That might soon be the case — in Nevada, at least.

“Assembly Speaker Marilyn Kirkpatrick, D-North Las Vegas, wants to amend the constitution to cap costs for anybody receiving treatment in a hospital emergency room.”

The story also adds: “Under the proposal, the Legislature would reserve the right to provide by law a different rate cap if necessary to preserve a ‘reasonable cost’ of emergency care. The Legislature would also be able to impose penalties on hospitals that don’t comply with the constitution.”

Wednesday’s Headlines

Best State to Strike In? California!: “Thousands of healthcare workers walked off the job at the University of California’s five medical centers on Tuesday, delaying emergency care, surgeries, diagnostic procedures and other medical treatment throughout the state.” [Reuters]

Healthcare is a Right: “Health and Human Services Secretary Kathleen Sebelius (shown) told the World Health Assembly (WHA) on Monday that ‘universal health coverage’ is a “right” and that it is the responsibility of “national governments” to achieve this goal.” In a country that thinks handgun ownership is an unalienable right, this seems to be a no-brainer, right? [The New American]

Even with Overregulation, Healthcare Execs are Poised to Make More Money Than a Lot of Us: “While they express opposition to regulation, 54 percent of execs reported revenue increases for their companies over the past 18 months. Additionally, 52 percent expect growth next year, 28 percent expect no change and 20 percent expect revenue to languish.” [HealthTech Zone]

Getting Closer To: Kathleen Sibelius: “Since taking her post as Secretary of the Department of Health and Human Services (HHS) in 2009, Power Woman Kathleen Sebelius has arguably one of the most difficult jobs in the nation. Just named by Forbes as the 25th Most Powerful Woman in the world, she’s not just at the center of one of the most controversial and immensely complicated pieces of legislation in this country – the Affordable Care Act – she’s tasked with turning it into a reality.” [Forbes]

The DSM-V: Harry Potter Dies at the End: “The most recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) has arrived, and the latest changes have caused divisions among those in the psychiatric community.” [Fox]

The post Healthcare Digest 5/22: Nevada Looks at Capping ER Charges appeared first on insidePatientFinance.

Healthcare is expensive, but why do we as human beings continue to spend money on medical treatments when the outcome is inevitable?

In The Cost of Hope, Pulitzer Prize winning writer Amanda Bennett retraces her husband’s seven-year battle with cancer, a battle he lost, and takes a hard look at the costs behind it.

Bennett recently presented at the TED conference on healthcare, “TEDMED 2013.”

“I believed I could keep him from dying,” Bennett says in her talk. Experts would say she was in denial. “‘Denial’ isn’t even close to a  strong enough word to describe what those of us facing the death of our loved ones go through,” she says. She prefers the word “hope.”

TED limits its speakers to less than 15 minutes, so Bennett did not have time to delve into what her book found, namely the cost of that hope, which in her husband’s case was nearly $700,000, most of which was paid by insurance.

The challenge, Bennett says in her talk, is that doctors and patients conspire to tell a heroic story, the dramatic fight against illness. ”We have a noble path to curing the disease … but there doesn’t seem to be a noble path to dying,” Bennett says. “Dying is seen as failing.” Perhaps it is time to construct a new story.

You can read our interview with Bennett here.

The post When Fatal Illness Strikes, Can We Put a Price on Hope? appeared first on insidePatientFinance.

The new regulations, however, do not penalize states that have elected not to expand Medicaid. Based on the formulas, these states may actually receive more DSH funds.

Providers and others have until July 12 to submit comments on the proposed rules.

When the U.S. Supreme Court last year ruled that states would not be required to expand Medicaid it unraveled a significant concession made by healthcare providers who agreed to a cut in DSH payments because more patients who currently contribute to bad debt would now be covered by Medicaid. Under the Patient Protection and Affordable Care Act, cuts to DSH have already been put into law to take effect over the next seven years. Beginning Oct. 1, the cut will be $500 million.

