Healthcare Transparency News – Weekly Wrap Up – April 17, 2015

Highlights from this week's Healthcare Transparency News, Studies, and Articles:

Top Hospital Ratings Prove Scarce In Medicare’s Latest Tally

[By: Jordan Rau, NPR]

On Thursday the federal government awarded its first star ratings to hospitals based on the opinions of patients. Some of the nation’s most lofty hospitals—the ones featured in best hospital lists—received mediocre ratings, while the maximum number of stars often went to small, regional hospitals and others that specialize in lucrative surgeries.

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The Quality Tower Of Babel

[By: Elizabeth Teisberg and Scott Wallace, Health Affairs Blog]

The quest for better health care, driven by measuring safety and quality, is well intentioned and has notable achievements. But like the Biblical story about building a better city, the measurement effort has become a cacophonous muddle that is distracting clinicians, raising the cost-of-care delivery, and not helping consumers make better health care choices.

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Chemo Decision First, Tell Them About the Cost Later

[By: Peter Ubel, Forbes]

[We need to] make discussion of out-of-pocket costs a more routine part of medical care, even when it is difficult to know the exact cost of care. Better yet, we need to fold these conversations into broader discussions of the pros and cons of patients’ medical alternatives. The “right” medical choice is often not purely a function of medical facts.

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Medical fees shrouded in mystery

[By: Marlene Harris-Taylor, The Blade]

Toledo-area hospitals object to talk of price comparisons

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Patients say health pricing must change

[By: Marlene Harris-Taylor, The Blade]

As hospital systems grow, so can charges they demand

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Minnesota health care data bill is a Luddite move

[By: STEPHEN T. PARENTE and DAVID NEWMAN, Star Tribune]

[As] the world marches forward toward the light [of healthcare transparency], attempting to pull back the veil, the Minnesota Senate is attempting to quarantine this state’s all-payer claims data set such that its potential value will never be realized and never become the “state’s resource” to spur improvements. S.F. 1818 prohibits the identification of individual payers, providers, hospitals or clinics.

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A growing risk: High-deductible health plans can ruin finances

[By: Ann Doss Helms, The Charlotte Observer]

High-deductible insurance is supposed to turn patients into smarter, healthier consumers. But for some, like David and P.J. Frick, the costs can become staggering. … “I think these high-deductible plans are going to become more the norm. They do reward folks who take good care of themselves,” said Joseph Piemont, chief operating officer for Carolinas HealthCare.

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Medicare doc fix bill would expand access to Medicare claims data

[By: Paul Demko, Modern Healthcare]

Transparency advocates are hailing a little-noticed provision in the pending Medicare physician-payment bill that would widen the availability of Medicare claims data … Supporters estimate that it would double the amount of publicly available data. … But some are worried about provisions allowing private groups to make money by selling public data. “I worry philosophically about creating little centers of monopoly power,” said David Newman, executive director for the Health Care Cost Institute, the only nationwide qualified entity participating in the Medicare data program. “It’s public data.”

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Obama Administration Report Slams Digital Health Records

[By: Melinda Beck, The Wall Street Journal]

Report criticizes vendors for making it costly to share patient information … The report … listed a litany of complaints it has received about vendors allegedly charging hefty fees to set up connections and share patient records; requiring customers to use proprietary platforms; and making it prohibitively expensive to switch systems.

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Priority Health launches health care app to pull up shades on provider cost differentials

[By: Jay Greene, Crain’s Detroit Business]

Priority Health is offering members a way to estimate the cost of their doctor visit or hospital procedure and shop around for a lower cost option.

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Consumer Needs Driving Price Transparency

[By: Patricia Smith, President and CEO, Alliance of Community Health Plans, The Institute for HealthCare Consumerism]

How could we benefit if it were the norm in health care to offer real-time, understandable, price information? Might consumers’ out-of pocket payments go down? Could the relentless climb in health care prices slow? Could the entire system – cost, health, quality and care experience – improve?

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[New Mexico] Governor Signs Health Care Price Comparison Bill

[By: , KUNM radio]

Gov. Susana Martinez signed a bill today that makes it so people seeking health care can find out what different routine procedures cost at hospitals around the state.

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Value, interoperability are keys to success

[By: Richard Pizzi, Healthcare IT News]

Humana CEO calls on healthcare industry to transform itself. … “Value-based reimbursement and interoperability are the keys to change … Information should be a shared asset, not a proprietary asset.”

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Looking for quality in health care

[By: DR. STANLEY SCHWARTZ, Tulsa World]

Well, OK, Inc. is a coalition of businesses in northeastern Oklahoma … bringing the nationally recognized Leapfrog Group to [the] region.

