All-Payer Claims Databases and Price Transparency

Most observers agree that it is very, very difficult for patients to choose health services wisely based on prices, because prices in U.S. health care are generally not transparent. The primary reason for this is that it has been many decades since health providers have relied on patients to pay their bills directly.

Instead, their business models rely on submitting claims to health insurers. Of course, there are convenient clinics and a few doctors and ambulatory clinics which post prices up front. However, the patient who enters the hospital – where most health costs are incurred – enters a maze of opaque and incomprehensible prices.

Some people believe price transparency can be commanded by government: Enter the “all-payer claims database,” which an increasing number of states are embracing.

Read the entire article at NCPA's Health Policy Blog.

Obamacare’s Uninsured Up 5 Million, Medicaid Dependents Up 16 Million Since Initial Estimate

Last week’s Congressional Budget Office’s Updated Budget Projections: 2016 to 2026 significantly reduced estimates of Obamacare’s benefits, relative to CBO’s estimates published in 2010, when the law was signed:

• In 2010, CBO estimated Obamacare would leave 22 million uninsured in 2016 through 2019. This month, CBO estimates Obamacare will leave 27 million uninsured through 2019 – an increase of almost one quarter.
• In 2010, CBO estimated Obamacare would leave 162 million with employer-based health benefits in 2016 through 2019. This month, CBO estimates Obamacare will leave only 155 million with employer-based plans. The number will decrease to 152 million in 2019.
• In 2010, CBO estimated Obamacare exchanges would enroll 21 million people in 2016, increasing to 24 million in 2019. This month, CBO estimates Obamacare’s exchanges will enroll only 13 million people this year, and 20 million in 2019.
• In 2010, CBO estimated Obamacare would result in 52 million Americans remaining or falling into dependency on Medicaid or the Children’s Health Insurance Program, the welfare programs jointly funded by state and federal governments that subsidizes low-income households’ health care, in 2016. CBO estimated that figure would drop slightly to 51 million in 2019. This month, CBO estimates 68 million will be dependent on the program this year through 2019 – an increase of almost one third in the welfare caseload.

Read the entire column at Forbes.

2015 GDP: Health Services Spending Grew Twice As Fast As Non-Health GDP

Last Friday’s release of the third estimate of Q4 Gross Domestic Product and annual GDP confirmed spending on health services grew at more than twice the rate of growth in non-health GDP in 2015.

Conclusion? There is no health spending slowdown.

Read more at NCPA's Health Policy Blog.

Americans Think Their Health Care Is Fine, But American Health Care Is Not

Almost half the people who believe their own state’s health care is excellent deny that it is excellent elsewhere in the country. This is one reason why American health care should not be put under even more control by national politicians: Citizens are poorly informed about what actions should be taken nationally, and incapable of giving coherent signals to politicians.

Read more at NCPA's Health Policy Blog.

California's Medicaid System Encourages Abuse

After more than a year, California’s politicians and health insurers have finally agreed to and passed last month what California Healthline calls a “tax hike in name only” to finance Medi-Cal. If only it were that simple. Funded jointly by the state and federal governments, Medi-Cal is the subject of perverse political incentives to hike taxes and spend more money on this welfare program, impoverishing treasuries. California and the nation need a new way to finance Medicaid.

Read the entire op-ed in the Orange County Register.

Two Thirds of Patients' Hospital Debts Unpaid

Holly Fletcher of The Tennessean describes an insane system of billing which has been focused on getting dollars out of the byzantine bureaucracies we call health insurers. When it comes to getting money from patients directly, hospitals are hopeless, with two thirds of their accounts receivable remaining unpaid.

One might think this was a problem that is not too difficult to solve: Just call the supermarket or department store and ask them to recommend a point-of-sale technology vendor.

Read the entire entry at NCPA's Health Policy Blog.

One Quarter of Obamacare Enrollees Dropped Out in 2015

The administration recently announced 12.7 million people selected or were automatically enrolled in an Obamacare exchange plan at the end of the third open season – February 1. Except for special cases, anyone who missed that deadline cannot enroll in an Obamacare plan for 2016.

That is a few more people than the 11.7 million than at the end of 2015’s open enrollment. However, the administration also announced that only 8.8 million people remained enrolled in Obamacare on December 31, 2015. That is a drop of almost one quarter from the end of 2015 open enrollment.

Read the entire article at NCPA's Health Policy Blog.

Whither Obamacare's Death Panel?

President Obama’s nomination of Merrick Garland to the U.S. Supreme Court has not shaken Senate Republicans from their commitment not to hold confirmation hearings for any candidate President Obama might nominate to the Supreme Court in the last eleven months of his second term.

Given the high drama and politics surrounding presidential appointments that require Senate confirmation, it might be a good time to ask why another 15-member “court,” which President Obama himself established in 2010, and which was supposed to deliver its first decision in January 2014, has not yet seen its first member nominated!

This “court” is the almost forgotten “death panel,” officially named the Independent Payment Advisory Board (IPAB). Based on a target rate of Medicare spending per capita, the IPAB was supposed to start cutting Medicare payments to providers in 2015.

Read more at NCPA's Health Policy Blog.

CPI: Health Insurance Premiums Jump Amid General Deflation

This morning’s Consumer Price Index corroborates yesterday’s Producer Price Index, which indicated health insurance and certain other health prices increased in a generally deflationary environment. While the CPI for all items dropped 0.2 percent in February, health insurance increased 1.3 percent. Over the last twelve months, CPI has increased just 1.0 percent, while health insurance has increased 6.0 percent.

