Perry Como sang “There’s no place like home for the holiday”….except for Republican Senators with their TrumpCare albatross

Since the American people overwhelming disapprove of the Trump/ Senate health care bill, why do Republicans remained determined to Repeal and Replace?

The facts are…
“Just 17 percent of those surveyed say they approve of the Senate’s health care plan, the Better Care Reconciliation Act. Fifty-five percent say they disapprove, while about a quarter said they hadn’t heard enough about the proposal to have an opinion on it…..
While Democratic opposition to the bill, as expected, is high, GOP support for the Senate GOP’s plan is very soft. Twenty-one percent of Republicans oppose the bill and just 35 percent support it. Sixty-eight percent of independents also oppose the proposed legislation.
In fact, while many Americans want changes to the ACA, also known as Obamacare, they want it to be more far-reaching. A 46 percent plurality say they want to see the ACA do more, while just 7 percent want it to do less. Keeping the ACA and having it do less is essentially what GOP congressional plans are doing.” (A)

Maybe here’s why….
“The budget office said the measure would leave 22 million more Americans without insurance by 2026. Hit hardest would be lower-income people between the ages of 50 and 64 and people struggling with chronic illness or battling addiction — many of the same voters who believed President Trump’s promises to improve their health care. The bill would cut $772 billion over the next decade from Medicaid, which covers most of America’s poor children and nursing home patients, to help finance tax cuts for the wealthy.” (B)

Doesn’t Senator McConnell care about Kentuckians? (Senator Paul too)
“Perhaps nowhere has health care law had as powerful an impact as in Kentucky, where nearly one in three people now receive coverage through Medicaid, expanded under the legislation. Perhaps no region in Kentucky has benefited as much as Appalachia, the impoverished eastern part of the state, where in some counties more than 60 percent of people are covered by Medicaid.
And in few places are the political complexities of health care more glaring than in this poor state with crushing medical needs, substantially alleviated by the Affordable Care Act, but where Republican opposition to the law remains almost an article of faith. While some Senate moderates say the Republican bill is too harsh, Rand Paul, Kentucky’s other Republican senator, is among Senate Republicans who say they are opposed to the current bill for a different reason: They believe it does not go far enough to reduce costs.” (C)

It is important to remember…
“Historically, insurance has been deeply intertwined with employment for many Americans. Most employed, non-elderly people in the U.S. get their health insurance through their employer. This means people often lose health insurance when they lose their jobs, making it nearly impossible to access care. The Affordable Care Act (ACA) – commonly known as Obamacare – sought to address this by creating premium tax credits so people could purchase insurance based on their income and expanded Medicaid to cover all low income adults. This was meant to help provide access to the health care system during periods of unemployment. Now, despite their promises to help the unemployed, the White House and Congress have begun the process of repealing the ACA, restructuring Medicaid, and reducing benefits.” (D)

One Republican legislative solution..
“The first step for McConnell and other Republican leaders is to get everybody in a room and figure out what it would take to get various factions on board. Moderates like Sen. Dean Heller of Nevada have argued that the cuts to Medicaid are too severe; perhaps McConnell can add enough Medicaid money to get Heller on board. Conservatives like Sen. Mike Lee of Utah wanted to see more flexibility for states to waive coverage requirements; perhaps there is a way to write this flexibility into the bill.” (E)

A better way….
“A once-quiet effort by governors to block the full repeal of the Affordable Care Act reached its climax in Washington on Tuesday, as state executives from both parties — who have conspired privately for months — mounted an all-out attack on the Senate’s embattled health care legislation hours before Republicans postponed a vote.
At the center of the effort has been a pair of low-key moderates: Gov. John R. Kasich, Republican of Ohio, and Gov. John W. Hickenlooper, Democrat of Colorado, who on Tuesday morning called on the Senate to reject the Republican bill and to negotiate a bipartisan alternative.”…
“Now that Senate Republicans have balked, aides to several of the governors said they hoped lawmakers in both parties would craft a different measure focused principally on stabilizing insurance markets. It is unclear whether the Senate might consider that approach.” (F)

Maybe that’s a start! Then move on piece by piece until ObamaTrumpCare is stabilized and sustainable.

