Pricing Transparency: Healthcare Policy

It is absolutely amazing how difficult it is sometimes to find out how much it costs to go to a healthcare facility, either a hospital and/or a clinic and receive a procedure or treatment. If you have ever asked for the price of a procedure you know how difficult it is to get a price or even an answer. Those of us with high deductible healthcare plans, or even no healthcare have figuratively (or maybe literally) pulled out our hair trying to get an answer on ‘what is this going to cost me to come in and get something done!’

Accomplishing healthcare cost transparency is a step in the right direction if our country is ever going to get our costs under control.

A recent opinion article written by a healthcare executive, Douglas Ghertner, criticized an attempt by CMS to release information about how we might become better healthcare consumers in an article published by CNBC. In the article Ghertner points out that while CMS’ intentions may have been sincere, the attempt neglected to capture what costs are truly conveyed to the actual patients. In point, CMS uses hospital charges and did not actually take into account what the reimbursements were after Medicare, Medicaid and insurers have negotiated what they would actually pay the hospital.

In the noted study, CMS also neglected to take into account quality of care measures that hospitals monitor. Certainly they don’t believe that all healthcare is created equal, and could probably agree that some measure should be in place for consumers to judge the quality of care they receive.

Ghertner also mentions in his article the increase need for this healthcare cost transparency, noting a study that showed the rise in high deductible healthcare plans.

Finally, Ghertner talks about the increasing need from a national perspective to increase this transparency.

“A recent analysis by West Health Policy Institute suggests that transparency initiatives could cut $100 billion over 10 years from health spending. This may be a small step towards reducing the trillions of dollars we spend each year on health care in this country, but it is a step in the right direction. Additionally, as we improve our ability to make public provider level outcomes from a quality perspective, the patient can assess the value of health-care services, forcing providers to compete on quality as well as cost.”

Hopefully those of us who manage healthcare today will be able to take additional steps to assist patients healthcare cost decisions. 

Share your Thoughts:

Have you ever tried to find out the price of a procedure before having the procedure? Was it difficult? Do you think transparency in healthcare costs is important? Do you think that health care policy should be transparent? What types of improvements would  you like to see in your healthcare?

Thank you to Baylor University MBA Healthcare for an education that encourages critical and creative thinking to solve complex healthcare and business problems. 

Sources:

http://www.cnbc.com/id/101880007

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American's Don't Feel Impacted from the ACA

Interesting poll results came out last week concerning American’s attitudes towards the Affordable Care Act. According to the latest Kaiser Health Tracking Poll 

"More than four years after passage of the Affordable Care Act (ACA) and several months into the first year of its coverage expansions, most Americans do not feel personally impacted by the law. Among the minority who say they have felt an impact, more feel they have been harmed than helped by the law, with Republicans more likely to say they have been hurt and Democrats more likely to say they have been helped."

However most would like politicians to stop talking about it. 51% of registered voters say they are tired of hearing candidates for Congress talk about health care law and want them to focus more on other issues like jobs. These results were also found similarly within Gallop poll findings. 

The Gallop poll results reiterated the same results regarding the health policy with more detail,

"About one month after the new healthcare exchanges closed with over 8 million new enrollees, there has been little substantial change in Americans' perception that the healthcare law has helped them. Most Americans say the law has had no impact on their healthcare situation, while those who do perceive an effect are more likely to say it has hurt them rather than helped them. The majority of Americans have reported that the Affordable Care Act has had little effect on their personal situations since Gallup first asked this question in early 2012. In more recent months, after the exchange-based enrollment opened up, Americans have gradually become more likely to indicate that the law has had an effect -- both positive and negative. The current 24% who say the law has hurt them is by one percentage point the highest measured, while the 14% who say the law has helped them is also within one point of being the highest measured on that dimension. In all instances, across seven different surveys, Americans have been at least marginally more likely to say the law has hurt them and their families than to say it has helped them.Americans' views on how the healthcare law has affected them personally are predictably partisan, as are almost all attitudes about Obamacare."

Share Your Thoughts:
Do you feel impacted by the Health Policy of the Affordable Care Act? If you were impacted by the change in health policy was it positive or negative? Do you feel this political debate about health policy is overdone or still of concern?



Thank you to Baylor MBA in Healthcare Program for helping it's students understand the impact of health policy in America.

Sources:
http://www.huffingtonpost.com/2014/05/30/aca-poll_n_5420425.html
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Healthcare Fraud Uncovered

Something those of us who are learning to become leaders in the healthcare industry are being taught is that we have to keep our eyes out for those who might be taking advantage of the system. Many of my posts have been about the significant costs of healthcare, totaling hundreds of millions of dollars on an annual basis. 

We have also discussed the causes of this cost, and why it continues to increase. But every once in a while, we are reminded about one of the causes of rising healthcare costs, and it may not be what you think.

Today it is being reported that one of the biggest scams in healthcare history is coming to a verdict. 

"Between 2006 and 2012, federal law enforcement authorities allege more than 230 Dallas-area home health care agencies funneled patients to an Arlington physician, Joseph Megwa to approve $100.5 million in care they did not need. The owner of the largest home care agency in the case, Nigerian-American Ferguson Ikhile of Irving, has pleaded guilty."

In a separate case, more than 500 home health agencies were accused of sending their patients for unnecessary care to a man, who gave 347 million dollars worth of unnecessary treatments. In both cases it was reported that most of the elderly patients who participated in the schemes did not even know what was going on. 

With this information, it’s important to realize that most individuals just simply don’t understand all the healthcare jargon like those of us training to become healthcare administrators. It’s always a good idea to take a step back and remember the entire scope of our responsibility going forward.

SHARE YOUR THOUGHTS:

Do you think there is enough health policy preventing healthcare fraud? How would you feel if your elderly loved one had been taken advantage of? Who do you think is the biggest victim in these types of fraudulent cases?

Special thank you to Baylor University Healthcare MBA program for the education to encourage honest, efficient healthcare policy and leadership. 

Sources:

http://www.dallasnews.com/business/health-care/20140215-dallas-area-home-to-huge-health-care-frauds.ece