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Mostashari wants ‘day of action’ for widespread patient access to records

[By: , MedCity News]

Patient advocates are planning a “day of action” to generate mass demand for consumer access to medical records in the wake of a plan to roll back the Meaningful Use requirement for engaging patients in their own care. … “Patients are not an advocacy group. They are not a special interest. They’re why we do this,” Mostashari said. … While no date has been set, the general consensus is that the event should take place by mid-June, in time to influence HHS in its Meaningful Use changes.

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[Texas] Senate Committee approves SB 425 to protect consumers through transparency for freestanding Emergency Rooms

[By: The Orange Leader]

Getting down to business with patient engagement

[By: Mike Miliard, Healthcare IT News]

“Disengaged consumers are more than twice as likely to experience a medical error,” [Jan Oldenburg, senior manager in the advisory services practice of Ernst & Young] said. “Engaged consumers actually cost less. They pick less expensive treatment options, are more thoughtful about what’s really important and tend to have fewer readmissions.”

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Mayo Clinic and Optum360 Partner to Improve Experience for Patients

[By: Press Release, Market Watch]

Optum360 and Mayo Clinic will collaborate on enhancing and redesigning specific elements of the revenue cycle to increase efficiency while creating a convenient, accurate, transparent and personal experience for patients. … The partnership includes a next-generation patient cost estimator…

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The Modern Day Health Care Disrupters

[By: Lola Butcher, Hospitals & Health Networks (H&HN)]

Loyalty recedes as cost, convenience drive consumer choice. Retailers, insurance exchanges and apps challenge hospitals’ traditional business model.

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HIMSS Leadership Survey: 11 Key Findings

[By: , HIT Consultant]

The survey of more than 300 participants … examined key trending issues impacting the business of healthcare … Here are 11 key findings from the survey … 72 percent of respondents report that consumer and patient considerations, such as patient engagement, satisfaction and quality of care will have a major impact on their organization’s strategic efforts over the next two years….

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Contact us with your news story at news@newchoicehealth.com

Healthcare Transparency News – Weekly Wrap Up – April 10, 2015

Highlights from this week's Healthcare Transparency News, Studies, and Articles:

New York’s public hospitals must compete to survive, CEO says

[By: Melanie Evans, modernhealthcare.com]

Dr. Ramanathan Raju, CEO of the New York City Health and Hospitals Corp., said … that the organization’s financial stability will depend on its ability to win over patients. “In this new environment, the marketplace will dictate and decide which hospitals will remain open, which hospitals will struggle and which hospitals will close.”

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A push for transparency in healthcare pricing

[By: Dan Gorenstein, Marketplace]

…when it comes to health care, an industry we spend $3 trillion dollars a year on, prices often remain a mystery. Some people say that genuine cost transparency would make some of the waste and price variations vanish.

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New Campaign to Advocate for Healthcare Transparency

[By: PR Newswire]

[Clear Choices Campaign’s] members include consumer advocates, insurers, pharmaceutical companies, employers, and doctor groups … committed to empowering consumers with the information needed to make wise healthcare decisions…

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Anthem CEO: Insurers must ‘pivot’ to win loyalty

[By: Holly Fletcher, The Tennessean]

“We believe we are moving into a retail world so that our customers … are having to make choices, … and so we have to be responsive,” [Joseph Swedish, CEO of health insurer Anthem] said. “We need to build loyalty on a brand they respect. That is retail behavior, not a traditional environment in a (business-to-business) world.”

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How did hospital bills get so complicated?

[By: , LA Times]

Billing has evolved continually over the last century, but rising costs and changes in insurance reimbursement during the 1980s — still central themes in today’s healthcare market — take center stage in this story.

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What’s New in Health Care Cost Transparency?

[By: Chris Duke, Altarum Institute]

Recent Developments in Health Care Cost Transparency

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Cost of cancer drugs varies widely based on who’s paying

[By: MedicalXpress.com]

Uninsured cancer patients are asked to pay anywhere from two to 43 times what Medicare would pay for chemotherapy drugs, according to a new study from the University of North Carolina at Chapel Hill.

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3 major challenges of healthcare price transparency

[By: Ayla Ellison, Beckers Healthcare]

The lack of price transparency in healthcare threatens to erode public trust in our healthcare system, but this erosion can be stopped.