In 2015 candidate Trump said:
“Save Medicare, Medicaid and Social Security without cuts. Have to do it,” he said then. “Get rid of the fraud. Get rid of the waste and abuse, but save it. People have been paying it for years. And now many of these candidates want to cut it….”

 

(A) Just 17 Percent Of Americans Approve Of Republican Senate Health Care Bill, by Jessica Taylor, http://www.npr.org/2017/06/28/534612954/just-17-percent-of-americans-approve-of-republican-senate-health-care-bill
(B) The Health Care Hoax Has Been Exposed, Senator McConnell, https://www.nytimes.com/2017/06/27/opinion/health-care-mcconnell-trumpcare-cbo.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
(C) In McConnell’s Own State, Fear and Confusion Over Health Care Bill, by Sheryl Gay Stolbergjune, https://www.nytimes.com/2017/06/28/us/mcconnell-kentucky-health-care-bill.html
(D) Unemployment and Addiction: How Health Insurance Could Increase the Number of Working People, by Lindsey Vuolo, https://www.centeronaddiction.org/the-buzz-blog/unemployment-and-addiction-how-health-insurance-could-increase-number-working-people?gclid=Cj0KEQjwp83KBRC2kev0tZzExLkBEiQAYxYXOnlspN_Ruz4KnTgKTc7T8WE9qAHxLZJE7NEJtdq2EAUaAq9_8P8HAQ
(E) What’s next on health care now that the Senate has punted?, by Paul Singer, https://www.usatoday.com/story/news/politics/2017/06/27/whats-next-health-care-now-senate-has-punted/433058001/
(F) How Governors From Both Parties Plotted to Derail the Senate Health Bill, by Alexander Burns, https://www.nytimes.com/2017/06/27/us/politics/affordable-care-act-governors.html

Is there more “heart” in the Senate health care bill? Or is it “meaner” than the House bill?

Let’s recall that President Trump called the House “Repeal and Replace” bill “mean” after having celebrated its passage by bussing House Republicans to the Rose Garden. And then we were promised a Senate bill “… that’s going to be a phenomenal bill to the people of our country: generous, kind, with heart. That’s what I’m saying.”” (A)

so here are some articles to help you decide–

“The Affordable Care Act gave health insurance to millions of Americans by shifting resources from the wealthy to the poor and by moving oversight from states to the federal government. The Senate bill introduced Thursday pushes back forcefully on both dimensions.
The bill is aligned with long-held Republican values, advancing states’ rights and paring back growing entitlement programs, while freeing individuals from requirements that they have insurance and emphasizing personal responsibility. Obamacare raised taxes on high earners and the health care industry, and essentially redistributed that income — in the form of health insurance or insurance subsidies — to many of the groups that have fared poorly over the last few decades.
The draft Senate bill, called the Better Care Reconciliation Act, would jettison those taxes while reducing federal funding for the care of low-income Americans. The bill’s largest benefits go to the wealthiest Americans, who have the most comfortable health care arrangements, and its biggest losses fall to poorer Americans who rely on government support. The bill preserves many of the structures of Obamacare, but rejects several of its central goals.” (B)

now, to dig deeper…

START WITH THIS CHART
CHART: Who Wins, Who Loses With Senate Health Care Bill
http://www.npr.org/sections/health-shots/2017/06/22/533942041/who-wins-who-loses-with-senate-health-care-bill

THEN LOOK AT THESE ANALYSES
Who gets hurt and who gets helped by the Senate health care bill
http://money.cnn.com/2017/06/23/news/economy/senate-health-care-hurt-helped/index.html

