Thursday, August 29, 2019

Book Review - Heaven on Earth: The Rise, Fall, and Afterlife of Socialism

The very first Armstrong & Getty Book Club (or A&G Book Review, TBD) has convened.  Jack & Joe were joined by "Tim The Lawyer" Sandefur and "Craig the Healthcare Guru/Gangsta" Gottwals. The group sat down at the A&G Radio Ranch for the first in a series of podcasts in which each participant shared their thoughts on "Heaven on Earth: The Rise, Fall, and Afterlife of Socialism" by Joshua Muravchik.

Listen to us discuss:
  • The difference socialism and fascism
  • Why communism will always lead to fascism
  • What leads folks to desire socialism
  • The work ethic of Karl Marx
  • Did you bring enough gum for everyone? 
  • And more  
We will be doing these roughly once per quarter with each of us selecting a book per year.  This book was my selection, up next is Tim with Enlightenment Now: The Case for Reason, Science, Humanism, and Progress by Steven Pinker.  We'll do that sometime on or near December 1st. 

Thursday, August 1, 2019

Trump And The Senate Make Significant Progress On Hospital Price Transparency w/Armstrong & Getty

From Forbes:  
On July 30, the Centers for Medicare and Medicaid Services proposed a landmark new rule that would require hospitals to make public, in a machine-readable format, prices “for all items and services provided by the hospital.” Critically, the rule would require hospitals to publish both their “gross charges,” or their sticker prices, along with “payer-specific negotiated charges,” or the prices hospitals negotiate with each insurer they work with. 
In addition, the proposed rule would require hospitals to disclose “payer-specific negotiated charges for common shoppable services in a manner that is consumer friendly.” For example, hospitals would have to post what they charge for MRI scans and common lab tests that patients often pay for out-of-pocket.

“This proposal is now the most significant step any President has ever taken to deliver transparency and put patients in control of their care,” said Health and Human Services Secretary Alex Azar. He’s right. This rule, if finalized, will revolutionize the market for hospital care.
Full story.

See also:

Thursday, June 20, 2019

Medicare For All? A False Sense Efficiency with Armstrong & Getty

As most of the folks running for President in 2020 profess their love for government provided healthcare and sing the siren song of “Medicare for All” you are likely to hear claims about Medicare’s efficiency and efficacy. Here are the facts they like to leave out:
  • In 1965, government experts projected that in 1990, on an inflation-adjusted basis, Medicare would cost $12 billion. In reality, Medicare cost $107 billion in 1990.
  • For nearly one-third of calls into the Medicaid/Medicare hotline reporting waste, fraud and abuse, government workers take over 4 months to begin investigation.
  • Supporters like to point out that Medicare uses 98% of its funding on claims and only 2% on administration while private insurers generally spend 85% on claims and 15% on administration. This, they claim is superior efficiency. This fails to acknowledge the rampant fraud, misuse and abuse within Medicare. 
    • Independent experts tell us that as much as a third to half of all Medicare spending is improper or wasteful. Malcolm K. Sparrow, a professor at the Kennedy School of Government at Harvard University whose book License to Steal is a classic in the field, thinks that Medicare’s fraud-related losses may run “as high as 35%” of its budget. 
    • An infinitesimal amount of Medicare’s budget is spent on fraud detection, so yes, it is easy to get to 98% claim payment when 1 in every 3 claims you pay is fraudulent and you spend little to no time detecting fraud. The less effort Medicare takes to prevent fraud and the more money it lavishes on criminals, the more efficient it looks. (Source for these stats: "Overcharged: Why Americans Pay Too Much for Health Care" by Charles Silver, David A. Hyman Chapter 16.) 
  • In 2015, the outside contractors that handle bills for Medicare processed 1.22 billion claims. That’s almost 3.4 million claims per day.
  • Medicare and Medicaid receive something like three billion claims a year. For a human being to spend five minutes reviewing each claim would require 125,000 people each working 2,000 hours a year. That’s not enough time to find and flag a fraud, much less to investigate one 
  • From 2009 to 2012, Medicare paid a total of $43 billion for durable medical equipment (DME). According to some reports, more than 60% of that amount—$25 billion plus—may have been paid out improperly. Unsurprisingly, DME suppliers lead the list of entities investigated for criminal health care fraud violations. But the federal government has recovered only about 3 percent of overpayment. (Source: Chapter 12 in Overcharged.) 
Other statistics:
  • Medicare/Medicaid pay 80 cents on the dollar for services, forcing private plans to pay $1.30 for that same service.
  • 65% of all healthcare is paid by taxpayers nationally, 70% in California. 
  • Medicare for all will cost an additional $32 Trillion over 10 years. Obamacare only costs $2T in comparison. 
  • Medicare is currently on pace to run out of money by 2026. 
  • US Spends $3.7 Trillion per year on health (today Medicare is just under a Trillion). 

