H.R.5659 Would Open Medicare Advantage to End-Stage Renal Patients

Dialysis Patient Citizens (DPC) hailed the introduction of H.R. 5659 as the latest milestone toward opening Medicare Advantage enrollment to end-stage renal disease (ESRD) patients. Stephen Anderson, a patient advocate from Indianapolis said, “As a dialysis patient of five years, I am fortunate to have secondary insurance to cover what Medicare does not. However, I know many patients in my facility don’t have that luxury. Providing dialysis patients access to Medicare Advantage will greatly help to reduce our out-of-pocket costs while improving our health with care coordination measures,” said. A study comparing outcomes of dialysis patients grandfathered into Medicare Advantage plans found that they have lower mortality rates than id their peers in fee-for-service plans. For more information, visit dialysispatients.org.

Hospitals Are Seeing Fewer Acute Patients

Rural hospitals that have higher volumes of less-acute patients, saw a 3.7% drop in year-over-year admissions (and 0.7% growth in admissions adjusted for outpatient activity), according to a report by Fitch. Payors are exerting pressure to reduce short-stay admissions and re-admissions; high-deductible health plans encourage patients to seek care in less expensive settings outside of the acute-care hospital; and technological advances allow more complex cases to be handled in outpatient settings.

New Law Voids Life Insurance Suicide Exclusion for Terminally Ill

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The End of Life Option Act, Assembly Bill X2-15 (Eggman) is now in effect. Under the new law, if a terminally ill Californian, who meets the criteria in the law, takes medication to end their own life, it is not considered a suicide, so life insurance policy exclusions for suicide do not apply. Under the Death with Dignity law, patients of sound mind who who have a terminal illness and meet certain qualifications can request aid-in-dying medication. Commissioner Jones said, “Terminally ill patients in California now have a choice when facing end-of-life decisions and do not have to worry that the choice will cause them to lose their life or health insurance or annuity policy…This law will make it possible for those who meet the protections in the new law to have the option to get a prescription for an aid-in-dying drug from their physician.” Consumers and their families with questions about the new law or its application are encouraged to contact the department online or 800-927-4357. 

ER Doctors Say that “Affordable” Premium Policies Mislead Patients

Ninety percent of emergency physicians say that health insurance companies mislead patients by offering affordable premiums for policies that actually cover very little, according to a survey by the American College of Emergency Physicians (ACEP). Ninety-six percent say that emergency patients don’t understand what their policies cover for emergency care. Eighty percent of ER doctors say they are seeing patients with health insurance who have missed or delayed medical care because of high insurance costs – a more than a 10% increase over six months ago.

Jay Kaplan, MD, FACEP, president of the American College of Emergency Physicians (ACEP) says, “Each day, emergency physicians are seeing patients who have significant co-pays for emergency care of up to $400 or more. It might as well be $4,000 for some people…Insurance companies must provide fair coverage…and be transparent about how they calculate payments. They need to pay reasonable charges, rather than setting arbitrary rates that don’t even cover the costs of care. Insurance companies are exploiting federal law to reduce coverage for emergency care knowing emergency departments have a federal mandate to care for all patients, regardless of their ability to pay. When plan reimbursements don’t cover the cost of providing services, physicians must choose between billing patients for the difference or going unpaid for their services. The vast majority of emergency physicians and their groups prefer to be in network.”

Dr. Kaplan says that health insurance companies are creating narrow networks of medical providers to increase profits, making it more likely for patients to go out-of-network. The survey of ER doctors also reveals the following:

  • 62% of ER doctors say that most health insurance companies provide inadequate coverage for emergency care visits.
    More than 80% of ER doctors who are aware of reimbursement issues agree that insurance companies have reduced emergency care reimbursements.
  • 60% of ER doctors say that, in the past year, they have had difficulty finding in-network specialists to care for patients with a quarter of them saying it happens daily.
  • 91% of ER doctors say that a new rule by the Centers for Medicare and Medicaid Services (CMS) would make it harder to find specialists and follow-up care for patients. The CMS rule exempts health insurance companies from meeting minimum standards to ensure adequate networks.
  • 79% of ER doctors who are familiar with the Fair Health database say it’s the best mechanism to ensure transparency and make sure that insurance companies don’t miscalculate payments.
  • 87% say that insurance companies should pay the in-network rate when an emergency patient does not have access to an in-network facility or physician.