The Senate health care bill: What’s in it and what to watch for in the CBO report
http://www.politifact.com/truth-o-meter/article/2017/jun/22/senate-health-care-bill-whats-it/

AND NEXT
The Congressional Budget Office has not yet issued its analysis of how this bill would affect the federal deficit and the number of Americans who have health coverage. That “score” is expected to be released next week. It’s also not clear yet whether the Senate parliamentarian will give all of the bill’s provisions her go-ahead.
http://www.slate.com/blogs/the_slatest/2017/06/22/live_blog_the_senate_republican_health_care_bill_is_revealed.html

 

(A) http://thehill.com/policy/healthcare/337651-trump-calls-house-healthcare-bill-mean

(B)  https://www.nytimes.com/2017/06/22/upshot/shifting-dollars-from-poor-to-rich-is-a-key-part-of-the-senate-health-bill.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

REVISE and RECALIBRATE Obamacare. Prevent Republican’s “mean” plan.

It is obvious that Repeal and Replace shouldn’t and won’t happen.

After bussing republican House members to the White House Rose Garden several weeks ago to celebrate House passage of the American Health Care Act, President Trump now “… bluntly derided a House attempt to repeal the Affordable Care Act as “mean,” “ and said “that he expected the Senate to come up with something more generous…” (A)

President Trump tweeted “”2 million more people just dropped out of ObamaCare,” “It is in a death spiral. Obstructionist Democrats gave up, have no answer = resist!” (B)

We know that the Obama administration planned to look at the following changes: Expand The Medicaid Expansion; Simplify Health Insurance Plans; Fix Surprise Medical Bills; Extend Coverage For Kids; Buff Up The Cadillac Tax; Improve Insurance Provider Networks; Rein In Prescription Drug Costs (C)
Any big new program like Obamacare has a “million” moving parts and some assumptions in the initial algorithms need to be recalibrated. Fortunately there has been plenty of evaluation and recommendations to do a mid-course correction to maintain access and address affordability.

Here is a list of approaches that must be considered:

Some initial corrections: (D)
1. Patch things up: Since affordability is a big issue, the federal government could spend more money to bring down the costs that individuals and families face. This could be done directly by raising the level of subsidies available for plans purchased on the exchanges, or raising the income thresholds at which the subsidies phase out—or both. Alternatively, the government could offer more generous subsidies to insurance companies, particularly those serving high-risk populations, in which case they wouldn’t have to raise prices as much, or impose such large deductibles.
2. Apply some force: One of the big problems that insurers are facing is that too few healthy people, and too many sick people, are signing up for the plans sold through the exchanges. For insurers, that changes everything. Faced with higher claims per enrollee than they expected, they seek to raise their prices, which makes healthy people, especially young healthy people, even less likely to sign up the following year. If unchecked, this process could lead to a spiral of rising prices and falling enrollment.
3. An obvious way to address this problem would be to drastically raise the fines that people face if they don’t purchase insurance. Under the terms of the Affordable Care Act, getting enrolled wasn’t meant to be a choice—it was a legal obligation. For political reasons, however, the penalty for flouting this “individual mandate” was set at a very low initial level, which is supposed to grow gradually. In 2015, the fines started at three hundred and twenty-five dollars per adult
4. Generally speaking, private insurance markets only work well when there is a large and diversified risk pool. If we are going to rely on them to provide universal, or near-universal coverage, the individual mandate will have to be enforced. That means raising the penalties for non-compliance and enforcing them effectively.
5. The Public Option: The rising cost of health care is an issue all over the world. The way most countries have dealt with it is by enrolling the entire population, or almost all of it, in a single-payer system, and using the bargaining leverage that creates (usually coupled with administrative fiat) to keep down costs. So far, the American political system, which is highly vulnerable to capture by powerful interest groups, such as doctors, hospitals, and pharmaceutical companies, has resisted going down this route. But this may be changing.