Wednesday, May 22, 2019

If You Like Your Deductible, You Can Keep Your Deductible ... Right After We Triple It

From Fierce Healthcare:
Health insurance deductibles have been steadily rising over the last decade, jumping 150% since 2009, according to an analysis by the Kaiser Family Foundation (KFF).

The report, published ahead of Deductible Relief Day on May 19, shows the average deductible for a single person in 2009 was $533. It was $1,350 in 2018.
The number of adults required to pay deductibles has gone up as well, the analysis found. In 2009, 59% of people on an employer plan were required to pay a deductible. That number was 85% in 2018.

Oof, How's That $2,500 Drop in Premiums for the Average Family Working Out?

From Modern Healthcare:
The Consumer Price Index for health insurance in April spiked 10.7% over the previous 12 months—the largest increase since at least April 2014, according to a Modern Healthcare analysis of the U.S. Bureau of Labor Statistics' unadjusted monthly Consumer Price Index data.

Tuesday, May 14, 2019

Generic Drugmakers Allegedly Inflated Prices Over 1,000% - 44% States Now Sue

60 Minutes blew the lid off of this unbelievable story here on Sunday night. 
It might be the biggest price-fixing scheme in U.S. history. On Friday, Connecticut and a coalition of more than 40 states filed a 500-page lawsuit accusing the biggest generic drug makers of a massive, systematic conspiracy to bilk consumers out of billions of dollars. It's a more sweeping version of a similar lawsuit the states filed in 2016 that's still being litigated. The generic industry vehemently denies the allegations.
On Tuesday morning I went on the Armstrong and Getty show to explain what governmental changes created the environment where such an absurd ripoff could occur. 

More on this story here:

Tuesday, April 16, 2019

Study: Wellness Programs "Don’t Cut Costs for Employers, Reduce Absenteeism or Improve Workers’ Wealth"

From Kaiser Health News
Workplace wellness programs have become an $8 billion industry in the U.S. But a study published Tuesday in JAMA found they don’t cut costs for employers, reduce absenteeism or improve workers’ health. 
Most large employers offer some type of wellness program — with growth fueled by incentives in the federal Affordable Care Act. 
A host of studies over the years have provided conflicting results about how well they work, with some showing savings and health improvements while others say the efforts fall short. 
Many studies, however, faced a number of limitations, such as failing to have a comparison group, or figuring out whether people who sign up for such wellness programs are somehow healthier or more motivated than those who do not. 
Now researchers from the University of Chicago and Harvard may have overcome these obstacles with one of the first large-scale studies that is peer-reviewed and employs a more sophisticated trial design. 
They randomly assigned 20 BJ’s Wholesale Club outlets to offer a wellness program to all employees, then compared results with 140 stores that did not.
The big-box retailer employed nearly 33,000 workers across all 160 clubs during the test. 
After 18 months, it turned out that yes, workers participating in the wellness programs self-reported healthier behavior, such as exercising more or managing their weight better than those not enrolled. 
But the efforts did not result in differences in health measures, such as improved blood sugar or glucose levels; how much employers spent on health care; or how often employees missed work, their job performance or how long they stuck around in their jobs.  
Full story.

Thursday, April 11, 2019

People Are Addicted to All Things Digital - And Yes, This Calls for Employer Accommodation

Pretty eye-opening piece from the folks over at Fisher Phillips:
... It is prudent to accommodate an individual with a digital addiction the same way you would accommodate any other individual: engaging in the interactive process, and reviewing and discussing any restrictions, limitations, or accommodations that may be needed. While there may be concerns regarding an employee’s ability to return to work in the digital age after receiving treatment for a directly related addiction, this concern cannot be used as a basis to engage in an adverse action against an employee. 
This remains the case even if the disorder is not officially “diagnosable.” In other words, an employer must take a digital addiction seriously, even if it does not understand the addiction or personally believe the addiction is legitimate. ...
The law requires that you participate in a “good faith” interactive process, which means considering each and every possible reasonable accommodation in “good faith.” Document any legitimate reasons why an accommodation may not be “reasonable,” but understand that not everything is “unreasonable.” While employers do not have to provide accommodations that are unduly burdensome, “undue burden” is an extremely tough standard to meet and is looked at primarily in financial terms by courts. So, unless a particular accommodation costs you some serious money, results in a loss of serious money through disruption to your operations, or is a direct threat to the health and safety of others, you are probably going to have to provide it. ...

