Citizen Cartwright

Why we should be celebrating the new transparency in medical billing

I’ve always respected the reporting of Elisabeth Rosenthal, a doctor turned New York Times journalist who now is editor in chief at Kaiser Health News.

 

She wants to be sure you know about a new Trump administration rule that she says “could be a game changer for health care.”

 

Starting this month, hospitals have to publicly reveal the contents of their master price lists — called “chargemasters” — online. These are the prices most patients never notice because their insurers negotiate them down or they're buried as line items on hospital bills. 

 

For the moment, these lists won’t seem very useful to the average patient — and they've been criticized for that reason, Rosenthal says. They're often hundreds of pages long, filled with medical codes and abbreviations.

 

"But don’t dismiss the lists as useless,” she says. "Think of them as raw material to be mined for billing transparency and patient rights. For years, these prices have been a tightly guarded industrial secret. When advocates have tried to wrest them free, hospitals have argued that they are proprietary information. And, hospitals claim, these rates are irrelevant, since — after insurers whittle them down — no one actually pays them. Of course, the argument is false.”

 

Hospitals routinely go after patients without insurance or whose insurer isn't in their network, she says.

 

Yes. One of the things that appalls me personally about the American medical industry is that the people who can’t afford health insurance are the ones who get the full-price bills when they need medical care. But pushing back can make a huge difference.

 

A neighbor of mine got a hospital bill for $100,000. The neighbor appealed to the hospital to reduce the price. The hospital called and basically said, “How about $50,000?”

 

But why does being sick involve the sickness-inducing stress of having to hustle the medical industry?

 

"Just as airlines have been shown to exaggerate flight times so they can boast about on-time arrivals, hospitals set prices crazy high so they can tout their generous discounts (while insurers tout their negotiating prowess),” says Rosenthal.

"Another rationale for those prices is just plain greed,” she says. 

 

Dr. Warren Browner, the chief executive of California Pacific Medical Center, describes this as the “Saudi sheikh problem”: “You don’t really want to change your charges if you have a Saudi sheikh come in with a suitcase full of cash who’s going to pay full charges,” he says.

 

Although making chargemaster pricing public won't, by itself, reform our high-priced medical system, it's an important first step, Rosenthal says.

 

While the lists are far from user-friendly, researchers and entrepreneurs now can create apps to make it easier for patients to match procedures to their codes and crunch the numbers. With access to list prices on your phone, you could reject the $300 sling in the emergency room and instead order one for a tenth of the price on Amazon. You could see in advance the $399 rate your hospital charges for each allergen it applies in a skin test and avoid the $48,000 allergy test that comes with an $8,000 deductible.

 

As a next step, regulators should insist that these prices be easily accessible on hospitals’ home pages — maybe in the place of “pay your bill now” — and in plain English, says Rosenthal. Seema Verma, head of the Centers for Medicare & Medicaid Services, has suggested that she may pursue this.

You can help, too, says Rosenthal. "Check out your hospital’s price list. If it’s not detailed or complete enough, demand more. For discrete items, like an MRI of the brain or a vitamin D blood test, take the trouble to scan the chargemaster for the item. Reject an overpriced procedure (even if your insurer is paying the bulk of the bill) and take your business elsewhere.”

 

Here is some guidance on negotiating to lower your medical bills.

 

From Consumer Reports.

 

From Medical Billing Advocates of America.

 

From Cancer ABCs.

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Intelligence agencies see very different threats than the president

Directly contradicting President Trump, U.S. intelligence agencies told the Senate Intelligence Committee on Tuesday that North Korea is unlikely to dismantle its nuclear arsenal, the Islamic State group remains a threat and the Iran nuclear deal is working. 

 

Top security officials including FBI Director Christopher Wray, CIA Director Gina Haspel and Director of National Intelligence Dan Coats made no mention of a crisis at the U.S.-Mexican border for which Trump has considered declaring a national emergency.