Stabilize the marketplace: (E)
6. “Marketplaces will only succeed if enough insurers participate, and many are running away from what they perceive as a high-risk, low-reward market opportunity,” …..All of this — insurer withdrawals and sharply escalating premiums — was avoidable and is fixable. We know how to draw insurers into markets, keep them there, and limit premium growth. We can do so by subsidizing plans more and by limiting their risk of loss. We’ve done both before.”
7. The Medicare Modernization Act also established Medicare’s prescription drug program, Part D, which offers another lesson. It’s also run entirely through private plans. They’re cushioned against large losses by a risk corridor program. This helps plans stay in the market if they miscalculated the mix of patients they’d attract, and it allows them to keep premiums lower than they might need to if they had to hedge against the full brunt of potential losses.
8. The Affordable Care Act included a risk corridor program for marketplace plans, too, but it expires at the end of this year. So does a reinsurance program that compensates insurers for unusually high-cost enrollees. Following the model of Part D and making the risk corridor program permanent, as well as the reinsurance program, could help stabilize the marketplaces.

Policy fixes that could plausibly improve Obamacare and attract bipartisan support. (F)
9. Defuse the Crisis. The leading enemy of stability is uncertainty, and for insurers who must decide what to do about the exchanges by June, the leading source of uncertainty before last Friday was the Republican repeal push itself. That threat has apparently subsided, but the House lawsuit over cost-sharing subsidies could still blow up the exchanges. The House put the suit on hold after Trump’s election, anticipating Obamacare’s repeal, but if the Republicans want to avoid a major mess, they need to make the suit go away and make sure the subsidies keep flowing.
10. Insure the Insurers: The Democratic push for health reform in 2010 relied on what The Washington Post described as “the near-daily demonization of the insurance industry.” Obama routinely attacked “insurance company bureaucrats who raise premiums and deny care.” Pelosi called them “villains.” And Obamacare included tough new rules that prohibited them from discriminating against customers with pre-existing conditions or capping how much they could spend on any customer.
11. Relax the Rules: The best evidence so far that the Trump administration hopes to prevent the kind of implosion the president keeps predicting is a new set of rules his Department of Health and Human Services recently proposed for the exchanges. The rules involve fairly modest adjustments for the 2018 enrollment, giving insurers more flexibility to offer slightly more generous plans while closing loopholes the insurers thought consumers were using to game the system. But they amount to an insurer wish list, which suggests a desire to keep insurers happy on the exchanges.
12. A Drug Deal: Obamacare has helped reduce the overall growth of health care costs to the lowest rate in half a century, but prescription drug prices have continued to soar. The cost of six brand-name diabetes medications rose more than 150 percent over the past six years. Multiple sclerosis drugs now cost more than $5,000 a month, increasing more than fivefold since 2001. Connolly says the nonprofit plans she represents now spend more on drugs than hospitalization. “That’s mind-boggling,” she says. “There’s no rhyme or reason to it, and it’s driving up premiums.”

Changes that would help bring down premiums on the exchanges. (G)
13. Require all insurers who want to sell in the individual insurance market to offer their plans through the exchange, so they couldn’t cherry-pick individuals outside the exchange (this is an idea championed by Henry Aaron of the Brookings Institution).
14. Reduce the waiting period for those on disability insurance to get Medicare coverage from two years to six months to move some of the very high-cost enrollees out of the individual-market pool.
15. Require any insurer that wants to offer a Medicare Advantage plan in an area also to offer a plan in the marketplace for under-65 enrollees.
16. Have the federal exchange adopt the procedures used by California in actively bargaining with plans instead of acting as a passive clearinghouses.
17. Create a public option for those aged 55-64 clearly identified as an early buy-in to Medicare.Create a second federally run public option for enrollees from 18 to 54.
18. Restore the risk corridor and reinsurance provisions that have expired that were intended to protect exchange plans against adverse selection.