While the half-trillion dollar cut is still in effect, the Centers for Medicare and Medicaid Services (CMS) has come up with a formula that, at least for the next two years, may actually provide higher subsidies to DSH hospitals in states that don’t expand Medicaid coverage. CMS will distribute DSH dollars to states based on a percentage of uninsured residents (meaning those states with a smaller percentage covered by Medicaid will receive a higher percentage).

What the formula does not do, however, is eliminate the mandated cuts to the program which this year has a budget of $11 billion. Future cuts will be much higher than 2014′s $500 million. The cuts in fiscal years 2015 and 2016 increase to $600 million each year, and then $1.8 billion in 2017, $5 billion in 2018, $5.6 billion in 2019, and $4 billion in 2020.

Effects on Providers

What follows is text from the proposed rule related to impact of the formula and cuts on healthcare providers:

We anticipate that the final rule would affect certain providers through the reduction of state DSH payments.

We cannot, however, estimate the impact on individual providers or groups of providers. This proposed rule would not affect the considerable flexibility afforded states in setting DSH state plan payment methodologies to the extent that these methodologies are consistent with section 1923(c) of the Act and all other applicable statute and regulations. States would retain the ability to preserve existing DSH payment methodologies or to propose modified methodologies by submitting state plan amendments to us. Some states may determine that implementing a proportional reduction in DSH payments for all qualifying hospitals is the preferred method to account for the reduced allotment. Alternatively, states could determine that it the best action is to propose a methodology that would direct DSH payments reductions to hospitals that do not have high Medicaid volume and do not have high levels of uncompensated care.

Regardless, the rule incentivizes states to target DSH payments to hospitals that are most in need of Medicaid DSH funding based on their serving a high volume of Medicaid inpatient and having a high level of uncompensated care.

This proposed rule also does not affect the calculation of the hospital-specific DSH limit established at section 1923(g) of the Act. This hospital-specific limit requires that Medicaid DSH payments to a qualifying hospital not exceed the costs incurred by that hospital for providing inpatient and outpatient hospital services furnished during the year to Medicaid patients and individuals who have no health insurance or other source of third party coverage for the services provided during the year, less applicable revenues for those services.

Although this rule would reduce state DSH allotments, the management of the reduced allotments still largely remains with the states. Given that states would retain the same flexibility to design DSH payment methodologies under the state plan and that individual hospital DSH payment limits would not be reduced, we cannot predict whether and how states would exercise their flexibility in setting DSH payments to account for their reduced DSH allotment and how this would affect individual providers or specific groups of providers.

The Centers for Medicare & Medicaid Services (CMS) published May 15 a proposed rule (78 Fed. Reg. 28551) for reducing Medicaid disproportionate share hospital (DSH) payments as required under the Affordable Care Act (ACA).

The post CMS Publishes Formula Cutting Disproportionate Share Hospital Reimbursement appeared first on insidePatientFinance.

Anyway, much as it has paved the way in terms of things like Death with Dignity and Medical Marijuana, Oregon might be the future of American health care. (See also: the Oregon Health Insurance Experiment, “the first randomized, controlled trial comparing Medicaid — or any kind of health insurance — with being uninsured.” Also: “Kitzhaber’s effort to rebuild the state’s Medicaid program around community health rather than individual fee-for-service treatments.”)

The article gives a good background into the fiscal challenge Oregon used to actually spark a LOT of interest in the ways in which Medicaid does and does not work. Now, Oregon is upping that ante: “In 2012, Kitzhaber struck an audacious deal with the Obama administration. If the federal government would give Oregon $1.9 billion to remake its Medicaid program, Oregon would put Medicaid on a tight budget, guaranteeing $11 billion in savings over the next decade. If the savings don’t materialize, the funds dry up and Oregon is left with a huge budget hole.”

Sure, Oregon has to go through life known as The Beaver State. But it’s a small price to pay for innovative thinking and progressive politics.

