This is interesting...

Wednesday, August 06, 2008

The WSJ Health Care Blog today reports that ER visits are at an all time high at a time when the number of emergency rooms is *shrinking.*

What's going on?

While conventional wisdom suggests that the uninsured are crowding the ER,
the data suggest that’s not what’s going on. The uninsured (comprised in this
survey of those who paid themselves, and those who didn’t pay) accounted for
between 17% and 18% of ER traffic in both 1996 ( see this report) and 2006.

A recent study in the Annals of Emergency Medicine noted a similar
trend, and found that the biggest rise came from well-off people who typically
get their care at a doctor’s office. The real problem, the authors suggested,
isn’t the lack of care for the uninsured, but the inability of the insured to
get prompt care at the doctor’s office.

Labels: Hospitals, InTheNews, Uninsured

posted by Hanh Kim Quach | Permalink | 10:59 AM


 

Sick, Twisted and Fun

Tuesday, July 08, 2008

The Sacramento Bee just posted this Hospital charge database of the 25 most common procedures by hospital. The Bee has compiled all the information reported to the Office of Statewide Health Planning and Development in 2006 and put it in an easy-to-use scroll down format.

The charges reflect what consumers would pay if they didn't have insurance -- in other words, the sticker price. Insurance companies negotiate far lower rates.

I'm finding it weirdly entertaining to see how broke I'd be if I ever found myself uninsured.

If I ever needed a hip replacement, it'd cost *as little* as $40,000 at Mercy Hospital in Folsom or *as much as* $1o9,000 at UC Davis Med Center down the street from me.

If I ever got pneumonia, and needed a breathing tube: $362,000 at Mercy San Juan, a whopping $850,000 at Sutter Memorial.

Play with it. Have a heart attack. (Get an angioplasty -- $94,000 at Sutter, $140,000 at UC Davis.) Pass comprehensive health reform so no one gets these sticker prices.

Labels: Hospitals, InTheNews, Underinsurance

posted by Hanh Kim Quach | Permalink | 5:38 PM


 

Whoopsy

Monday, July 07, 2008

Boston Globe has this story about a surgeon accidentally operating on the wrong side. Here's a memo that also went out in the hospital, in which hospital administrators explain what went wrong.

We have a bill this year - AB 2146 (Feuer), which would make sure the patient, who would have to undergo surgery on the correct side, is not charged for the flubbed one too.

Labels: Hospitals, InTheNews

posted by Hanh Kim Quach | Permalink | 11:29 AM


 

So "never events" never happen...

Monday, June 30, 2008

Jordan Rau at the Los Angeles Times has an important article (with lots of links to primary source documents!) on the key issue of "never events"--those things that should never, ever happen when you get care.

It's a list that includes getting severe ulcers from bedsores, having equipment left in a person during surgery, undergoing the wrong surgery or having the wrong limb amputated, or being given the wrong medication or wrong dosage. Unlike other parts of the art of medicine, these are problems that are preventable if the systems are in place.

The number of these adverse events reported is over 1,000 in a 10-month period. It's a wake-up call--Many in the health care community would not have predicted such a large number. These medical errors are serious--in some cases, deadly serious. By definition, these are "never" events--not "sometimes OK" events.

The article highlights AB2146 (Feuer), an important bill supported by many consumer groups like Health Access California, AARP, CALPIRG, Consumers Union, as well as business and labor organizations. It would have California follow the federal government in not paying for these adverse events, as part of a shift to change the financial incentives in this category.

I would also add AB2967 (Lieber), which would add more transparency to the cost and quality of the care being provided in California. This information is valuable in its own right, and will have a impact in getting hospitals to prevent these errors, which will improve health outcomes, and save money too. Information shouldn't be the only tool, but it should be part of more aggressive oversight.

Read the article. It's worth your time.

Labels: Hospitals, InTheNews, Legislation, Prevention, Research

posted by Anthony Wright | Permalink | 1:32 AM


 

Bills before break...

Thursday, June 26, 2008

HEALTH ACCESS UPDATE
Thursday, June 25th, 2008

HEALTH BILLS LIVE AND DIE BY THE COMMITTEE
* Health legislation heard in final policy committees before July break
* Bills pass to require 85% of premium to go to patient care; regulate recissions; foster a public insurer; discourage "never events," encourage hospital community benefits.

Click Here for What's New on the Health Access WeBlog: Continued Real-Time Budget Conference Committee Reports; The Perils of "Junk" Insurance; Gender Discrimination in the Individual Insurance Market; The Mortgage Metaphor for SB1522; Improving Medicare with a Phone Call.


With tomorrow's deadline for legislation to have cleared policy committees in the second house, lawmakers heard a battery of bills this past week. Key pieces of legislation of interest to health advocates were also on the agenda. Many of the bills advocates have been tracking passed.

Following is a list of the bills heard this week and the outcome. Additionally, advocates may visit the Health Access website, at http://www.health-access.org/advocating/2008_bills.html for a complete list of bills.

The following bills passed in Assembly Health Committee, chaired by Assemblyman Mervyn Dymally, on Tuesday:

* SB 1198 (Kuehl): DURABLE MEDICAL EQUIPMENT: Would require group health plans and insurers to offer coverage for durable medical equipment, such as wheelchairs and shower seats. Support
* SB 1440 (Kuehl): CAPPING ADMINISTRATION AND PROFIT: Would set a minimum medical loss ratio – requiring every insurer to spend at least 85 percent of premiums on patient care. Would also require plans to report how much they spend on health care versus administration on each single product they offer. Support
* SB 973 (Simitian) PUBLIC INSURER: Would create a statewide public insurer, connecting existing regional, county-based health care plans, to compete with private health care plans and provide consumers more affordable coverage choices.
* SB 1300 (Corbett): CONFIDENTIALITY CLAUSES: Would prohibit confidentiality clauses, which keep secret information on pricing and health care quality from consumers, in contracts between providers and insurers. Support
* AB 1351 (Corbett): DISTRICT HOSPITAL OVERSIGHT: Would require Attorney General oversight into transactions involving district hospitals. Support

