Category Archives: Health-care Policy

Patient finds shopping for a CT scan doesn’t pay off

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Shopping CartBy Jay Hancock
KHN

Douglas White knew high-deductible insurance is supposed to make patients feel the pain of medical prices and turn them into smart shoppers. So he shopped.

He called around for price quotes on the CT scan his doctor ordered. After all, his plan’s $2,000 deductible meant paying the full cost out of pocket. Using information from his insurer, he found a good deal — $473.53 at Coolidge Corner Imaging in Boston, a half hour from his house.

But the bill he got later was for $1,273.02 — more than twice as much — from a hospital he had no idea was connected to the imaging center.

“I was shocked,” said White, a doctor of physical therapy who thought he knew his way around the medical system. “If I get tripped up, the average consumer doesn’t have the slightest chance of effectively managing their health expenses.”

national study by Consumers Union basically comes to the same conclusion, suggesting that there are millions of Douglas Whites lost in the medical billing maze. Continue reading

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Is getting a second opinion worth it?

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Second opinions often sought but value is not yet proven

By Michelle Andrews
KHN

Dye with Yes, No and Maybe of the three visible sidesActress Rita Wilson, who was diagnosed with breast cancer and underwent a double mastectomy recently, told People magazine last month that she expects to make a full recovery “because I caught this early, have excellent doctors and because I got a second opinion.”

When confronted with the diagnosis of a serious illness or confusing treatment options, everyone agrees it can be useful to seek out another perspective. Even if the second physician agrees with the first one, knowing that can provide clarity and peace of mind.

A second set of eyes, however, may identify information that was missed or misinterpreted the first time. A study that reviewed existing published research found that 10 to 62 percent of second opinions resulted in major changes to diagnoses or recommended treatments.

Another study that examined nearly 6,800 second opinions provided by Best Doctors, a second-opinion service available as an employee benefit at some companies, found that more than 40 percent of second opinions resulted in diagnostic or treatment changes.

But here’s the rub: While it’s clear that second opinions can help individual patients make better medical decisions, there’s little hard data showing that second opinions lead to better health results overall. Continue reading

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Medicaid expansion helps cut rate of older, uninsured adults from 12 to 8 percent

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ACA health reform logoBy Michelle Andrews
KHN

The health law’s expansion of Medicaid coverage to adults with incomes over the poverty line was key to reducing the uninsured rate among 50- to 64-year-olds from nearly 12 to 8 percent in 2014, according to a new analysis.

“Clearly most of the gains in coverage were in Medicaid or non-group coverage,” says study co-author Jane Sung, a senior strategic policy adviser at the AARP Public Policy Institute, which conducted the study with the Urban Institute.

Under the health law, adults with incomes up to 138 percent of the federal poverty level ($16,243 for one person in 2015) are eligible for Medicaid if a state decides to expand coverage. Twenty-seven  states  had done so by the end of 2014.

The study found the uninsured rate for people between age 50 and 64 who live in states that haven’t expanded Medicaid was twice as high—11 percent—as for those who live in states that have done so.

More than 2 million people between 50 and 64 gained coverage between December 2013 and December 2014, according to the study. Continue reading

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Most enrolled in exchange plans satisfied with premiums, cost sharing and provider networks, survey finds

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Affordability Remains Significant Concern for Many in Non-Group Plans

ACA health reform logoFollowing the Affordable Care Act’s second open enrollment period, most people enrolled in marketplace plans report being satisfied with a wide range of their plan’s coverage and features, finds a new Kaiser Family Foundation survey of people who buy their own health insurance.

A large majority (74%) of those in marketplace plans rate their coverage as excellent or good, the survey finds.

Most (59%) also say their plan is an excellent or good value for what they pay for it, though the share rating the value as “excellent” declined somewhat from 23 percent last year to 15 percent in the current survey.

Majorities also say they are “very” or “somewhat” satisfied with seven different features of their plans, including:

  • Their choice of primary-care doctors (75%), hospitals (75%) and specialists (64%);
  • What they have to pay out of pocket for doctor visits (73%), prescription drugs (70%) and annual deductible (60%);
  • And their monthly premiums (65%).

To learn more go here.

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Paramedics steer non-emergency patients away from ERs

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By Anna Gorman
KHN

SPARKS, Nev. — Paramedic Ryan Ramsdell pulled up to a single-story house not far from Reno’s towering hotels and casinos in a nondescript Ford Explorer.

No ambulance, no flashing lights. He wasn’t there to rush 68-year-old Earl Mayes to the emergency room. His job was to keep Mayes out of the ER.

Mayes, who has congestive heart failure and chronic lung disease, greeted Ramsdell and told him that his heart was fluttering more than usual. “I had an up-and-down night,” he said.

Paramedic Ryan Ramsdell checks 68-year-old Earl Mayes blood pressure during a home visit on March 26, 2015 in Sparks, Nevada. Ramsdell is part of a community health plan to help reduce avoidable emergency room visits by treating patients at home (Photo by Heidi de Marco/Kaiser Health News).

Paramedic Ryan Ramsdell checks 68-year-old Earl Mayes blood pressure during a home visit on March 26, 2015 in Sparks, Nevada. Ramsdell is part of a community health plan to help reduce avoidable emergency room visits by treating patients at home (Photo by Heidi de Marco/Kaiser Health News).

“Let’s take a look at it,” the paramedic responded, carrying a big red bag with medical supplies. “We’ll put you on the monitor.”

Since Mayes was released from the hospital a few weeks earlier, paramedics had visited him several times to monitor his heart and lungs and make sure he was following his doctor’s orders.

“With these guys coming by and checking me all the time, it makes it so much better,” Mayes said.  “When they leave, you know where you stand.” Continue reading

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What preventive services must be provided for free under the Affordable Care Act?

