500 Million Lines of Code

[Shafpocalypse Now]

So you make damn sure you go to an UC place if you can.

[Alfred_E._Neuman]

So you make damn sure you go to an UC place if you can.

UC handles all my basic illnesses and booboos. The wife got dehydrated after a race and went to the ER @ around 6pm. I told her we'd be home some time after midnight. She thought I was full of shit. 2am and a saline IV later we're home. Bill was north of $400 after copay.

Stitches at the UC for a cut from work: $20 copay and out the door in about 45 minutes.

[Turdacious]

So you make damn sure you go to an UC place if you can.

And harass your state legislature: https://www.aanp.org/legislation-regula ... ce-by-type

[Turdacious]

Rand_OutNetwork_RevenueNJ.PNG (39.88 KiB) Viewed 9567 times

Another argument for urgent care-- http://www.rand.org/pubs/research_reports/RR1809.html

[Turdacious]

We found narrow physician provider networks in 31% of all qualified silver plans offered in 2016, compared to 29% in 2014. While the average prevalence of narrow network plans has remained stable over time, there are important shifts in the plans with narrow networks. X-small networks have doubled from 6% of silver plans to 12% of silver plans. On a state level, the propensity to offer narrow networks changed considerably, with narrow networks emerging in some states that had none (IA, AR, NH) while disappearing in others in which they had been prevalent (for example, NJ, AK).

index.png (13.22 KiB) Viewed 9485 times

ldi.upenn.edu/brief/trends-physician-networks-marketplace-2016

Crazy year over year variance.

[Grandpa's Spells]

The MI GOP guy advising people to not take their kids to the ER right away when they have arm fractures is not making a winning argument.

[Turdacious]

His point is a little more nuanced:

“At some point or another we have to be responsible or have a part of the responsibility of what is going on,” Huizenga said. “Way too often, people pull out their insurance card and they say ‘I don’t know the difference or cost between an X-ray or an MRI or CT Scan.’ I might make a little different decision if I did know (what) some of those costs were and those costs came back to me.”

The father of five offered a personal example of how this shift might play out. He says his youngest son fell and injured his arm. Not sure if it was sprained or broken, he and his wife decided to wait until the next morning to take the 10-year-old to the doctor’s office, instead of going to the emergency room that night. The arm was broken.

“We took every precaution but decided to go in the next morning (because of) the cost difference,” Huizenga said. “If he had been more seriously injured, we would have taken him in. … When it (comes to) those type of things, do you keep your child home from school and take him the next morning to the doctor because of a cold or a flu, versus take him into the emergency room? If you don’t have a cost difference, you’ll make different decisions.”

http://www.patheos.com/blogs/dispatches ... roken-arm/
It's a variation of one of the arguments used to justify both Obamacare and Medicare Part D-- the cost of care keeps people from seeking it/ using prescriptions correctly (perversely raising long term costs while decreasing health outcomes). Stupid for someone in his income bracket, but realistic for someone struggling to make ends meet. Of coarse, if Huizenga isn't suggesting increasing Medicaid reimbursement rates on an ongoing basis as part of the solution, he's part of the problem.

[Turdacious]

For those of you in TX, AZ, and CO-- beware of surprise out of network charges from free standing emergency rooms: http://www.9news.com/news/investigation ... /378475561

[Turdacious]

Six years ago, federal health officials were confident they could save taxpayers hundreds of millions of dollars annually by auditing private Medicare Advantage insurance plans that allegedly overcharged the government for medical services. An initial round of audits found that Medicare had potentially overpaid five of the health plans $128 million in 2007 alone, according to confidential government documents released recently in response to a public records request and lawsuit. But officials never recovered most of that money. Under intense pressure from the health insurance industry, the Centers for Medicare and Medicaid Services quietly backed off their repayment demands and settled the audits in 2012 for just under $3.4 million — shortchanging taxpayers by up to $125 million in possible overcharges just for 2007 […]

Michael S. Adelberg, a former CMS official who is now an industry consultant in Washington, said that in retrospect the audit process was “probably rushed.” Adelberg said the audits “raised strong industry concerns” on a variety of fronts, from whether CMS had the legal authority to conduct them to the soundness of their methods […]

And the center did the same for 32 additional 2007 audits, which officials had predicted would refund up to $800 million to the federal treasury. In the end, CMS wound up with $10.3 million from the 32 plans […] The GAO, the watchdog arm of Congress, called for “fundamental improvements.” The watchdogs also found that CMS has spent about $117 million on the audits, but recouped just under $14 million.

http://khn.org/news/medicare-failed-to- ... ords-show/
AFAIK in fraud control a 10-1 recovery/fraud control expenditure ratio is considered good. A 1-8 ratio is abysmal.

