DoD spent nearly $363 million on weight-loss surgeries in past decade
Filed under: Health data, Health journalism, Hot Health Headline, Public records
Reporting for KIRO-Seattle, Chris Halsne used FOIA requests to find out how much the military’s TriCare plan is paying for weight-loss surgeries for soldiers and their dependents. Including post-surgery tummy tucks, Halsne calculates (PDF) that the government was on the hook for at least $362,971,831 for such procedures over the past decade.
The military defends the expenditures by pointing to the long-term savings of having healthier TriCare enrollees, though Halsne found those savings difficult to prove, as 86 percent of soldiers and their families leave the plan before they qualify for lifetime benefits.
Halsne found that even some active-duty personnel are getting bariatric procedures, which are officially off limits to them as they are required to stay fit through diet and exercise to remain in the military.
While analyzing Defense Department records on health-related costs, KIRO Team 7 Investigators also discovered the military continues to pay for some weight loss surgery for active duty personnel. Records show $2,400,000 worth since 2001. The military banned bariatric procedures for active duty soldiers and sailors in 2007, yet it appears they approved around 57 of them after that.
Tricare, the military’s health insurance program funded by federal taxpayers, declined KIRO’s repeated questions for an interview.
Lieberman: Election is evidence media got reform coverage wrong
Filed under: Health care reform, Health journalism
In her column on CJRorg, AHCJ Immediate Past President Trudy Lieberman writes that this week’s elections showed just how thoroughly the media missed the mark on health care reform coverage.
After the economy (62 percent), health care (19 percent) was the second most important issue to voters. And while the media (and the administration) trumpeted the benefits of health reform and “glossed over” the drawbacks, public opinion soured. The biggest oversight, Lieberman writes, was the national insurance mandate, a policy that was more Republican than Democrat.
Lieberman says it best:
If the media failed to discuss in detail the law’s less attractive points, it also missed one of the campaign’s biggest ironies. Republicans, with their repeal and replace slogans, stirred up discontent about a law that was basically built with Republican and conservative ideas. That irony escaped the media.
She doesn’t explicitly frame it as such, but Lieberman’s column leaves me with the distinct impression that with the health care debate reignited by a Republican landslide, journalists are being given a second chance to provide the public with a clear understanding of what’s going on in Washington, an impression that’s cemented with her final sentence:
Whatever happens, the U.S. health system is still its dysfunctional, fragmented, costly self, in need of repair or wholesale reform. Going forward, this is the story the media need to tell.
Mass. reform, cost-cutting crush safety net hospital
Filed under: Government, Health care reform, Health policy, Hospitals
Boston Medical Center has been pushed to the financial brink by a mix of politics, economics and expanded health coverage. In Boston Magazine, Eileen McNamara examines the forces that are dragging down the commonwealth’s largest safety net hospital, in the process painting a cautionary tale of what happens when universal health care and cost-cutting collide. If it keeps eating through its financial reserves at the current rate, the hospital will become insolvent next year.
Photo by Wade Roush via Flickr
BMC is in a unique position, thanks to a legal mandate (not shared by its wealthier, Harvard-affiliated competitors) that it “consistently provide excellent and accessible health care services to all in need of care, regardless of status or ability to pay,” McNamara writes. In return, the state is supposed to compensate for its disproportionate load of low-income patients. Instead, the state’s clamping down on Medicare reimbursement.
BMC is locked in a battle with the Patrick administration over dramatic cuts in how the state pays for treating the poor. Barring a last-minute settlement, a Suffolk Superior Court hearing on September 29 will consider the state’s motion to dismiss a BMC lawsuit that challenges Massachusetts’ reimbursement rate. (The state currently pays the hospital 64 cents for every dollar it spends on patients with Medicaid.)
BMC says the new reimbursement formula violates state and federal law, and will sound the death knell for the state’s largest safety-net hospital. The commonwealth says it has the power to set any rate it wants; if BMC finds the payments inadequate, it can simply stop taking Medicaid patients. The state’s argument might have some merit in the case of doctors being free to choose their patients, but it’s a ludicrous posture to adopt toward an inner-city hospital that is required — by state law — to serve all comers.
On MedpageToday, Kevin “@kevinMD” Pho, who trained at BMC, pulls no punches as he riffs on McNamara’s article.
Universal coverage makes great headlines, helps get politicians elected, and, to be fair, is something that needed happen. But doing so without adequately addressing its cost is going to bankrupt hospitals, especially inner-city ones like BMC. That will hurt the Medicaid and Medicare patients dependent on them.
And that’s a goddamn shame.
