[Reblog] Debunking myths designed to hinder price, quality transparency efforts

From the 18 May 2015 post from the Association of Health Care Journalists

When writing about transparency in health care prices and quality, journalists should expose the myths that health care providers promote. That’s the advice Francois de Brantes gave during a session on price and quality transparency at Health Journalism 2015 last month.

…
Providers promote the false ideas that gathering accurate price and quality data is difficult, if not impossible, and that variations in price result from the severity of illness in populations, de Brantes explained. By debunking these myths, journalists would inform policymakers and the public that there are ways to calculate the prices of medical episodes of care accurately, and that price variation can be controlled. “Price varies because of the way physicians practice,” he said.

…

Among those myths:

• Price is a trade secret
• Disclosing prices would impede the ability of health plans, hospitals and physicians to compete effectively
• Revealing prices enables collusion and thus violates antitrust law
• Publishing prices leads to higher health care costs.

…

Both Quincy and Suzanne Delbanco (@SuzanneDelbanco), executive director of the Catalyst for Payment Reform, made the point that price and quality transparency are similar in that both seem simple but are in fact extremely complex topics to cover. Most consumers, for example, are unaware of such quality measures as hospital infection rates and the CAHPS Hospital Survey from the federal Agency for Healthcare Research and Quality, Quincy said.

…

 

 

Online Health Care Data Sources | Brookings Institution

Online Health Care Data Sources | Brookings Institution.

 

From the Web site

This is a preliminary scan of publicly available online health care datasets, transparency websites and tools, gathered from expert recommendations and intensive review. Though this list is not exhaustive, we have attempted to include the most relevant sources for the purposes of this study. Each health data source is assigned an icon representing (1) who the source is useful to i.e. consumers or researchers; (2) what information the source includes i.e. data pertaining to quality of care or cost of care; and (3) who the source provides information on i.e. providers or payers.

[Report] Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs

From the 1 January 2014 report at Health Affairs

Abstract

Private insurers pay widely varying prices for inpatient care across hospitals. Previous research indicates that certain hospitals use market clout to obtain higher payment rates, but there have been few in-depth examinations of the relationship between hospital characteristics and pricing power.

This study used private insurance claims data to identify hospitals receiving inpatient prices significantly higher or lower than the median in their market. High-price hospitals, compared to other hospitals, tend to be larger; be major teaching hospitals; belong to systems with large market shares; and provide specialized services, such as heart transplants and Level I trauma care.

High-price hospitals also receive significant revenues from nonpatient sources, such as state Medicaid disproportionate-share hospital funds, and they enjoy healthy total financial margins.

Quality indicators for high-price hospitals were mixed: High-price hospitals fared much better than low-price hospitals did in U.S. News & World Report rankings, which are largely based on reputation, while generally scoring worse on objective measures of quality, such as postsurgical mortality rates.

Thus, insurers may face resistance if they attempt to steer patients away from high-price hospitals because these facilities have good reputations and offer specialized services that may be unique in their markets.

 

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• The Recovery Audit Contractor Program and Observation Status for Hospitalized Medicare Beneficiaries
• National inpatient hospital costs: The most expensive conditions by payer, 2011

 

[Infographic] The Top Five Most Expensive Conditions Treated in US Hospitals, 2011

From the Agency for Healthcare Research and Quality

Related articles

• National inpatient hospital costs: The most expensive conditions by payer, 2011 (phlibraryres.wordpress.com)
• HHS Data Release Reveals Major Disparities In Outpatient Charges From Hospital To Hospital (medicaldaily.com)
• High bills even higher at some hospitals (mysanantonio.com)
• The Price And The Pricelessness Of Healthcare (forbes.com)

[Reblog] New database from CMS: Medicare Provider Charge Data

From the 15 October 2013 post at Public Health – Research & Library News

 

The Department of Health & Human Services has created a database that for the first time gives consumers information on what hospitals charge.  The data, on the charges for services that are provided during the 100 most common Medicare inpatient stays and 30 common outpatient services, show significant variation across the country and within communities.

For example, average inpatient charges for services a hospital may provide in connection with a joint replacement range from a low of $5,300 at a hospital in Ada, Okla., to a high of $223,000 at a hospital in Monterey Park, Calif.  Even within the same geographic area, hospital charges for similar services can vary significantly. For example, average inpatient hospital charges for services that may be provided to treat heart failure range from a low of $21,000 to a high of $46,000 in Denver, Colo., and from a low of $9,000 to a high of $51,000 in Jackson, Miss.

Access the database here and on the Health Statistics research guide.

