The study results suggest that despite growth in value-based payment arrangements from payers, health systems currently incentivize physicians to maximize volume, thereby maximizing health system revenues.
This in-depth multimodal cross-sectional assessment of compensation and incentives among health system–affiliated POs [physician organizations] for which there is greater exposure to VBP [value-based payment] and APM [alternative payment model] arrangements compared with independent practices found that volume was the most common form of base compensation by a wide margin, being included by more than 80% and 90% of POs for PCPs [primary care physicians] and specialists, respectively, and representing more than two-thirds of compensation when included. Similarly, actions to increase volume were the most commonly cited means for physicians to increase their compensation. Base compensation incentives for physicians were not dominated by population or value-oriented payments, with only a third of POs reporting inclusion of capitation with PCPs and averaging only about a third of total compensation when included. Performance-based financial incentives for value-oriented goals, such as clinical quality, cost, patient experience, and access, were commonly included in compensation but represented a small fraction of total compensation for PCPs and specialists in health systems, operating at the margins to affect physician behavior. Taken together, these findings suggest that despite growth in APMs and VBP arrangements, these value-based incentives were not commonly translated into health system physician compensation, which was dominated by volume-oriented incentives.
The problem is that it’s a lot easier to measure volume than value. Easy wins.
A new law that took effect on January 1 protects patients with private insurance from surprise medical bills for services received in an emergency situation or when care at a facility covered by a patient’s health insurance plan is provided by an out-of-network clinician.
The No Surprises Act, which the US Congress passed in 2020 as part of legislation to fund the federal government for fiscal year 2021 and provide stimulus relief for the COVID-19 pandemic, applies to most surprise bills for emergency care and for nonemergency services received at in-network facilities.
According to a recent issue brief from the Kaiser Family Foundation, the federal government estimates that the act will apply to approximately 10 million out-of-network surprise medical bills a year.
Steve Parker, M.D.
PS: Avoid the medical-industrial complex as much as you can by exercising and avoiding obesity. Let me help.
Posted onAugust 5, 2021|Comments Off on Wasteful Spending on Heathcare in the U.S.: $1,800 to $5,700 per person per year
From a December 2020 article in the American Journal of Public Health:
Landmark reports from reputable sources have concluded that the United States wastes hundreds of billions of dollars every year on medical care that does not improve health outcomes. While there is widespread agreement over how wasteful medical care spending is defined, there is no consensus on its magnitude or categories. A shared understanding of the magnitude and components of the issue may aid in systematically reducing wasteful spending and creating opportunities for these funds to improve public health.
To this end, we performed a review and crosswalk analysis of the literature to retrieve comprehensive estimates of wasteful medical care spending. We abstracted each source’s definitions, categories of waste, and associated dollar amounts. We synthesized and reclassified waste into 6 categories: clinical inefficiencies, missed prevention opportunities, overuse, administrative waste, excessive prices, and fraud and abuse.
Aggregate estimates of waste varied from $600 billion to more than $1.9 trillion per year, or roughly $1800 to $5700 per person per year. Wider recognition by public health stakeholders of the human and economic costs of medical waste has the potential to catalyze health system transformation.
Posted onMarch 9, 2021|Comments Off on Kaiser Family Foundation’s 2020 Employer Health Benefits Survey
This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices. The 2020 survey included 1,765 interviews with non-federal public and private firms.
Annual premiums for employer-sponsored family health coverage reached $21,342 this year, up 4% from last year, with workers on average paying $5,588 toward the cost of their coverage. The average deductible among covered workers in a plan with a general annual deductible is $1,644 for single coverage. Fifty-five percent of small firms and 99% of large firms offer health benefits to at least some of their workers, with an overall offer rate of 56%.
Posted onMarch 8, 2021|Comments Off on Looks Like Blue Cross Has Lost a Huge Antitrust Lawsuit
From The New York Times, Sept 24, 2020:
The nation’s Blue Cross plans have reached a tentative $2.7 billion settlement in a federal lawsuit filed by their customers that accuses the group of engaging in a conspiracy to thwart competition among the individual companies, according to two people with knowledge of the discussions.
The settlement, which was first reported by The Wall Street Journal, would need to be agreed to by each of the three dozen Blue Cross insurers that make up the trade group, the Blue Cross Blue Shield Association. Judge R. David Proctor of the U.S. District Court for the Northern District of Alabama, who is overseeing the case in that state, also still needs to approve the proposed settlement.
It seems that the judge did indeed approve the settlement. I’v read elsewhere that the settlement was only $2.67 billion. This the culmination of litigation that started in 2012. Check the settlement website to see if you qualify for a piece of the pie. The lawyers are asking for 25%. From the settlement website:
Plaintiffs allege that Settling Defendants violated antitrust laws by entering into an agreement not to compete with each other and to limit competition among themselves in selling health insurance and administrative services for health insurance. Settling Defendants deny all allegations of wrongdoing and assert that their conduct results in lower healthcare costs and greater access to care for their customers. The Court has not decided who is right or wrong. Instead, Plaintiffs and Settling Defendants have agreed to a Settlement to avoid the risk and cost of further litigation.
Steve Parker, M.D.
PS: Keep yourself as healthy as possible so you don’t have to get mired in the medical-industrial complex. Let me help.