20 New Healthcare-Related Bills in California's Legislature

Friday, March 22, 2019

Best of March Compliance and Benefit News

March 21, 2019 – McGriff Insurance Services
Excerpt: “An opinion letter from the Department of Labor (DOL) clarifies that employers cannot delay designating paid leave as FMLA leave, even if the employee would prefer this delay. Employers must notify employees that their leave is FMLA-protected within five days of obtaining enough information to make this determination.”

March 11, 2019 – McGriff Insurance Services
Excerpt: “On March 7, 2019, the DOL issued its new proposed rule on overtime exemptions. This proposal would increase the salary threshold for employees who qualify for the white collar exemptions under the FLSA from $455 per week to $679 per week ($35,308 per year). This is a far less significant increase than the $913 minimum weekly salary level set in the DOL's 2016 final rule (which never went into effect because of a federal court injunction). The proposed rule would also increase the $100,000 salary level for highly compensated individuals to $147,414 per year."

March 14, 2019 – Thomson Reuters
Excerpt: “A group health plan subject to COBRA is required to provide an initial (or “general”) COBRA notice to a covered employee or covered spouse only once—within 90 days after the individual first becomes covered under the plan…Remember, though, that…”

March 14, 2019 – U.S. Department of Labor, Wage and Hour Division
Excerpt: “FMLA2019-1-A: Provides an opinion on the obligation to designate FMLA-qualifying leave and prohibition on expanding FMLA leave; FLSA2019-1: Clarifies FLSA wage and recordkeeping requirements for residential janitors and the “good faith” defense; and FLSA2019-2: Addresses FLSA compliance related to the compensability of time spent participating in an employer-sponsored community service program.”

March 12, 2019 – BakerHostetler
Excerpt: “The DOL will then issue a Final Rule, taking all comments into consideration. The DOL expects that the Final Rule will ultimately take effect in January 2020. Employers should begin preparing now to ensure that their payroll procedures comply with the new rule by first reviewing payroll and salary records to determine which employees would no longer be exempt under the higher salary requirements.”

March 11, 2019 – Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.
Excerpt: “Not surprisingly, however, the COBRA rules are complex, and we frequently field questions from employers who are facing employee terminations and just want to get things right. Here are some of the more common questions we receive from our employer clients.”

March 11, 2019 – World at Work
Excerpt: “In the meantime, employers are in a holding pattern awaiting the EEOC’s guidance on this issue. Paretti said he expects that guidance come within the next week and that employers should sit tight until it does…Murdock said she wouldn’t be surprised if the EEOC extends the deadline for employers to report on the revised W-2 wage information and total hours worked. Paretti said he believes the DOJ has strong grounds for an appeal or a stay that would push back the collection of the pay data another year.”

March 11, 2019 – Winston & Strawn LLP
Excerpt: “…the benefit can be wrapped into the employer’s existing medical plan as a participating benefit. However, if an employer offers the telemental health benefit outside of the medical plan to all of its employees, the benefit may be treated as a separate ERISA plan with separate COBRA administration and, if not integrated with a medical plan, may not comply with the all of the requirements under the Affordable Care Act (ACA) that apply to group health plans.”

March 2019 – Harvard Business Review
Excerpt: “For competitive companies, providing quality coverage is good business. It helps attract and retain employees (good health plans are a sought-after benefit), and workers who receive good, affordable care are more satisfied and productive. But that coverage is expensive, and costs are rising.”

March 18, 2019 – Fisher & Phillips LLP
Excerpt: “…the EEOC this morning unveiled its 2019 EEO-1 reporting system that fails to include any request for such pay data. It appears as though employers will not have to provide information about their employees’ 2018 compensation for the time being…We fully expect the EEOC or OMB to appeal the judge’s decision and seek a delay of the revised EEO-1’s implementation while the appeal is pending. However, you should operate under the assumption that you will soon have to comply with the revised EEO-1 reporting rules.”

March 15, 2019 – FMLA Insight
Excerpt: “Despite the Clarity for the Rest of Us, the Opinion Letter Creates Quite a Trick Bag for Employers in the 9th Circuit.”

March 14, 2019 – Forbes
Excerpt: “So far, the partnership accounts for almost 100 million health plans and IBM expects additional members such as health care providers, technology companies, startups, and health organizations to join in the coming months. Among other things, the blockchain project encompasses a system for processing insurance claims and payments, which should decrease administrative costs and remove some duplication issues.”