 

Hospital (Photo credit: José Goulão)

 

Related articles

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• University of Miami Hospital overbilled Medicare $3.7 million, audit says (miamiherald.com)
• Medicare rules leave patients in limbo (jsonline.com)
• When Is an Inpatient Not an Inpatient? CMS Adopts a 2-Midnight Standard (patsoshealthlawblog.com)
• New rule addresses hospital stays (nwitimes.com)
• CMS is Serious: Two Midnights for Inpatient Medical Necessity (3mhealthinformation.wordpress.com)
• Feds Refuse To Shut Down Controversial ‘Two-Midnight’ Rule For Hospitals (forbes.com)
• Study finds wide disparities in hospital costs (kansascity.com)

 

Status of Medicare patients can result in huge bills

The main entrance to the east campus of the Beth Israel Deaconess Medical Center, on Brookline Avenue in Boston. (Photo credit: Wikipedia)

“At the very least, Paulson said, patients should receive immediate written notice of observation status and the chance to appeal while they are still in the hospital. For now, she and Edelman recommend that patients and families always ask — and push back if needed.”

From the 25 August 2013 Boston Globe article

Harold Engler recently spent 10 days in a Boston teaching hospital, trying to snap back from complications after urgent hernia surgery. Nurses provided around-the-clock treatment, changing the 91-year-old’s catheter, for example, and pumping him with intravenous drugs for suspected pneumonia.

It all seemed like textbook hospital care to his wife, Sylvia. So she was shocked to learn that Beth Israel Deaconess Medical Center had never “admitted” her husband at all.

“Mrs. Engler, we have bad news for you. This was marked ‘medical observation,’ ” said a nurse at the nursing home where her husband was sent for rehabilitation. The hospital had decided Harold Engler was not sick enough to qualify as an official “inpatient.”

The difference in terminology was not a mere technicality: the observation classification left the Englers with a huge bill. It triggered a mystifying Medicare rule that required the Framingham couple to pay the entire $7,859 cost of his rehabilitation care and the medications he needed while at the nursing facility. If Harold Engler, a retired sales executive, had been admitted to the hospital, they would have likely paid nothing.

It is a striking example of just how impenetrable the US health care system can be for those who use it. Thousands of Medicare enrollees in Massachusetts and across the country are finding themselves caught in the same perplexing bind: Despite long hospital stays, they have been deemed observation patients or outpatients whose follow-up care is not covered. They also can face higher costs for the hospital stay itself when they are not officially admitted.

Read the entire article here

Related articles

• Medicare Admissions Rules Causing Havoc, Need a New Model As It Is Becoming Yet One More Way to Shift Cost to the Patients (ducknetweb.blogspot.com)
• Observation stays don’t count for Medicare coverage, many seniors harshly learn (triblive.com)
• Observation stays don’t count for Medicare coverage, many seniors harshly learn (goerie.com)
• Hospital patients sometimes ‘observed’ rather than admitted — and end up with unexpected financial pain (pennlive.com)
• A detailed breakdown of penalties for excess readmissions shows scale of challenge facing hospitals (medcitynews.com)
• Boston hospital settles Medicare complaint (sacbee.com)
• Inpatient or observation: Medicare rule causes confusion (medcitynews.com)
• Slow Progress on Addressing Medicare Observation Days at Federal Level (agingpolicy.wordpress.com)
• Medicare Observation Status: Update (eldercenter.wordpress.com)
  “a patient who is admitted to the hospital under observation status and then discharged for rehabilitation will find himself responsible for the full cost of skilled nursing expenses.”
  “A lawsuit, Bagnall v. Sebelius, is currently working its way through the courts. The plaintiffs are seeking the elimination of hospital observation stays, or at least requiring hospitals to inform Medicare patients that their stay is classified as observation status.
  On the legislative front, the “Improving Access to Medicare Coverage Act” was introduced on March 13 of this year (Senate Bill 569 and House Bill 1179). If passed, the law will amend Title XVIII of the Social Security Act, and permit a 3 day inpatient hospital stay to meet the 3-day hospital requirement for coverage of skilled nursing facility services under Medicare.
  The judicial and legislative wheels turn very slowly, so here are some steps you can take to protect yourself and your pocketbook if you are admitted to the hospital:
  • You or your family member should find out how the hospital has classified your stay. Is it inpatient or observation status? Ask each day, because it may change from day to day.
  • If you have been admitted under observation status, contact your primary care doctor or the hospital doctor treating you. Ask that you be admitted an an inpatient. This has to be done promptly, since under Medicare rules, reclassification from observation status to inpatient status cannot be done after you are discharged.
  • If you go to a skilled nursing facility for rehabilitation following your hospital stay and then discover Medicare is not covering the costs because you were under observation status, you may appeal. When you receive your Medicare Summary notice, highlight the disputed charges and follow the directions on the form regarding where to send your appeal. Needless to say, the wheels of this process also turn slowly, and there is no guarantee that your appeal will be successful, but keep at it. Note that you have only 120 days to appeal.
  Check back to my blog for updates on this issue of great importance to seniors and their loved ones.”

