliant Lockout Tags in English and in Spanish. Safety Sign Builder 2.0 is sponsored by St. Claire, Inc.
OSHA – OSHA recently announced eight new OSHA Training Institute (OTI) Education Centers. Current OTI Education Centers offer training courses on OSHA standards and occupational safety and health issues. The Centers provide safety and health training to private sector and federal personnel from agencies outside OSHA.

Health Wonk Review and news roundup

Thursday, January 10th, 2008

Bob Laszewski of Health Care Policy and Marketplace Review has posted the first Health Wonk Review of 2008, and it’s a good one because people had to save up their best posts over the last month since we had a short hiatus. Many entries focus on analysis of the presidential candidates’ positions on health care, which will be one of the hot-button issues for the coming election.
A deadly year for public servants – Celeste Monforton of The Pump Handle tells us that 2007 was a deadly year for law enforcement officers, with a 28 percent increase in on-the-job fatalities compared to 2006. Shooting deaths were up 33% and traffic fatalities up 10%. And Occupational Hazards reports that 115 on-duty firefighters died in 2007. Fire Administrator Greg Cade labels 2007 it “one of the most tragic years for firefighters in recent memory.”
High cost of chronic diseaseAn Unhealthy America – the economic burden of chronic disease – is a good reference site to bookmark. Find specific prevalence and costs by disease or by state.
From the courts – Peter Rousmaniere at Working Immigrants posts about a recent South Carolina Supreme Court ruling upholding the right for illegal immigrants to receive workers comp benefits. Courts continue to protect workers who are injured on the job, regardless of legal status. Justice James E. Moore stated that “…disallowing benefits would mean unscrupulous employers could hire undocumented workers without the burden of insuring them, a consequence that would encourage rather than discourage the hiring of illegal workers.” In making its decision, the court cited prior decisions by North Carolina, Florida, Georgia, Maryland, and Minnesota.
Laptop safety – By their very design, laptops force users into awkward positions so prolonged use can result in muscular fatigue in various body parts and may lead to repetitive stress injuries. Laptop Ergonomics discusses the particular safety hazards related to using laptops and offers recommendations to help help reduce the risk of developing injuries. Hat tip to Ergonomics in the News for the pointer.
Weighty mattersStudy links obesity to absenteeismOccupational Hazards reports on a recent study that links increased rates of absenteeism to morbid obesity, putting the cost at $4.3 billion per year in the United States.

News roundup: Health Wonk Review, survival story, manhole covers, I.C.E. followup, OSHA agenda

Thursday, December 13th, 2007

David Harlow hosts the holiday edition of Health Wonk Review at Health Blawg, our final edition of the year. As one of the few attorneys in our HWR lineup, David lends a unique and valuable perspective to our discussions. Today, he sheds light on a variety of health matters in what may well be the largest edition of the year. Grab some coffee and holiday cookies – there’s enough good reading to carry you into the New Year.
Survival story – Thanks to Jordan Barab for calling our attention to this follow-up story to the recent scaffolding tragedy in New York: After a Window Washer’s 47-Floor Plunge, the Big Question Is: How Did He Survive?
NYC to India and back again – A freelance photographer for the New York Times captures a work scene out of the Middle Ages in India, and it happens to be a foundry with a local link: New York Manhole Covers, Forged Barefoot in India. Here’s an excerpt:

When officials at Con Edison — which buys a quarter of its manhole covers, roughly 2,750 a year, from India — were shown the pictures by the photographer, they said they were surprised.
“We were disturbed by the photos,” said Michael S. Clendenin, director of media relations with Con Edison. “We take worker safety very seriously,” he said.
Now, the utility said, it is rewriting international contracts to include safety requirements. Contracts will now require overseas manufacturers to “take appropriate actions to provide a safe and healthy workplace,” and to follow local and federal guidelines in India, Mr. Clendenin said.

Immigration raids – one year later – Chris Ortman of Change to Win follows up on I.C.E. Raids – one year later in Greeley, Colorado; Worthington, Minnesota; and Grand Island, Nebraska. Peter Rousmaniere also features an item from Morning Edition revisitng a Cargill plant in Beardstown, Illinois one year later.
OSHA’s agendaThe Pump Handle reports on OSHA’s issuance of its semi-annual agenda, noting that several of the safety issues and standards that had been on the agenda in the past are curiously missing: “The Secretary’s last regulatory agenda (April 2007) listed 38 workplace health and safety hazards for possible regulatory action, 16 for MSHA and 22 for OSHA. The newly published regulatory agenda lists only 9 items …”. The post details what’s still on the list and what’s missing.