Nancy Pfotenhauer and Nathan Nascimento: States Strike a Blow for Freedom in the ObamaCare Age – WSJ

February 21, 2015

One of ObamaCare’s many unfortunate effects is its centralization of the nation’s health-care debate. Even Republicans now assume only Washington can fix America’s broken health-care system—look at the various federal-centric ObamaCare replacement plans that have been released in recent months. But state lawmakers can play an important role in improving health outcomes, lowering costs and increasing choices for patients.

Fortunately, elected officials in some states are showing promise in this regard. For example, legislators in South Carolina, Georgia, New Hampshire and Washington have recently introduced bills to weaken or repeal their states’ “certificate of need” laws, which increase health-care costs and empower bureaucrats and lobbyists rather than patients.

via Nancy Pfotenhauer and Nathan Nascimento: States Strike a Blow for Freedom in the ObamaCare Age – WSJ.


Medicare to Publish Physician-Payment Data Yearly – WSJ

February 2, 2015

The U.S. government will begin releasing Medicare physician-payment records every year, cementing public access to how tens of billions of dollars are spent annually on everything from office visits to radiation therapy.

Last April, a year’s worth of the data was released for the first time in more than three decades after Wall Street Journal parent Dow Jones & Co. challenged a 1979 injunction that prohibited Medicare from disclosing its payments to doctors. It was unclear at the time if any more records would be released.

The data provided the first comprehensive look at a central part of the taxpayer-funded program for the elderly and disabled. It detailed payments to 880,000 individuals and organizations totaling more than $77 billion from the Medicare program in 2012, covering more than 5,000 different procedures.

via Medicare to Publish Physician-Payment Data Yearly – WSJ.


North Carolina Blues plan unloads price transparency surprise – Modern HealthcareVital Signs | The healthcare business blog from Modern Healthcare

January 13, 2015

There’s a fascinating story out of North Carolina about that state’s largest insurer unexpectedly publishing information on how much it pays healthcare providers for a wide range of elective, non-emergency services.

Providers were not pleased. More surprisingly, consumer advocates were sharply critical. But more such efforts are on the way and providers should stop complaining and get prepared.

Blue Cross and Blue Shield of North Carolina suddenly released its all-inclusive payment rates for services including kidney transplants, knee replacements, coronary bypass procedures, screening colonoscopies and other services. The insurer’s online look-up tool includes all payments for a service, including facility fees, doctor fees and pathology.

via North Carolina Blues plan unloads price transparency surprise – Modern HealthcareVital Signs | The healthcare business blog from Modern Healthcare.


Medical Records: Top Secret – NYTimes.com

November 9, 2014

“You should be able to walk into a provider’s office and say, ‘I want a copy’ — you are legally entitled to that,” said I. Glenn Cohen, a professor at Harvard Law School, noting that there were only a few exceptions, such as for prisoners. But the reality is that many hospitals and doctors have created a series of hurdles that must be cleared before patients can get their information. And many of those hurdles, experts say, are based on the economics of medicine.“The medical record is held hostage,” Professor Cohen said. “The reason is often to keep a customer or keep a patient from leaving the practice.”

via Medical Records: Top Secret – NYTimes.com.


Price transparency picks up speed | Healthcare Finance News

October 23, 2014

It’s no secret that the price transparency movement has picked up speed and become increasingly complicated for all stakeholders. Though over 30 states have passed or proposed legislation to increase price transparency, and released median prices for specific services, many supporters of price transparency have pushed for more detailed data. Specifically, all amounts paid to every provider, for every service, so prices and trends can be tracked more definitively.

This past March, Health Care Incentives Improvement Institute HCI3 and Catalyst for Payment Reform CPR released their second annual Report Card on State Price Transparency Laws. Forty-five states failed and only two were awarded a B.

With these types of developments in mind, the George Washington University’s online master of public health, MPH@GW, recently released Illuminating Health Care Prices: Organizations to Watch, which profiles 14 organizations helping to achieve greater healthcare price transparency through policy as well as various initiatives, resources and tools. Since price transparency is a primary or subsidiary goal for myriad organizations and companies, the list isn’t intended to provide a comprehensive view of the price transparency landscape, but rather to explain the multifaceted hurdles and triumphs of the movement by taking a deep dive into the work that several of these organizations are doing.

via Price transparency picks up speed | Healthcare Finance News.

Note: the original blog post that inspired this guest post is here:  http://publichealthonline.gwu.edu/healthcare-price-cost-transparency/


Medicare Star Ratings Allow Nursing Homes to Game the System – NYTimes.com

August 25, 2014

an examination of the rating system by The New York Times has found that Rosewood and many other top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes.The Medicare ratings, which have become the gold standard across the industry, are based in large part on self-reported data by the nursing homes that the government does not verify. Only one of the three criteria used to determine the star ratings — the results of annual health inspections — relies on assessments from independent reviewers. The other measures — staff levels and quality statistics — are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value.

via Medicare Star Ratings Allow Nursing Homes to Game the System – NYTimes.com.


You Think Financing U.S. Health Care Is Bizarre? Check Out 340B Drug Pricing

August 22, 2014

Indeed, it can be said that in no other country is as much oversight necessary—and performed—as it already is in the U.S. Here hospitals spend hundreds of millions, possibly billions, every year to be in compliance with government regulations, and government auditors and the Inspector General’s offices cost hundreds of millions more. Every U.S. hospital now has some executive vice president in charge of compliance, has a board subcommittee dealing with compliance and has a sizeable compliance department and confidential hotline for whistle blowers. There are a growing number of compliance consulting firms helping hospitals and clinics to remain in compliance with U.S. federal and state regulations, earning a fine living from the process—all at patients’ expense, of course. I have never encountered anything like it in other countries whose health systems I have studied.

via You Think Financing U.S. Health Care Is Bizarre? Check Out 340B Drug Pricing.


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