The following bills passed in Senate Health Committee, chaired by Senator Sheila Kuehl, on Wednesday:
* AB 2146 (Feuer): ‘NEVER EVENTS’: Bans providers from billing patients or insurers when they have made an avoidable mistake, such as operating on the wrong person, prescribing the wrong drugs, or leaving foreign objects inside a surgery patient. Support
* AB 2549 (Hayashi) RECISSION TIME LIMIT: Would impose an 18-month time limit in which insurers have to rescind individual health care policies once consumers’ applications are approved. This bill was amended from previous versions, which limited the time frame for rescission to the first six months. Watch, seeking shorter time limit.
* AB 2569 (De Leon) RESCISSION AND BROKER ACCOUNTABILITY: Ensures that family members whose coverage depends on that of the rescinded person may be offered another individual policy. Also requires brokers who take applications to attest, under penalty of perjury, that the information is complete and accurate to the best of their knowledge. Support.
* AB 2697 (Huffman) BOUTIQUE HOSPITALS: Would require so-called “boutique hospitals’’ to asses their impact on a community’s health system annually, specifically whether they siphon doctors, workers, providers from general acute hospitals caring for less affluent populations. Support
* AB 2942 (Ma) COMMUNITY BENEFITS: Would standardize what non-profit hospitals report as “community benefits” to justify their non-profit status. Support

The Legislature will now take a break from committees while budget negotiations are expected to continue throughout July. Both houses will resume committees on August 4. These bills will need to pass fiscal committees by August 15th and the final floor votes by August 31. If they pass through the Legislature, the Governor will have the month of September to decide to sign or veto the bills.

Health Access will continue to track the progress of this legislation in the coming months. For information, please contact the author of this report Hanh Kim Quach at hquach@health-access.org.

Labels: Hospitals, Insurers, Legislation, Updates

posted by Anthony Wright | Permalink | 1:28 AM


 

When medical debt attacks...

Wednesday, June 04, 2008

If you want to know more about the financial consequences of being uninsured, read yesterday's Wall Street Journal article by Sara Rubenstein.

In a move that consumer groups say could increase pressure on people with unpaid medical bills, some hospitals are trying out a new tactic to recoup patients' debts: They're auctioning the debt online.

Hospitals have long relied on outside collection agencies to go after debtors. Under traditional arrangements, these agencies receive a percentage of any money they get from a debtor; the more they collect, the more they earn.

Now, some of the same collection agencies, as well as other firms that purchase debt outright, have begun participating as bidders in online auctions, in which they buy the debt or provide guaranteed payments to hospitals for access to the unpaid accounts. Some experts say this gives them more reason to aggressively pursue patients in arrears. Auctions can drive up the amount paid for debt, meaning a collector must recoup more money from patients to cover its initial investment and turn a profit. And the winning bidders often get to keep all the money they collect on the auctioned debt.

Health Access California has talked to lots of Californians with medical debt, as we worked to pass AB774(Chan), to prevent hospitals from overcharging the uninsured. Invariably, the experience of these patients in dealing with the bill was worse after the bill was referred to collections, and much worse after the debt was sold. That's why AB774 included a moratorium on patients being sent to collections. There are other existing consumer protections against aggressive collections practices, but is it enough?

Winning bidders may "have to work harder" to make a profit from auctioned debt, says Michael Klozotsky, an analyst at Kaulkin Ginsberg Co., a collections-industry strategic-advice company. "Working harder means sometimes using strategies that are more aggressive.

"Many of the auctions of hospital debt have been done through Web site ARxChange.com1 -- shorthand for "accounts receivable exchange" -- owned by TriCap Technology Group. Another site is medipent.com2, run by Medipent LLC. The auction-site owners, both small companies based in New York, say their systems create safeguards that protect patients from potential abuse. Collection firms are vetted for their tactics and approach to patient needs and concerns before they are allowed to participate in auctions, the site owners say. The site owners also try to ensure that collectors comply with hospital rules -- whether they must record phone calls, for instance, or get the hospital's permission before initiating a lawsuit against a patient. Hospitals have final say over who bids on their accounts, and, on ARxChange.com, don't necessarily award the contract to the highest bidder.

Consumer advocates say patients are less likely to successfully dispute bills or negotiate them downward if they are dealing with a third-party collector rather than a hospital directly. Collectors also are further removed from hospitals' financial-assistance policies."The hospital is an institution in the community, has a reputation, in many cases has a nonprofit mission to uphold," says Anthony Wright, executive director of the consumer-advocacy coalition Health Access California. "Once it goes to collections, that starts a process that can get a lot more antagonistic, a lot more aggressive, and a lot more damaging to a family's credit history and financial future."

The federal Fair Debt Collection Practices Act and some state laws govern how debt collectors can treat consumers. For instance, debt collectors aren't allowed to harass consumers or make false statements, including implying they will sue if they don't intend to do so. Consumer groups say calling the medical provider or your insurer could help clarify any confusion about what you owe. The hospital also could provide information about financial assistance or charity-care.

A hospital bill is typically the biggest bill a person gets in their entire life. The first goal is to prevent these situations from happening in the first place: to make sure people are covered, or have other financial options that can help pay the bill. But in any case, patients with medical debt should have basic consumer protections. We don't want people to not go to the hospital for fear of the bill, or those who come to collect it.

Labels: Hospitals, InTheNews, MedicalDebt

posted by Anthony Wright | Permalink | 10:59 AM


 

Two more passed...

Thursday, May 29, 2008

Two more bills of interest to health advocates passed:

AB 2942 (Ma) which would require all hospital (both for- and non-profit) to show how their existence is a community benefit in order to be licensed. That includes providing health services that are important to the community it serves, including care for the most vulnerable. (Passed 43-35.)

SB 1633 (Kuehl) which would protect low-income patients receiving dental work from high-interest credit card schemes promoted by their dentists. (I'll post the vote later)

Labels: Hospitals, Legislation

posted by Hanh Kim Quach | Permalink | 4:58 PM


 

Never-never land...

Wednesday, May 28, 2008

One more bill passed today of interest to health advocates: 2146(Feuer), so that health care providers would not charge for "never events"--events that should never happen. These include surgery performed on the wrong body part; surgery on the wrong patient; deaths from medication errors; etc.

The bill got a 42-21 vote, with most Democrats in support, with Soto absent, and De La Torre, Dymally, Galgiani, Hernandez, Krekorian not voting.