HHS publishes insurance prices, Consumer Reports explains reform
Filed under: Government, Health care reform, Health policy
The first big wave of health care reform implementation has brought with it a mini-boom in consumer-oriented explainer sites and publications. You may remember the Kaiser Family Foundation’s Health Reform Source from our implementation coverage. In the days since, it’s been joined by offerings from Consumer Reports and the federal government, among others.
Since its launch this summer, Healthcare.gov has slowly evolved, adding explainers, tools and a Spanish-language version. Now, it has officially entered the meat-and-potatoes, utility-belt phase with an insurance search tool that includes detailed pricing and coverage information (press release). According to USA Today’s Alison Young, the tool indexes 4,400 plans from 225 insurers, and will be updated monthly.
And while it caters to consumers with things like monthly premiums, out-of-pocket costs and deductibles, the tool also includes some great data points for reporters, including covered services, percent of applications denied in the past three months, and percent of applicants charged more than the base price. One caveat: All the information is hidden behind a little search wizard, and you’ll have to enter demographic information and click a few tabs before you get to the good stuff.
And finally, as an antidote to the sometimes bureaucratic HHS site, the Consumers Union guide to the first six months of health care reform (Six-page PDF) is heavy on bullet points and easy-to-understand, categorical statements like “Sick children can’t be denied coverage” and “Preventive health care and screenings covered.”
Each major topic area is broken down into four key elements: “What’s New?”; “You may benefit if you”; “What you get”; and “The fine print.” The last subheading is where the guide really shines, as it briefly details exactly how an insurer can slip out of that particular provision.
Get up to speed on Sept. 23 insurance changes
Start with this primer from the AP’s Carla K. Johnson, an AHCJ board member. The big lesson is that you’ll see some changes, but only if your insurer has changed your plan significantly since the reform law went into effect on March 23, 2010. And, as we’ve established, insurers are very cognizant of these dates and are managing plans accordingly.
Johnson’s article (and others like it) emphasize the big-picture, top-level implementation issues, but things start getting more interesting when the rubber hits the road and each state sets up a slightly different system. For more on how each state is a unique reform lab, see Lynn Blewett and Sharon Long’s piece in the Health Affairs Blog.
From there, the gaps are filled by a slew of specialized articles detailing how reform will impact different sectors of the population. Some issues to look for:
A number of major insurers appear to be playing a high-stakes game of chicken with regulators over children’s health coverage. As N.C. Aizenman reports in The Washington Post, insurers like Anthem, Humana, WellPoint, Cigna and Aetna have decided to “stop offering new child-only plans, rather than comply with rules in the new health-care law that will require such plans to start accepting children with preexisting medical conditions after Sept. 23.”
The insurers cite “uncertainty” in the market, a concept which Julie Rovner ably explains in the NPR health blog. The issue, industry representatives say, is that the law would effectively allow children to sign up for insurance after they get sick, which may not be conducive to a sustainable business model for the companies. It is, after all, the very dilemma that led to the universal mandate vs. no denial for pre-existing conditions tradeoff which forms a key pillar of health care reform legislation.
More about children’s coverage
Q&A: Extending children’s health coverage, Chicago Tribune
Health reform: Will your kids be covered? Reuters Finance
New Health Law’s Protections For Adult Children Start Tomorrow, Kaiser Health News & USA Today
College kids
5 Ways Health Reform Affects College Students, U.S. News & World Report
Small businesses
Lightening the Health Care Load for Small Businesses, The New York Times
The long-term ill
Insurance Companies To Remove Benefit Caps, WBUR
The overweight and others in need of preventive care
Few Insurers Provide Coverage For Weight Loss Treatment, Kaiser Health News
And, of course, politicians
A Tale of Two Campaigns: Repeal vs. Reinforce, California HealthLine
Tool for tracking implementation
The Kaiser Family Foundation has added “Health Reform Source” to its stable. The site is dedicated to helping readers understand laws and regulations behind health reform, and to tracking their implementation, both locally and nationally. The site’s heavy on graphics, video and nifty interactive bits.
For those just looking for a feed full of reform implementation news to add to their Google Reader, I recommend The Scan (RSS) which, though Kaiser heavy, includes reports from all over.
Looking at most profitable hospitals in U.S.
On Forbes.com, David Whelan directs our attention to the magazine’s listing of the nation’s 25 most profitable hospitals with the irresistible tease that “some American hospitals make 25 cents or more for every $1 in patient revenue they take in.”
Our list, done by the American Hospital Directory, is based on operating income figures that hospitals must report to the federal Medicare program each year. It found that 24 hospitals in the country with over 200 beds make an operating margin of 25% or more.
In fact, we learn later, one Alabama hospital – the national profit leader – enjoyed 53 percent operating margins, though it now disputes those numbers and says it somehow overstated its revenue by $180 million. Of the top 25 on the list, 15 are for-profit hospitals. Of those, 10 belong to the Hospital Corporation of America chain. The dominance of consolidators like HCA likely has quite a bit to do with rising costs.