A good summary – (H)
“First, despite some genuine problems, the Affordable Care Act is mostly working quite well.
Second, far from solving the problems of Obamacare, the Republicans’ AHCA would have made them worse.
Third, real leaders don’t run away from problems; they fix them. Fourth and most important, a compromise plan could have appealed to — and could still appeal to — enough members of both parties to pass.”

 

 

(A) Trump, in Zigzag, Calls House Republicans’ Health Bill ‘Mean’, by Thomas Kaplan, et al, https://www.nytimes.com/2017/06/13/us/politics/trump-in-zigzag-calls-house-republicans-health-bill-mean.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
(B) Trump: Dems ‘gave up’ on fixing ObamaCare, by Rebecca Savransky, https://www.nytimes.com/2016/11/15/upshot/politics-aside-we-know-how-to-fix-obamacare.html?_r=0
(C) How Obama Would Fix Obamacare If Congress Would Let Him, by Jeffrey Young http://www.huffingtonpost.com/entry/how-obama-would-fix-obamacare_us_56bcd8d6e4b0c3c550506e19
(D) Three Ways to Fix Obamacare, by John Cassidy, http://www.newyorker.com/news/john-cassidy/three-ways-to-fix-obamacare
(E) Politics Aside, We Know How to Fix Obamacare, Austin Frakt, https://www.nytimes.com/2016/11/15/upshot/politics-aside-we-know-how-to-fix-obamacare.html?_r=0
(F) Four Things Trump Could Do Right Now To Fix Obamacare, by Michael Grunwald, http://www.politico.com/magazine/story/2017/03/four-things-trump-could-do-right-now-to-fix-obamacare-214962
(G) Obamacare has some problems. Here’s how we can fix them, by Paul Waldman, https://www.washingtonpost.com/blogs/plum-line/wp/2016/10/25/obamacare-has-some-problems-heres-how-we-can-fix-them/?utm_term=.4f04717a4c90
(H) Want to fix Obamacare? Here’s how by Henry Aaron, http://www.nydailynews.com/opinion/fix-obamacare-article-1.3013226

 

 

Study Findings: Five percent of pregnant women with a confirmed Zika infection.. went on to have a baby with a related birth defect

DOCTOR tracked ZIKA last year and proposed the designation of REGIONAL EMERGING VIRUSES REFERRAL CENTERS.
It seems that when it was an isolated mainland event in south Florida, public concern disappeared and public health authorities breathed a sigh of relief.
Even though we now know that more ZIKA outbreaks are likely and that the consequences for some babies will be catastrophic, authorities apparently are leaving every hospital to plan on its own.
Here’s one reason centralized planning is a necessity and Referral Centers need to be designated.

The New York Times story, by Catherine Saint Louis, noted:(A)
“Women who do not have any symptoms of Zika virus still may give birth to a baby with Zika-related birth defects, research has shown. The only way to catch those infections is to screen women because they may have been exposed to Zika-infected mosquitoes or may have had sexual contact with an infected partner.
In this new report, “The presence or absence of symptoms was not predictive of whether a baby would be damaged,” … “There were women who had asymptomatic Zika whose babies were damaged.”
Currently, only about 60 percent of babies born alive in United States territories had results of Zika laboratory testing reported to pregnancy and infant registries. It’s important that all babies who may have been affected are monitored, as early intervention can help.
For instance, some babies who appear normal at birth later develop an unusually shrunken head. Only with long-term tracking can health officials get an accurate estimate of the scope of the problem.”