Labels: Hospitals, Legislation

posted by Anthony Wright | Permalink | 6:30 PM


 

Health reform lives on in Sacramento...

Tuesday, May 27, 2008

HEALTH ACCESS UPDATE
Tuesday, May 27th, 2008


KEY HEALTH BILLS PASS FLOOR VOTES IN CALIFORNIA LEGISLATURE
* Senate Passes SB1522 (Steinberg), Standardizing Insurance & Prohibiting "Junk" Coverage
* Assembly Passes AB2967 (Lieber), Providing Transparency on Cost and Quality of Care
* Also: Bills Pass to Regulate Insurers on Rescission, Maternity Coverage, Mental Health Parity, and Requiring 85% of Premium for Patient Care

* More on the Legislative Debate and much more at the Health Access WeBlog (www.health-access.org/blogger.html):


Health reform continues to be a hot topic at the State Capitol. Passing their first floor vote and the half-way point in the California Legislature, key health bills would provide patients with new information and needed consumer protections regarding their care and coverage.

The Assembly and Senate passed several key health care bills, including ones to protect consumers from "junk" insurance; to increase transparency about the cost and quality of care; to regulate the practice of retroactively denying coverage to patients; and to mandate coverage of maternity and mental health services. The health reform conversation is alive and well.


The following bills passed:


INSURER OVERSIGHT

* STANDARDIZING INSURANCE: SB1522(Steinberg), eliminating "junk" insurance and standardizing the insurance market to allow for "apples-to-apples" comparison for consumers. The bill would set a minimum benefit standard for coverage by requiring coverage to have an overall cap on out-of-pocket costs, and cover doctor, hospital, and preventative care. It would sort health insurance policies into five coverage categories, ranging from “comprehensive’’ to “catastrophic." Here's a fact sheet, and a patient story that illustrates the issue.

Organization of plans into these categories would enable consumers to better track premium, benefits and cost-sharing. The bill would also prevent consumers from not understanding their coverage, or having "junk" coverage where they are paying a premium by are still facing unlimited financial exposure. Sponsored by Health Access California. (Passed by the Senate 22-16 with most Democrats in support; Ducheny and Ridley-Thomas not voting; Correa voting no.)


* MEDICAL LOSS RATIO: SB1440(Kuehl), to require that at least 85% of premium dollars go to patient care, rather than administration, marketing and profit. The proposal seeks to ensure that consumers are getting value for their dollar. (Passed by the Senate 22-16, with most Democrats in support, with Machado and Simitian not voting, and Yee voting no.)

* RESCISSIONS: AB1945(De La Torre), to require insurers to get an independent review before retroactively denying coverage from patients. (Passed the Assembly 57-16, with significant bipartisan support.) Also passing was AB2549(Hayashi) which sets a six-month time limit for insurers to rescind once consumers' applications are approved. (Passed the Assembly 44-26.)

BENEFITS


* MENTAL HEALTH: AB1887(Beall) to expand the requirement on insurers to cover mental health services. (Passed by the Assembly 44-26, with most Democrats in support, and with Arambula, Mullin, Calderon, Galgiani not voting; Soto absent.)

* MATERNITY: AB1962(De La Torre), to require insurers to cover maternity benefits. (Passed the Assembly 44-31, with most Democrats in support; Soto absent; Galgiani not voting; and Calderon and Parra voting no.)


PROVIDER OVERSIGHT

* TRANSPARENCY: AB2967(Lieber), to require better data from health providers and plans to increase the transparency of the cost and quality of care. This effort has yielded one of the most interesting coalitions, with strong support by prominent consumer, labor, and business groups--all purchasers of health care trying to get a better sense of what they are getting for their money. (Passed by the Assembly 41-32, with most Democrats in support but Soto absent; Fuentes, Krekorian, Ruskin, Portantino, Solorio not voting; and Arambula voting no.)

* DISTRICT HOSPITAL TRANSACTIONS: SB1351(Corbett), to require Attorney General oversight over district hospital sales and closures. (Passed the Senate 24-14, with most Democrats in support, and Scott not voting.)

Health Access will continue to track these and other bills on our website, at
http://www.health-access.org/advocating/2008_bills.html

Labels: Hospitals, Insurers, Legislation, Updates, YearOfReform

posted by Anthony Wright | Permalink | 7:46 PM


 

A quick floor report...

Busy and productive day in the Assembly and Senate on many of the key health care bills. The health reform conversation is alive and well...

Here's what passed (partial list--we'll have a fuller update later today):

* SB1522(Steinberg), eliminating junk insurance and standardizing the insurance market to allow for "apples-to-apples" comparison for consumers. (Passed by the Senate 22-16 with Ducheny and Ridley-Thomas not voting; Correa voting no.)

* AB2967(Lieber), to require better data from health providers and plans to increase the transparency of the cost and quality of care. (Passed by the Assembly 41-32. Party line vote with Fuentes, Krekorian, Ruskin, Portantino, Solorio not voting; Soto absent; Arambula voting no.)

* SB1440(Kuehl), to require that at least 85% of premium dollars go to patient care, rather than administration, marketing and profit. (Passed by the Senate 22-16, with Machado and Simitian not voting, and Yee voting no.)

* AB1945(De La Torre), to require insurers to get an independent review before rescinding coverage from patients. (Passed the Assembly 57-16, with significant bipartisan support.) Also passing was AB2549(Hayashi) which sets a time limit for insurers to rescind. (Passed the Assembly 44-26.)

* AB1887(Beall) to expand the requirement on insurer to cover mental health services. (Passed by the Assembly 44-26, with Arambula, Mullin, Calderon, Galgiani not voting, Soto absent.)

* AB1962(De La Torre), to require insurers to cover maternity benefits. (Passed the Assembly 44-31, with Galgiani not voting; Soto absent; and Calderon and Parra voting no.)

* SB1351(Corbett), to require Attorney General oversight over district hospital sales and closures. (Passed the Senate 24-14, with Scott not voting.)

Good things. Good day for consumers.

Labels: Hospitals, Insurers, Legislation

posted by Anthony Wright | Permalink | 5:59 PM


 

Getting over a huge hurdle...

