(Illustration: Andy Warner)
It’s been almost three weeks since we launched our PriceCheck project, and women statewide are continuing to share what they — or their insurance companies — have paid for a mammogram.
Is your insurer paying $134 or $1,200?
I talked about PriceCheck and our most recent data with Rachael Myrow on The California Report Thursday morning.
It’s been fun to see people’s mouths fall open when I tell them the range we’re seeing that insurers pay for mammograms across California: $134 on the low end to $1,200 on the high end. Continue reading
Dudley Pratt (left) talks to reporter Jenny Gold at a gas station in Fenner, Calif. His complaint is health insurance paperwork. (Ilana Lipsett/Kaiser Health News)
By Jenny Gold, Kaiser Health News
Recently, I moved from Washington, D.C., to San Francisco. I drove the Southern route and decided to conduct an informal survey.
“I wish it would be cheaper mainly — more affordable.”
I asked folks I met along the way a question relevant to the health care reporting I’ve been doing for the past five years: What bugs you most about your medical care?
Few people I talked with — at gas stations, coffee shops, grocery stores, parking lots, bars and everywhere in between — even mentioned the Affordable Care Act or Obamacare by name. But I heard again and again how health policy issues I’ve been reporting on in Washington are affecting their lives.
What did I find out? Continue reading
More complicated office visits are billed at a higher reimbursement level and can cost patients more in higher copays. (John Moore/Getty Images)
By Lisa Aliferis, April Dembosky and Lisa Pickoff-White
When people think of seeing a doctor, generally the first thing that comes to mind is an office visit. But not all visits are the same. Frequently, patients have minor problems, which can be dispensed with quickly. Other problems are much more complex and require more of a doctor’s time and expertise. Not surprisingly, doctors get paid more for these more complex visits. Office visits for established patients are billed across five levels.
Three California doctors are among the top five nationally in billing for the most complex office visits.
Most doctors’ billing patterns to the Medicare program fall in the middle ground between simple and complex.
In California, only 5 percent of doctors’ office visits for Medicare patients were billed at the highest level in 2012. It is unusual for doctors to determine — and bill — a large proportion of their office visits as complex.
Now an analysis of Medicare billing data — which was made public for the first time last month — shows that three California doctors are among the top five nationally in billing for the highest number of the most complex office visits. In addition, they tended to bill at the highest level significantly more frequently than peers in their specialty. Continue reading
California — and 44 other states — received failing grades in a new analysis on transparency of health care prices. The report comes from Berkeley-based Catalyst for Payment Reform (CPR), and it shows that consumers remain pretty much in the dark if they want to figure out, in advance, what a treatment or procedure will cost.
“Very few states have done anything meaningful to help consumers understand what their health care costs were going to be,” said Suzanne Delbanco, executive director of the organization.
CPR looked primarily at laws and regulations around price transparency, as well as whether a state had a consumer-facing website where people could easily look up price information.
While California has taken “important symbolic steps” by passing price transparency laws, Delbanco said, “what hasn’t happened is turning that information into something that’s useful to consumers.” Continue reading
(flickr: Images Money)
The largest public employees retirement system in the country – CalPERS – has plenty to gain from a drop in health care costs. After all, they cover 1.6 million employees, retirees and their families in California.
Now they’re saying, they found a way to decrease the amount they’ve spent on knee and hip replacements by 19 percent in a year, which could have implications for other employer health plans.
Lisa Aliferis blogged about the CalPERS experiment in controlling costs right here on State of Health about a year ago. Aliferis wrote that they decided to tackle costs around these two surgeries, which cost them $55 million dollars a year in 2008.
Now, you might not think there would be much difference in the price for getting a knee or hip replacement across the state. But think again. CalPERS asked Anthem Blue Cross — which manages its PPO plans — to examine the range of prices for these operations in California.
Anthem came back with the startling information that CalPERS was paying $15,000 on the low end to $110,000 on the high end, a more than seven-fold difference from lowest to highest.
“So we started asking ourselves,” Kathy Donneson, Chief of the CalPERS Heatlhy Plan Administration Division told me, “what are we getting from the $110,000 surgery that we couldn’t get from the $15,000 surgery?”
That’s when CalPERS turned to what’s called a “value based purchasing” approach for elective hip and knee replacements, starting with its non-Medicare population. CalPERS set a threshold price of $30,000 for the hospitalization and device charges for these operations. That $30,000 is slightly higher than the average price CalPERS had been paying for a hip or knee replacement. Anthem identified 46 hospitals across the state which would do these operations at the threshold price.
