Sunday, May 24, 2009

Weekend Update / Miscellany

Happy Memorial Day weekend, everyone.

  • Following up last Thursday's post, the AP expanded on Senator Baucus's health care reform comments to report that "the health overhaul would cover nearly everyone _ 94 percent to 96 percent of the population _ but not undocumented workers. The current system covers 86% according to the same article. Also the American Hospital Association weighed in with Sen. Baucus's Finance Committee on the public plan option under consideration. According to Modern Healthcare,

    A chief concern, the AHA letter states, centers on a history of government
    underpayments in programs such as Medicare and Medicaid. According to a 2007 AHA survey, 58% of U.S. hospitals, or 2,840, said they were not paid their cost for providing care to Medicare patients. With Medicaid, hospitals lost some $10.4 billion in 2007 due to payment shortfalls.

  • The American Hospital Association also wrote to the Justice Department raising antitrust concerns about health plan consolidation. America's Health Insurance Plans (AHIP) retorted in a press release that
    “A recent letter from American Hospital Association to the Department of
    Justice (DOJ) asks the department to take a ‘more aggressive role in
    understanding how health plan market power and consolidation harm hospitals and other providers.’ This letter uses erroneous data to draw an erroneous
    conclusion that, unfortunately, is being used today by advocates for creating a
    public program in health care reform to justify their position.

    “We are forwarding today to the DOJ a letter reiterating our concerns with hospital consolidation through merger and affiliation, and its effect on costs for
    consumers. As the nation pursues health care reform, our public discourse
    must be based on the facts and must be focused on what the outcome of our
    discussion will mean for consumers and the economic health of our nation.”
  • Also speaking of hospitals, the New York Times reported on a new trend in hospital construction to utilize private rather than semi-private rooms. That will have an interesting impact on health plan benefits which are based on semi-private room coverage. In that regard, the actuarial consulting firm Milliman released its fifth annual Medical Index. According to a Milliman press release,

    Key MMI findings include:

    The total 2009 medical cost for a typical American
    family of four is $16,771, compared with the 2008 figure of $15,609. This is a
    7.4% increase from 2008 to 2009.

    This is the third straight year of decreasing cost trends. Even so, the $1,162 increase is the highest since the 2006 increase of $1,169, when cost trends were at 9.6%.

    Every category of costs except inpatient and outpatient facility care experienced lower cost trends than last year.

    This is the third consecutive double-digit percentage increase in the amount that employees spend for healthcare services. This is primarily due to increased employee contributions, as out-of-pocket cost-sharing trends were more modest.

    The current economic environment has significant implications for healthcare costs. The consequences of employers' lost business, consumer insecurity, and provider revenue pressures affect healthcare utilization, charges for healthcare services, and who pays for the healthcare. The unprecedented uncertainty has accelerated cost increases in some ways and at the same time has reduced certain categories of utilization (e.g., electiveprocedures).
  • The American Medical Association and the American Association of PPOs partnered on a health care provider contracting toolkit, an encouraging development. According to the AMA press release,

    The toolkit provides quick reference documents on several key issues that arise during the contracting process, including:

    Responsibilities of PPNs/Payers
    Physicians Contracting with PPNs
    Assessing Network Value
    Primary/Secondary Network Matrix
    Understanding Silent PPOs

    The toolkit is available in hard copy, or can be accessed online at AAPPO and AMA Web sites.

  • Government HIT News reports that "The Office of the National Coordinator for Health Information Technology (ONC) has proposed developing a Web site containing facts about personal health record (PHR) systems and the privacy policies related their use to help consumers make informed decisions.

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