Thursday, May 22, 2008

HEALTH ACCESS UPDATE
Thursday, May 22nd, 2008


FISCAL COMMITTEE REPORT: OUTCOME OF KEY HEALTH BILLS
* In budget crisis, only a third of proposed bills pass Appropriations Committee
* Health bills move to standardize insurance, provide transparency, protect consumers
* Deadline to pass full floor vote in the house of origin is Friday, May 31st

Click Here for What's New on the Health Access WeBlog: Budget reactions; The media's miss in reporting the impact of the health budget cuts; Over 1,000 rescinded patients reinstated; the lessons of health reform for the budget, and vice versa; Big balance billing fight; McCain's high-risk pool highjinks from California perspective; Prescription drug discounts in peril


Today was a big day for the fate of many bills of interest to health advocates, which would provide consumer protections and place needed oversight over health insurers and providers.

For those who follow legislation, the Appropriations Committees in both the Assembly and Senate made decisions about whether to let legislation proceed to floor votes, or to hold them in committee, evaluating them on how much the bills will cost the state's general fund.

The Appropriations Committees in both houses considered nearly 600 bills Thursday. Given the state's $17.2 billion -- and growing -- deficit, only one-third passed. In the Assembly, only 79 of 414 bills survived. In the Senate, it was 99 out of 157 bill passing--and of the only $26 million in general fund spending approved, $23 million was in two bills responding to court orders.

Many health consumer bills in committee--many with no general fund cost--cleared this hurdle, however, and will head to the respective houses next week. All bills must pass their respective houses by May 31st. Many bills face difficult floor votes next week.

BELOW is a list of health consumer bills--it will be updated on the Health Access California website as the session continues, at http://www.health-access.org/advocating/2008_bills.html

For every bill, the list includes the bill number (the author) and A SHORT DESCRIPTION IN CAPS: There's also a longer description of the legislation, Health Access California's position on the legislation, and finally, where the legislation is currently pending.

Health Access will send out another list Friday of all bills pending on the Assembly and Senate floors for a vote. Coverage of the floor votes will be available on the Health Access blog, at: http://www.health-access.org/blogger.html


Health Access California -- Selected Bill List

INSURER REGULATIONS

Insurance Oversight & Market Reforms
· PASSED- SB 1522 (Steinberg) INSURANCE MARKET STANDARDS: Would sort health insurance policies into five coverage categories, ranging from “comprehensive’’ to “catastrophic.’’ Organization of plans into these categories would enable consumers to better track premium, benefits and cost-sharing, and assist consumers in making apples-to-apples comparisons between plans. Would weed out “junk’’ insurance by developing minimum benefit standards. Health Access California is the sponsor. Support. PASSED Senate Appropriations. To Senate Floor.
· PASSED- SB 1440 (Kuehl) CAPPING ADMINISTRATION AND PROFIT: Would set a minimum medical loss ratio – requiring every insurer to spend at least 85 percent of premiums on patient care. Support, seek amendments. PASSED Senate Appropriations. To Senate Floor.

Rescissions
· PASSED- AB 1945 (De La Torre) INDEPENDENT REVIEW: Would require approval by Department of Managed Health Care or Department of Insurance for each individual rescission. Support. PASSED Assembly Appropriations. To Assembly Floor.
· PASSED- AB 2549 (Hayashi) TIME LIMIT: Would impose a six-month time limit in which insurers have to rescind individual health care policies once consumers’ applications are approved. Support. PASSED Assembly Appropriations. To Assembly Floor.

Benefit Mandates
· PASSED- AB 1887 (Beall) MENTAL HEALTH PARITY: Would require health plans to provide coverage for all diagnosable mental illnesses. Support. PASSED Assembly Appropriations. To Assembly Floor.
· PASSED- AB1962 (De La Torre) MATERNITY COVERAGE: Would require all individual insurance policies to cover maternity services. Support. PASSED Assembly Appropriations. To Assembly Floor

Improved Insurance Options
· HELD IN COMMITTEE- SB 1622 (Simitian) PUBLIC INSURER: Would create a statewide public insurer, connecting existing regional, county-based health care plans, to compete with private health care plans and provide consumers more affordable coverage choices. Support. HELD. Will not advance this year.

HEALTH CARE PROVIDERS

Transparency
· PASSED- AB 2967 (Lieber) TRANSPARENCY AND DISCLOSURE: Would require public reporting of cost and quality by doctors, hospitals HMOs and others in the health care industry. Support. PASSED Assembly Appropriations. To Assembly Floor.
· PASSED- SB 1300 (Corbett) CONFIDENTIALITY CLAUSES: Would prohibit confidentiality clauses, which keep secret information on pricing and health care quality from consumers, in contracts between providers and insurers. Support. PASSED Senate Appropriations. To Senate Floor.

Doctor and Hospital Oversight
· PASSED- AB 2146 (Feuer) ‘NEVER EVENTS’: Bans providers from billing patients or insurers when they have made an avoidable mistake, such as operating on the wrong person, prescribing the wrong drugs, or leaving foreign objects inside a surgery patient. Support. PASSED Assembly Appropriations. To Assembly Floor.
· PASSED- AB 2942 (Ma) COMMUNITY BENEFITS: Would standardize what non-profit hospitals report as “community benefits” to justify their non-profit status. Support. PASSED Assembly Appropriations. To Assembly Floor.

Hospital Transactions
· PASSED- AB 2741 (Torrico) HEALTH IMPACT ANALYSIS: Would require for-profit hospital sales to undergo health impact analyses to gauge the transaction’s effects on the affected community, health care services, and the community’s public interest. Support. PASSED Assembly Appropriations. To Assembly Floor.
· PASSED- SB 1351(Corbett) OVERSIGHT: Would require Attorney General oversight into transactions involving district hospitals. Support. PASSED Senate Appropriations. To Senate Floor.

Balance Billing
· PASSED- AB 2220 (Jones) BINDING ARBITRATION: Requires providers and health plans to resolve contracting and payment disputes through binding arbitration. Watch. PASSED Assembly Appropriations. To Assembly Floor.