Previous ZIKA related DOCTOR posts:
ZIKA UPDATE #1. EBOLA is back in Africa. Is ZIKA next? Are we prepared? (B)
All pregnant women with Zika diagnosed at community hospitals must be referred to academic medical centers for prenatal care! (C)

Former hospital prez says: Designate local Zika centers now. “Medical experts do not know if, or where, or how much, or on what trajectory the Zika virus may spread across the United States.” (D)

(A) https://www.nytimes.com/2017/06/08/health/zika-birth-defects-cdc.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
(B) https://doctordidyouwashyourhands.com/2017/05/ebola-is-back-in-africa-is-zika-next-are-we-prepared/
(C) https://doctordidyouwashyourhands.com/2016/09/all-pregnant-women-with-zika-diagnosed-at-community-hospitals-must-be-referred-to-academic-medical-centers-for-prenatal-care/
(D) https://doctordidyouwashyourhands.com/2016/06/former-hospital-prez-says-designate-local-zika-centers-now-medical-experts-do-not-know-if-or-where-or-how-much-or-on-what-trajectory-the-zika-virus-may-spread-across-the-united-states/

Hard to believe a congressman said NOBODY DIES BECAUSE THEY DON’T HAVE ACCESS TO HEALTH CARE

…according to Iowa Republican Congressman Raúl R. Labrador. *

But New York Democratic Congressman Sean Patrick Maloney got it right when he said “Any member of congress who voted for the bill should be obligated to join a high risk pool.” ** 

HIGH RISK HEALTH INSURANCE POOLS in Trump/ Ryan Care carve out individuals with pre-existing conditions but does not guarantee them access to affordable health care.

This is under-the-radar but that’s why we need to be vigilant. So here’s a nerdy HIGH RISK 101.

The House Trump/ Ryan Care bill… would allow states to apply for waivers for certain ObamaCare provisions, such as a ban on insurers charging premiums based on a customer’s health and the requirement that insurers’ basic health plans cover certain services, like prescription drugs and mental health. 

How do we know this was a dodge?

An under-the-radar GOP amendment would have exempted members of Congress and their staffs to ensure that they will still be protected by those ObamaCare provisions. It was deleted after it was discovered. (A) When Congress tries to exempt itself, we know its shenanigans!

High-risk pools are private, self-funded health insurance plans organized by state to serve high-risk individuals who meet enrollment criteria and do not have access to group insurance. (B)

“High-risk pools are a key concept that helped House Republicans pass their replacement for the Affordable Care Act. That bill, the American Health Care Act…allows states to opt out of the requirement for insurers to cover people with preexisting conditions and set up high-risk pools for these people instead. A late amendment to the bill added $8 billion* in additional funding over five years for these potential pools, and that change garnered enough new Republican votes for AHCA to pass the House.” (C)

 “In a nutshell, high-risk pools: are prohibitively expensive to administer, are prohibitively expensive for consumers to purchase, and offer much less than optimal coverage, often with annual and lifetime limits, coverage gaps, and very high premiums and deductibles.” (D)

There have been state high-risk pools for 35 years, prior to the ACA. A recent Kaiser Health Foundation report on the state programs noted: “These high-risk pools likely covered just a fraction of the number of people with pre-existing conditions who lacked insurance, due in part to design features that limited enrollment. State pools typically excluded coverage of services associated with pre-existing conditions for a period of time and charged premiums substantially in excess of what a typical person would pay in the non-group market.” (E)

“…unless high risk pools are adequately subsidized, high premium costs will mean all high need consumers will not be able to afford coverage. State policymakers will need to address those implications as more consumers may face personal bankruptcies and unmet needs, and as states witness an increase in the number of uninsured and more demand for uncompensated care.” (F)

“The history of high-risk pools demonstrates that Americans with pre-existing conditions will be stuck in second-class health care coverage — if they are able to obtain coverage at all.” (G)

WHAT OTHER DAMAGE TO ACCESS IS BURIED IN THE BILL THAT HOUSE MEMBERS DIDN’T READ BEFORE THEY VOTED FOR IT?  