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Preventive Services Covered Under the Affordable Care A

stethoscope doctor's bag chest x-rayIf you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a copayment or co-insurance or meet your deductible. This applies only when these services are delivered by a network provider.

  • Covered Preventive Services for Adults
  • Covered Preventive Services for Women, Including Pregnant Women
  • Covered Preventive Services for Children

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Learning a new health insurance system the hard way

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By Jenny Gold
KHN

The insurance program was called “Believe Me”  — but Kairis Chiaji had her doubts.

She and her husband Arthur were skeptical that the new health plan they purchased for 2015 would actually work out. That’s because their experience in 2014 had been a disaster, she said.

The Sacramento, Calif., couple had been thrilled to learn last year about the prospect of subsidized coverage under the nation’s health law, she recalled. Each of them had been uninsured for years when they signed up for coverage through the state exchange, Covered California.

“I just thought about how many people who are like me,” explained Kairis, 43, a self-employed natural hairstylist and doula. “If you have a lot of money, you’re covered. If you don’t have any money, you’re covered. When you’re in the middle, working hard every day, that’s when it’s really tough.”

When her children were little she worried about paying for their care if they were injured.

“I just simply told my children, listen, all I’ve got is a ruler and duct tape, so you’re not allowed to break any bones. Literally you can’t get hurt,” she said. Continue reading

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Helping the mentally ill stay out of hospitals

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By Christine Vestal
Stateline

NEW YORK – It is a busy Friday afternoon. Staff members check in guests at the front desk. Other employees lead visitors on tours of the upstairs bedrooms, or field calls from people considering future stays. Aromas of garlic and roasted chicken seep out of the kitchen.

Community Access is not a bed and breakfast, although it feels that way when you walk through its unmarked door off Second Avenue on Manhattan’s Lower East Side. Also known as Parachute NYC, this quiet seven-bedroom facility is one of four publicly funded mental health centers in New York City (located in Manhattan, Brooklyn, Queens and the Bronx) that provide an alternative to hospital stays for people on the verge of a mental health crisis.

Parachute’s respite centers have no medical staff, no medications, no locks or curfews and no mandatory activities. They are secure, welcoming places where people willingly go to escape pressure in their lives.

Parachute’s respite centers have no medical staff, no medications, no locks or curfews and no mandatory activities. They are secure, welcoming places where people willingly go to escape pressure in their lives and talk to trained “peer professionals” who can relate to what guests are going through because they are recovering from mental illness themselves.

Without places like this, New Yorkers who suffer from serious mental illness would have little choice but to check into a hospital or a hospital-like crisis center when their lives spin out of control. Some people need to be hospitalized for severe psychosis and depression, but many others end up in the hospital because they have no other options.

Relatively rare in the U.S., respite centers like this one cost a fraction of the price of a hospital stay, and can be far more effective at helping people avoid a psychotic break, severe mood swing or suicidal episode. Continue reading

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After two years, statewide health care transparency database signed into law – Puget Sound Business Journal

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$100-dollar bill inside a capsuleGov. Jay Inslee signed legislation that will create what’s called an all-payer claims database where health insurers are mandated to provide information about the cost and quality of care.

The database will be open and available to employers, consumers and providers.

Source: After two years, statewide health care transparency database signed into law – Puget Sound Business Journal

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Just say no . . .

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Radical Approach To Huge Hospital Bills: Set Your Own Price

Twenty-dollar bill in a pill bottleBy Jay Hancock
KHN

In the late 1990s you could have taken what hospitals charged to administer inpatient chemotherapy and bought a Ford Escort econobox.

Today average chemo charges (not even counting the price of the anti-cancer drugs) are enough to pay for a Lexus GX sport-utility vehicle, government data show.

Hospital prices have risen nearly three times as much as overall inflation since Ronald Reagan was president.

When hospitals send invoices with charges that seem to bear no relationship to their costs, one benefit firm tells its clients to just say no.

Health payers have tried HMOs, accountable care organizations and other innovations to control them, with little effect.

A small benefits consulting firm called ELAP Services is causing commotion by suggesting an alternative: Refuse to pay.

When hospitals send invoices with charges that seem to bear no relationship to their costs, the Pennsylvania firm tells its clients (generally medium-sized employers) to just say no. Continue reading

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‘Free’ contraception means ‘free,’ Obama administration tells insurers

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Birth control patch - Photo by John Heilman, MD under creative commons licesnse

Birth control patch – Photo by John Heilman, MD (CC)

By Phil  Galewitz
KHN

Free means free.

The Obama administration said Monday that health plans must offer for free at least one of every type of prescription birth control — clarifying regulations that left some insurers misinterpreting the Affordable Care Act’s contraceptive mandate.

“Today’s guidance seeks to eliminate any ambiguity,” the Health and Human Services Department said. “Insurers must cover without cost-sharing at least one form of contraception in each of the methods that the Food and Drug Administration has identified … including the ring, the patch and intrauterine devices.”

The ruling comes after reports by the Kaiser Family Foundation and the National Women’s Law Center, an advocacy group, found many insurers were not providing no-cost birth control for all prescription methods. (KHN is an editorially independent project of the Kaiser Family Foundation.) Continue reading

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Home visits by nurses for first-time mothers help reduce costs

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Symphonie Dawson and her son Andrew.

By Michelle Andrews
KHN

Symphonie Dawson was 23 and studying to be a paralegal while working part-time for a temporary staffing agency when she learned that the reason she kept feeling sick was because she was pregnant.

Living with her mom and two siblings near Dallas, Dawson worried about what to expect during pregnancy and what giving birth would be like, not to mention how to juggle having a baby with being in school.

(Photo courtesy of Symphonie Dawson)

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