Tuesday’s Headlines

Strike Possibly Imminent at California Hospital: “Nearly 13,000 healthcare employees at five University of California medical centers plan to strike on Tuesday in a move that threatens to back up emergency rooms and already has forced the postponement of elective surgeries.” [Reuters]

Healthcare Regs on Parade!: “The Obama administration is moving forward with a pair of major Affordable Care Act (ACA) regulations, as Republicans move to link the landmark law to the ongoing scandal at the Internal Revenue Service. [The Hill]

Personalized, Population-Based Healthcare: “We are going to see medical practice highly customized for each individual, using real time information and considering individual preferences and tastes.”[Venture Beat]

The Emerging Power of Emergency Room Healthcare: “Emergency departments (EDs) play an increasingly important role in U.S. healthcare by sorting through possible hospital admissions and supplementing the work of primary care doctors, according to a new study.” [The Hill]

How to Negotiate a Healthcare Bill: “Q: How can I find out how much local hospitals and doctors charge for different procedures? I hear their prices are all over the map.” [Patriot News]

The post Healthcare Digest 5/21: Will Oregon Lead the Way to Healthcare? appeared first on insidePatientFinance.

“Just because you can slip in under the grandfather exemption doesn’t mean you should. You may find it advantageous to move into one of the new plans.”

Her rationale:

1) “The Obamacare plans are largely designed to protect consumers – limiting what workers have to pay out of pocket and what insurers can refuse to cover. All new individual policies will have to cover more services, including medication, maternity and mental healthcare.”

2) However, regarding your current, or “grandfathered,” plan: “Grandfathered plans don’t have to provide full, co-payment-free coverage of preventive services, such as flu shots, mammograms and cholesterol screenings. They don’t have to cover a government-designated “essential benefits package” of procedures and treatments. Out-of-network emergency care may still require prior authorization, unlike with new plans.”

3) Additionally, “Despite the enchancements, plenty of people will look at the new benefits under PPACA and think, ‘Thanks, but no thanks.’ Their current policy, grandfathered in, may satisfy their needs and include their doctors in its networks – at a manageable price.”

4) “Technically, a plan can stay grandfathered indefinitely, but few, if any, will. Most grandfathered plans have gone away already.”

Monday’s Headlines

Department of Defense Could be Out of Healthcare Money Soon: “The Department of Defense’s Health Program could be out of money as soon as August, resulting in possible disruptions to payments for Tricare Providers.” [Alabama.com]

Slipping the Tyranny of the Mandatory Flu Shot: “Wisconsin employers, including hospitals, nursing homes and other health care agencies, could no longer require workers to get flu shots under a bill pending in the Legislature.” [FDL.com]

You Guys Got Any Good Ideas About Healthcare Reform?: “This is a big question, and could easily form the subject of several books. But since I don’t have the time to do this, I am only going to highlight a couple points and keep the discussion brief, and welcome input from others.” [FitnessGoop.com]

Voters Will Save Healthcare Reform!: “Obamacare backers stymied by conservative legislatures in red states may have a new approach: letting the voters break logjams with state ballot initiatives in 2014.” [Politico.com]

Healthcare Costs Too Damn Much: “Capping prices of drugs is not enough; the government has to deliver on affordable healthcare, says Biocon founder Kiran Mazumdar Shaw.” [MoneyControl.com]

An Easier Way to ICD-10?: “University of Illinois at Chicago researchers have developed a website that walks healthcare providers through the challenging transition from the current International Classification of Diseases — ICD-9 — to the new ICD-10.” [ClaimsJournal.com]

The Healthcare Paradox: “We have a real paradox in American healthcare. On the one hand we have exceptionally well educated and well trained providers who are committed to our care…But, on the other hand, we have a dysfunctional health care delivery system.” [MedCityNews.com]

Can We Trust This Healthcare Spending Slow-Down?: “We all know that Stein’s Law will someday apply to health care spending, which has risen from 5 percent of the economy (gross domestic product) in 1960 to almost 18 percent now. What we don’t know is how and when its share of the economy will stabilize. Will this result from spending controls imposed by Washington; or from delivery-system ‘reforms’ that spontaneously cut ‘waste’; or from rationing, which limits spending by denying people treatment; or by some combination of these? As for when, could it be now?” [Telegram.com]

How Do You Screen for Bad Debt?: “Medical centers in western North Dakota’s booming oil patch will get some help in diagnosing which patients seeking nonemergency services are bad debt risks.” [San Francisco Chronicle]

The post Healthcare Digest 5/18: Should You Switch to Obamacare Come October? appeared first on insidePatientFinance.

