The surprising reason drug prices are on the rise – VOX

Background: Many people in Jefferson County have been discussing the rising price of drugs, including retired physicians, pharmacists and patients. While the President has made bold statements that have never materialized into actions, (and only seem to provide a buying opportunity to purchase drug stocks at a discount during the 24 hours after the tweet), the industry has chosen to continue to raise it’s prices. Many horrific stories are starting to appear on NPR and the mainstream media.

Here’s an overview of some ideas on why this is happening.

https://www.vox.com/policy-and-politics/2019/1/7/18172678/how-much-drug-prices-rise-voxcare

Why requiring hospitals to post prices may not help patients avoid surprise costs – KING TV

While I am very leery of KING now that they have been taken over by an extreme right wing ownership team, this is a good overview of where we are at now and some of the issues.This ends with the woman reporter describing what happened to her when she had her child. High out of network costs that took her years to pay off.

https://www.king5.com/article/news/local/take-5/why-requiring-hospitals-to-post-prices-may-not-help-patients-avoid-surprise-costs/281-41a11426-5a06-434f-89fd-2c3a2ee6eb57

What A French Doctor’s Office Taught Me about Health Care – New York Times

I have found in my conversations with Americans that very few have any understanding of how bad American health care is compared to other industrialized countries. While it’s true that we have great medical professionals, the actual cost to deliver that care is much higher than other similar countries, the outcomes are much worse. Here is a ground level view of a real patient who fled America because of her inability to afford care, and what she found in France.

Taking Surprise Medical Bills to Court – NY Times

With a growing number of people being sent to collections here in Jefferson County by JHC, this article points out a very interesting issue of whether the “contract” between a patient (especially one coming into an E.R.) and the hospital is a legal and binding contract for billing purposes. Can you have a binding agreement if the client/consumer doesn’t know the price they are paying when they sign the consent agreement?

 

Trump Administration Slashes Medicare/Medicaid Payments. Local Hospital Is Targeted

The Peninsula Daily News (PDN) is reporting that the Trump Administration, against the wishes of hundreds of letters and testimony against it, is slashing Medicare and Medicaid reimbursal rates to clinics more than 250ft away from a central hospital. The new rule is called the “CY (for Calendar Year) 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System”

The rule announcement from July is found at

https://www.cms.gov/newsroom/press-releases/cms-empowers-patients-and-ensures-site-neutral-payment-proposed-rule

and the October 30th update is found here:

https://www.cms.gov/newsroom/fact-sheets/cms-finalizes-hospital-outpatient-and-ambulatory-surgical-center-policy-and-payment-changes

The goal of the proposed rule was to eliminate patient clinic visits to hospital clinics that charge more than non hospital clinics. The Center for Medicare and Medicaid Services (CMS) claims in it’s press release that, “Currently, CMS often pays more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting.” They offer no proof to that claim.

The most affected facility for this on the Olympic Peninsula is Olympic Medical Center’s (OMC) offsite clinics in Sequim. Ironically the clinics serve a population that voted for President Trump in the last election and they will, if this rule is not overturned via legislation, be the most effected by it. The chart at the link below shows how various precincts voted in 2016.

https://www.nytimes.com/interactive/2018/upshot/election-2016-voting-precinct-maps.html#8.27/47.920/-122.715

The PDN is reporting that payments may be slashed up to 60%, which would apparently make these clinics financially nonviable. Medicare and Medicaid payments today are so lean that many physicians do not take new Medicaid/Medicare patients because they cannot survive on the reimbursal rates.

The outcome of this will be that seniors and the poor will have to travel further for medical care, and that some hospitals, like OMC may be forced to close their remote facilities and possibly even put their main hospitals in financial jeopardy. Hospital closings in the last decade in rural areas have reached new highs, leading to rural areas often being the most under-served areas for healthcare in the country. Forbes magazine, in 2017, had an article that researched the issue and found that “Approximately 2300 rural hospitals are in the United States. Of those, 81 have closed since 2010.” Forbes went on to show how President Trump’s proposed healthcare cuts were putting “673…at risk of closing”. The full story from Forbes is available at https://www.forbes.com/sites/bisnow/2017/07/26/obamacare-repeal-could-cripple-rural-hospitals-and-lead-to-more-closures/#6dbd6b4f42b8

It is not known how this will affect Jefferson Healthcare (JHC) as they have kept their clinics within the required 250 yard rule. They have worked around the issue by setting up their clinics in Quilcene and Port Ludlow in a different legal framework. They claim that they will be less affected.