UNDERSERVED COMMUNITIES

· PASSED- AB 2902 (Swanson) COMMUNITY HEALTH WORKERS: Would require the Office of Multicultural Health to encourage the use of community-based health care workers to help facilitate and coordinate better health outcomes in underserved communities. Support. PASSED Assembly Appropriations. To Assembly Floor.
· HELD IN COMMITTEE- AB 3027 (De Leon) LANGUAGE ACCESS: Would require health plans to translate materials into Medi-Cal threshold languages. Support. HELD in Assembly Appropriations. Will not advance this year.
· HELD IN COMMITTEE SB 1332 (Negrete-McLeod) MANDATORY MEDI-CAL MANAGED CARE: Would require seniors and persons with disabilities in Riverside-San Bernardino Counties to enroll in Medi-Cal managed care. Oppose. HELD in Senate Appropriations. Will not advance this year.

COVERAGE

· HELD IN COMMITTEE: SB 1593 (Alquist) BRIDGING COVERAGE: Would clarify that children currently covered by county health initiatives would be first in line to receive Medi-Cal and Healthy Families coverage once those programs are expanded. Support. HELD in Senate Appropriations. Will not advance this year.

Labels: Hospitals, Insurers, Legislation, Updates

posted by Anthony Wright | Permalink | 9:35 PM


 

Guest blog on balanced billing from a veteran health advocate...

Friday, May 16, 2008

Beth Capell, Health Access' contract lobbyist extraordinaire, has been advocating for consumers for more than two decades. She offers these thoughts on balance billing, an insidious practice of some doctors and hospitals who decide to threaten insured consumers with aggressive collection agency if the consumer does not pay the “balance” between the insurer or HMO paid for their care and what the doctor or hospital wanted to be paid. (Relatedly, we blogged on a recent and egregious example of the Prime/Kaiser situation. 5/17 UPDATE: There's a new development, where a legal injunction has been ordered, as reported in the Orange County Register on balance billing. The LA Times also has a story.)

“Balance” billing has been illegal for Medicare and Medicaid enrollees for decades. It is illegal for HMO enrollees if they go to a contract facility. And until a few years ago, we probably would have said balance billing was illegal when an insured consumer got emergency care, even at a non-contract hospital.

As consumers, we are sympathetic to doctors and hospitals who feel badly treated by HMOs and insurers. We know what that’s like.

But as consumer representatives, we are pretty impatient with doctors and hospitals that treat consumers badly. We don’t like that either. And when it is all about a billing dispute between providers and plans, we say a pox on both their houses: get consumers out of the middle.

Well, this week DMHC had a hearing on a regulation to do just that: to say that if a consumer with coverage regulated by DMHC gets emergency care, then the consumer is only responsible for applicable copays or deductible, not for the difference between what the emergency doctor or the hospital wanted to be paid and what the HMO paid. Health Access is fortunate that our representative at this hearing is Elizabeth Abbott, who formerly headed the federal Centers for Medicare and Medicaid Services (CMS) in the western region of the United States: she has heard plenty of plan-provider disputes in her day and has no surfeit of patience with whining. She reports that doctors are furious at the proposed regulation.

As we said, we are sympathetic to doctors and hospitals fighting with HMOs. And indeed we as well as the Department have spent endless hours listening to the complaining of doctors and hospitals.

After all that, we know several things: first, consumers deserve to be protected from bad behavior by doctors and hospitals as well as HMOs and insurers. Second, under California law, doctors and hospitals that do not have a contract with the consumer’s HMO do in fact get paid and usually get paid in a reasonable period of time (less than 60 days). So what are the doctors and hospitals fighting with the HMOs about? It turns out it is not just about the amount of the payment but also what counts how.

You would think that it would be easy to decide that when an ER doc takes care of you because you have a broken bone, he should be paid for reading the x-ray or MRI, but it turns out whether that is part of the bundle of services or not is part of what providers and plans fight over. And they fight over it partly because there is no standardization of bundling. The docs, not surprisingly, want the bundling system the docs have developed (called the AMA/CPT code, if you care). But Medicare decided a long time ago that letting the docs set the rules by which they are paid does not make much sense and ditto with Medi-Cal.

And we made it lots more complicated in California when we allowed the development of the “delegated medical model”. (If your eyes are crossing, welcome to my world.) That means that Blue Shield does not just contract with individual docs, but instead contracts with Sutter Medical Group or Hill Physicians or Beaver or Scripps or some other outfit with thousands of docs and hundreds of thousands of patients. So if you are a Sutter Medical Group patient but you end up at UC Davis emergency room because that is where the ambulance took you, what are the rules for bundling the claim? Is that thing-y they put on your finger to check your blood oxygen in or out of the bundle? Is it the Medicare rules? The Sutter group rules? The Blue Shield rules? Or are you actually HealthNet? And why do you care? Well, probably you will when the ER doc or the hospital loses their
patience with the HMO and just decides to send you to collections and let you
fight it out with the HMO.

And yes, this is yet another way in which our current system piles on administrative overhead for no good reason. So in addition to fighting to prohibit balance billing of consumers, we are trying to help figure out how to minimize the provider-plan disputes by supporting a single set of rules for bundling as well as other changes.

The need to end balance billing got a lot more obvious this week when we found out that one hospital system in Southern California, Prime Healthcare, had sent over 6,000 Kaiser members to collections because Kaiser would not pay whatever Prime Healthcare wanted to charge for their emergency care. Prime Healthcare is a system that refuses to contract with most insurers---so it is not just Kaiser members who are at risk: it is anyone with insurance who walks into their emergency room. It looks as if Prime Healthcare took on Kaiser first but nothing prevents the hospitals from doing the same thing to consumers covered by other insurers that Prime fails to contract with. And Prime also seems to be engaged in the same old game that for-profit Tenet used to play of turbo-charging the charges for care so that the sticker price goes up and up.

As well as the proposed regulations, we are working on AB1203 (Salas) and SB981 (Perata) to prevent balance billing of patients who get emergency care. While both these bills are still in progress, we hope this year we can get consumers out of the middle of these provider-plan disputes.

Labels: BalanceBilling, Hospitals, Insurers, Schwarzenegger

posted by Hanh Kim Quach | Permalink | 4:53 PM


 

The timing could not have been better...

Friday, May 09, 2008

Dr. Prem Reddy, owner of Prime Healthcare Services, is running around terrorizing 6,000 Southern California Kaiser Permanente members -- sending them enormous hospital bills (via an aggressive collection agencies) and telling them to pay up, or ruin their credit. See the story here. One patient featured is being asked to pay $50,739.70 in full by June.