Posted onJanuary 9, 2021|Comments Off on Snapshot of the Swiss Healthcare System
<p class="has-drop-cap" value="<amp-fit-text layout="fixed-height" min-font-size="6" max-font-size="72" height="80"><span class="has-inline-color has-black-color">The Swiss have the U.S. beat in terms of longevity and percentage of gross domestic product devoted to healthcare. Their healthcare system may or may not have something to do with it.</span> Switzerland, which has twice as many square miles as New Jersy, only has 8,700,000 people compared to the 331,000,000 in the U.S. The Swiss have the U.S. beat in terms of longevity and percentage of gross domestic product devoted to healthcare. Their healthcare system may or may not have something to do with it. Switzerland, which has twice as many square miles as New Jersy, only has 8,700,000 people compared to the 331,000,000 in the U.S.
This analysis of the Swiss health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Swiss health system is highly complex, combining aspects of managed competition and corporatism (the integration of interest groups in the policy process) in a decentralized regulatory framework shaped by the influences of direct democracy. The health system performs very well with regard to a broad range of indicators. Life expectancy in Switzerland (82.8 years) is the highest in Europe after Iceland, and healthy life expectancy is several years above the European Union (EU) average. Coverage is ensured through mandatory health insurance (MHI), with subsidies for people on low incomes. The system offers a high degree of choice and direct access to all levels of care with virtually no waiting times, though managed care type insurance plans that include gatekeeping restrictions are becoming increasingly important. Public satisfaction with the system is high and quality is generally viewed to be good or very good. Reforms since the year 2000 have improved the MHI system, changed the financing of hospitals, strengthened regulations in the area of pharmaceuticals and the control of epidemics, and harmonized regulation of human resources across the country. In addition, there has been a slow (and not always linear) process towards more centralization of national health policy-making. Nevertheless, a number of challenges remain. The costs of the health care system are well above the EU average, in particular in absolute terms but also as a percentage of gross domestic product (GDP) (11.5%). MHI premiums have increased more quickly than incomes since 2003. By European standards, the share of out-of-pocket payments is exceptionally high at 26% of total health expenditure (compared to the EU average of 16%). Low and middle-income households contribute a greater share of their income to the financing of the health system than higher-income households. Flawed financial incentives exist at different levels of the health system, potentially distorting the allocation of resources to different providers. Furthermore, the system remains highly fragmented as regards both organization and planning as well as health care provision.
I wonder if we should adopt some of their system’s attributes.
Posted onOctober 31, 2020|Comments Off on We Must Have Healthcare Price Transparency! #HealthcareReform
From the Independent Women’s Forum:
A few days after a breast biopsy at a Stanford Health Care facility, Perla Ni opened her bill: $143,396.66.
A breast biopsy takes about 45-minutes. Ms. Ni had a high deductible insurance policy, and she paid $7,750 out of pocket. Her insurer, able to negotiate a discount, paid $67,088. By the way, Ni’s insurer is raising its premiums.
Dr. Marty Makary, Professor of Surgery and Health Policy at the Johns Hopkins School of Medicine, and an advocate of price transparency, points out over at Market Watch that what Ms. Ni paid out of her own pocket would have covered the entire cost of the same procedure at the respected Surgery Center of Oklahoma, which requires cash and posts a menu for its prices.
ObamaCare is more formally known as the Affordable Care Act (ACA), which was passed in 2010. From an article published March 5, 2020, at The Hill:
In its first decade, ObamaCare has failed to solve many of the health care problems it was supposed to address. Even worse, it has compounded many of the issues it was meant to fix — the law of unintended consequences in action.
First, then-candidate Barack Obama said his namesake act would “cut the cost of a typical family’s premiums by up to $2,500 a year.”In reality, the opposite has occurred. According to the Department of Health and Human Services (HHS), “premiums have doubled for individual health insurance plans since 2013, the year before many of Obamacare’s regulations and mandates took effect.”
Third, President Obama repeatedly assured voters, “If you like your health care plan, you’ll be able to keep your health care plan, period.” After ObamaCare was enacted, millions of Americans were unable to keep their pre-ObamaCare health insurance plan.
Individual market premiums were $2789/year in 2013, compared to $5712/year in 2017.
Obamacare proponents promised that the plan would drastically reduce the number of uninsured folks. Wasn’t it 30 million uninsured? But there are still 28 million uninsured. And it’s probably going to get worse since citizens are no longer forced to buy something they don’t want or can’t afford.
Nearly all of Obamacare remains in effect except for the mandate to purchase health insurance whether you want it or not.
The author of the article is affiliated with The Heartland Institute.
Washington Examiner has an opinion piece on Pres. Trump’s proposed (or initiated/) healthcare reforms:
“Patient choice and control are at the heart of Trump’s plan. It includes alternative forms of coverage, such as association health plans and short-term limited duration plans. It invests in telehealth services, which have been critical for patients during the COVID-19 pandemic. It gives major discounts to seniors for their prescription drugs. The plan increases access to direct primary care, which all but eliminates the insurance bureaucracy that decides what patients will and won’t get.
Perhaps most importantly, it requires price transparency, so patients know what services and procedures cost before they are forced to pay for them. It tips the scales in favor of patients to lower premiums and the cost of care. There will be no more surprise billing bankrupting families.”