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Virginia Mason Medical Center embraces price transparency

[By: Anthony Brino, Healthcare Finance]

Seattle’s Virginia Mason Medical Center is now disclosing estimated prices for its 100 most common outpatient surgical procedures, and posting it for the public online. … “Changes in health insurance plans often mean individuals are paying higher out-of-pocket costs for healthcare services,” said Steve Schaefer, Virginia Mason’s vice president of finance. “Understandably, they are looking ever more closely at cost…”

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What’s So Interesting About Atlantic’s Huge Health Care Give

[By: Kiersten Marek, Inside Philanthropy]

The Atlantic Philanthropies … just made a massive five-year $14.8 million grant to the Boston-based nonprofit, Community Catalyst, with the goal of empowering consumers—especially among vulnerable populations—to transform health care systems in ways that improve care, expand access, and reduce costs.

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NY law that protects consumers from surprise medical bills takes effect today

[By: James T. Mulder, syracuse.com]

A new state law designed to protect New York consumers from getting hit with surprise medical bills from doctors and other providers … took effect today. … “We have seen thousands of cases where consumers who had done everything right and tried to stay in network still got socked with huge, surprise, out-of-network medical bills,” said Benjamin Lawsky, the state’s superintendent of financial services. … The law treats consumers as if they stayed in-network.

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Healthgrades names top hospitals for patient experience, patient safety

[By: Henry Powderly, Healthcare Finance]

Read more…

Contact us with your news story at news@newchoicehealth.com

Healthcare 101 — 3 Things You Need to Know about Healthcare Consumerism

Need a Medical Procedure? You Have More Choices Than You Think!

Everyday thousands of patients in the U.S. use NewChoiceHealth.com to shop for a medical procedure. Whether they are insured or uninsured, whether they need a simple MRI or a more complex surgery – they are seeking help to better understand their options and to make an informed decision. Our conversations with these healthcare consumers and experience helping them shop for local providers continues to remind us how much confusion still exists, and that patients are often kept in the dark or misinformed.

To help you with your shopping experience, we boiled down the most common questions and misconceptions into this short introduction on Healthcare Consumerism. Whether you are new to healthcare consumerism, or if you have experience shopping for your healthcare needs – we hope you find NewChoiceHealth.com to be an informative guide to help you better navigate today’s healthcare market. Continue reading

Blue Cross Blue Shield Study Highlighting Healthcare Price Discrepancies

Last week Blue Cross Blue Shield released a very informative report (The Health of America Report) showing how the same procedure can cost significantly more at one facility over another – even within the same market. Healthcare price discrepancies are not news, but it is encouraging that a large insurer like Blue Cross is making this information public. But more on that in a second, let’s take a quick look at the data.

Continue reading

Healthcare Transparency Part 3: Why It Is Necessary.

Transparency in healthcare has become one of the most actively discussed topics today.  The major questions have been:

  1. What should healthcare transparency look like?
  2. Why does healthcare transparency matter now?
  3. Why is it important to the consumer?

This is the final installment of New Choice Health’s three part article to answer these questions. 

Continue reading

Healthcare Transparency Part 1: What Does It Look Like?

Transparency in healthcare has become one of the most actively discussed topics to date.  The major questions have been:

  1. What should healthcare transparency look like?
  2. Why does healthcare transparency matter now?
  3. Why is it important to the consumer?

New Choice Health will begin to answer these questions in a three part article, starting with Question One. Continue reading

Common Healthcare Definitions for Consumers

When beginning to investigate healthcare, the consumer is sometimes overwhelmed with the enormous amount of information to be processed.  To alleviate some of the stress that may be caused by this, New Choice Health has compiled a list of Common Healthcare Definitions.

Charge, Cost, and Price

Charge. The dollar amount a provider sets for services rendered before negotiating any discounts. The charge can be different from the amount paid.

Cost. The definition of cost varies by the party incurring the expense:

  • To the patient, cost is the amount payable out of pocket for healthcare services.
  • To the provider, cost is the expense (direct and indirect) incurred to deliver healthcare services to patients.
  • To the insurer, cost is the amount payable to the provider (or reimbursable to the patient) for services rendered.
  • To the employer, cost is the expense related to providing health benefits (premiums or claims paid).

Price. The total amount a provider expects to be paid by payers and patients for healthcare services.

Stakeholders

Care purchaser. Individual or entity that contributes to the purchase of healthcare services.

Payer. An organization that negotiates or sets rates for provider services, collects revenue through premium payments or tax dollars, processes provider claims for service, and pays provider claims using collected premium or tax revenues.

Provider. An entity, organization, or individual that furnishes a healthcare service.

Related Definitions

Out-of-pocket payment. The portion of total payment for medical services and treatment for which the patient is responsible, including copayments, coinsurance, and deductibles.

Price transparency. In health care, readily available information on the price of healthcare services that, together with other information, helps define the value of those services and enables patients and other care purchasers to identify, compare, and choose providers that offer the desired level of value.

Value. The quality of a healthcare service in relation to the total price paid for the service by care purchasers.


 

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