Hospital charges represent about a third of total health care spending – $718 billion altogether. It’s more than what’s spent on doctors, drugs, nursing homes or any other category-type of care. Hospitals have been quietly consolidating in recent years. Now many hospital “systems” dominate their regional markets, often allowing them to dictate prices to insurers who pay the bill.
Whelan also looks at the possible connection between profitability and quality of care, though there don’t seem to be any hard and fast numbers.
‘Main Street’ informed, skeptical on health reform
In her blog on CJR.org, AHCJ Immediate Past President Trudy Lieberman updates what is becoming an annual franchise: Her summer man-on-the-street column gauging popular opinion on health reform. Just like last year, Lieberman found her subjects on the streets of Columbia, Mo., a town that’s about as close to the (population) center of the United States as you can get.
The common thread? Missourians were pretty sure health care reform wasn’t all it was cracked up to be, but still weren’t willing to vote “yes” in the state’s referendum on opting out of the individual mandate.
Lieberman added a concrete dimension to her main street opinions by prying details on income and expenses from her sources, numbers and ideas which she then used to link their stories to the larger themes surrounding reform implementation.
Keep an eye out for part two of the column, which should be coming soon.
Lundberg’s list of why health care costs are rising
While people on the streets, experts and legislators debate the causes of rising health care costs, George Lundberg, M.D., editor-at-large of MedPage Today, does no such hand wringing.
He declares that a survey of the topic that was posted by his publication missed the point and did not provide the correct answers.
Lundberg, who edited the Journal of the American Medical Association for 17 years and is a member of the Institute of Medicine, lists what he sees as the “Primary Drivers of Rising Healthcare Costs.”
AP takes on medical costs of overtreatment
Filed under: Health policy, Hospitals, Hot Health Headline
The AP’s Lauran Neergaard has taken on medical overtreatment in America in the first two parts of a six-part series, both of which eschew the cost angle in favor of a more purely clinical discussion.
In the first installment, she focuses on the medical consequences of overtreatment, which include radiation exposure and complications. She looks at every stage of life, from cesarean births to unnecessary and painful cardiac tests performed on dying patients. In the second piece, she takes on one of the most notorious sectors of overtreatment: back surgery. Back pain is notoriously complicated, and surgeries are on the rise despite little evidence that they’re necessary or effective.
“The way medicine is so Star-Treky these days, they believe something can be done,” said Dr. Charles Rosen, a spine surgeon at the University of California, Irvine.
The reality is that time often is the best antidote. Most people will experience back pain at some point, but up to 90 percent will heal on their own within weeks. In fact, for run-of-the-mill cases, doctors aren’t even supposed to do an X-ray or MRI unless the pain lingers for a month to six weeks.
Related
- Understanding variations in spending (Elliot Fisher presentation)
- MedPACReport: Measuring Regional Variation in Medicare Service Use (Mark Miller presentation)
- Opportunities and Pitfalls of Spotlighting Regional Cost Differences (Patrick Romano presentation)
- Author Q&A: Shannon Brownlee on overtreatment of patients
Blame aggressive treatment, tech for rising costs
Wholesome, clean-living and thrifty, Provo, Utah, has always been a Dartmouth Atlas darling. But in recent years, health costs in Provo – like those in similarly cheap markets nationwide – have risen faster than in the rest of the country. Kaiser Health News’ Jordan Rau takes a deeper look at the Utah college town in an effort to figure out why, despite recent efforts to bring everybody else down to Provo’s cost level, Provo seems to instead be climbing up to join its costlier cousins.
Provo, Utah (Photo by jpstanley via Flickr)
In Provo, the costs seem to come down to a few interlocking factors which should already be familiar to anyone who has investigated health care costs in the past. They include advancing technology and more aggressive treatment, all driven by an increase in the number of hospitals and clinics competing in the area. It’s a combination that’s looking increasing irresistible.
To some, it’s inevitable low cost areas such as Provo will catch up to their more expensive peers as a greater proportion of medical spending goes toward expensive machines and nursing salaries, which are rising, says Greg Poulson, senior vice president at Intermountain. Aggressive marketing of the latest technology also is making it more likely that patients everywhere are demanding the same novel treatments, even ones that aren’t proven to work better, Poulson says.
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New at HealthJournalism.org
- Data gives depth to investigation of patient safety
- What reporters should know about Alzheimer’s and related dementias
- Apply for fellowships to attend Health Journalism 2012
- AHCJ asks Supreme Court to permit broadcast of arguments in health reform case
- Tips for print, online journalists to embrace broadcast opportunities
- Numbers reveal how often, or how rarely, states check doctors’ disciplinary records
- 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
