Insurers Fill Gaps in Health-Law Plans

The Wall Street Journal article noted “Health insurers in several states are adding to the choices of doctors and hospitals in their health-law plans amid concerns among some consumers and state officials about access to care.”

“The insurers that are expanding their networks said they aren’t responding to complaints. Instead, they said, the tweaks reflect more willingness by some health-care providers to join the new networks, which often pay them less than traditional employer plans, as well as adjustments to serve the specific populations who enrolled.” Read more

The Foreign Language of Health Insurance

The Kaiser Health News article noted “As soon as Deb Emerson, a former high school teacher from Oroville, Calif., bought a health plan in January through the state’s insurance exchange, she felt overwhelmed.”

“She couldn’t figure out what was covered and what wasn’t. Why weren’t her anti-depressant medications included? Why did she have to pay $60 to see a doctor? The insurance jargon – deductible, co-pay, premium, co-insurance – was like a foreign language. What did it mean?”

Read more

Shift from Fee-for-Service Medical Care to Fee-for-Quality

The Forbes article noted “If you didn’t know it, the key intent of Affordable Care Act is to shift medical care from fee-for-service to fee-for-quality.”

“For too long, hospitals have gorged on referrals into their systems and walk-ins to their emergency rooms. But besides electronic medical records—a low hanging fruit–hospitals are hailed widely as being inefficient and sloppy. But the game changes when hospitals start getting paid for how many people they heal, not how many people they process. Think: outcomes not transactions.”

Read more

NY – Will Not Require Out-of-Network Coverage Health Plans Next Year

The New York Times article noted “Restricting consumers to a fixed network of doctors and hospitals, called in-network coverage, helps keep costs down, and for the first year, none of the 16 insurance companies in New York’s exchange deviated from that model.”

“Advocates for consumers had lobbied hard for out-of-network coverage, saying that some patients needed more choices, particularly since the networks are being kept small to further reduce costs. Under the current in-network system, someone who lives part of the year out of state, or a student at a college out of state, are not covered while they are away, except for emergency care.”

Read more

“We Called It a Hotel near a Major Teaching Hospital”

“Though the views were spectacular, the cardiac arrest team could not get there as quickly as it could to the regular wards.”

The New York Times article asked the questions “What is going on here? Is This a Hospital or a Hotel?”

“The Henry Ford health system in Michigan caused a stir after it hired a hotel industry executive, Gerard van Grinsven of the Ritz-Carlton Group, in 2006 to run its new hospital, Henry Ford West Bloomfield. There are some medical arguments for the trend — private rooms, for example, could lower infection rates and allow patients more rest as they heal. But the main reason for the largess is marketing.”

Read more

“Medical Errors Are a Quiet and Largely Unseen Tragedy.”

“Every year between 210,000 and 440,000 Americans die as a result of medical errors and other preventable harm at hospitals, according to researchers.”

These numbers are equivalent to a jumbo jet crashing every day with no survivors. Based on these figures, medical errors could be considered the third-leading cause of death in America, behind heart disease (more than 590,000 a year) and cancer (more than 570,000 a year).

Read more

“A Visit To The Doctor May Mean Seeing Someone Else Instead.”

New models of clinical practice are being used in the “doctor’s office.”

A Wall Street Journal article noted: “An increasing number of practices are scrapping the traditional one-on-one doctor-patient relationship. Instead, patients are receiving care from a group of health professionals who divide up responsibilities that once would have largely been handled by the doctor in charge. While the supervising doctor still directly oversees patient care, other medical professionals—nurse practitioners, physician assistants and clinical pharmacists—are performing more functions. These include adjusting medication dosage, ensuring that patients receive tests and helping them to manage chronic diseases.”

Read more

Cancer Patients May Learn That Some Of The Best Cancer Hospitals Are Off-limits

The New York Post reported “An Associated Press survey found examples coast to coast. Seattle Cancer Care Alliance is excluded by five out of eight insurers in Washington state’s insurance exchange. MD Anderson Cancer Center says it’s in less than half of the plans in the Houston area. Memorial Sloan-Kettering is included by two of nine insurers in New York City and has out-of-network agreements with two more”

“Doctors and administrators say they’re concerned. So are some state insurance regulators. In all, only four of 19 nationally recognized comprehensive cancer centers that responded to AP’s survey said patients have access through all the insurance companies in their state exchange”.

Read more