The company, with 9 hospitals Southern California, is demanding payment for emergency services that are currently under dispute with Kaiser. The patients are being told they must come up with the money to pay for their treatment (the portion that Kaiser is disputing and has not agreed to pay).

The tactic being used by the hospital chain is called "balance billing,'' where patients are asked to pay the difference between what the hospital billed, and what the insurance company paid. The Schwarzenegger Administration has been working on regulations to ban this practice, and in a strongly worded notice releasing their proposed rules, accused providers -- such as hospitals and physicians -- who engage in this behavior of using "innocent enrollees'' as "bargaining chips in an unfair provider billing pattern'' that leads to "long-term harm o the enrollee's health, safety and financial stability.''

Coincidentally -- the Administration's Department of Managed Health Care will hold a hearing on this very issue in Irvine on Wednesday, the heart of Orange County where three of Prime's hospitals are located (and presumeably many of the recipients of these giant bills.)

Testimony anyone?

(Relatedly, AB1203 by Mary Salas would ban this practice.)

Labels: Affordability, BalanceBilling, Hospitals

posted by Hanh Kim Quach | Permalink | 12:56 PM


 

Find the solutions, not blaming the victim...

Tuesday, April 15, 2008

"Don't Blame Crowded ERs on the Uninsured" is the pitch-perfect headline of an article by Suzanne Bohan in the San Mateo County Times and other papers.

The articles reports on a UC-San Francisco study that reports that asks "Are the Uninsured Responsible for the Increase in Emergency Department Visits in the United States?" and answers "no." In fact, the "proportion of adult ED visits by persons without insurance was stable across the decade," roughly in the 14-15% range.

Despite the belief that the uninsured are the majority of those crowded in our emergency rooms, I note that this figure is a bit lower than the overall percentage of uninsured people in the country, which is around 16%.

This is consistent with other findings, such as a 2004 Urban Institute report by researchers Zuckerman and Shen on ocassional and frequent ER users. That paper concludes, in part, "The uninsured and the privately insured adults have the same risk of being frequent users... It seems hard to blame the overcrowding of EDs on the uninsured."

MISSING THE MESSAGE: Some conservative commentators will use this research to attack the notion that of a "hidden tax" that we all pay in our premiums for having such a large uninsured population, and to attack the notion of health reforms and coverage expansion generally. I get a very different lesson from the study.

I too have been a skeptic of the Governor Schwarzenegger's "hidden tax" rhetoric, because it led people to blame the uninsured for high health costs, rather than the reverse.

If the uninsured go to the emergency room, they have only a right to be stabilized. But even then, they get a bill--typically the biggest bill they will see in their lives, and often one that is inflated well above what an insurer would pay for the same service. No wonder they may actually go to the ER less.

LOTS OF FACTORS: That said, there's nothing inconsistent with saying that the uninsured, when they finally do go to get care, are in a worse condition since they let their conditions linger and mestatisize, costing the health system more money in the long run. Or that the uninsured get the bill, but some face bankruptcy not being able to pay, and as a result leave the hospital unpaid.

In other words, I think the real world in health care is more complicated than one cause. Some uninsured get the care they need. Others go without and simply die. And in between, some uninsured wait until the problem gets worse. And some of these factors end up costing the health system. So reforming health and increasing coverage is needed and urgent, even for the regular, insured California.

SOLUTIONS: So how much is the "hidden tax?" I don't know, but it's real. But I think the focus should be on fixing the system, not the victims of that system:

* We all pay when McDonald's, Wal-Mart, or Applebee's don't, when some employers don't pay their fair share. Those who are uninsured are those who fall through our health system that relies on voluntary employer contributions.

* We should ensure that those who are uninsured are not overcharged and thus discouraged from getting needed care. California passed a fair hospital pricing law in 2006, and other protections would be helpful.

* We who are *insured* would not go to the emergency room as much if we had the ability to get timely access to care to primary care and specialists. There's pending regulations for insurers and providers at the California Department of Managed Health Care.

Our health care system doesn't have just one problem, and doesn't have just one solution. The new research helps us understand that.

Labels: ExpandingCoverage, Hospitals, Research, TimelyAccess, Uninsured

posted by Anthony Wright | Permalink | 10:45 PM


 

Consumer reporting on health care...

Thursday, April 10, 2008

Another moment during the debate on the transparency bill, AB2967(Lieber) was when Assemblymember Ted Gaines questioned a key supporter of the bill, Laurie Sobel from Consumers Union, and asked "isn't this something that you should be doing?"

It's not a uncommon question for those who work at Consumers Union, publisher of Consumer Reports magazine--one of the one of the most read magazines in the country, and one of the most trusted. I've been proud to work alongside them in different roles in my decade-and-a-half of consumer advocacy.

Laurie had an answer: she thanked the Assemblymember for the confidence, but that as much as Consumer Reports would be happy to provide the same kind of evaluation of doctors and hospitals as they do for cars and ceiling fans, with the trademark circles, there's a limit to what they can do without this bill in place.

Most tellingly, no independent group can mandate reporting of doctors and hospitals, and it's hard to provide a meaningful and complete report with the largely voluntary reporting systems we have now. This is a governmental function. There might be a role for CU or other advocates in analyzing the data, but we need the government to collect it and appropriately categorize it.

There's often been several times in just the last few years when policymakers who oppose legislation to set consumer standards or provide more consumer information will say on the floor of the Assembly that this should be the role of Consumer Reports, not government. Yet these same policymakers never seem to follow the position of the actual publisher of Consumer Reports.

Labels: Employers, Hospitals

posted by Anthony Wright | Permalink | 11:05 PM


 

A Busy Day for Bills....

Wednesday, April 09, 2008

HEALTH ACCESS UPDATE
Wednesday, April 8th, 2008


HEALTH CONSUMER PROTECTIONS PASS ASSEMBLY HEALTH
* Insurers would face restrictions in cancelling coverage retroactively
* Patients would be better able to assess hospital cost and quality data
* Other bills on hospital community benefits, boutique hospitals, and others

Click Here for What's New on the Health Access WeBlog: Balancing the Budget; Re-Examining Hillary-Care; Balance Billing; Dennis Quaid and Medical Mistakes; Prescription Drug Gifts to Doctors; PHRMA's Revenge; Coverage Matters; Deaths Due to Uninsurance; The Health Wonk Review Spotlight; The Individual Market; Nuggets from the Medi-Cal Cuts Hearings.


