In win for hospitals, Supreme Court rules DSH change violated law – Healthcare Dive

The Supreme Court temporarily have saved hundreds of hospitals from losing substantial benefits to help Medicaid and uninsured patients. Justice Neil Gorsuch,writing for the majority, ordered Health and Human Services to go back and get written comment from the public.

This is the outcome of voters electing a Republican Congress and President who are only out to slash costs regardless of the outcome to hospitals and patients. If this goes through, look for even more critical care hospitals to shutdown.

https://www.healthcaredive.com/news/in-win-for-hospitals-supreme-court-rules-dsh-change-violated-law/556054/

Physician revenues have jumped 52% since 2016 – Healthcare Dive

It would be interesting to know how much Physician revenues are up here at Jefferson Healthcare.

Physician revenue is growing in tandem with utilization, driven in part by an aging population presenting increasingly complex conditions.

Cardiologists, neurosurgeons, orthopedic surgeons and cardiovascular surgeons are the highest revenue-generators among their peers, each netting more than $3 million a year for their hospitals, according to the survey.

https://www.healthcaredive.com/news/physician-revenues-have-jumped-52-since-2016/554746/

Many Hospitals Charge Double or Even Triple What Medicare would pay – NY Times

While our PT hospital is not named in this study, this article is relevant because Jefferson Healthcare is *allowed* to charge much higher rates that competing hospitals, since we are deemed “rural”. Yes, it’s strange that a hospital only 60 miles from a gigantic urban center could be considered rural, but that is what it is. And given the experiences that myself and others I’ve interviewed have shown, JHC is significantly overcharging for many of it’s procedures. The medical staff (doctors, PAs etc) are not aware of the pricing, as it’s all done by the billing department. But the watchword is that if you are going to go in for any kind of procedure that allows you the time to shop around, do so. I have been quoted $500 for a three view x-ray, and Sequim quoted me $250 while Poulsbo quoted me $150 and I ended up paying less than $50.

It is important to note that Medicare does *NOT* pay enough to make many hospitals profitable, or even break even. There is a very real threat to JHC if the Medicare For All proposals of Bernie Sanders and others are actually put into law, without government funding for hospitals that care for high Medicare/Medicaid populations, such as Jefferson County. We could lose our hospital under a badly implemented M4A.

ACA plans denied nearly 1 in 5 in-network claims in 2017 – Healthcare Dive

To see that almost 20% of ACA in-network claims have been denied in 2017 is not a good situation. And the lack of appeals on them (.05%) shows that for most providers, they just push back on the patient to pay.

A very good read to help consumers understand that the marketplace is not working properly and that you should be very careful talking to your medical provider about what they are prescribing you to do. Be very open in telling them that your financial situation cannot afford surprise bills, and ask if there is a way to check first before moving forward with your provider.


https://www.healthcaredive.com/news/aca-plans-denied-nearly-1-in-5-in-network-claims-in-2017/549312/

Hospital lobby ramps up ‘Medicare for all’ opposition – Healthcare Dive

We had an inkling that the Medicare for All would find heavy opposition quickly. Was debating a supporter on FB just yesterday saying essentially exactly what this article states. A day later, here we are. Want to state clearly here and now that I support getting the U.S. to a universal healthcare place, but I’m very dubious that Medicare for All is a way that will garner enough support. Why? Because the government has done a terrible job of reimbursing front line providers for their time. Many front line providers are not accepting Medicare patients, or new Medicare patients. Hospitals are subsidizing this cost by higher costs elsewhere. This has to be fixed before this idea will gain ground with providers. While it would be great to tear down the whole system and start fresh, that just is political rhetoric to get the base motivated to vote next year, a non starter in this current climate with Republicans controlling two branches of government. And we haven’t yet seen the money from the special interest groups show up in any large scale way.

The article points out that the AMA, PHrMa, American Health Insurance Plans, and the Federation of American Hospitals have come out against it, asking Congress to “fix what’s broken and improve what’s working, don’t start over”. My guess is that for a start, raising reimbursals for Primary Care would be a good place for Congress to begin, to slow the bleeding of funds from hospitals etc. In fact, the article points this out, from a document from the coalition of these providers, showing that “66% of hospitals received Medicare payments less than the cost of care, for an industry wide shortfall of $53.9 Billion dollars. Locally, I know that Jefferson Healthcare would be considered part of that amount. While the nurses union claims that hospital coffers have ‘swelled’ there is no truth in that here locally. Of course, we are a public hospital, but the ACA has helped our bottom line, allowing for JCH to better support primary care by hiring more providers, for example. While proponents are arguing that the reduction in administrative costs would help, there is no real understanding of whether these costs would be offset here locally.

Read the whole article for a better understanding. It brings the Koch Brothers into the picture for their efforts, along with the Nurses Union, etc.

Hospital lobbies are mounting a coordinated effort to dissuade legislators from supporting Medicare for all, a policy health systems argue would cut into profits and ultimately force facilities to shutter.

https://www.healthcaredive.com/news/hospital-lobby-ramps-up-medicare-for-all-opposition/547678/

The Insulin Wars – NY Times

More on the national crisis over insulin. Superb article with background on the problem. A good idea is to contact your Federal legislators and request Congressional hearings on this.

Between 2002 and 2013, prices tripled for some insulins. Many cost around $300 a vial, without any viable generic alternative. Most patients use two or three vials a month, but others need the equivalent of four. Self-rationing has become common as patients struggle to keep up. In the short term, fluctuating blood sugar levels can lead to confusion, dehydration, coma, even death. In the long term, poorly controlled diabetes is associated with heart attacks, strokes, blindness, amputation and the need for dialysis.

The Insulin Wars

Insulin prices skyrocketing -Washington Post

The Washington Post has an interesting article on the issues of skyrocketing insulin prices. If you are a Jefferson or Clallam County resident and having a hard time affording your insulin, I would like to know. Would like to look at the scope of the problem here in on the Peninsula.  Contact me at Al_inPT@outlook.com

www.washingtonpost.com/news/magazine/wp/2019/01/07/feature/insulin-is-a-lifesaving-drug-but-it-has-become-intolerably-expensive-and-the-consequences-can-be-tragic/