North Carolina Just Made It A Lot Easier To Figure Out If Your Hospital Is Ripping You Off

From the 23 August 2013 Think Progress article

North Carolina Gov. Pat McCrory (R) has signed abill that will require the state’s hospitals and ambulatory surgical centers to publicly disclose how much they charge — and how much insurers pay them — for 140 common medical procedures. The information will be posted to the Tar Heel State’s Department of Health and Human Services website and provide consumers a way of knowing which hospitals are giving them the most bang for their buck.

….

The federal government took a small step towards addressing this lack of transparency by releasing charge records for the most common inpatient procedures at more than 3,300 hospitals across 306 locales in May. The numbers confirmed health care experts’ suspicions: the cost of U.S. medical care is essentially arbitrary, with even hospitals in the same county charging anywhere from $7,000 to $99,700 for the same procedure. And the hospitals charging the most money don’t even offer much better services. Reform advocates say these staggering fluctuations are a direct result of price opacity.

But North Carolina’s law actually goes further than the federal government did by giving consumers even more relevant information. The top-line charge data released by the government isn’t actually what insurers and patients pay hospitals. The actual payments are negotiated between the hospitals, insurers, and uninsured Americans. To address that, the North Carolina will require hospitals to disclose the actual prices paid by Medicare, Medicaid, and Americans without any health coverage for the procedures in question, as well as the average and range of prices paid by the top five insurers in the state.

…

Read the entire article here

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Supplies and Devices Are Biggest Cause of Hospital Cost Increase

There just might be a link between rising healthcare costs and hospital marketing of their procedures (some elective) which require expensive devices (as da Vinci) (I’m thinking).

And this marketing might be tied in with over diagnosing and fear of malpractice suits, perhaps…

From a recent email update received from AHRQ (US Agency for Healthcare Research and Quality

Medical supplies and devices represented nearly one-fourth (24.2 percent) of rising hospital costs between 2001 and 2006, according to a new AHRQ-funded study.    Among all types of hospital stays, the cost percentage impact for supplies and devices was nearly three times that of operating room services.  While rising inpatient costs are typically associated with imaging services such as computed tomography scans and magnetic resonance imaging, those services only contributed a 3.3 percent increase in the cost of an average hospital stay, the study found.   Because rising hospitals costs are an ongoing concern, payers and policymakers may want to explore the specific factors driving those costs and the factors associated with them, according to the study authors.  The study, “What Hospital Inpatient Services Contributed the Most to the 2001 to 2006 Growth in the Cost per Case?,” was published online in Health Services Research on September 4. Select to access the abstract on PubMed.®

[Principal Findings of this study – “Supplies and devices were leading contributors (24.2 percent) to the increase in mean cost per discharge across all discharges. Intensive care unit and room and board (semiprivate) charges also substantially contributed (17.6 percent and 11.3 percent, respectively). Imaging and other advanced technological services were not major contributors (4.9 percent).”]

Related articles

• Rising cost of inpatient care linked to medical devices and supplies (medicalxpress.com)
• Health care spending: Study shows high imaging costs for defensive purposes (jflahiff.wordpress.com)
• 9-part series on over-diagnosis (short reads from a health care journalist) (jflahiff.wordpress.com)
• Where do our wasted health dollars go to?(KevinMD.com)

  Excerpt:

