insured

HealthNet fined $1M for non-disclosure of cancellation bonuses

Fri, 16 Nov 2007 06:59:58 -0500

Following disclosures forced by a lawsuit, HealthNet has been fined $1 million by the state's Department of Managed Health Care (DMHC) for failing to admit that it did indeed have plans in place which compensated employees partly for how many policies they could cancel.

According to the DMHC, it asked HealthNet on two separate occasions whether it had such plans in place, but HealthNet execs denied it. (I can only class this as "chutzpah.") Last week, however, proof that it was indeed basing bonuses partly on rescissions came to light, when HealthNet was ordered to produce documents as part of a suit filed by a former insured whose policy was canceled.

Unfortunately for Health Net, the fine addresses only to its failure to disclose details of its incentive plan. The DMHC is still investigating whether Health Net (and other state health plans) are making illegal rescissions--which leaves it wide open for additional fines and administrative sanctions. In short, the situation is likely to get uglier in coming months.

To find out more about the fine:
- read this DMHC press release

Related Articles:
Health Net set goals, bonuses based on policy cancellations. Report
CA regulators plan limits to health policy cancellations. Report
BC of California fined $1 million for cancellations. Report
CA agency mulls review of policy cancellations. Report
Kaiser forced to reinstate coverage. Report
Blue Cross of California settles plan-cancellation suits. Report
Kaiser pushes for policy cancellation rules. Report

Study: Percent of ED charges paid is decreasing

Mon, 12 Nov 2007 06:59:54 -0500

With hospital emergency departments already taxed enough, the following isn't reassuring. A new study concludes that the proportion of outpatient ED charges paid by both government and private insurers decreased consistently from 1996 through 2004, undercutting their ability to subsidize care for the uninsured. The study, which appears in the Annals of Emergency Medicine, found that while adjusted mean charges for outpatient ED visits climbed from $713 to $1,390 during the study period, adjusted mean payments climbed from $410 to $592. All told, the overall share of charges paid decreased from 57 percent in 1996 to 42 percent in 2004. Reimbursement for ED care grew more slowly than charges across all payer groups. Not surprisingly, the same study found that the proportion of total charges paid by the uninsured (35 percent) was lower than from those from privately-insured patients (56 percent).

To get more data from the study:
- read this Annals of Emergency Medicine study (.pdf)

Avoidable hospitalizations puzzle health leaders in D.C.

Fri, 26 Oct 2007 06:59:54 -0400

Officials in D.C. are troubled by a newly-documented rise in avoidable hospitalizations among children and adults, a trend which cuts across both insured and uninsured patients. Statistics released by research firm Rand show that such hospitalizations have climbed from 39.1 per 1,000 adults aged 40-64 in 2004 to 43.4 in 2006. Meanwhile, among children through age 17, the rate shot up from 8.9 to 12.1. The rate began to climb in 2005, largely tied to MRSA infections, but officials say more is involved, including an overloaded primary care system and strained emergency departments. Officials commissioned the study to help them decide how to spend $116 million in tobacco settlement funds; they've suggested that this data may change their plans from building a new hospital and clinics to rehabbing and selling D.C.'s Greater Southeast Community Hospital.

To learn more about this trend:
- read this article from The Washington Post

CA reform bill backs off doctor tax

Wed, 10 Oct 2007 06:59:57 -0400

All signs seem to suggest that California is poised to move ahead with substantial health system reforms, some of which hit providers in the pocketbook. However, the role of doctors in the proposed new system seems to have shifted from a direct tax to an expanded indigent care role. Why are we bothering telling you so? Because if that's the compromise California makes, you can count on similar provisions turning up elsewhere.

Previous iterations of the state's reform proposal would have required physicians to pay 2 percent of their revenue to subsidize the new program, which is structured to give all Californians affordable health insurance. The latest version, however, drops the pay-in by physicians, adding in its place new rules that would require physicians to care for many of the newly-insured. In another effort to expand healthcare access, the proposal would boost public hospital funding by $500 million.

To learn more about the legislation:
- read this Sacramento Business Journal article

Related Articles:
AMA promotes plan to cover the uninsured. Report
California system launches pro-reform ads. Report
California health reform accelerating. Report

Mandated coverage: A smart idea?

Fri, 21 Sep 2007 06:59:59 -0400

Following the high-profile lead of Massachusetts, states like California are considering legislation requiring that citizens have health coverage. And in theory, that's good for providers, who theoretically end up carrying less bad debt created by uninsured patients.

However, as the Massachusetts example shows, it's easy to be seduced by the idea of seeing only insured patients--then finding out that the reality isn't as rosy as you'd hoped. I realize that I'm stating the obvious here, but I think it's worth noting that all coverage isn't made equal.

