More M.D.s asking for deductible up front
Spurred by higher co-pays and the ability to estimate billing amounts faster, more doctors are requiring patients to pay their full co-pays at the time of the visit, Francesca Lunzer Kritz reported in The Washington Post.
“It’s a paradigm shift from what most consumers are used to at their doctor’s office,” says Red Gillen, a San Francisco-based analyst with consulting firm Celent, who last month published a report on doctors seeking upfront payment from their patients. Gillen says that until recently, insurers paid so much of the cost of medical care that medical providers, including doctors, labs and hospitals, focused their fee recovery efforts on the companies. But in the past few years, Gillen says, employers and insurers have shifted more costs to consumers in the form of higher co-pays, higher co-insurance and higher deductibles, making those payments an increasingly large share of doctors’ incomes. According to Gillen, consumer out-of-pocket spending as a percentage of all health-care spending rose to 12 percent last year, and is expected to continue rising.
Patient advocates regard the faster billing process as a positive for consumers, Lunzer Kritz found, but some are concerned that patients are not warned about their doctor’s billing practices and that higher up-front payment demands may discourage sick people from seeking care.
Sunshine Week: Some hospital quality measures online
Felice Freyer, a medical writer at The Providence (R.I.) Journal and a member of AHCJ’s Right to Know Committee, writes in an article for AHCJ that “In recent years, state and federal agencies have begun yanking data out of filing cabinets and opening their folders to the daylight of cyberspace.”
As Freyer points out, “The Internet offers vast new opportunities to answer every patient’s most pressing question: Am I entrusting my health to people who will take good care of me?”
Web sites that offer hospital quality data not only inform consumers, they prod everyone in health care to do a better job. Much more can and should be done to give the public better access to what the regulators know.
Read more of Freyers article.
Additional Sunshine Week coverage: Online health data varies by state
Sunshine Week: Online health data varies by state
Filed under: Government, Health journalism, Public records
The Sunshine Week 2009 Survey of State Government Information Online found that while more and more government records are being posted online, some of the most important information is being left offline. And in some cases governments are charging taxpayers to access records that they already paid for, such as death certificates.
Sunshine Week 2009:
March 15-21
Sunshine Week is a national initiative to open a dialogue about the importance of open government and freedom of information. Participants include print, broadcast and online news media, civic groups, libraries, nonprofits, schools and others interested in the public’s right to know.
Teams of surveyors scanned government Web sites in every U.S. state to look for 20 different kinds of public records.
The survey (PDF) included nursing home inspection reports, hospital inspection reports and death certificates. It found that nursing home inspection reports are available online in 29 states, hospital inspection reports are available online in 17 states and death certificates are available online in five states.
The report says that “Death certificates are apparently a revenue source for many states, as they charge relatives and “legitimately” interested parties for copies of the records, or farm out the work to a third-party service such as VitalChek. Some states provide historical access online to older death certificates, mostly prior to 1960, although there generally is a fee for hard copies.”
Other health-related highlights in the report:
In Oklahoma, hospital inspection reports are said to be “confidential by statute” and would not be disclosed publicly unless there was a case involving a licensing question or revocation/suspension of a license.
Louisiana: “We have a problem with the legality of it,” a Louisiana Department of Transportation official told the survey reporter who called the office after failing to find bridge inspection reports online. Calls to other Louisiana agencies after finding neither hospital or nursing home inspections, nor environmental citations online yielded otherwise unlinked URLs for information.
Maryland: Nursing home information got high marks for facilitating online search and for allowing users to “compare data in a variety of ways.”
Minnesota: The state’s Department of Human Services says it expects corrections orders and licensing sanctions, not currently posted, to be online “in the near future.”
California: Because the state of California is so large, surveyors looked at whether individual departments and agencies posted their audits and personal financial disclosure forms, including audits from the Department of Health Care Services. They found that the data is not clearly linked from the department’s home page, though it is free to view and download. The most recent audit reports online where from 2007.
Department of Health and Human Services
University of Missouri graduate students reviewed the Web site of the Department of Health and Human Services and reported on what documents are available in electronic reading rooms. The students noted that the HHS Web site is difficult to navigate because it is comprised of so many divisions that “vary in content, organization and utility.”
They found multiple problems with many of the HHS administrative manuals and other documents, including documents that were locked because someone else was viewing them and documents that were not clear about when they were created or modified.
FDA creates tipster Web page for alleged crimes
Do you know something about the sale of counterfeit prescription drugs or off-label promotion of medical devices? What if you came across fraud committed by a clinical trial investigator or a case of product tampering? Do you know how to get in touch with the Food and Drug Administration if you knew about an alleged crime?
Well, the FDA is trying to encourage tipsters to get in touch. The agency recently created a special page on its Web site to report suspected criminal activity, and the info gets forwarded directly to the FDA’s Office of Criminal Investigation.
Here are activities the FDA’s OCI would investigate: illegal diversion of pharmaceuticals and other regulated products; Prescription Drug Marketing Act violations; schemes involving fraudulent treatments, cures or devices; New Drug Application fraud; crimes affecting the safety or integrity of the nation’s blood supply or the adulteration and/or misbranding of food; Internet facilitated criminal violations involving FDA regulated products; illegal importation of FDA regulated products, and crimes involving the manufacture, sale or distribution of unapproved FDA regulated products.
We asked an FDA spokeswoman what exactly prompted this initiative and whether any tips have actually been reported. The FDA responded that nothing prompted the move and that it “can’t comment on any of the e-mails we have received or any other communication we receive via other means.”
Fla. Medicare fraud flourished under lax oversight
Jay Weaver of the Miami Herald followed up on the Herald’s investigations into widespread Medicare fraud in South Florida. Weaver found that when 18 shuttered providers appealed to Medicare, they were reinstated only to turn around and further defraud the government of at least $5 million, much of which may never be recovered.