  • Failure of care coordination ($25 to $45 billion wasted). I see examples of this all the time. Docs and hospitals don’t talk to each other, and patients don’t bring records—so tests get repeated, or (even worse), medicines are added on top of other (unknown) medicines, creating costly havoc. The patients suffer. Why does this happen? Docs (like me!) get paid to see patients, not to read charts and chase down forms. In fact, HIPAA “privacy” laws have made care coordination even more time-consuming and frustrating for everyone.
  • Failure of care delivery ($102 to $154 billion). I’m not really sure exactly what that means. I imagine they mean waste created by not treating medical conditions early, when they’re less expensive to address.
  • Overtreatment ($158 to $226 billion). In part, this is defensive medicine—docs do whatever they think they need to do to they don’t get sued. Show up in the ER with a headache? You get a $1600 CAT scan! Those tests not only cost money themselves, but they lead to more tests and procedures and costs that really aren’t making anyone healthier. (Except the medical-malpractice industry. They’re doing real well.) Overtreatment also includes steps taken by lazy doctors who find it quicker—and better for business—to just order the tests and treatments the patients expect, rather than doing what’s medically appropriate.
  • Unnecessary administrative complexity ($107 and $389 billion). We love filling out forms, and we love hiring staff to wait on hold for administrative pygmies at the insurance agency to approve Grandma’s catheters. Yup, that’s why we went to med school.
  • Noncompetitive pricing ($84 and $178 billion). “Noncompetitive”, I think, must be a euphemism for “batshit crazy”. Ever see a doctor or hospital’s price sheet? They’re locked up, guarded by poisonous lizards deep in an underground bunker. Prices have to be super-inflated so the insurance companies can negotiate them down to what they’ve already decided they’ll pay (when they get around to it, which is after they’ve paid for the VP’s executive jets and haircuts.) People who don’t have insurance, of course, get hosed.
  • Fraud and abuse ($82 to $272 billion). With this much money sloshing around, scumbag frausters (including some with MD degrees) crawl out and starting grabbing what they can. For every jerk the government finds and prosecutes, there’s a handful of other cockroaches to take their place. Though there’s certainly insurance fraud in the private market, there is far more abuse designed to extract money from government health programs. Insurance companies do what they can to guard against fraud, which could hurt their profits or drive them out of business. Government agencies just don’t seem as driven to control costs. I guess they figure we can always borrow more money from our grandchildren.
• Choosing Wisely – Conversation starters for office visits on choosing health care (jflahiff.wordpress.com)

  Choosing Wisely – a Web site that aims to “aims to promote conversations between physicians and patients by helping patients choose care that is:

  Supported by evidence
  Not duplicative of other tests or procedures already received
  Free from harm
  Truly necessary

• Electronic Medical Records Reduce Negative Outcomes and Related Costs After Patient Safety Events Occur (ahrq.gov)

• [Reblog] Use of patient decision aids may lead to “sharply lower hip/knee surgery rates & costs”
  

• Electronic Medical Records Reduce Negative Outcomes and Related Costs After Patient Safety Events Occur (ahrq.gov)

 

 

[Reblog] How hospitals recoup the cost of buying robotic surgery systems (& questions to ask surgeon before consenting to robotic surgery)

Image via Wikipedia

Posted February 6, 2012 by Gary Schwitzer at HealthNewsReview.org 

The blogger known only as the Skeptical Scalpel (self-described as a surgeon for 40 years and a surgical department chairman and residency program director for over 23 of those years) continueshis thread of posts raising questions about the proliferation of robotic surgery.

The latest is entitled “Study: Robotic surgery financials explained.” It’s his take on a paper presented at the annual meeting of the American Association of Gynecologic Laparoscopists.  Excerpts:

The headline, “Robotic Hysterectomy Cuts Blood Loss in Obese,” is certainly catchy. Let’s look deeper. 

…

The lead author said, “The robotic hysterectomy does … offer lower rates of conversion to laparotomy but does cause higher facility and total charges, as well as higher reimbursement rates.” The mean total hospital charge for robotic hysterectomy was $44,700 versus $25,557, a statistically significant difference. The average charge for the robotic instruments was $8,322 compared to $3,762 for standard laparoscopy equipment, also a significant difference. In response to a question about why there was such a disparity, the lead author said: “The charges are likely to recoup the cost of the robot purchase. We have multiple robots … four at our main institution and several others at other sites.”

The reimbursement actually received for robotic hysterectomy was $19,000 and for standard laparoscopic, a mere $$8,000.

I congratulate the authors for their candor [though no doubt inadvertent] in sharing the financial data and the reasons why robotic surgery is more costly. I am gobsmacked* at the differential in charges and reimbursement for the two types of hysterectomy and that the secret would be so openly shared.

I guess someone has to help the hospital “recoup the cost of the robot purchase.” But I wonder why third party payers are shelling out almost two-and-a half times more money for a procedure that has not been proven more effective than standard laparoscopic surgery?

And you wonder why health care costs are skyrocketing?

Comments

Walter Lipman posted on February 13, 2012 at 9:25 am

Using this “pay as you use” logic, I wouldn’t be the least bit surprised to see one set of charges for your bed being located in the hospital’s parking lot versus another and higher set of charges for your bed being located in a room inside the hospital.

