Jul
19

Healthcare costs are…

heading up.

First, a bit of background.

Big health insurers that sell insurance via the Exchanges have to file their rates with the Feds now. While they don’t insure a lot of people, their filings are detailed, public, and cover 13 states – Georgia, Indiana, Iowa, Kentucky, Maryland, Michigan, Minnesota, New York, Oregon, Rhode Island, Texas, Vermont, and Washington DC.

The fine folks at the Kaiser Family Foundation did a lot of analysis, here are the key takeaways.

  • many insurers are projecting a medical cost trend of 4-8%.
  • “A substantial share of the increase in premiums is from rising health prices and utilization of health care”
  • one insurer said “Medical Care Services CPI in March 2020 (pre-pandemic) was 5.5% and as of March 2022 is 2.9%. This data suggests a correction is imminent as labor and supply cost increases directly impact hospitals and physician offices.” [emphasis added]

Oh, and that COVID thing? “many insurers are projecting the pandemic will have a net neutral or only slight impact on health costs and premiums.”

So…what does this all mean?

My view.

  • for this year, increased utilization and prices will drive trend north of 5%
  • we’ll see a bump in Q3/Q4 as increased labor costs work their way thru the system
  • 2023 trend will likely settle around 5% as inflation in other sectors eases off.

The wild card is – brace yourself – politics.

Sen Manchin – the mercurial-I-can’t-make-up-my-mind-and-it-sure-is-fun-being-the-center-of-attention Senator from West Virginia will determine if 13 million Americans can no longer afford health insurance.

If legislation doesn’t pass, health systems will have to care for more people without health insurance; some systems and hospitals will raise prices to cover their losses.

What does this mean for you?

Higher healthcare costs for the privately insured, workers’ comp insurers, employers, and taxpayers.


Jul
18

(Perhaps) unintended consequences of abortion bans

With all the attention paid to abortion these days, I thought it worthwhile to dig into the financial and health impact of abortion and childbirth.

First, the cost.

Women who give birth incur about $19,000 in additional healthcare costs compared to women who don’t.

And that’s for women covered by large employers’ health plans.

Second, medical debt.

Lower-income adults in the South and/or in states that have not expanded Medicaid are much more likely to have medical debt than the rest of us.

Third, coverage.

About 13 million of us will see their health insurance premiums jump in January unless Congress acts. The issue is subsidies for lower-income folks who get their insurance via the Exchanges will expire at the end of this year unless they are extended. So far, the chances for an extension don’t look promising.

Fourth, societal costs.

  • Almost half of the women receiving abortions have incomes below the poverty line.
  • Lives will be hugely impacted, as “the expansion of abortion access … reduced teen motherhood by 34% and teen marriage by 20%”
  • Women who are denied abortions are three times more likely to be unemployed than women who were able to receive one, according to a 2018 study.
  • Women who were not allowed to access abortion services had nearly a four times greater chance of living below the federal poverty line.
  • And…”research shows that in 2010 the public paid just under $13,000 on “prenatal care, labor and delivery, postpartum care and 12 months of infant care.” per birth.”

Connecting the dots.

States that have or are likely to ban abortion are:

  • unlikely to have expanded Medicaid,
  • have much more restrictions on Medicaid coverage so far fewer people qualify for Medicaid, and
  • therefore many more poor women who are forced to have children will have higher medical debt,
  • will not escape living in poverty, and their child will grow up poor.

What does this mean for you?

If one is going to force people to do things, one should understand and be responsible for the consequences.


Jul
11

Healthcare Sharing Ministries and the brutal reality of medical debt

Last week I posted on Health Care Sharing Ministries, noting I’d been reaching out to the PR firm that works with theAlliance of Health Care Sharing Ministries, the PR people put out a release touting their new accreditation standards.

As I noted last week the accreditation process/requirements don’t appear to require minimum cash reserves, specific expense ratios or meet other financial adequacy minimums and the accreditation board doesn’t include individuals with actuarial or financial credentials.

In English, this is a very big deal. Unlike real health insurers, HCSMs aren’t required to have enough cash to pay your medical bills. Also unlike health insurers, members don’t have any recourse if their “ministry” decides your care isn’t worthy of their support.

This comes on the heels of a recent study that found almost a third of all Americans have medical debt; in their efforts to pay off debt respondents made a number of sacrifices and suffered substantial financial consequences: (actual study and responses from KFF)

  • cutting back on household spending
  • more than four in ten say they or a household member have used up all or most of their savings
  • respondents reported skipping payment on other bills,
  • and delaying college or buying a home, or changing their housing situation, while
  • half of adults with health care debt say they have made what they feel to be a difficult sacrifice in order to pay down their debt
  • One in seven adults with health care debt say they have been denied care by a provider due to unpaid bills

Here’s the truly awful thing…the least fortunate among us are in the worst shape.