 

The Senate hearing coincided with the Tuesday release of the intelligence community's “Worldwide Threat Assessment” that’s provided annually to Congress. The report also stressed a growing cyberthreat from Russia and China, countries it called “more aligned than at any point since the mid-1950s.”

 

Much of the hearing focused on the cyberthreats from Russia and particularly from China, which the written report said is now positioned to conduct effective cyberattacks against U.S. infrastructure. It specifically cited China's ability to cut off natural gas pipelines.

Lawmakers discussed the challenges that new technologies being developed by China, Russia and others pose.

“We’re now living in yet another new age, a time characterized by hybrid warfare, weaponized disinformation, all occurring within the context of a world producing more data than mankind has ever seen,” said Sen. Richard Burr, R-N.C., the committee’s chairman.

Foreign enemies “want to see the United States weakened, if not destroyed,” Burr said. “They want to see us abandon our friends and our allies. They want to see us lessen our global presence. They want to see us squabble and divide. But their tools are different.”

 

The written report found that Russia’s ability to conduct cyberespionage and influence campaigns remains similar to its efforts in the 2016 American presidential election. But the bigger concern is that “Moscow is now staging cyberattack assets to allow it to disrupt or damage U.S. civilian and military infrastructure during a crisis,” it said.

The report specifically noted Russia’s planting of malware in the U.S. electricity grid. Russia already has the ability to bring the grid down “for at least a few hours,” the report said. And Russia is “mapping our critical infrastructure with the long-term goal of being able to cause substantial damage.”

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U.S. drops out of group of 20 least-corrupt countries in annual survey

The watchdog group Transparency International has released on Tuesday its Corruption Perceptions Index for 2018.

 

The CPI uses 13 surveys and expert assessments to measure public sector corruption in 180 countries and territories, giving each of them a score from zero, meaning highly corrupt, to 100, meaning "very clean."

 

The United States scores 71, down four points from last year, putting it out of the top 20 countries for the first time since 2011.

 

"The low score comes at a time when the U.S. is experiencing threats to its system of checks and balances as well as an erosion of ethical norms at the highest levels of power," says a Transparency International press release.

 

Denmark and New Zealand are the top scorers, with 88 and 87 points, respectively. Somalia, South Sudan and Syria are at the bottom of the index, scoring 10, 13 and 13 points, respectively. 

 

The highest-scoring region is Western Europe and the European Union, with an average of 66. The lowest scoring regions are Sub-Saharan Africa, with an average score of 32, and Eastern Europe and Central Asia, with an average score of 35.

 

"To make real progress against corruption and strengthen democracy around the world," Transparency International is calling on all governments to:

— strengthen the institutions responsible for maintaining checks and balances over political power — and ensure that they’re able to operate without intimidation

 

— close the "implementation gap" between anti-corruption legislation and practice and enforcement

 

— support civil society organizations that enhance political engagement and public oversight over government spending, especially at the local level

 

— support free and independent media and ensure the safety of journalists and their ability to work without intimidation or harassment.

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Hospitals asking for donations from their patients

Many nonprofit hospitals across the country conduct nightly wealth screenings — using software to go through public data such as property records, contributions to political campaigns and other charities — to determine which patients are most likely to be the source of large donations, says a Kaiser Health News article that ran over the weekend in The New York Times.

 

People who seem to be promising targets for fundraising may get a visit from a hospital executive in their rooms, as well as extra amenities like a bathrobe or a nicer waiting area for their families, says KHN.

And some hospitals train doctors and nurses to identify patients who have expressed gratitude for their care — and then put the patients in touch with staff fundraisers, KHN says.

 

A 2016 survey of 108 hospitals found that 68 of them had grateful patient programs, according to the Advisory Board, a consulting firm.

 

Big hospitals that say they screen patients’ wealth include those run by MedStar Health in Columbia, Md.; the Johns Hopkins Hospital in Baltimore; Cedars-Sinai in Los Angeles; and NYU Langone Medical Center in New York.