The Assembly Health Committee on Tuesday approved a smattering of bills that would begin to set the foundation for health care reform, providing security to health consumers – both for their coverage and choice of provider.

Two of the bills deal with the insurer practice of retroactively canceling policies after patients become sick and need expensive treatments. These rescissions leave patients tens of thousands – if not hundreds of thousands in debt. Another bill would require medical providers to disclose cost and quality information in order to give purchasers more power in selecting the highest quality and most efficient care.

RESCISSIONS

* AB1945 (De La Torre) would create an independent panel to review cases where an insurance company wishes to rescind a policy. The bill passed on a bipartisan 11-0 votes, with Republicans Alan Nakanishi and Bill Emmerson voting for the bill. In addition to an independent panel, and review by regulators for rescissions, AB1945 would establish a standardized application for consumers to fill out. De La Torre cited recent investigations by state regulators, which found violations in every single instance.“That’s not an accident,’’ he said. Insurers, he said, should not be permitted to “act as judge and jury whenever they want to rescind a policy.’’

SUPPORT: California Medical Association, Health Access, California Alliance for Retired Americans, AARP, Congress of California Seniors, CalPIRG, Consumers Union, California Teachers’ Association, California Academy of Family Physicians and Consumer Federation of California spoke in support of the bill.

INDUSTRY: Industry associations were not completely opposed to the bill, but were concerned about whether the application would give insurers enough information about a potential enrollees condition so that “they can do reasonable underwriting up front,’’ said Charles Bacchi, for the California Association of Health Plans. That means the industry wants to be able to deny for pre-existing conditions, and the questions need to elicit enough detail to do that. Others had concerns about the need for regulator approval of rescissions, and the authority given to the state to revoke the licenses of health plans. Blue Cross of California opposed the measure.

* AB2549 (Hayashi) is a related measure would limit health plans ability to cancel coverage because of a fraudulent application to six months after the application is approved. The bill passed on a party line vote, with Republicans either abstaining or opposing. The industry opined that the six-month period was too short. Current industry practice allows a period of two years for insurers to rescind because an expensive claim may not occur within the first six months – usually the trigger to review an enrollees application.

SUPPORT: Health Access, California Teachers Association, Congress of California Seniros, AARP, California Medical Association, California Academy of Family Physicians, AFSCME, California Psychological Association and Having Our Say!

OPPOSITION: Association of California Life and Health Insurance Companies, California Association of Health Plans, California Association of Health Underwriters.

TRANSPARENCY

Another important bill passed by Assembly Health Committee on Tuesday would require medical providers to publicly disclose price and safety information.

* AB2697 (Lieber) would create an independent panel, which would include hospitals, doctors, consumer and labor representatives to recommend a plan that would be continuously updated. The data collected would be scientifically based, consider where providers practiced (urban, rural, affluent or poor communities) and risk adjusted – to account for the fact that some physicians/hospitals would attract higher risk patients. This bill passed 11-5 on a party line vote, with Republicans opposing in spite of small business support.

SUPPORT: Along with a usual cast of consumer groups, the National Federation of Independent Businesses, Pacific Business Group on Health and Small Business California supported the measure. “We all know the challenges small businesses face. A system of comparable statistics is important to helping rectify the situation,’’ said Michael Shaw, with NFIB. Other supporters included Health Access, SEIU, AARP, CalPIRG, California Labor Federation, Consumers Union, Congress of California Seniors, Having Our Say among many others.

OPPOSE: The California Medical Association opposed saying that the state should work on the existing program, rather than create a new expensive one funded by providers. The hospitals also opposed the measure.

OTHER HEALTH CONSUMER BILLS ON HOSPITALS

The following bills also passed in Assembly Health Committee on Tuesday. For a broader list of interest to health advocates and Health Access California, visit our website, at:
http://www.health-access.org/

* AB2942 (Ma) would require all hospitals to develop and publicly a community benefit plan, just as non-profit hospitals are currently required to. The plans would need to consider and report what the community needs and levels of charity and discount care. The bill passed 11-3.

* AB2697 (Huffman) requires “boutique hospitals,’’ which tend to serve more affluent patients to assess its impact on the community health system, and whether it siphons dollars and workers from providers and hospitals that take care of sicker or less affluent populations. This bill passed 12-5.

In addition to these and other bills heard this past Tuesday, another bill, SB1633 (Kuehl), passed Senate Business and Professions Committee on Monday. SB1633 addresses the issue of credit cards for dental services. These are offered in dentists offices with little explanation to the patient of their course of treatment or the terms, and interest rates on the cards. Patients are often charged the full amount of services, even before they are rendered and some are asked to sign for the credit line while under the influence of anesthesia. This bill passed with a unanimous vote.

Bills need to pass policy committees by April 18. Health Access will continue to provide updates on actions taken in the Legislature. For more information, contact the author of this report, Hanh Kim Quach, at hquach@health-access.org.

Labels: Hospitals, Insurers, Legislation, Updates

posted by Anthony Wright | Permalink | 2:14 AM


 

Medical Errors: an issue that's Yours, Mine, and Ours

Friday, March 28, 2008

Sarah Arnquist at The Health Care Blog and Rong-Gong Lin of the Los Angeles Times report from the Association of Health Care Journalists (which I hope bucks the trend of declining membership).


The big news: Actor Dennis Quaid is considering suing Cedars-Sinai Medical Center, which gave their twin newborn babies a massive overdose (1,000 times the prescribed dose) that almost caused their death.

The bigger news: The experience has made Quaid an activist against medical errors. He's set up a organization, The Quaid Foundation, dedicated to patient safety. He's urging Cedars-Sinai and hospitals across the country to implement a bar code system that would ensure that the right drug and dose are provided to patients. It's a worthy cause to highlight: the Insitute of Medicine suggests that there are between 44,000 to 98,000 preventative deaths each year because of medical errors--not to mention the significant costs that could be saved.