In Massachusetts, as they will elsewhere, reforms have relied heavily on high-deductible health plans. While high-deductible plans may work for some, it's clear from current data that consumers aren't funding them fully from the get-go. And that means that even insured patients are uninsured when it comes to receiving routine care.

To me, this suggests that the industry's leading lights ought to be very careful when throwing their weight behind any "coverage" proposal. Using up political capital to protect your interests is fine, but if you don't like the results when you're done, well, then, where are you? - Anne

ALSO NOTED: Tenet loses CMO; CT medical malpractice premiums drop; and much more...

Thu, 13 Sep 2007 06:59:50 -0400

> Tenet's chief medical officer has announced that she's leaving to take a similar position at Partners Community Healthcare in Boston. Report

> Connecticut doctors should see some significant medical malpractice premium decreases in the future due to some changes in the marketplace. Report

> With the state's health reform rules boosting the number of insured patients, Massachusetts community health centers are facing big patient loads. Article

> A judge has told the state of Illinois that it needs to refile its civil case against 20 MRI centers accused of paying kickbacks to doctors. Article

And Finally... Has the CDHP movement peaked? Blog

SPOTLIGHT: Creating a 'Medical Security System'

Thu, 30 Aug 2007 06:59:52 -0400

Even patients who have decent health insurance can still lose their job, hit plan coverage limits, face exclusions which prevent them getting coverage for special needs and more. In other words, even the insured aren't that secure, suggests columnist Laurence Kotlikoff of The Boston Globe. To address this problem, he recommends the federal government create a "medical security system" which issues vouchers each year for a health plan payment, with amounts based on a person's health status. In Kotlikoff's view, such an approach meets both Democratic and Republican policy objectives while making sure all citizens get the care they need. Article

Primary care MDs ask patients for extra dollars

Fri, 03 Aug 2007 06:59:55 -0400

Struggling to pay even their basic expenses, primary care doctors are increasingly asking patients for an annual fee in addition to co-payments on insured services. This isn't a high-touch concierge medicine model--patients are getting traditional primary care--but rather, a method for desperate physicians to keep afloat financially, they say.

For example, geriatrics specialist Dr. Mary Colburn of West Palm Beach, Fla. began asking all of her 400 patients to pay an administrative fee of $250 per year last month. "I wish it were not so that we were in this position. But we are," she said. And she's not unusual. According to the Society for Innovative Medical Practice Design, which promotes the fees, hundreds and hundreds of doctors are taking this tack. "It's not going away," says president Chris Ewin.

To find out more about this trend:
- read this South Florida Sun-Sentinel piece

Related Articles:
Study: Primary care costs, reimbursement low. Report
White paper: Building Teams in Primary Care: Lessons from 15 Case Studies. Report
SPOTLIGHT: Upping pay for primary care. Report

Study: Uninsured cancer patients diagnosed later

Mon, 11 Jun 2007 20:01:34 -0400

Even when other factors like age and gender are factored out, it seems that under- and uninsured patients with cancer are likely to be diagnosed at a later stage in their disease than patients with private insurance, according to a new pair of studies published in the journal Cancer. The studies, which looked at the breast cancer and oral cancer, found that the availability and type of health insurance could predict the severity of the illness at the point when it was diagnosed. The studies noted that uninsured and underinsured patients may not have the same access to care as privately insured patients, or at minimum, may have to wait longer to be seen. The authors recommend that health systems and public health organizations establish screening programs specifically for the under and underinsured patients to improve the timeliness of cancer treatment diagnoses.

To find out more about the study:
- read this United Press International piece

Related Articles:
Study: Childhood cancer survivors lack follow-up. Report
Bill promotes standardized cancer care. Report
Groups slam CMS prostate cancer policy. Report

ALSO NOTED: NH hospitals shift $345M to private plans; Cigna pays for "e-visits"; and much more...

Tue, 10 Apr 2007 20:01:30 -0400

> New Hampshire hospitals shifted $345 million onto privately insured patients in 2005, according to a new report. Article

> Cigna HealthCare for Seniors has agreed to reimburse doctors for Web-based "e-visits" and online health services. Article

> Autism diagnoses are on the rise. Now a furious debate is under way: is the disorder occurring more often or are health professionals simply getting better at detecting the condition? Article

> Maryland's Dimensions Healthcare, long on the brink financially, may file for bankruptcy or close for good now that the state has backed out of a plan to pump money into the system. Article

> The National Institute of Allergy and Infectious Diseases will spend $23 million a year over the next seven years to establish a consortium of six research centers to investigate influenza viruses--including H5N1. Report

> Which medical therapies will be discredited in the near future? Blog

And Finally... A drug researcher is turning to patients to financially support his work. Article