Reply

Michelle Luthringshausen, MD posted on February 21, 2012 at 8:54 am

As a surgeon, I am fascinated by this shallow analysis of cost and complete disregard for what is best for the patient. An open hysterectomy has a complication rate of 11%, highest in obese patients. A robotic hysterectomy done by an experienced surgeon in an obese patient has a complication rate of 3%. Complications are expensive for hospitals, health systems and especially patients. According to the American College of Surgeons NSQIP data, one complication’s DIRECT costs are around $12,000.
My second comment is that “charges” are only relevant in the uninsured patient, which will rarely be recouped anyway. The “cost” is what the insurance company and patients actually pay or reimburse, which is a contracted price based on the procedure done, NOT the way it was done, in an insured patient. In most cases, the hospital and surgeon get paid the same fee whether the robot was used or not…..

Related article

A 27 February 2012 article at HealthNewsReview.org summarizes a recent Chicago Tribune article on the evidence (sorely lacking) that robotic surgery allows for quicker healing and less pain.

Excerpts

Despite a flood of scientific papers associated with the da Vinci, there is a dearth of randomized, controlled studies showing patients do best if procedures are performed with the da Vinci. Federal oversight of medical devices such as the da Vinci is light. There have been voluntary recalls — more than a dozen since 2005 — involving problems with software and surgical instruments. Lawsuits have helped raise concerns that some surgeons are using the devices before the doctors are adequately trained.

Here are some questions patients should ask their surgeon when considering a robot-assisted procedure:

•When did you do your first robot-assisted procedure? How were you trained? How many robot-assisted cases have you done? How often do you do them? How many robot-assisted cases have you done of my procedure?

•Are you more comfortable doing this type of procedure laparoscopically, robot-assisted or the traditional open approach? What are the pros and cons of each?

•What happens if the robot malfunctions during surgery or you have to convert to open surgery? How many open cases of my procedure have you performed? How often do you do them?

•What kind of training on the da Vinci do the nurses and other surgeons in the operating room get? How experienced are they? How experienced are they in converting to an open procedure mid-surgery?

•Will you be mentoring another surgeon during my procedure? Will he or she be doing any of it? If so, how many cases has he or she performed?

 

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• Men’s hopes for robot prostate surgery unrealistic: Study (vancouversun.com)
• Pricey Surgery Robots Lack Clear Benefits (nlm.nih.gov)
• Stemming the Tide of Overtreatment in Health Care (Chicago Tribune)
• Robotic surgeries costlier but safer than more invasive techniques (healthzone.ca)
• Remote-control surgery grows despite inconclusive evidence (seattletimes.nwsource.com)
• Houston Colorectal Surgeon Discusses Advanced Robotic Surgery for Cancer Treatment (prweb.com)
• Problems with robotic surgery (myblogroboticsurgery.wordpress.com)
• So many questions…. (myblogroboticsurgery.wordpress.com)

“When hospitals buy robots they also use them as a marketing tool in direct-to-consumer marketing. That startedwith the drug companies and it worked well. It’s very effective,” said Dr. Hugh Lavery, a urologist at Mount Sinai Medical Center in New York who authored the study.”

Top 10 musts for your hospital visit

From an August 2011 posting by MITCHELL BROOKS, MD  in KevinMD.com

 Whether you are going to the hospital for an outpatient procedure or whether you will be admitted to the hospital for medical illness or surgical procedure, there are certain things you must know and certain things you must do in order to ensure that your reasonable expectations will be met….

 

Read the article (with the list of 10) here

 

CMS Launches Tools and Initiatives to Help Improve American Health Care Quality

The Centers for Medicare & Medicaid Services (CMS) announced a new tool for patients and caregivers, and other enhanced initiatives, to empower consumers to make informed choices about their health care, and to help improve the quality of care in America’s hospitals, nursing homes, physician offices, and other health care settings.

From the  5 August 2011 press release

“These tools are new ways CMS is making sure consumers have information about health care quality and important information they need to make the best decisions about where to receive high-quality care,” said Dr. Don Berwick, the CMS Administrator.  “These efforts are designed to also encourage providers to deliver safe, patient-centered care that consumers can rely on and will motivate improvement across our health care system.”

The steps announced today include:

·       A Quality Care Finder to provide consumers with one online destination to access all of Medicare’s Compare tools — comparison information on hospitals, nursing homes and plans: www.Medicare.gov/QualityCareFinder.

·       An updated Hospital Compare website, which now includes data about how well hospitals protect outpatients from surgical infections and whether hospitals care for outpatients who are treated for  suspected heart attacks with proven therapies that reduce death: www.hospitalcompare.hhs.gov

Read the entire press release 

Related articles

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