News Blog

Bare-Bones Health Policies Are Cheaper Than ACA Plans—and Riskier Too
Thursday, April 19, 2018

Sales are growing for a type of bare-bones health policy that offers a cheaper alternative to traditional insurance but leaves buyers risking big bills if they have major medical needs.
Known as fixed indemnity plans, the products offer limited help, typically paying set amounts toward the cost of doctor visits, hospital days or other services..
They generally carry restrictions on people with pre-existing conditions, and they aren’t considered true health insurance under the Affordable Care Act. But insurance agents say individuals are increasingly purchasing the plans as a substitute for ACA coverage, which has become far more costly for many people who don’t get federal subsidies.
“Without question, people are using that as a good alternative when they can’t afford anything else,” said Dave Keller, an executive at Independence Holding Co., known as IHC Group, which says sales of its indemnity products last year were roughly 10 times the year before.
Other insurers and insurance agents, including eHealth Inc., American Insurance Agencies Direct LLC and, a unit of Health Insurance Innovations Inc., also say they have seen recent indemnity sales grow. Many of the products are sold only to those who can attest to being healthy. Daily Health Policy Report&utm_source=hs_email&utm_medium=email&utm_content=62226035&_hsenc=p2ANqtz-8EapjynRpHjKMJJNkXxaadJ4Io9SS5g4THAlrMlVhtcqTvioDaaP8zwSBn3CHIZ_zOZgfRxWVG9vRp_ksm29e1X_DTcg&_hsmi=62226035

Where Compassion and Technology Meet: Children’s Mercy
Friday, April 06, 2018

Children’s Mercy, a 367-bed hospital in Missouri, is leading medical professionals to reach more patients with telemedicine. Dr. Laura Fitzmaurice, Chief Medical Information Officer, stresses that the telemedicine program is about putting the patient at the center. “What’s the easiest way for the patient to get their medical care, advice or education? With our telemedicine program, we go where the patient wants to be.” Read this case study to learn more about Children's Mercy's implementation and how it has improved patient satisfaction.

Healthcare Needs a New Architecture for Patient Identity Interoperability
Friday, April 06, 2018

Read this whitepaper to learn about how poor patient matching approaches are harming our healthcare system - both today and in the future:

  • The ability to access patient information is integral to care coordination across the full continuum of care
  • Resolving patient identities across disparate systems is critical to accessing information
  • Existing patient matching approaches cannot resolve identities consistently or well enough to support healthcare's emerging needs
A new approach, "referential matching," is proving to hold the answers vexing the US healthcare industry on patient matching.

The differences between EMR and EHR have largely eroded but speak to the maturation of health IT use among providers.
Friday, April 06, 2018

The terms electronic medical record (EMR) and electronic health record (EHR) have become widely synonymous, but they did not start that way and some still argue that a distinction between is necessary to restate.
Healthcare organizations and providers have a greater tendency to still use EMR when discussing the health IT system in use by clinicians in the treatment of patients, but many have gravitated toward saying EHR when describing this technology. And there is ample evidence to suggest that the shift is the byproduct of a nationwide effort to promote health data exchange and interoperability.
While EHR is common parlance nowadays, that was not always the case. With EMR usage waning for a large portion of the healthcare industry, an understanding of the EMR/EHR difference demonstrates how far the industry has come — and the progress still needed to be made.


Ironically, the federal agency with the responsible for promoting the adoption of certified EHR technology (CEHRT) over the past seven years has very little say on the subject of EMR versus EHR.
CMS provides this tidbit of insight on the subject relative to the EHR Incentive Programs:

How much is too much? What does the US actually spend on health care administration?
Friday, April 06, 2018

The United States spends much more on health care each year than wealthy equals around the globe. That’s not just true for spending on direct patient care, but also for spending on health care administration. Many scholars recognize the cost containment potential in curbing administrative costs. Determining just how much the US spends on health care administration and in what ways are critical first steps.
How much of US health care spending is on administration?
Health care administration includes all activities related to coordinating health and medical services, such as scheduling, billing, and claims processing. Administrative costs’ contribution to overall health care spending is large and growing.
System-level estimates for health care administrative costs are limited and often dated. One highly cited estimate suggests that administrative costs accounted for about 30% of total health care expenditures in 1999. In 2006-2007, administrative costs outpaced growth in other health care categories, such as professional services, and matched growth rates in typically costly categories, such as prescription drug spending.
Though we may not be able to pin down a current estimate of total administrative costs, we do know it’s substantial and continues to increase. Other research focuses on administrative costs in three, large subcategories: billing and insurance-related (BIR) costs, hospital administration, and physician practice administration. 2018-04-05 Healthcare Dive [issue:14760]&utm_term=Healthcare Dive

Can Doctors Choose Between Saving Lives and Saving a Fortune?
Friday, April 06, 2018