 

Mark Rothstein, a bioethics professor at the University of Louisville, says, “Getting physicians involved in philanthropy is something fraught with danger.” He says it could make patients worry that their care might be affected by whether they make a donation.

 

Many doctors are uneasy about being asked to help raise money from their patients, according to studies.

“It makes doctors very uncomfortable for a lot of reasons — No. 1 is that the doctor is there to see the patient for a problem they have and not to ask the patient for money,” says Dr. Rosalyn Stewart, an internist at Johns Hopkins who has researched physician attitudes at Hopkins toward the practice.

She says she worries that if a wealthy patient makes a large donation, doctors would feel obligated to treat them differently, perhaps by returning their calls more quickly.

 

“I feel like the risk is we are setting up a two-tiered health care system — one for wealthy patients and one for everyone else,” Stewart says.

 

A change in federal health privacy law in 2013 made it easier for hospitals to target their patients for donations, says KHN. It enabled hospital records departments to share with staff fundraisers some personal details of patients, including their health insurance status, the department treating them, the name of their doctor and the results of their care.

When patients are admitted to the hospital, they typically sign a stack of papers that include permission for the hospital to use this information for fundraising. While the 2013 law requires hospitals to inform patients that they can decline to be solicited by fundraisers, few patients are aware of this, says Deven McGraw, a former deputy director of health information privacy at the federal Department of Health and Human Services. And, she says, few patients appear to realize that their wealth may be assessed for fundraising.

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Big brands to test a milkman model of packaging to combat plastic pollution

Coca Cola, Nestlé, Unilever, Procter & Gamble, United Parcel Service and others are partnering with the recycling firm TerraCycle in an e-commerce service called Loop that was announced at the World Economic Forum in Davos on Thursday.

 

Products such as orange juice, shampoo and laundry detergent will be delivered in reusable glass and metal containers to shoppers’ doorsteps, and the empties will be retrieved for cleaning and reuse.

 

For example, Procter & Gamble will sell Pantene shampoo in an aluminum bottle, Tide laundry detergent in a stainless-steel container and an Oral B toothbrush with a durable handle and a replaceable head.

 

Nestlé has spent a year creating a reusable container for its Haagen-Dazs ice cream. 

 

“When creating more sustainable packaging, we also wanted to prioritize the consumer experience,” says Tommy See Tho, packaging manager at the Nestlé Product Technology Center for Ice Cream. “For example, when opened, the package is designed so ice cream melts more quickly at the top to provide the perfect texture for enjoyment. The container is double-walled which keeps the ice cream cold but also makes the outside of the canister pleasant to hold. The metal lid is easy to open — it juts out so there’s a higher surface area to hold and twist. And, we rounded the corners of the container to make it easy to scoop and enjoy.”

 

Unilever estimates that a refillable steel container for its Axe and Dove stick deodorants will last eight years — long enough to prevent the disposal of as many as 100 traditional deodorant packages.

 

Loop’s unveiling comes just months after China’s decision to stop collecting and processing plastic waste escalated alarm over environmental damage to the oceans, says Reuters.

 

And government bans on products like single-use plastic water bottles, shopping bags and polystyrene cups have sent retailers and consumer goods companies searching for solutions, Reuters says.

 

The service launches in May in Paris and in the New York-New Jersey-Pennsylvania area. A British program is scheduled for later in 2019, with Toronto, Tokyo and California projects next year.

 

Users will order products online and pay fully refundable deposits for the reusable packaging. They can wipe out shipping fees of $15-$20 by including about seven items in their order, says Tom Szaky, chief executive of TerraCycle.

 

Refillable containers once dominated industries such as beer and soft drinks but lost out to convenient, affordable single-use containers, says The Wall Street Journal. 

 

In 1947, refillable containers made up 100 percent of soft-drink containers by volume and 86 percent of beer containers, according to the nonprofit Container Recycling Institute. By 1998, those numbers had dropped to 0.4 percent and 3.3 percent respectively.

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