The FEHBlog noticed two articles advocating healthcare price transparency -- one from the provider perspective and one from the payer perspective. It is encouraging that doctors are being asked to take cost effectiveness into account.
On the flip / discouraging side is this article from NorthJersey.com with a chilling discussion of how investors have been converting struggling non-profit hospitals to for-profit hospitals in order to take advantage of a loophole in New Jersey law that allows emergency rooms to gouge insurers.
Bayonne Medical Center wasn’t just bragging about efficiency when it posted a big digital clock on a highway billboard a few years ago to show the real-time waits in its emergency room. It wanted patients to come to its ER. Lots of patients.Fortunately for FEHB plans, the FEHB Act preempts such state laws and regulators, but cost curve up. In this regard, the Wall Street Journal reports on 2013 and 2014 hospital earnings here.
It didn’t matter if the hospital was in the patient’s insurance network. On the contrary, to the businessmen who had recently purchased the medical center, those “out-of-network” patients held the key to reversing Bayonne’s fortunes.
These owners, who bought the hospital in bankruptcy, had found an unintended — and very profitable — consequence to a state regulation that was designed to protect patients with urgent medical needs. While the regulation required insurance companies to pay for emergency treatment at hospitals where their coverage wasn’t normally accepted, it did nothing to control the size of the bills the hospitals could submit to those insurers.
And that loophole enabled Bayonne, which had ended its contracts with some of the state’s largest insurers, to charge those higher out-of-network rates. The result was striking: The strategy contributed to a $17 million operational profit within two years of its 2008 takeover.
Kaiser Health News reports on an interesting case management service called Vital Decisions that some insurers offer seriously ill members. The program seeks to get these members more actively involved in managing their own health care.
Finally the Drug Channels blog discusses seven trends for specialty pharmacy's bright future.