Republicans are using this tempest in a teapot to suggest that healthcare reform is absolutely the WRONG thing to do right now because…

Well, that’s the thing. It’s not at all clear what this has to do with healthcare reform. “Half of the billion dollars allocated to cover implementation of the Affordable Care Act went to the IRS. Starting in 2014, the agency will distribute subsidies for health-care coverage through state exchanges and issue penalties against individuals who do not get or businesses that do not provide insurance.”

Republicans feel that the IRS shouldn’t hire more agents for the implementation process because — and this is what we in the writing business call “irony” — the IRS profiled conservative groups in much the same way many conservative Republicans support racial profiling for safety. Clearly, they can’t be trusted to hire fairly so let’s dump the sick baby out with its typhus-ridden bathwater.

Or something.

“What’s happened heightens fears about how the IRS will handle taxpayer information and wield its power when it enforces Obamacare starting next year,” Sen. Chuck Grassley (R-Iowa) told the Washington Examiner.

It’s gonna be a LOOOOONG summer, guys.

Thursday’s Headlines

Wanna Increase Our Deficit? Repeal Obamacare: “Congressional budget analysts said Wednesday that repealing ObamaCare would increase the deficit by scrapping the law’s taxes, fees and spending cuts.” [The Hill]

Now’s the Time for a Healthcare Career!: “Unemployment rates may still be high and the opportunities out there in specific careers might be waning, but there is one job sector that may be promising — healthcare.” [Perry Daily]

Striking Healthcare Workers Arrested: “Thirteen people were arrested Wednesday at the UC regents meeting during a sit-down protest by healthcare workers threatening to strike at the system’s medical centers.” [LA Times]

California Democrat Says, “Come ON Already!”: “Let’s Move On and Implement Health Care Reform” [Huffington Post]

Medicare/Medicaid Chief Selected: “The U.S. Senate on Wednesday confirmed Marilyn Tavenner, a former nurse and hospital company executive, as the first full-fledged administrator for the Medicare and Medicaid healthcare programs since 2006.” [Chicago Tribune]

How Much for That Innovation?: “The Obama administration on Wednesday announced a $1 billion initiative to fund innovations in federal healthcare programs aimed at cutting costs while improving the health results.” [Reuters]

The post Healthcare Digest 5/16: Republicans Use IRS, Healthcare for Irony Lesson appeared first on insidePatientFinance.

“The government’s sixth national crackdown on healthcare fraud since 2010 involved $223 million in fraudulent claims in jurisdictions including Miami, Detroit, Los Angeles and Brooklyn, New York, the Justice Department said.”

Hooray! we all say, because those are Bad People and they’re not helping the price of healthcare go down just like shoplifters do nothing to make things cheaper but wait!

“Holder said efforts to expand the battle against fraud is being affected by automatic across-the-board federal budget cuts, known as sequestration, which have stripped $1.6 billion in funding from the Justice Department for the fiscal year ending September 30.”

Wanna see more bad guys get in trouble for pocketing funds that aren’t theirs? Too bad! Sequestration!

“Since 2007, officials say the government’s Medicare Fraud Strike Force has charged more than 1,500 defendants who have falsely billed the Medicare program for the elderly and disabled for $5 billion.”

What’s sad about that figure, just from looking at the headlines over the past year: that 1,500 number should be a LOT higher, right? Because it seems like everyone and his brother is bilking Medicare out of millions.