[Turdacious]

Where you're most likely to face surprise medical bills:

OutOfNetwork.PNG (383.21 KiB) Viewed 9270 times

http://www.mass.gov/anf/budget-taxes-an ... tation.pdf

[johno]

The MI GOP guy advising people to not take their kids to the ER right away when they have arm fractures is not making a winning argument.

His point is a little more nuanced:

“At some point or another we have to be responsible or have a part of the responsibility of what is going on,” Huizenga said. “Way too often, people pull out their insurance card and they say ‘I don’t know the difference or cost between an X-ray or an MRI or CT Scan.’ I might make a little different decision if I did know (what) some of those costs were and those costs came back to me.”

The father of five offered a personal example of how this shift might play out. He says his youngest son fell and injured his arm. Not sure if it was sprained or broken, he and his wife decided to wait until the next morning to take the 10-year-old to the doctor’s office, instead of going to the emergency room that night. The arm was broken.

“We took every precaution but decided to go in the next morning (because of) the cost difference,” Huizenga said. “If he had been more seriously injured, we would have taken him in. … When it (comes to) those type of things, do you keep your child home from school and take him the next morning to the doctor because of a cold or a flu, versus take him into the emergency room? If you don’t have a cost difference, you’ll make different decisions.”

I've been an emergency responder for 29 years. And I guarantee you: A) most people have no idea what merits a trip to the ER and what doesn't; and B) people who have some skin in the game (and who value on their time) are much less likely to go to the ER.

Also, from the scanty description above, no harm was done by waiting til the next day to visit the MD.

I don't know the %, but ER's are often flooded with people who don't need to be there. That drives up medical costs for those who pay the bills.
My town is the most diverse (seriously) population in the US and immigrants have told me that their sponsors have instructed them to call 911 for anything medical. So emergency responders function as the Family Doc to many immigrants. And, at 2:00 AM, the EMT will most likely send a complainer in to the ER rather than risk a second call at 3:15 AM.

Solutions:
1 - Better education for the general population. And some skin in the game.
2 - ER apps that guide people to appropriate facilities. Or tell them to suck it up & stay home.
3 - Phone apps that can convey basic vital signs to screeners. Then see #2, above.
4 - Empower emergency responders to say, "No," when the patient wants to go to the ER for a finger laceration. Or a low-low speed fender bender. Or for a general bad feeling but good vital signs.

[Shafpocalypse Now]

No shit on the stand alone ERs...never a good idea

[Turdacious]

Out-of-pocket costs with high deductible health plans may discourage some poor and chronically ill patients from getting needed care, a U.S. study of diabetics suggests. Researchers examined data on about 12,000 people with diabetes who enrolled for one year in health insurance plans with annual deductibles of no more than $500, then switched for two years to plans with a deductible of at least $1,000. Overall, the switch to insurance with higher out-of-pocket costs wasn’t tied to meaningful changes in how often these diabetics got outpatient checkups or tests to monitor their disease, researchers report in JAMA Internal Medicine. But after the switch, emergency department visits for preventable diabetes complications spiked for poor patients […] In the diabetes study, annual emergency department visits rose by 8 percent overall after people switched to high-deductible plans but climbed 22 percent for poor patients.

http://www.reuters.com/article/us-healt ... healthNews

Life expectancy for the U.S. population in 2015 was 78.8 years, a decrease of 0.1 year from 2014 [...] The 10 leading causes of death in 2015 remained the same as in 2014. Age-adjusted death rates increased for eight leading causes and decreased for one.

https://www.cdc.gov/nchs/data/databriefs/db267.pdf

[Turdacious]

For the two-year budget 2017-2018, Oregon faces a $700 million deficit due to Medicaid, created by two changes in federal matching formulae: the resetting of the federal match for the 400,000 newly eligible from 100 percent to 95 percent, and a downward readjustment of the match for the rest of its Medicaid population based on improvements in Oregon’s per capita income. There is also a large unfunded liability for pension costs for Oregon’s public employees, bringing the state’s looming deficit to around $1.3 billion.
In the November 2016 election, which was otherwise a Democratic sweep in the state, Oregon voters rejected Measure 97, which would have levied a 2.5 percent gross receipts tax on all businesses with more than $25 million in sales. This tax would have raised $6 billion over two years, creating a comfortable fiscal cushion to sustain committed public spending. Governor Kate Brown has apparently taken rolling back the Medicaid coverage expansion off the table in budget talks, focusing instead on raising revenues and cutting OHP expenses. It remains to be seen how enduring this commitment will be.

http://healthaffairs.org/blog/2017/01/1 ... expansion/
Pretty much every state is facing this problem. Rising employee health care costs and pension bombs combined with the inability to raise taxes doom Medicaid programs nationwide.