Read the entire entry at NCPA's Health Policy Blog.

Donald Trump on Drugs

In last Thursday’s Republican presidential primary debate in Florida, Donald Trump made the curious assertion that Medicare does not “bid out” prescription drugs, before moving on to a similar assertion about military procurement. As with all thing related to whatever “Trumpcare” would look like if he were President, this statement requires some effort to decipher.

Medicare’s prescription drugs are very well “bid out.” Indeed, they are “bid out” twice – both directly and indirectly.

Read the entire column at Forbes.

PPI: Health Insurance Jumps As Deflation Returns

Deflation returned to the Producer Price Index (PPI) last month, as the PPI for final demand dropped 0.2 percent from January. Prices for final demand goods, less volatile food and energy, increased 0.1 percent. Most prices for health goods for final demand were flat. The exception – again – was pharmaceutical preparations, for which producer prices increased 1.2 percent.

What is new for February is the increase in health insurance. Increasing health costs are finally being passed on through premiums.

Read more at NCPA's Health Policy Blog.

QSS: Revenue Growth Strong in Health Services, Hospital Profitability Recovered

The Quarterly Services Survey (QSS) from the Census Bureau showed 2015 was a good year for revenue growth in health services. Overall, fourth quarter revenue grew 1.8 percent on the quarter, 3.7 percent from Q4 2014, and 5.5 percent year on year.

Revenue growth in psychiatric and substance abuse hospitals really blew the doors off in Q4, increasing 8.2 percent. However, this looks idiosyncratic. Q4 2014 to Q4 2015 growth was only 1.6 percent, and year on year growth was 4.0 percent.

Read more at NCPA's Health Policy Blog.

Bipartisan Agreement to Destroy Medicare As We Know It, But Not Quickly Enough

Last week, the Centers for Medicare & Medicare Services announced by it had beat its target of tying 30 percent of Medicare Part A and B payments to “quality of care rather than quantity of services.” T
hat goal was initially set for the end of 2016, but was actually achieved in January.

Another way to describe paying for “quality of care rather than quantity of service” could be “plotting to destroy Medicare as we know it,” although the politicians who brought this about would not use those words. On the contrary, Republican and Democratic politicians accuse each other of plotting to destroy “Medicare as we know it” when campaigning against each other, because they know that is the easiest way to scare granny at the voting booth.

Read the entire column at Forbes.

Ten Percent of Cancer Drug Spending Wasted

A remarkable study published in the BMJ concludes that $1.8 billion of the $18 billion spent on the 20 most expensive cancer drugs in the U.S. is wasted due to cunning marketing by drug-makers. Chemotherapeutic doses are often adjusted by body weight. However, the drugs are shipped in vials containing doses appropriate to bigger people. Once opened, the drug that remains after an oncologist selects the does appropriate for a smaller or average-sized person has to be discarded.

The authors allege the drug-makers do this deliberately, to increase profits. Their proposed solution is that the Food and Drug Administration should regulate the size of vials! There is a better way.

Read more at NCPA's Health Policy Blog.

Health Jobs Still Grow Faster Than Other Jobs

The latest jobs report was greeted as good news, with nonfarm payroll increasing by 242,000 jobs in February. Health services jobs accounted for 38,000 (16 percent) of the growth. Health services jobs accounted for a smaller share of job growth than in previous months. Nevertheless, they grew faster (0.25 percent) than other nonfarm jobs (0.16 percent).

Jobs in ambulatory settings accounted for 24,000 (62 percent) of health services jobs. Physicians’ offices and home-health services accounted for the lion’s share of growth in jobs in ambulatory settings. This is likely good news because it corroborates the shift of the health services workforce from inefficient hospitals to more efficient locations of care.

Read the entire entry at NCPA's Health Policy Blog.

Massive Fraud Likely In Obamacare Exchanges

The Government Accountability Office has just released a report detailing the massive opportunities for fraudulently getting tax credits in Obamacare’s health insurance exchanges. Obamacare sends billions of taxpayers’ dollars to health insurers which operate in these exchanges – $37 billion last year alone. These tax credits are used to discount premiums for plans offered in the exchanges.

Read more at NCPA's Health Policy Blog.

Is Telehealth Another Health Care Silo?

When we say health care operates in silos, we mean a patient’s cardiologist, psychiatrist, and general practitioner have no idea what each other are doing. Or that the individual departments in a hospital have no idea what each other are doing. Or your new family doctor has no idea what former doctors did to you, and you have to fill in a sheet on a clipboard in the waiting room with decades-old information you barely remember or even understood when former doctors told you.

“Connected care” is supposed to break down these silos. Is telehealth doing it? Probably not.

Read the entire column at Forbes.

Health Construction Still Very Weak in January

Construction of new health facilities remained very weak in January, shrinking 0.1 percent since December, while other construction grew at 1.6 percent (Table I).

The rate of decline in public health facilities continued to be dramatic at 5.0 percent, versus booming 4.8 percent growth in other public construction starts. Private health facilities construction grew 1.3 percent in slow private construction market, which grew just 0.5 percent.

Over the last twelve months, health facilities construction starts have lagged other construction significantly. This suggests health systems are pessimistic about their ability to extract further revenue from the system.

Read the entire entry at NCPA's Health Policy Blog.