 

 * https://www.washingtonpost.com/news/powerpost/wp/2017/05/06/nobody-dies-because-they-dont-have-access-to-health-care-gop-lawmaker-says-he-got-booed/?utm_term=.93a5e7087576

 ** WAMC public radio

 

(A)   House GOP health bill changes exempt members of Congress by Peter Sullivan, The Hill, http://thehill.com/policy/healthcare/330592-house-gop-health-bill-changes-exempt-members-of-congress

(B)    CONSUMER GUIDE TO HIGH-RISK HEALTH INSURANCE POOLS, NAHU,  http://www.nahu.org/consumer/hrpguide.cfm

(C)   Sounds Like A Good Idea? High-Risk Pools, by Julie Rovner and Francis Ying, KHN, http://khn.org/news/sounds-like-a-good-idea-high-risk-pools/

(D)   Why High Risk Pools (Still) Won’t Work, by  Jean P. Hall, Commonwealth Fund, http://www.commonwealthfund.org/publications/blog/2015/feb/why-high-risk-pools-still-will-not-work

(E)    High-Risk Pools For Uninsurable Individuals, by Karen Pollitz,   http://kff.org/health-reform/issue-brief/high-risk-pools-for-uninsurable-individuals/

(F)    High Risk Pools Deja Vu – Lessons from States, Questions for Policymakers, by Trish Riley and Anita Cardwell, NASHP,  http://www.nashp.org/high-risk-pools-deja-vu-lessons-from-states-questions-for-policymakers/

(G)  High-risk pools won’t match Obamacare’s protections for pre-existing conditions by Tami Luhby, CNN, http://money.cnn.com/2017/05/03/news/economy/high-risk-pools-obamacare-pre-existing

 

 

 

write in AS LONG AS THE PROVIDERS ARE IN MY NETWORK…before you sign any hospital admission documents accepting financial responsibility for your care

 “No Surprise Charges” is one of the key Lessons Learned in Elisabeth Rosenthal’s fabulous new book AN AMERICAN SICKNESS (Penguin Press, 2017). “Hospitals in your network should also be required to guarantee that all doctors who treat you are in your insurance network.”

We have all harshly experienced or heard about under-the counter out-of-network hospital charges:

(A)   “A Kaiser Family Foundation survey finds that among insured, non-elderly adults struggling with medical bill problems, charges from out-of-network providers were a contributing factor about one-third of the time.  Further, nearly 7 in 10 of individuals with unaffordable out-of-network medical bills did not know the health care provider was not in their plan’s network at the time they received care.”

(B)   A new study that looked at more than 2 million emergency department visits found that more than 1 in 5 patients who went to ERs within their health-insurance networks ended up being treated by an “out-of-network” doctor — and thus exposed to additional charges not covered by their insurance plan.”

Here is a brief case study:

“When Janet Wolfe was admitted to the hospital near Macon, Georgia, a few years ago, her lungs were functioning at just one-fifth their normal capacity. The problem: graft-versus-host disease, a complication from a stem cell transplant she received to treat lymphoma. Over the course of three days she saw three different doctors. Unbeknownst to Janet and her husband, Andrew, however, none of them was in her health plan’s network of providers. That led the insurer to pay a smaller fraction of those doctors’ bills, leaving the couple with some hefty charges.” (C)

So what can you do to avoid out-of-network charges? (D)

– Speak with a practice representative before being seen to understand the costs of seeing your doctor on an out-of-network or a cash basis. (DOCTOR note: maybe you need to leave and go to an in-network physician instead)

– If you need additional services, such as surgery, imaging or physical therapy, ask your doctor to refer you to an in-network facility to keep your costs down.

A New York law is a great start toward transparency to reduce out-of-network surprises.

Under a recent New York law, Hold Harmless Protections for Insured Patients, “… patients are generally protected from owing more than their in-network copayment, coinsurance or deductible on bills they receive for out-of-network emergency services or on surprise bills.