I get that some people have had good experiences with HCSMs. I also know others have not, and are now among those with crippling, life-changing medical debt.

What does this mean for you?

HCSMs are no silver bullet…rather they are a “send the check in and hope you are covered if you get hurt or sick” non-solution.

It’s a measure of just how dysfunctional our healthcare system is that HCSMs even exist.

Ed note – I’ve been holding off on this post for days, hoping to hear something from AHCSM. I’ve repeatedly asked the PR firm for more details; evidently the right folks haven’t been able to respond.

I first reached out to the PR contact on June 21, 2022…three weeks ago.

 


Jul
6

Healthcare Sharing Ministries – the latest

Healthcare costs are about to jump again, driven by exploding staffing expenses, continued healthcare provider consolidation, and the brilliant profiteering by some of the largest (mostly for-profit) healthcare systems.

So, what’s a family to do?

A few have turned to Healthcare Sharing Ministries, a thing that looks like health insurance but isn’t. HCSMs purport to “share” health care costs among members in what might best be described as a risk-pooling framework. Almost all claim to be “Christian”, they are largely unregulated (except as charities), don’t comply with insurance regulations or laws in most states, and most have requirements that members:

  • are in good health,
  • make a statement of Christian belief, attend church regularly, don’t use tobacco or have sex outside of marriage and
  • commit to taking care of their own health.

note there are ministries focused on other religious denominations.

So…sounds good right? cheaper healthcare is better…well, HCSMs also:

  • are not legally required to pay your medical bills,
  • require enrollees to do much of the groundwork to get bills paid (negotiate upfront with the provider, get all the paperwork and documentation, pay upfront then seek reimbursement)
  • medically underwrite – meaning they require disclosures of pre-existing conditions and can reject applicants for medical reasons,
  • can refuse coverage to anyone for any reason,
  • have limits on what they’ll pay for healthcare,
  • can’t guarantee healthcare providers will accept sharing ministry coverage, and
  • have appeals processes that aren’t subject to regulatory oversight.

Enrollment is a bit hard to nail down; the Alliance of Health Care Sharing Ministries claims 1.5 million enrollees although it doesn’t specify the year. Other reports indicate AHCSM reported membership was “over 1 million” in February of 2019. Other sources report membership closer to that 1 million figure.

HCSMs tend to be significantly cheaper than health insurance plans, making them increasingly attractive. However, most families that buy health insurance through the exchanges get major subsidies that significantly reduce their premiums.

There have been multiple reports of individuals and families stuck with huge bills after their “Ministry” refused to pay for care. Aliera Healthcare Inc. and Trinity Healthshares, Inc are the most visible example of what can happen without tight regulation. Regulators in multiple states issued cease and desist orders after concluding the companies violated laws; Aliera was found guilty of fraud and filed for bankruptcy late last year.

Tops among concerns is this – HCSMs are NOT required to have enough cash on hand to pay medical bills. Even more concerning, they don’t have to report their finances, cash reserves, expense ratios or other data.

There’s an effort underway to “accredit” HCSMs; the process/requirements don’t appear to address this critical issue and the accreditation board doesn’t include individuals with actuarial or financial credentials.

I’ve asked the lobbying outfit that purports to represent HCSMs for details on the financial portion of that accreditation process. So far they’ve been less than forthcoming.

What does this mean for you?

be very careful.

 


May
27

Things I missed while despairing

We’ll get to what we missed in a second; first this – The slaughter in Buffalo and Uvalde had me focused elsewhere, as it did for many.

That focus must not shift as we celebrate Memorial Day with friends and family; we cannot just move on, as tempting as that is. Rather I’d encourage you to commit to doing something, to be a difference maker.

Please don’t just move on. Please.

  • Get the facts about gun violence here.
  • Support the Sandy Hook parents’ efforts here.
  • Support Moms Demand Action here.

WCRI published two excellent studies this week…thanks to Andrew Kenneally for sharing the news.

The craziness of workers’ comp extends to the prices you pay doctors and therapists for carehow crazy you say?

Bonkers.

Docs in Florida are getting screwed (but FL hospitals are rolling in dough), while their counterparts in Wisconsin are making bank. Like so many things in comp, this makes zero sense.