Kaplan said, “Health insurance companies have a long history of not paying for emergency care and…discouraging their customers from seeking it. For example, United Healthcare was sued successfully by the State of New York for fraudulently calculating and significantly underpaying doctors for out-of-network medical services. They used the Ingenix database, which forced patients to overpay up to 30% for out-of-network doctors. The company, which, at the time, was led by the acting head of CMS, Andy Slavitt — paid the largest settlement to the state of New York and the American Medical Association. Part of that settlement created the Fair Health database.”

Patients Are Paying More, But Health Plans Are Not

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From 2004 to 2014, patient cost-sharing rose much faster than payments that health plans made for care, according to a report by the Kaiser Family Foundation. Deductibles and coinsurance rose considerably faster than the cost for covered benefits. Average payments toward deductibles still account for a relatively small share of total household budgets, they have been increasing rapidly.

Health care spending has grown fairly modestly in recent years. But, while out-of-pocket costs are growing, wages are remaining largely stagnant. Patients in large employer plans are paying more out-of-pocket. Deductibles are the most visible element of an insurance plan, which may help explain why consumers are showing concern about their out-of-pocket costs. The report reveals the following averages from 2004 to 2014:

  • Patient cost-sharing rose 77%, from $422 to $747.
  • Deductibles accounted for 24% of cost sharing in 2004 and 47% in 2014.
  • Enrollees saw a 256% increase in average deductibles from $99 to $353.
  • Coinsurance payments rose 107%, from $117 to $242.
  • Copays fell 26%, from $206 to $152. Copayments accounted for nearly half of the cost sharing payments in 2004, falling to 20% in 2014.
  • Payments by health plans rose 58%, from $2,748 to $4,354. Large employer plans covered 87% of covered medical expenses in 2004 and 85% in 2014.
  • Workers’ wages rose 32% from 2004 to 2014.

The increase in coinsurance may reflect the strong growth in plans that qualify a person to establish a health savings account; these plans are more likely to have coinsurance than copayments for physician services. Patients are more sensitive to the price of health care with deductibles and coinsurance than they are with copays, which are flat dollar amounts. Also, copays may add up over time while a deductible may need to be met at once, causing affordability challenges

One-Third of Doctors Consider Quitting After Passage of the ACA

Thirty-six percent of all doctors, and 45% of private practice doctors say they are more inclined to leave the medical profession because of the Affordable Care Act (ACA), according to a study by CompHealth. Fifty-one percent of doctors surveyed view the ACA unfavorably while 30% view it favorably. Physicians in private practice are most pessimistic, with 61% saying they view the law negatively. Doctors also say the following about practicing medicine after the ACA:

  • 47% say the ACA has improved access to healthcare and insurance.
  • 44% say the ACA has had a neutral effect on their patients’ quality of healthcare.
  • 76% of all doctors, and 86% of private practice doctors say they are not properly compensated by ACA reimbursements.
  • 38% say their salaries have decreased.
  • 44% spend less time with their patients.
  • 68% spend too much time entering data.
  • 59% spend too much time doing paperwork.

To cope with challenging circumstances, 40% of doctors are supplementing their income by filling in for other doctors, moonlighting, and consulting.

What Consumers Are Saying About Obamacare and Cancer Coverage

When consumers talk about Obamacare online, cancer is the most frequently discussed health condition, according to a report by Treato. Online, consumers discuss cancer 2.5 times more often than any other health condition. When discussing cancer, the leading topics are breast, lung, and colon cancers. Online discussions about Obamacare generally skew negative among cancer patients, but those who are positive express extreme gratitude. Twenty percent of patients and caregivers on cancer forums express gratitude and 48% have various criticisms about Obamacare.