Wednesday’s Headlines

Good News for Old(er) People!: “Healthcare costs put a big squeeze on retiree pocketbooks, but the grip may be relaxing a bit.” [Reuter]

Every Good Deed Has a Hook: “A healthcare company that provided aid to disabled Miami-Dade students may have overbilled the school district by more than $1 million, according to the district’s chief auditor.” [Miami Herald]

You’re Making Healthcare Worse By Not Using the Cloud: “Healthcare delivery in the United States is high cost and suffers from inconsistent quality. A primary cause of these issues has been the reliance on antiquated, paper-based clinical records. These paper records have been an enormous barrier to high quality care — making it virtually impossible to deliver coordinated care, locking away in paper data needed to analyze what works and doesn’t in healthcare. For years lack of available data structured a system that pays for activity, rather than results. Now with the introduction of Electronic Healthcare Records (EHR), technology has stepped in to lead healthcare reform.” [Computer World]

The post Healthcare Digest 5/15: Jail Time for Healthcare Fraud appeared first on insidePatientFinance.

Oof. You guys.

If you’re partial to this administration, and willing to extend some empathy, then you might point some fingers of blame at Congress, a body that has “rejected the Obama administration’s requests” for the extra dollars needed.

Hence, Sibelius’s door-to-door campaign.

She’s been focusing primarily on “health industry executives, community organizations and church groups.” Her push: getting these executives to “contribute whatever they can to nonprofit groups that are working to enroll uninsured Americans and increase awareness of the law.”

Republicans, of course, see Sibelius’s actions as “improper” because of course they do. However, others, too, are looking askance. Meredith McGehee, policy director for the nonpartisan Campaign Legal Center, which researches government ethics issues, said she was troubled by Sebelius’s activities because the secretary seemed to be “using the power of government to compel giving or insinuate that giving is going to be looked at favorably by the government.”

Senator Orrin Hatch — the Senate’s resident Angela Lansbury — said in a statement. “I will be seeking more information from the administration about these actions to help better understand whether there are conflicts of interest and if it violated federal law.”

Tuesday’s Headlines

Spotlight on the IRS: “The nonpartisan IRS is charged with some of the law’s most important functions, such as distributing tax credits and enforcing the individual mandate to buy health insurance. IRS duties on healthcare were bound to be politically charged given the controversy surrounding the law, which remains divisive with the public. Now the IRS’s job has become even more difficult given the certainty of an investigation into the agency’s scrutiny of conservative groups.” [The Hill]

How Hospitals Could Lose $500M in Federal Funds: “Hospitals nationwide could lose half a billion dollars in federal funding for uninsured patients next year under the national health overhaul — a loss that will hit especially hard in states that decided against expanding Medicaid coverage. Cuts could jump to $4 billion in 2020, according to estimates released Monday by federal health officials.” [AP]

I’m Told This Makes Sense: “So, responding to both the Seeking Alpha reader request and Ycharts.com migration to an eleven sector list, this report provided three actionable conclusions about the highest yield (dividend / price) stocks from the Morningstar/YCharts (M/Y) sectors: basic materials; communication services; consumer cyclical; consumer defensive; energy; financial services; healthcare; industrials; real estate; technology; utilities.” [Seeking Alpha]

Want to Build a Better Healthcare Board? Here’s How!: “Whether boards are too large, too unwieldy, or have members who are underqualified to effectively provide strategic direction, many of them need help to deal with the new realities of healthcare.” [HealthLeadersMedia.com]

How Florida Lawmakers Get Cheap Health Insurance: “Florida House Republicans last month loudly and proudly rejected billions of dollars in federal money that would have provided health insurance to 1 million poor Floridians. Quietly, they kept their own health insurance premiums staggeringly low. House members will pay just $8.34 a month for state-subsidized health care next year, or $30 a month to cover their entire family.” [Miami Herald]

Medical Debt Reform: “There’s at least one thing Congressional Republicans and Democrats agree on, and it’s that medical debt is a problem. Members of Congress and their staff recognize that medical bills are confusing and prone to errors—and the debts can hurt creditworthy consumers by constraining their access to credit.” [Forbes.com]

The post Healthcare Digest 5/14: Sebelius Door-to-Door for Healthcare Fundraising appeared first on insidePatientFinance.