Download Rebecca (Rui) Yang PhD and Olesya Fomenko PhD’s insightful study – for free – here.

There’s far too little information on the outcomes of chiropractic care. WCRI just published a multi-pronged analysis of chiropractic care’s impact on low back pain, with a comparison of costs and disability duration for patients treated by chiros vs other care givers.

An intro video is here.

The study, authored by Kathryn Mueller, Dongchun Wang, Randall Lea, M.D., and Donald R. Murphy is available for purchase here.

Have a safe weekend, and remember – Democracy depends on your involvement.


May
25

This is about your children.

Once again children have been killed.

Yesterday’s slaughter of little children cut me to the heart, coming the day after I spent hours watching our granddaughter. Hours of delight, wonder, love, joy and promise.  Sitting together in a swing as she munched on goldfish, picking dandelions, working on puzzles and learning more colors, doing nose kisses and picking out her outfit for the day (rain boots, shorts, and a favorite shirt, with a pretty awful ponytail (as it always is when grandpa does it)).

I cannot imagine the heartbreak suffered by families in Uvalde Texas, nor can I imagine how this reverberated among parents of kids killed in Sandy Hook Connecticut a decade ago, ripping open wounds painful beyond measure. That’s awful indeed – what’s worse – if that’s possible – is there have been dozens of mass shootings this year alone.

Look at your kids, your schoolyards, your sports fields, your graduation ceremonies and school plays and imagine the impact of a Uvalde/Sandy Hook/Buffalo/Laguna Woods/Milwaukee/Brooklyn/Sacramento.

If we do not do something about gun violence, some of you, dear readers, may come to understand all too well the heartbreak and utter devastation suffered by families victimized by gun violence.

Make no mistake, this butchery would not happen without grandstanding by vote-seeking pols, lax background checks, wildly inadequate mental health care, incredibly permissive concealed carry laws in some states and easy access to guns, many of which serve no purpose other than killing people.

What does this mean for us?

We are failing to protect children, loved ones, parents and family. This is a national disgrace. 

Note – I am a gun owner and hunter. Family members are first responders, former law enforcement and national security.

 


Apr
4

Facility costs…more bad news

Here’s two things which will likely increase facility costs.

Becker’s reported last week that so far this year hospital and health system margins (with some very notable exceptions) are pretty crappy – down almost 12 percent month over month in February, and a whopping 42% below February 2020 (jsut before COVID).

My bet is significantly higher staffing costs are a major contributor; the giant Henry Ford system said labor costs were up 8% in February over the same month in 2021; Providence’s increase was even higher at 10%.

Couple that with a steep drop-off in health insurance coverage as COVID-related medicaid coverage ends, and you can expect facility costs to jump.

That’s because we’re going to see a lot more uninsureds seeking care at hospitals.

Medicaid is likely the single largest payer today, with about one out of every four of us covered by Medicaid.

The problem will be especially acute in states that have not expanded Medicaid – if your members/insureds/injured workers are in the orange states, you’ve already been paying a hidden tax to help pay for uninsured care delivered by hospitals.

Since states can pretty much determine who gets Medicaid, the problem is even worse in places like Mississippi that have long restricted Medicaid coverage to a very thin slice of the poor.

If you make more than 27% of the federal poverty level, you’re too rich to get Medicaid in Mississippi – which is both the poorest and sickest state in the nation.  (kudos to Louise Norris for her intel on the issue)

What does this mean for you?

Success favors the prepared. If you think you’ve got an answer to this you’re likely wrong. 


Mar
25

WCRI #4 – Provider consolidation’s impact on workers’ comp

Is Not Good.

that’s the primary takeaway from Bogdan Savych PhD’s presentation at WCRI’s annual conference– and a lot of other work I’ve done on the topic.

Consolidation eliminates competition – although I’d posit there’s little true competition in health care services. [I’ve written a LOT about  consolidation and the impact thereof]

There’s solid evidence that consolidation actually leads to increased prices and some research indicating it leads to decreased quality.

So how has healthcare evolved – well, primary care docs shifted from mostly solo practice to employment by health systems or group practices. Note this data is from 2018; consolidation has accelerated since then.

Of course, like everything else in healthcare, it’s local…orthopedic practices in Wisconsin are much more likely to be owned by health systems than those in Delaware.

Dr Savych’s research hit on a critical issue – exactly how many workers’ comp patients do primary care docs see? – the answer is most see almost none – with just one out of every ten physicians seeing more than 10 WC patients per year. Of course orthos see more – but still not many; only about a third see more than 10 claimants per year.

