Pay­ing more for less

As more at­ten­tion fo­cuses on prices, pa­tients face big­ger bills for fewer ser­vices

Modern Healthcare - - THE WEEK IN HEALTHCARE - Me­lanie Evans

Health­care prices, one flash­point in the na­tional de­bate over health­care spend­ing and ac­cess, have at­tracted height­ened in­ter­est from re­searchers, the in­dus­try and Congress.

Prices have climbed, as has the house­hold share of health­care spend­ing, for 1 out of 5 pa­tients with in­sur­ance through an em­ployer, newly re­leased re­search shows. Those find­ings come as the ef­fort to col­lect cash from pa­tients has again fo­cused na­tional at­ten­tion on how hos­pi­tals bill pa­tients for med­i­cal care.

Mean­while, Ac­cre­tive Health, a com­pany at the cen­ter of re­newed con­tro­versy over how hos­pi­tals col­lect from pa­tients, said it would push to es­tab­lish na­tional stan­dards for how to com­mu­ni­cate fi­nan­cial in­for­ma­tion. And a con­gress­man rein­tro­duced a bill with the back­ing of the Amer­i­can Hospi­tal As­so­ci­a­tion that would re­quire states to pro­mote dis­clo­sure of hospi­tal charges and pa­tient out-of-pocket costs.

Data re­leased by the Health Care Cost In­sti­tute, a not-for-profit launched roughly one year ago, found prices in­creased in al­most ev­ery one of 30 cat­e­gories of health­care ser­vices, from emer­gency room vis­its to brand-name pre­scrip­tion drugs.

The anal­y­sis in­cluded 3 bil­lion claims for those younger than 65 with em­ploy­er­spon­sored in­sur­ance from Aetna, Hu­mana, Kaiser Per­ma­nente and Unit­edhealth­care. The data cap­tured prices for hospi­tal, doc­tor, lab­o­ra­tory and nurs­ing home care be­tween 2007 and 2010.

Price in­creases fu­eled over­all growth in health­care spend­ing of 3.3% in 2010 com­pared with 2009, ac­cord­ing to the in­sti­tute. Use of health­care ser­vices de­clined.

“It’s in­ter­est­ing how it looks like peo­ple are get­ting fewer med­i­cal ser­vices but they’re pay­ing more over time,” said Chapin White, a se­nior health re­searcher at the Cen­ter for Study­ing Health Sys­tem Change.

White said the growth in prices at a time

when health­care use has flagged sug­gests that cov­er­age through an em­ployer is in­creas­ingly un­af­ford­able. “This re­port is high­light­ing that peo­ple are pay­ing higher and higher prices and get­ting fewer and fewer ser­vices,” he said.

The re­port also found out-of-pocket spend­ing by pa­tients, such as co­pay­ments and de­ductibles, grew faster than spend­ing by in­sur­ers. Pa­tient spend­ing in­creased 7.1% com­pared with the 2.6% growth among in­sur­ers. Pa­tients also ended 2010 re­spon­si­ble for a greater share of over­all spend­ing (16.2%) com­pared with the prior year (15.6%).

Ef­forts to es­ti­mate prices and col­lect money from pa­tients at one Twin Cities health sys­tem have at­tracted na­tional at­ten­tion af­ter Min­nesota’s at­tor­ney gen­eral sug­gested a billing and col­lec­tion com­pany may have vi­o­lated laws that pro­tect con­sumers, privacy and ac­cess to emer­gency care.

Ac­cre­tive Health, which has dis­puted the at­tor­ney gen­eral’s claims, lost its con­tract to han­dle billing and col­lec­tions at Fairview Health Ser­vices amid the at­tor­ney gen­eral’s in­quiry. Fairview last week said its board of di­rec­tors, in a spe­cial meet­ing, did not re­new the ex­pir­ing con­tract for the sys­tem’s pres­i­dent and CEO, Mark Eustis.

Ac­cre­tive Health’s share prices fell af­ter the at­tor­ney gen­eral re­leased her re­port, which claimed the com­pany ag­gres­sively sought to col­lect med­i­cal bills from pa­tients be­fore or as they sought med­i­cal care. In re­sponse, the com­pany said it would fund and es­tab­lish a panel to iden­tify stan­dards for how providers com­mu­ni­cate in­for­ma­tion to pa­tients about prices and med­i­cal bills.

Ac­cre­tive named Mike Leav­itt, founder of the con­sult­ing com­pany Leav­itt Part­ners and for­mer HHS sec­re­tary, to head the panel. An ini­tial ad­vi­sory group will meet in June to se­lect an out­side or­ga­ni­za­tion that will seek to ex­pand the ad­vi­sory group’s mem­ber­ship and so­licit com­ment from the in­dus­try, pa­tient groups and oth­ers, said Wayne Sen­sor, a part­ner and man­ag­ing di­rec­tor for Leav­itt Part­ners.

Sen­sor said Ac­cre­tive pro­vided seed money for the ef­fort but an­tic­i­pates oth­ers will help fi­nance the stan­dards de­vel­op­ment.

In Congress, Rep. Michael Burgess (RTexas), a physi­cian, rein­tro­duced a bill that would set a new stan­dard for dis­clo­sure of con­sumer in­for­ma­tion by hos­pi­tals and in­sur­ers.

The bill, first in­tro­duced in 2006, would re­quire states to en­act laws that would re­quire dis­clo­sure of hospi­tal charges and com­pel in­sur­ers to pro­vide es­ti­mated out-of-pocket costs to pa­tients.

Me­gan Cun­dari, se­nior as­so­ci­ate di­rec­tor for fed­eral re­la­tions at the AHA, said the trade group sup­ports the state-level man­dates to al­low lo­cal com­mu­ni­ties to en­act laws that suit their needs.

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