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Cost Containment

The Cost of Overseeing the Business of Medicine

Overseeing the business of medicine is big business. Per capita annual spending in the U.S. on health care administration is $606, more than double that of France, which has the next highest rate among industrialized nations.

The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries, according to an analysis performed for The New York Times by Compdata Surveys: $584,000 on average for an insurance chief executive officer, $386,000 for a hospital C.E.O. and $237,000 for a hospital administrator, compared with $306,000 for a surgeon and $185,000 for a general doctor. Administrative costs make up 20 to 30 percent of the United States health care bill, far higher than in any other country. Read more…

Spotting Medicare Fraud

Medicare insures 49 million Americans a year, at a cost of about $604 billion annually – and spent another $1.5 billion fighting health-care fraud last year. But a loose system of investigators can’t reliably spot suspicious billing.

Medicare made public the details of $77 billion in payments to doctors, labs, ambulance companies, and other medical providers in an effort to increase transparency and get the public’s help identifying improper payments.Within days of the document dump, Bloomberg News, the New York Times, USA Today, and ProPublica, among others, did just that, uncovering tens of millions of dollars’ worth of questionable billing practices, as well as payments to doctors whose checkered records the federal government may not have been aware of. Read more…

Choices Being Limited Under Some New Health Care Plans

Since the Affordable Care Act created marketplaces for private health plans last fall, insurers expecting to lure customers with low premiums have fashioned smaller networks of medical providers.

By cutting out expensive hospitals and negotiating favorable rates with doctors in exchange for sending more patients their way, insurers can keep premiums down. In one instance, Blue Shield’s new network includes 43 hospitals in Los Angeles County, about 64 percent of what its standard coverage offers. Read more…

Tracking Patient Data to Reduce Emergency Room Visit Frequency – and Cost

As the Affordable Care Act expands Medicaid to a greater number of patients, the need for states to keep emergency room costs in check will become more pressing.

In a trial program in Washington State, ERs are now required to upload information on patients they’ve treated into a new database.  This allows other ER doctors and providers to research incoming patients, making a big impact on cost savings, with doctors now able to track patients whose situations would be better served by far less expensive office visits.

Patients with multiple visits (those who went to the ER more than four times a year) — suggesting they are using the ER in lieu of visiting primary case visits — made up a fifth of all ER visits paid for by Medicaid.

Data released on March 20 shows that ER visits by Medicaid patients fell 10 percent in the 2013 fiscal year, and the rate of ER visits that resulted in a non-acute diagnosis decreased by more than 14 percent. Database use is credited for a substantial amount of the state’s $33.7 million reduction in 2013 Medicaid costs. Read more…

 

How Doctors Rate Patients: What’s Your Activation Level?

More hospitals, health plans and employers are scoring patients on how engaged they will be in their care using an assessment called the Patient Activation Measure, or PAM. Scores make it easier to customize information, coaching and other interventions.

The aim is for patients, rather than feel overwhelmed by instructions, to become confident that they can change their own behavior.

Another aim: To reduce costs incurred through additional patient visits. Hospitals are using PAM to tailor support they give patients at discharge to avoid readmissions. Patients with low activation scores have nearly twice the risk of 30-day post-discharge hospital admission as patients with higher activation, according to a study last fall in the Journal of General Internal Medicine.

PeaceHealth, of Vancouver, Wash., used PAM at a primary-care practice in Eugene, Ore., and found over 18 months a 42% decline in average quarterly emergency and urgent-care visits. Read more…

Smoking Proves Hard to Shake Among the Poor

 

This article provides a stark description of the socioeconomic aspects of smoking and nicotine addiction. While rates of smoking in the US has plummeted, the actual rate varies widely by socioeconomic levels. The majority of today’s smokers took up the habit after the dangers of tobacco use were clear, and warning abounded. A choice for some became an addiction, as well as an expensive habit. Even at the $5.00 per pack cited in the article as the price in Clay County, this adds up to $150.00 per month for a pack a day smoker – a considerable expense for those with limited income and prospects.

Virtual Doctors’ Visits

Several insurance companies are covering options like LiveHealth Online, a service that connects patients with doctors via video calls.

Telemedicine has been spurred in part by the Affordable Care Act, which is funneling more patients into a system plagued by physician shortages. By 2020 the U.S. will have 91,500 fewer doctors than needed, says the Association of American Medical Colleges. Telehealth providers say they help make up for this shortfall by aiding doctors in delivering services more efficiently. WellPoint says users of LiveHealth Online saved an average $71 per visit and most of them saved two to three hours of time.

The American Telemedicine Association is developing an accreditation program for telehealth providers. A bill introduced in Congress last year by Representatives Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio) would create federal telecare standards.

Another benefit of the use of camera-equipped devices: remote medical connections have been made easier, and high-definition video often provides enough detail for medical professionals to make diagnoses. “Sometimes if it’s a rash, we can see the rash,” says Katherine Sandstrom, a nurse practitioner in Portland, Ore., who sees a few patients via video each week through health-services provider ZoomCare.

Virtual doctor visits can’t fully replace in-office visits, of course. There’s only so much a doctor can tell without an examination performed in-person and telemedicine visits could result in unnecessary medication. But with telehealth companies reporting double-digit revenue growth and attracting high-profile investors the option is definitely finding a niche among consumers for patient care options.

Health Care Costs and Credit Scores

Health care bills are now the largest source of business for collection companies, according to consumer protection agency officials.  The Consumer Financial Protection Bureau has been studying the impact of medical billing on credit scores since 2012.

The problem is accelerating for several reasons. Charges are rising. Insurance policies are requiring more patient outlays in the form of higher deductibles and co-payments. More important, perhaps, is that while doctors’ practices traditionally worked out deals for patients who had trouble paying, today many doctors work for large professionally managed groups and hospital systems whose bills are generated far away, by computer. Examples abound, as exemplified in this editorial, of the complex and confusing system.  Read more…

Chronic Pain: Back in Control

Brian L. Grant, MD
My friend and colleague David Hanscom MD recently appeared on Dr. Oz discussing his experience and research on chronic pain, and the tragedy of operating on basically normal backs, on people in pain. He has published a book that anyone considering back surgery might consider reading first.

Sadly, common sense and good care as represented by Dr. Hanscom does not pay. No expensive back implants are sold, no surgical fees generated and no hospital stays take place. And for those who were not truly injured but underwent the knife for symptoms and not true pathology, they decidedly have an injury afterwards. This is tragic.

Common Surgery May Not Actually Help

The most common orthopedic procedure in the United States appeared to be no more helpful for some patients than a completely simulated surgery, according to an unusual Finnish study.

The Finnish study does not indicate that surgery never helps; there is consensus that it should be performed in some circumstances, especially for younger patients and for tears from acute sports injuries. But about 80 percent of tears develop from wear and aging, and some researchers believe surgery in those cases should be significantly limited.

Arthroscopic surgery on the meniscus is the most common orthopedic procedure in the United States, performed, the study said, about 700,000 times a year at an estimated cost of $4 billion. Read more…