Friday, January 17, 2020

2019 Compliance Review

Links to all the articles, publications, and legislative educational resources that we distributed in 2019.

Monday, December 16, 2019

Why All Democratic Approaches to Healthcare for 2020 Candidates Lead to Medicare for All by 2030 on Armstrong & Getty

Hospital Groups Sue Trump Administration Over Pricing Transparency Rule

On Wednesday, Dec. 4, 2019, four major hospital groups filed a lawsuit against the Trump administration to challenge the Nov. 15, 2019, final rule that would require hospitals to disclose their pricing information, including negotiated rates.

The Federation of American Hospitals, the American Hospital Association, the Association of American Medical Colleges, the Children’s Hospital Association and three hospitals filed the suit in the U.S. District Court for the District of Columbia, stating that the Centers for Medicare and Medicaid Services (CMS) exceeded their authority with the rule. The lawsuit also states that the pricing disclosure rule violates the First Amendment.

What’s included in the final rule?

Under the rule, hospitals are now required to provide easily accessible billing information to patients by Jan. 1, 2021. This means having all standard charges available online and in one single data file that can be “read by other computer systems,” according to a CMS press release.

The charges listed would include “the gross charges, payer-specific negotiated charges, the amount the hospital is willing to accept in cash from a patient, and the minimum and maximum negotiated charges,” to the release. Hospitals that fail to comply with the rule’s requirements would face a $300 per day civil penalty.

The hospital groups’ lawsuit contends that requiring hospitals to publish the different charges, including their privately negotiated prices with insurers, “will confuse patients and unduly burden hospitals.”
“CMS' final rule fails to offer patients easy-to understand information regarding their out-of pocket obligations for care -- so we feel obligated to contest the regulation. We contend the agency exceeded its authority and should go back to the drawing board.” - Chip Kahn, chief executive of the Federation of American Hospitals 
What’s next? 

We will continue to monitor any developments regarding this lawsuit and will provide updates as necessary.

DOL Issues Model Health Care Transparency Disclosure Documents

Thursday, September 19, 2019

California is Burning $80,665 on Healthcare for One Employee Per Year

Honestly, I have no clue how that is even possible.  The annual cost of healthcare for one person per year should be between $6,000 and $9,000.  California's state average is $9,500.  Yet we have a plethora of "public servants" costing the state over $50,000 per year.  Yet another example as to how taxpayer dollars are flat-out abused and wasted by elected officials and bureaucrats.  These amounts are so absurdly high, it is hard to imagine how this could happen without rampant fraud.  

This is from the OC Register:   
One of the most generous health insurance plans enjoyed by a California public servant last year — costing $80,665 — went to a communications manager for the obscure Water Replenishment District of Southern California. 
At the embattled Los Angeles Department of Water and Power — raided by the FBI in July, and yet to produce documents detailing how a worker earned $313,865 in overtime pay — there were 153 workers with health plans costing $57,816 each. 
In Riverside County’s Rubidoux Community Services District, the general manager received health benefits totaling $55,717. In San Bernardino County’s Cucamonga Valley Water District, the general manager’s health benefits cost $38,191 to cover his family. In Anaheim, 31 workers — mostly in public safety — had health plans costing more than $36,000 each. 
A new analysis of public spending on employee health insurance by Transparent California — whose findings were mirrored by the Southern California News Group’s own data crunching — found that workers toiling in California’s cities, counties, special districts and state offices received health benefits costing about 50 percent more than the average in California, which is $9,476.

And, surprisingly often, benefits cost two, three, four, up to even eight times as much. 
“Spending over $50,000 on a single employee’s health insurance plan is an inexcusable waste of taxpayer funds,” said Robert Fellner, executive director of Transparent California, in a statement. 
“Medical plans this expensive simply don’t exist in the broader market, which is a strong indication that providers are exploiting the fact that these governments are happy to pay inflated prices with other people’s money.”
California’s “wildly inflated health costs” bleed some $3.3 billion from taxpayers each year, Fellner calculated. ... 
And a recent survey from the Kaiser Family Foundation found that 92 percent of family medical plans cost less than $26,000....

Nationwide, workers contribute one-third of their health care premiums, according to UBA’s data. In California, government workers pay an average of 23.3 percent. 
But the Water Replenishment District of Southern California — like many public agencies here — doesn’t ask workers to pay anything. 
The district not only picks up 100 percent of premiums for workers and their dependents, but also gives them an “IRS qualified health reimbursement account” for out-of-pocket expenses of $8,196 per worker and $4,928 per dependent. Each year.

Unused funds roll over for three years, then revert to the district. ...
The full story is definitely worth your time to read.   

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.