Last fall, the U.S. Department of Health and Human Services’ Office of Inspector General cited the 18 medical equipment suppliers in a critical report concluding that Medicare’s appeals system was flawed because it lacked strict rules of evidence. Medicare officials don’t disagree.
”It’s always troubling when you have 18 reinstated like that,” acknowledged Kimberly Brandt, Medicare’s anti-fraud director. “They may have gotten back in, but they didn’t get back in for a very long time. That doesn’t mean we couldn’t have been more vigilant.”
Weaver reports that, six months later, officials have yet to put rules in place to prevent suspected fraudulent equipment operators from regaining billing priviliges.
P-I reporter committed to covering W.R. Grace trial
AHCJ member Andrew Schneider of the Seattle Post-Intelligencer is covering the W.R. Grace criminal trial in Missoula, Mont. The federal government alleges that Grace officials mined vermiculite in the small town of Libby, Mont., for decades, even though the company was aware of health risks.
Ten years ago, Schneider and David McCumber exposed that W.R. Grace was polluting the town and hiding the risks that its vermiculite mine posed to the town. “Toxic dust contaminated with lethal asbestos fibers poured out of the mine for decades, poisoning the men who worked there, the families they went home to and the town that grew around in.”
Schneider writes on his personal blog:
“It’s bizarre and a bit prickly to sit in a federal courtroom and watch a story that you broke a decade ago, then chased with about 240 follow-ups and a book, being played out in front of you.
It becomes surreal when the judge talks about the book from the bench and defense lawyers introduce excerpts into evidence and then do dramatic readings to the star witness for the prosecution.”
Schneider is writing about the trial for the Seattle P-I and on his personal blog as well. Although the P-I is expected to close or move to an online-only publication very soon, he says he will continue to cover the trial.
“I plan to keep covering the trial as money permits on schneiderinvestigates.com.”
Related
University of Montana students from the law school and the journalism school also are covering the Grace trial and provide a great deal of background on the Grace Case Web site.
Progress on open access issue not what it seems
A press release from the Alliance for Taxpayer Access yesterday raised hopes that permanent open access to federally funded research through the National Institutes of Health had been assured by President Obama.
As the release pointed out, on Wednesday, Obama signed the 2009 Consolidated Appropriations Act (PDF), which includes a provision making the NIH Public Access Policy permanent (section 217 on page 621 of this PDF document). The NIH policy that had been in place requires eligible NIH-funded researchers to deposit electronic copies of their peer-reviewed manuscripts into the National Library of Medicine’s online archive, PubMed Central, but the provision had to be renewed every year.
That sounds like a positive step toward ensuring public access to publicly funded research, right?
Well, not so fast.
The Fair Copyright in Research Works Act, HR 801, introduced by U.S. Rep. John Conyers Jr. and others, is still active and has been referred to the House Committee on the Judiciary.
AHCJ opposes that bill because it would completely reverse the NIH’s open access policy and would essentially nullify the provision that Obama just signed into law. As Gregg Leslie of the Reporters Committee for Freedom of the Press said, “… any later piece of legislation modifies the current law, so Obama could sign something into law and then soon invalidate it by signing a new bill sent to him after approval by Congress.”
Showdown over Medicare Advantage looms
Filed under: Government, Health care reform, Health journalism
In support of a range of folks including President Obama and his local orthopedists, Gilbert Cranberg takes on Medicare Advantage plans in the Nieman Foundation’s Neiman Watchdog.
Cranberg urges the press to pay close attention to the impending showdown between the president and a coalition of insurance companies and Medicare Advantage clients grown accustomed to heavy government subsidies. The administration estimates cutting the Advantage program will save $176 billion over the next decade, money the president hopes to use to expand coverage.
Top HHS positions remain vacant
Dave Helling of The Kansas City Star found vacant positions at the highest levels of many government agencies, including the Department of Health and Human Services.
There are 19 subcabinet jobs at HHS that require presidential appointment and Senate confirmation — assistant secretaries, administrators, commissioners and directors, all key players at the $730 billion agency.
Fifteen of those jobs are open.
It isn’t just HHS. Nearly seven weeks after taking office, President Barack Obama has a Cabinet, but hundreds of other senior-level jobs across the executive branch lack permanent occupants.
Helling reports that empty spots at the highest levels are common during transitions between presidents of opposite parties, but that the resulting lack of policy direction still leaves legions of bureaucrats rudderless and trapped in a transitional purgatory.
At HHS, the list of important agencies lacking permanent leadership is long: The Food and Drug Administration. The Centers for Disease Control and Prevention. The Centers for Medicare and Medicaid. The National Institutes of Health.
Regional health reform forum webcast from Mich.
The forum starts at 2 p.m. ET and will be streamed live.
This is the first of five regional forums that were announced by President Obama last week. They are intended to continue the public discussion about bringing down health care costs and making coverage more widely available. The president said:
“The forums will bring together diverse groups of people all over the country who have a stake in reforming our health care system and ask them to put forward their best ideas about how we bring down costs and expand coverage for American families.”
The other four events have been scheduled:
- March 17 in Burlington, Vt.
- March 23 in Des Moines, Iowa
- March 31 in Greensboro, N.C.
- April 6 in Los Angeles
Check HealthReform.gov for more details.
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Awards for Excellence in Health Care JournalismDeadline: Feb. 3
- How I did it: Falsified charts in nursing homes linked to patient care
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
- Focus on freelancing: Tips for buying liability insurance
- Why do some patients get stuck in hospitals for weeks, months?
- Investigate health professionals and the boards that regulate them
- Presidents of AHCJ, SPJ call for more openness from Obama administration