By Patti Neighmond, NPR
Mike Jackson has diabetes and high blood pressure. His eye was damaged after he cut back on insulin because he couldn’t afford it. (Bryan Terry/NPR)
For many years, high medical bills have been a leading cause of financial distress and bankruptcy in America. That pressure may be easing ever so slightly, according to a survey released earlier this month by the Centers for Disease Control and Prevention.
But 1 in 5 Americans still face hardships due to medical costs — and African-Americans continue to be the hardest hit.
A poll by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health found that 24 percent of African-American families say they’ve had problems paying for needed prescription drugs. The poll is part of NPR’s ongoing series, The View From Black America.
Mike Jackson is one of those people. Jackson, 52, lives in Oklahoma City and works for a major insurance company. He has high blood pressure and hypertension, and has been diabetic for 15 years.
Treating these chronic health problems isn’t cheap. Jackson’s medical bills add up to nearly $500 a month. “Diabetes alone — just the two medications alone for diabetes would have run $325 a month,” he says. Continue reading
By Sarah Varney, Kaiser Health News
Researchers report that the Affordable Care Act shifted $147 million from individuals — or hospitals, in the form of uncompensated care — to private insurance plans. (Indoloony/Flickr)
Researchers at the RAND Corporation set out to find some hard data on one aspect of the health law: Does having medical insurance protect young adults from the financial ruin that often comes with a major injury or illness?
The quick answer: Yes, it does.
Since September 2010, the Affordable Care Act has allowed young adults to remain on their parents’ medical insurance until they turn 26, and an estimated 3.1 million young people have taken advantage of the new rule.
The RAND researchers looked at nearly a half a million visits young adults made to emergency departments around the country before and after the under-26 provision took effect.
“We looked at just the most serious conditions,” said Andrew Mulcahy, an associate policy researcher at the RAND Corporation. Mulcahy and his colleagues pored over actual hospital records for bone fractures, poison, traumatic brain injuries, and other incidents that would require an urgent trip to the hospital. Continue reading
It’s nearly unbelievable to average consumers, but well known to wonks: health care prices are impossible to come by. Even calling and asking about a specific procedure, as researchers recently reported, led to an “I dunno” from the hospital itself more than half the time.
But now, a little bit of light is being shed on this dark area of health care. Wednesday morning, the federal government released a massive amount of data: the prices that hospitals across the country charge for 100 of the most common inpatient treatments.
Skipping over the wonk for now, let’s dive in to some numbers right here in the Bay Area. They cast a spotlight on how random and wildly variable health care prices are.
I picked one procedure, a hip or knee replacement (“lower extremity major joint replacement”) without major complications.
A joint replacement is generally a procedure you would schedule in advance, not a race-to-the-hospital-life-or-death-spare-no-cost situation. You might think the range of prices would be somewhat narrow.
You would be wrong. Continue reading
A major new analysis shows that hundreds of thousands of Californians will see their monthly insurance premiums fall an average 47 percent under President Obama’s health care overhaul, in large part due to tax credits and subsidies. It is the first detailed look at how health insurance premiums could change under President Obama’s Affordable Care Act, which goes into effect on Jan. 1, 2014.
Covered California, the agency charged with creating the state’s new health insurance marketplace, commissioned the analysis. The report looked at the individual market only and did not examine the small or large group market.
Under the ACA people with incomes up to four times the federal poverty level (about $94,000 for a family of four; $46,000 for an individual) will be eligible for subsidies from the federal government. That’s about 570,000 people, Covered California said.
Major findings from the study include:
- Individuals with incomes less than four times the poverty level are “likely to pay” 47 to 84 percent less for their monthly premium compared to this year
- Premiums would have increased 9 percent in 2014 because of health care inflation, even without the ACA Continue reading
It seems that “32 percent” is the number of the day today. First, actuaries believe that medical claims costs will go up 32 percent, and now the Centers for Disease Control tells us that 32 percent of U.S. families are having trouble paying their medical bills:
(Centers for Disease Control)
Nearly one in four children ages birth to 17 live in families that are struggling to pay medical bills, according to CDC data from the National Health Interview Survey, from January – June, 2011.
Here are more findings. In the first six months of 2011: Continue reading