A bill is considered a surprise if consumers receive services without their knowledge from an out-of-network doctor at an in-network hospital or ambulatory surgical center, among other things. In addition, if consumers are referred to out-of-network providers but don’t sign a written consent form saying they understand the services will be out of network and may result in higher out-of-pocket costs, it’s considered a surprise bill. (E)

 

(A)   Surprise Medical Bills by Karen Pollitz, kkf.org, http://kff.org/private-insurance/issue-brief/surprise-medical-bills/

(B)   Many get hit with surprise ‘out-of-network’ bill after emergency rooms: Study” by Dan Mangan, CNBC, http://www.cnbc.com/2016/11/16/many-get-hit-with-surprise-out-of-network-bill-after-emergency-rooms-study.html

(C)   When Out-Of-Network Charges Pop Up, Try An Appeal, by Michelle Andrews, NPR, http://www.npr.org/sections/health-shots/2011/06/21/137304710/when-out-of-network-charges-pop-up-try-an-appeal

(D)   What It Means If Your Doctor is Out of Network, by Sergio Viroslav, Angie’s list, https://www.angieslist.com/articles/what-it-means-if-your-doctor-out-network.htm

(E)    N.Y. Law Offers Model For Helping Consumers Avoid Surprise Out-Of-Network Charges by Michelle Andrews, KHN  http://khn.org/news/n-y-law-offers-model-for-helping-consumers-avoid-surprise-out-of-network-charges/ 

 

EBOLA is back in Africa. Is ZIKA next? Are we prepared?

Lesson Learned from recent EBOLA and ZIKA episodes. We need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).

1. There should not be an automatic default to just designating Ebola Centers as REVRCs although there is likely to be significant overlap.

2. REVRCs should be academic medical centers with respected, comprehensive infectious disease diagnostic/ treatment and research capabilities, and rigorous infection control programs. They should also offer robust, comprehensive perinatology, neonatology, and pediatric neurology services, with the most sophisticated imaging capabilities (and emerging viruses “reading” expertise).

3. National leadership in clinical trials.

4. A track record of successful, large scale clinical Rapid Response.

5. Organizational wherewithal to address intensive resource absorption.

REVRC protocols will be templates for are other mosquito borne diseases lurking on the horizon, such as Chikungunya, MERS, and Dengue.

Fast forward to this weekend:  “There have been 17 suspected cases and two confirmed cases of Ebola in Congo’s Bas-Uele province,…. Of the 19, three deaths have been reported. …. health officials were trying to located 125 people believed to be linked to the cases.” (A)

What are we waiting for? DESIGNATE REVRCs NOW!

 

(A)   EBOLA RETURNS: WHAT YOU NEED TO KNOW ABOUT THE OUTBREAK IN CONGO, by BY CONOR GAFFEY, Newsweek, http://www.newsweek.com/democratic-republic-congo-ebola-609143

 

Background posts:

EMERGENCY ROOMS are not all created equal!   https://doctordidyouwashyourhands.com/2016/04/emergency-rooms-are-not-all-created-equal/

We don’t know what we don’t know”  https://doctordidyouwashyourhands.com/2016/04/we-dont-know-what-we-dont-know-about-zika-1-the-challenge-to-emergency-preparedness/

Former hospital prez says: Designate local Zika centers now.   https://doctordidyouwashyourhands.com/2016/06/former-hospital-prez-says-designate-local-zika-centers-now-medical-experts-do-not-know-if-or-where-or-how-much-or-on-what-trajectory-the-zika-virus-may-spread-across-the-united-states/

 “I got Zika. The US health care system had no idea what to do with me…”  https://doctordidyouwashyourhands.com/2016/08/i-got-zika-the-us-health-care-system-had-no-idea-what-to-do-with-me/

 “With little known about Zika virus, hospitals scramble to stay ahead.”  https://doctordidyouwashyourhands.com/2016/08/with-little-known-about-zika-virus-hospitals-scramble-to-stay-ahead/

Hospitals are developing their own Zika preparedness models. Compare the Central Florida and Johns Hopkins approaches! Which template makes more sense?    https://doctordidyouwashyourhands.com/2016/09/hospitals-are-developing-their-own-zika-preparedness-models-compare-the-central-florida-and-johns-hopkins-approaches-which-template-makes-more-sense/