There have been rumors from healthcare providers that other standalone clinics may be affected, those not attached to a hospital. We will track those as we hear from the community. Your comments and insights are welcome to be sent to albergstein@gmail.com

What is happening is an ongoing push to centralize healthcare in urban centers and reduce the costs. While healthcare costs are rising, much of these costs are centered in the last years of life. Our insistence on providing all out high cost medical support to terminally ill patients, for example, rather than focusing on expanded hospice care has led to a heavy weighing of costs to end of life medical intervention. From personal experience, I can say that in some locales there seems to not be honest dialogue between patient and provider about the likelihood of a successful outcome, leading to the patient not knowing that they are essentially terminally ill and wanting to continue, under the providers suggestions, with expensive treatment that will only likely extend life a few months.

Medical providers are also, due to litigation costs, often insisting on far more tests than necessary, driving up costs. There is no easy route out of that issue, as patient expectations are not often aligned with actual healthcare scenarios and outcomes. The inability to also properly judge physician history and ratings also make it hard for patients to know when some providers have a history of malpractice.

But the slashing of medicaid and medicare costs to OMC and other hospitals like it, is a cynical ploy by the Trump Administration and Congress to do a stealth attack on these services, one which was highlighted in an article last month.

Larry Kudlow, the director of the Trump White House’s National Economic Council, recently said he wants to take aim at “entitlements” as early as “next year.” A few months earlier, House Speaker Paul Ryan (R-Wis.) said he wants to see policymakers bring the budget closer to balance by cutting “entitlements.” Rep. Steve Stivers (R-Ohio), who currently chairs the National Republican Congressional Committee, made the same argument in August.

And now Senate Majority Leader Mitch McConnell is making the identical pitch.

http://www.msnbc.com/rachel-maddow-show/mcconnell-eyes-cuts-medicare-social-security-address-deficit

This all comes after slashing taxes to the wealthiest Americans and corporations earlier in the year.

It is worth remembering that this administration and previous ones have spent approx. $170M a day for 16 years funding the war in Afghanistan. We have the money to fund Medicare and Medicaid at appropriate levels. It’s all about priorities.

Just last month, our legislators from both Clallam and Jefferson counties, including some of our county and hospital commissioners and executives, traveled to Washington D.C. and met with numerous staffers, both at the White House and Congress. Some of them, such as Republican Congresswoman Jamie Herrera Butler, was not in Washington and sent out a staffer who knew nothing of the issues.

It remains to be seen if our legislators can fix this problem in Congress next year. If you want to help ensure it gets done, vote Democratic on Tuesday November 6th. Putting Democrats at least in charge of the House will allow a real debate and bipartisan approach on how this all proceeds. Representative Kilmer, who is up for re-election, along with other Democratic Representatives have been fighting hard to protect rural hospitals. These politicians are not perfect. None of them will agree with all of us all the time. That’s just not how this representative democracy works. But these Democratic politicians in our district have a track record and to elect more Republicans and expect a different outcome seems unrealistic.

Otherwise these kind of cuts are going to continue to come at us, with the outcome being far worse healthcare options for all of us, no matter who you voted for in this election. This is not “making America great again.”

The final rule will appear in the November 13, 2015 Federal Register and can be downloaded from the Federal Register at: http://www.ofr.gov/inspection.aspx?AspxAutoDetectCookieSupport=1.

 

Three take-aways from Nancy Guinto’s transparency testimony to the US Senate HELP Committee – State of Reform

Nancy Guinto, Executive Director of the Washington Health Alliance (WHA), testified before the US Senate HELP (Health, Education, Labor and Pensions) Committee last week about how price transparency initiatives can increase value in health care. Three key takeaways:

  • Congress should create incentives to align stakeholder interests in leveraging data to improve care value. Congress should look across public and private sectors to coordinate efforts to increase transparency.
  • Congress should support federal agency efforts to increase transparency by promoting initiatives that tie cost, quality, and value together and by making access to data less burdensome.
  • Congress should leverage existing networks that promote transparency, like regional health improvement collaborative, that already have the trust and support of local stakeholders and who are already working to make care improvements.

Those of us involved in the Jefferson County Healthcare Access Group (CHA) have struggled for a few years now to increase pricing transparency at Jefferson Healthcare. We have met with resistance every step of the way. Breakthroughs in the last year have led to citizens having a somewhat better understanding of the prices they face before they get into the hospital. We fully support the efforts of the Washington Healthcare Alliance.

It is clear to those of us involved in understanding the healthcare industry on a local level, that increasing centralization, decreasing independent medical providers, penalization of individual providers by Congressional funding mandates,  and a lack of transparency are creating a system the more resembles a monopoly, costs more and does not  necessarily provide better indices of health.

Read more on this at

https://stateofreform.com/featured/2018/09/three-take-aways-from-nancy-guintos-transparency-testimony-to-the-us-senate-help-committee/