Conversations about the downside of Obamacare’s cancer coverage generally fall into two categories: dissatisfaction with coverage and frustration with the lack of plan options. Consumers discuss the challenges of deciphering insurance rules to get the coverage they want, and confusion about subsidies, exclusions, inclusions, and co-pays.

Consumers are also complaining that certain groups are gaining more from Obamacare. The strongest criticisms are about women having access to more preventative screenings and more coverage for conditions, such as for breast cancer, and the poor getting free coverage. Consumers are also critical of other health conditions getting less coverage than cancer.

Consumers complain about losing good private insurance plans because of Obamacare and paying more out-of-pocket for cancer treatment. Many say that Medicare and Medicaid are simpler to access and easier to understand. Those who like Obamacare cite preventative screenings, coverage of pre-existing conditions, removal of lifetime limits on coverage, and the affordability of coverage

CVS Explores Telehealth

CVS Health is exploring collaboration among telehealth providers, retail pharmacies, and retail clinic providers. CVS is working with three telehealth companies: American Well, Doctor On Demand, and Teladoc. As well as offering telehealth physician care online, CVS Health will explore enabling MinuteClinic providers to consult with telehealth physicians. This would expand the scope of care offered at MinuteClinic. In addition, MinuteClinic will explore serving as a site for in-person exams to facilitate telehealth medical visits.

Andrew Sussman, M.D. of CVS Health said, “We have the opportunity to partner with telehealth organizations in the care of patients at home. In doing so, CVS Health will add value for patients, clients and health plans by improving access to low-cost quality care. During our initial phase of exploration, we learned that we could deliver excellent quality care and that patients were extremely satisfied with the care provided.”

MinuteClinic data recently published in the Journal of General Internal Medicine showed that 95% of patients were highly satisfied with the care they got, the ease with which telehealth technology was integrated into the visit, and the timeliness and convenience of their care. He added, “With the increased demand for patient…as a result of the…Affordable Care Act, the primary care physician shortage, aging of the population and epidemic of chronic disease, telehealth gives us the opportunity to offer high quality care to an expanded group of patients in a variety of convenient and cost-effective locations.”

Patients Are Less Satisfied With Health Care

Patient satisfaction continues to fall in the health care and social assistance categories, according to the American Customer Satisfaction Index (ACSI).  Patient satisfaction is down 3.2% to an ACSI score of 75.1, the lowest level in nearly a decade. Patients say that visits to doctors, dentists, and optometrists (76) are better than hospital services (74), but the quality of care is lower than it was a year ago.

The demand for health care services is rising, with preliminary figures on household health care spending up nearly 6% in 2014 – the largest increase since before the recession. This is probably because more Americans have health insurance.

The rate of growth in the health care workforce slowed, which likely contributed to less efficient access to care. However, since the middle of 2014, the health care sector has been adding workers at a significantly faster pace, which may lead to higher patient satisfaction in the near future.

ACSI managing director David VanAmburg said, “The influx of the newly insured is putting pressure on a system that is still playing catch up. Rising demand that is outpacing supply, coupled with increasing healthcare costs, is a formula for lower satisfaction.”

Satisfaction with outpatient hospital care improved 5% to a score of 80 compared to considerably lower satisfaction with inpatient services and emergency room service (-10% to 64)

CMS Releases First Ever Hospital Compare Star Ratings

The Centers for Medicare & Medicaid Services (CMS) introduced star ratings on “Hospital Compare,” the agency’s public information website. The comparison site covers topics like the following:

  • How well nurses and doctors communicate with patients.
  • How responsive hospital staff are to patient needs.
  • How clean and quiet hospital environments are.
  • How well patients are prepared for post-­hospital settings.

Last Updated 11/1/2017

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