There's a lot of policy efforts on the subject. There is Consumers Union's work on hospital infections. There's health reform efforts at transparency of cost and quality data, both last year with AB x1 1, and this year, with bills like AB2967(Lieber).


And there's the question of enforcement. Julie Sevrens Lyons at the San Jose Mercury News reported that some of the first fines allowed under a new law were levied against Cedars-Sinai and 10 other hospitals, for severe--and even lethal--mistakes like the Quaid case. The fine, however, was a mere $25,000--which is the billed charged of only a day or two at a hospital.




Quaid says that Cedars-Sinai at least decided not to send a bill. And some hospitals are adopting the policy of not charging insurers or patients for "never events"--the severe mistakes that lead to injury or worse. So the financial incentives are starting to turn. But the key is to prevent the medical errors in the first place.

Labels: HealthyLiving, Hospitals, InTheNews

posted by Anthony Wright | Permalink | 11:07 PM


 

New website on hospital "fair pricing" policies...

Tuesday, January 22, 2008

On the eve of a vote on a major health reform, it's good to see reforms passed in previous years bear fruit.

There's a new website out today, that helps uninsured and underinsured hospital patients and health consumers, by allowing them to find the fair pricing and free care policies of any hospital in California, including those in their area.

A new California law, sponsored by Health Access California in 2006, now requires hospitals to make public their guidelines for their pricing policies, and this website will help in getting that information out to the public. Uninsured or underinsured hospital patients have long been charged several times what insurers and government programs pay for exactly the same service. The new law makes sure than low- and moderate-income Californians should not be overcharged, and that hospitals make public their eligibility policies about providing free or discounted care.

The website, even in "stage one" of its development, is a one-stop shopping, allowing people to use Google Maps to identify hospitals in a given area, and then have access to the "fair pricing" eligibility policies, financial assistance applications, and the contact person of a key contacts at each hospital. It is expected to include the information for all 400 hospitals in California.

This will be a big boon to those who get a big hospital bill, and are looking for what financial assistance might be available.

The Web site, sponsored by the Office of Statewide Health Planning and Development (OSHPD), can be accessed at:
www.oshpd.ca.gov/fairpricing

The bill, AB774(Chan), sponsored by Health Access Californian and signed into law in 2006, states that self-pay patients under 350% of the federal poverty level (around $72,000 for a family of four) should not have to pay more than the Medicare or Medi-Cal rate for hospital services. It also requires that uninsured and underinsured hospital patients get information about their consumer rights and financial options, and that hospital make public their policies of who qualifies for financial assistance, including fair prices, reduced prices, and free care. Along with a New York law also passed in 2006, it is the nation's strongest in preventing hospital overcharging.

Labels: Hospitals

posted by Anthony Wright | Permalink | 2:36 PM


 

The transparency revolution...

Sunday, December 09, 2007

It hasn't been the sexiest issue, but "transparency" could be the sleeper section of health reform that really breaks the mold in terms of decreasing costs while improving quality.

The issues are laid out in this guest editorial in the San Francisco Chronicle by the CEOs of AARP, Consumers Unions, and Pacific Business Group on Health. The distingished groups represented include the publishers of two of the most-circulated magazines in the country, Consumer Reports, and Modern Maturity. Health Access has been working with them in support of this important goal.

Labels: Hospitals, YearOfReform

posted by Anthony Wright | Permalink | 6:07 PM


 

Those with the least get charged the most...

Saturday, December 08, 2007

For years, we've made the case that the uninsured actually get charged *more* than anybody else in the health care system. Because they don't have the group purchasing power of an insurer or a public program, those typically with the least get charged the most--the "sticker price" which the insurers and public programs always pay less than.

Our advocacy over the past few years has been to correct this with regard to drugs (last year's AB2911) and hospital bills (last year's AB774). And now there is some movement on doctor's visits. Barbara Feder at the San Jose Mercury News reports on a new lawsuit against ER doctors.

When we did our work against hospital overcharging, we found that uninsured patients would typically get several bills from an emergency room visit, not just from the hospital but from the ER doctor, any specialist that was involved in the care provided, the ambulance company, etc. While the hospital bill was by far the biggest bill (and because these smaller providers seem to be more aggressive in billing and collections), patients were likely to pay the smaller bills first, without realizing it was also inflated.

Lieff Cabraser, the law firm, had done some of the previous class actions against hospital chains like Sutter and Catholic Healthcare West, which resulted in settlements for consumers. So this is no frivolous lawsuit.

Labels: Hospitals, Uninsured

posted by Anthony Wright | Permalink | 5:49 PM


 

A BIG, unfortunate and expensive illustration for health reform

Monday, December 03, 2007

The Wall Street Journal had this tragic story last week about a Merced man -- who was insured -- but still socked with a $1.2 million hospital bill (not counting thousands in doctor's office bills also).

What happened to Jim Dawson, of Merced, that landed with debt that could bankrupt him is a textbook example of what health consumer advocates have been fighting to reform for years.

Dawson had a good job with Valero Energy Corp., a big oil refinery. He had Valero-sponsored comprehensive health insurance policy, and a regular primary care physician who knew his medical history, *should* not have been vulnerable to medical-financial angst. That's at least what many think. But Dawson's story shows how anyone can be vulnerable.

First thing that went wrong: His primary care physician, and subsequent specialists were not able to diagnose a staph infection until six months after his first doctor's visit -- and by that time, the infection had ended up in his blood stream.

Next: He ran up against a lifetime cap on his health coverage -- a max of $1.5 million (which, incidentally is considered generous. Most policies have a cap of $1 million, but where set in the 1970s when the purchasing power was equal to $6 million today, according to WSJ)

Lastly: Dawson and his wife, in combing through their hospital bills, realized the hospital had inflated various items at tens and hundreds of times their actual cost on the street. For instance, stockings for $791, when they could have purchased them for $12; oxygen for up to $6,675 PER NIGHT, when it could have been rented for $250. All those numbers added up to "Disneyland numbers,'' admitted the hospitals chief medical officer.

The Dawson case highlights a number of issues:

*DISCLOSURE OF QUALITY AND COST:

Dawson visited many providers who were unable to accurately diagnose him at first. Still, Dawson (or his insurance) paid all these providers full price for their conjecture. If providers were asked to a