Remedial healthcare education
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Good morning and welcome to the Friday Pulse Check.
In the news:
The American Hospital Association petitions DoJ to investigate routinely denied claims
In an open letter to the Department of Justice this week, the American Hospital Association asked the federal government to investigate insurance companies who routinely deny claims. They pointed specifically to an inspector general report from a few weeks ago that discovered nearly 18% of Medicare Advantage claims were denied improperly. They are calling on the Justice Department to exercise its authority under the False Claims Act to investigate and prosecute some of these Medicare Advantage organizations. You can read the whole letter here.
Massachusetts man infected with monkeypox
Let’s get started with an interesting public health one, shall we? The New York Times reports that a man who traveled to Canada has been diagnosed with the monkeypox virus. This is a very rare disease and is the first reported in the US this year; last year Texas and Maryland each reported one case. Unusual clusters, however, have begun to pop up in other countries. The United Kingdom has identified nine monkeypox cases. One of those patients traveled to Nigeria, where that strain of the virus is commonly seen. The others were infected by community transmission; three of them live in the same household. Spain currently has twenty-three cases, Portugal has five, and Canada is investigating fifteen possible cases in Montreal.
Six hospital system deals called off this year
If you like watching the business side of healthcare, this story might interest you. Becker’s Hospital Review is reporting on six mergers and acquisitions that have been called off this year. They include systems in New England, the Pacific Northwest, and the New York area. None of them appear to me to be large extremely large systems, however, decisions like these no doubt affect the communities they serve. As a bonus article, here are six deals that have gone through.
This week on the podcast, Ron and I decided to go back to school and do some remedial work. Specifically, we went through the basics of health insurance. It is surprising to me that for an industry that has such a large sector of our economy, very few people seem to understand where the money goes.
For example, here are some claims we have heard in recent years:
“When my doctor prescribes me a pill, he gets a cut of that money.”
“The medical guidelines are bought and paid for by the drug companies.”
“I met my deductible so I shouldn’t have to pay.”
“I switched to a Medicare Advantage plan and now my doctor isn’t in my network. Someone must have messed up.”
I will fully admit that I did not know what I was investing in when I had my first job out of college. I sat down with Human Resources, and they showed me the three options that the company provided. I believe it was a PPO plan, an HMO plan, and an HSA plan. What I immediately looked at was how much it was going to cost me. The PPO plan was going to cost $120 a month, the HMO plan was going to cost $70 a month, and the HSA was going to cost $100 a month. (I want to point out that these are estimates from what I remember, and this is not a comment on my former employer.). I immediately went for the HMO plan because it wasn’t going to cost me as much. After all, I’m generally healthy and I’m most likely only going to go to the doctor once a year, so I can follow the referral restrictions and stay in-network and all that. I have a pretty good impression that I am not the only young American out there that does this.
Ron and I even discussed that this was one of the accusations thrown at HMO plans, that because they were cheaper they were drawing the healthier people away from the PPO plans and thus driving up the costs for everyone else. It was also one of the holes that needed to be plugged in the Affordable Care Act. Congress fixed that by saying if you are offered health insurance through your employer, you cannot buy ACA plans even if they might be cheaper.
So, if you have ever been confused about what deductible, out-of-pocket maximum, in-network/out-of-network, PPO, or HMO means, I suggest you take a listen to this week’s episode of the FLATLINING Podcast.
Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, and Audible.
Turning to Ukraine, the World Health Organization this week called for a formal probe into Russian bombing of health facilities in that country. CNBC reports that the global health agency has documented 226 attacks since late February. This latest figure more than doubles the one-hundred attacks verified by the WHO over a month ago.
Have a good weekend,
Matthew