To understand something about the spiraling cost of health care in the United States, we might begin with a typical conundrum: Imagine a 60-something man — a nonsmoker, overweight, with diabetes — who has just survived a heart attack. Perhaps he had an angioplasty, with the placement of a stent, to open his arteries. The doctor’s job is to keep the vessels open. She has two choices of medicines to reduce the risk for a second heart attack. There’s Plavix, a tried-and-tested blood thinner, that prevents clot formation; the generic version of the drug costs as little as 25 cents a pill. And there’s Brilinta, a newer medicine that is also effective in clot prevention; it costs about $6.50 a pill — 25 times as much.
Brilinta is admittedly more effective than Plavix — by all of 2 percentage points. In a yearlong trial of 18,600 patients, 10 percent died from vascular causes, heart attack or stroke on Brilinta, while about 12 percent did on Plavix. Should the doctor prescribe the best possible medicine, assuming that the man has private health insurance that will pay the bulk of the costs? Or should she try to conserve health care costs by prescribing the cheaper medicine that is nearly as good? And consider this: If the cost to you was the same — you have maxed out your co-pay and will end up with the same out-of-pocket expenditure — would you agree to take the slightly inferior drug to benefit the system as a whole? You’ve just had a heart attack, for God’s sake. You pay thousands of dollars for health insurance. Is it fair to ask you to bear the slightly increased risk to enable some broader social good?
“We thought about this nearly every day when discharging patients from the cardiology unit,” Dhruv Khullar, a newly minted hospital attending, told me. “Some of us believed that a doctor’s job is to deliver the best possible care, period. Others argued that doctors should aim to find some balance between medical benefit, financial cost and social responsibility. It’s the kind of question that we aren’t really trained to solve. Are costs something that an individual doctor should do something about? What is a doctor supposed to do?” 2018-04-05 Healthcare Dive [issue:14760]&utm_term=Healthcare Dive

ACA plans expanded coverage for chronic conditions
Friday, April 06, 2018

  • As the Affordable Care Act increased the number of Americans with health coverage, 45% of adult ACA exchange enrollees had chronic conditions in 2014 and 2015. That’s a higher percentage than those with employer-based insurance and in nongroup plans not in the exchanges, according to a new study in Health Affairs.
  • The report, which was written by Michael Karpman, Sharon K. Long and Lea Bart, all from the Urban Institute, found people in ACA plans used more healthcare services than those in other plans, which the study authors said is part of the reason for rising premiums in nongroup insurance.
  • The authors warned that repeal of the individual mandate penalty in 2019 will force states to figure out how to stabilize nongroup premiums and protect coverage for adults with chronic conditions. That may include creating a balanced insurance pool.

My Job Isn't to Move Patients Quickly
Friday, April 06, 2018

A hospitalist is tired of being a cog in a machine

"We are playing the same sport, but a different game," the wise, thoughtful emergency medicine attending physician once told me. "I am playing speed chess -- I need to make a move quickly, or I lose -- no matter what. My moves have to be right, but they don't always necessarily need to be the optimal one. I am not always thinking five moves ahead. You guys [in internal medicine] are playing master chess. You have more time, but that means you are trying to always think about the whole game and make the best move possible."
In recent years, the drive toward "efficiency" has intensified on the wards. I am seeing much more speed chess played by us hospitalists, and I don't think that is a good thing.
The pendulum has swung quickly from, "problem #7, chronic anemia: stable but I am not sure it has been worked up before, so I ordered a smear, retic count, and iron panel," to "problem #1, acute blood loss anemia: now stable after transfusion, seems safe for discharge and GI follow-up." (NOTE: "acute blood loss anemia" is a phrase I learned from our "clinical documentation integrity specialist" – I think it gets me "50 CDI points" or something).

Rural Hospital Scam; Overdose Undercount; Prison Flu-Shot Scandal
Friday, April 06, 2018

The past week in health-related investigations

Welcome to MedPage Today's Investigative Roundup, highlighting the best pieces published in the past week with in-depth examinations of healthcare issues. As usual, we'd love to hear your ideas for issues to explore next. More evidence is better, and if you don't feel comfortable using the normal channels, we're available through more secure methods, too.

The CBS Evening News looks at the case of the small Campbellton-Graceville hospital in Florida's panhandle, which was purchased by the Miami-based Empower Group just days before the hospital was set to close. The Empower Group ran it for $30,000 a month, but also routed laboratory tests through the hospital -- which insurance companies then paid at much higher rates than they would in a more urban setting. In just over a year, $120 million in tests were funneled through the small hospital's lab, the hospital's attorney said.
The hospital's board shuttered the program, which led to lawsuits. In the end, Campbellton-Graceville had to close anyway.
More:   ...

Hospital Prices Spike in February
Friday, April 06, 2018

Prescription drug price increases seem to be the biggest driver of healthcare spending

Hospital prices grew 3.8% last month, when compared with February 2017, the highest growth rate in more than a decade, according to Altarum's Health Sector Economic Indicators.
"We are puzzling over this significant jump in hospital prices in recent months based upon the hospital produce price indexes from Bureau of Labor Statistics," said healthcare economist Charles Roehig, of Altarum in with Ann Arbor, Michigan.
"Hospital prices averaged 1.6% growth in 2017, increasing to 3.5% during the first 2 months of 2018. Further, growth has accelerated for each of the three main payers: Medicare, Medicaid, and private health plans," he said.
For all of 2017, national health spending grew by 4.6% from its 2016 level.
"Year-over-year spending growth has remained close to this moderate but still not sustainable rate in each month since July 2017," according to the analysis. "We see 22 consecutive months where the healthcare spending share of GDP [gross domestic product] has not fallen below 17.9% nor risen above 18.1% including the most recent 3 months of the share being 18.0%."


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