There are a whole host of issues with this which we’ll get into in a future post. For now, the net is researchers have to identify the specific physician responsible for the care of and outcomes for specific patients – which is fiendishly difficult especially when that physician moves from a group practice to employment by a health system. Provider identification is the main challenge – but by no means the only one.

Case mix adjusting – the art of comparing patients with similar diagnoses (often primary, secondary, and tertiary) over time – is as or almost as hard to get consistently right.

All that said, Dr Savych noted that cost increases are due more to a shift in the volume and type of procedures than higher prices for individual services.

The initial takeaway (there’s a LOT more research and analysis to do) is vertical integration (physician practices absorbed but health systems) leads to docs providing more expensive services.

What does this mean for you?

Consolidation raises work comp medical costs.

The best way to think about this is on a state-specific basis; understand where there’s more consolidation and watch the type of services delivered to your patients like a hawk.


Mar
11

I told you so.

I cannot stand that statement…yet it is spot on. I’ve been posting on this for some time, often feeling like Cassandra.

Healthcare staffing shortages are fast approaching crisis levels, with major implications for each of us.

From ModernHealthcare:

As of last month, 27% reported critical shortages to the Health and Human Services Department…During crisis levels in the early phases of the pandemic, mortality rates spiked as hospitals rationed care. One-quarter of COVID-19 deaths between March and August 2020 were attributable to overstretched hospitals, according to the National Institutes of Health. Patients with the most serious non-coronavirus illnesses suffered under the same conditions. [emphasis added]

HHS recommended that providers use the Sequential Organ Failure Assessments score, which evaluates organ function to determine patients’ likelihood of mortality if they were to receive treatments or beds. Those most likely to die go untreated and often are diverted to palliative care.

Terminal burnout is the main driver. Nurses and hospital staff have been dealing with entitled, arrogant, mean-spirited patients many of whom are unvaccinated for more than two years.

One of the drivers is the archaic, hidebound, and wildly incompetent way we license nurses. Full disclosure – a future family member and nursing school graduate has been waiting three months for their nursing license paperwork to come through.

This at a time when nursing shortages are forcing hospitals to close entire departments and shutter entire floors.

It doesn’t have to be this way; the licensing compact adopted by 35 states and Guam allows some nurses licensed in one state to practice in others – with limitations.  Revamping the criteria and removing limitations would speed up the licensing process immeasurably.

But the licensing debacle is an effect, not a cause. The real cause is the unvaccinated who get COVID and spread and their enablers.

What does this mean for you?

Some people’s “freedoms” are killing others. 


Mar
1

Stuff you should know

When Physician Management Companies took over anesthesia practices, the units (amount of services) and prices went up dramatically (when compared to other practices).

As in 16.5% and 18.7% respectively.

No surprise, prices went up even more – as in 26% – if the PMCs were owned by private equity companies.

The fine folks at WorkCompCentral published the news that OptumRx settled with the Commonwealth of Massachusetts over the Commonwealth’s claim that OptumRx failed to follow workers’ compensation prescription drug pricing procedures. OptumRx agreed to pay the state $5.8 million. The settlement is here.

I’m trying to get more detail on this as the Commonwealth’s press release is a bit confusing.  You’ll know if/when we get more details.

Finally, the conspiracy theory that somehow COVID came from a lab has been put to rest – at least for those of us who believe in science. Somehow I doubt the tin foil hat crowd will accept the news that the virus originated in the Wuhan market.

Where COVID originated 

From Michael Worobey, a co-author on both studies and an evolutionary biologist at the University of Arizona via Medscape “When you look at all the evidence together, it’s an extraordinarily clear picture that the pandemic started at the Wuhan market…”

More details on the two studies:

In one study, researchers used spatial analysis to show that the earliest COVID-19 cases, which were diagnosed in December 2019, were linked to the market. Researchers also found that environmental samples that tested positive for the SARS-CoV-2 virus were associated with animal vendors.

In another study, researchers found that two major viral lineages of the coronavirus resulted from at least two events when the virus spread from animals into humans. The first transmission most likely happened in late November or early December 2019, they wrote, and the other likely happened a few weeks later.

There’s an excellent synopsis of the research and methodologies here. If you want to weigh in, please review the article at the link first.

What does this mean for you?

For-profit healthcare can be very problematic, and science always wins.

We are all shocked and heartsick over Putin’s War on Ukraine – if you want to help Ukraine and Ukrainians, please consider a contribution to Care. Care is a very reputable and highly effective NGO with a rich history of successfully mitigating disasters and helping people.