The UPI story goes on to say: “During 2009-11, per-capita national health spending grew about 3 percent annually, compared with an average of 5.9 percent annually during the previous 10 years.”

A main contributor in the “optimistic slowdown” is, of course, the fact that fewer and fewer people can afford to go to the doctor. So, the adjective optimistic seems…I don’t know. Weird. It just seems like Americans should be getting MORE healthcare, not less. And if Americans are eschewing healthcare because they can’t afford treatment, that seems not something to be optimistic about; it, instead, speaks to systemic issues within the system that’s supposed to ensure life, liberty, and the pursuit of happiness — none of which any of us can do if we’re too ill to pursue them.

“The findings, published in the journal Health Affairs, suggested cautious optimism that the slowdown in the growth of healthcare spending might persist — a change that, if borne out, could have a major impact on U.S. health spending projections and fiscal challenges facing the country.”

Maybe I just don’t know how words work any more.

Monday’s Headlines

Why Can’t Everything Just Cost the Same Amount of Dollars?: “Cancer patients could face high costs for medications under President Barack Obama’s health care law, industry analysts and advocates warn. Where you live could make a huge difference in what you’ll pay.” [Associated Press]

Big Employers Wait for Healthcare Clarity: “Under the federal Affordable Care Act , large employers — those with the equivalent of 50 or more full-time employee­s — must offer what the federal government considers quality, affordable health insurance to their employees and employees’ children, or face fines. But other large local employers, who declined to speak on the record for this story, are struggling to grasp the immense and complex reforms. Some are facing major changes, such as having to offer health insurance for employees’ children, where before they offered coverage only to employees.” [Register Guard]

This Question Again: “What is the future of healthcare? What is real reform? It is difficult to see the future, however, as the Secretary of Health and Human Resources for the Commonwealth of Virginia, stated in our Chamber luncheon last week, “Healthcare reform is essential.” His comments went on to illustrate that the U.S. spends a great deal more on healthcare than any other country. OECD Health Data showed that in 2010 the U.S. per capita healthcare expenditures were $7,910 with the nearest country being Switzerland at $5,270. And yet, we are struggling with escalating healthcare costs.” [DailyProgress]

But What About the Children?: “Since 2009, with passage of the Children’s Health Insurance Program Reauthorization Act (CHIPRA), states have had the option of extending eligibility for Medicaid and SCHIP to all lawful immigrant children residing in the United States, with no waiting period. The legislation provides federal matching dollars if the state does away with the waiting period. Florida, however, has yet to change any provisions in its law. [NewAmericaMedia.org]

Healthcare Communications: “Understanding the “who” in healthcare communications has always been critical, but it is becoming more complicated than ever to really pinpoint who the “who” really is. No, I am not talking about delving into the psyche of Dr. Seuss’ famous community. I am talking about identifying the person, group, or entity that should be at the center of our communications, the audience who will truly influence perception and adoption.” [Press Release]

Opportunities for Entrepreneurs: “Thousands of would-be entrepreneurs are itching to start their own businesses, but many are shackled to their current employer by health-care benefits they don’t think they could otherwise afford. Economists call this phenomenon ‘job lock,’ or ‘entrepreneurship lock.’” [Wall Street Journal]

IT Guys to Watch! (No really: watch these guys because they’re in control of things like your passwords): “A few years ago Atrius Health, a major independent physicians group, tried giving elderly, chronically ill patients devices that they could use in their homes to do things such as provide a verbal reminder to take their medications. “It absolutely made sense,” says Dr. Michael Lee, Atrius’s director of informatics. “It just didn’t work.” People simply didn’t like using the devices, so adoption was tiny. But, Lee says, this is exactly the kind of experimentation health IT leaders need to be doing. ‘The honest answer is we don’t know what changes in processes will truly impact a lot of these patients,’ he says, ‘… and the only way we can learn is to innovate and try and see what the outcome is.’” [InformationWeek]