[Shafpocalypse Now]

So you make damn sure you go to an UC place if you can.

And harass your state legislature: https://www.aanp.org/legislation-regula ... ce-by-type

Super interesting. Texas is extremely repressive in odd areas.

[dead man walking]

good article about the importance of primary care physicians--how they are undervalued, underpaid (relatively), and save more lives than fancy specialists.

http://www.newyorker.com/magazine/2017/ ... M5NzE3NgS2

if you don't read good, it's got cartoons to entertain you.

. . studies demonstrating that states with higher ratios of primary-care physicians have lower rates of general mortality, infant mortality, and mortality from specific conditions such as heart disease and stroke. Other studies found that people with a primary-care physician as their usual source of care had lower subsequent five-year mortality rates than others, regardless of their initial health. . . . reforms in California that provided all Medicaid recipients with primary-care physicians resulted in lower hospitalization rates. By contrast, private Medicare plans that increased co-payments for primary-care visits—and thereby reduced such visits—saw increased hospitalization rates. Further, the more complex a person’s medical needs are the greater the benefit of primary care.

[Turdacious]

What do households on food stamps buy at the grocery store? The answer was largely a mystery until now. The United States Department of Agriculture, which oversees the $74 billion food stamp program called SNAP, has published a detailed report that provides a glimpse into the shopping cart of the typical household that receives food stamps.

The findings show that the No. 1 purchases by SNAP households are soft drinks, which accounted for 5 percent of the dollars they spent on food. The category of ‘sweetened beverages,’ which includes soft drinks, fruit juices, energy drinks and sweetened teas, accounted for almost 10 percent of the dollars they spent on food. “In this sense, SNAP is a multibillion-dollar taxpayer subsidy of the soda industry,” said Marion Nestle, a professor of nutrition, food studies and public health at New York University. “It’s pretty shocking.”

https://www.nytimes.com/2017/01/13/well ... -soda.html
Another reason Obamacare failed-- the best health care advisor in the WH was Michelle Obama and nobody listened to her.

Check out Table 1 for the difference between grocery spending for SNAP and non-SNAP families.
https://www.fns.usda.gov/sites/default/ ... ummary.pdf

[dead man walking]

What do households on food stamps buy at the grocery store? The answer was largely a mystery until now. The United States Department of Agriculture, which oversees the $74 billion food stamp program called SNAP, has published a detailed report that provides a glimpse into the shopping cart of the typical household that receives food stamps.

The findings show that the No. 1 purchases by SNAP households are soft drinks, which accounted for 5 percent of the dollars they spent on food. The category of ‘sweetened beverages,’ which includes soft drinks, fruit juices, energy drinks and sweetened teas, accounted for almost 10 percent of the dollars they spent on food. “In this sense, SNAP is a multibillion-dollar taxpayer subsidy of the soda industry,” said Marion Nestle, a professor of nutrition, food studies and public health at New York University. “It’s pretty shocking.”

https://www.nytimes.com/2017/01/13/well ... -soda.html
Another reason Obamacare failed-- the best health care advisor in the WH was Michelle Obama and nobody listened to her.

Check out Table 1 for the difference between grocery spending for SNAP and non-SNAP families.
https://www.fns.usda.gov/sites/default/ ... ummary.pdf

"failure" is the wrong concept.

a shortcoming. yeah. so you fix it. you still could, couldn't you, except the r's are wed to their myths?

saw an interesting piece that argued much of the d.c. hostility to obamacare was because members of congress and staff didn't get to keep their fancy coverage ,but had to go to obamacare and get the same insurance the rest of us poor slobs have.

[Turdacious]

This aspect can be fixed in 2019 (next time the Farm Bill's up for renewal)-- nobody forced Obama to sign two of them. For Obamacare to work they had to identify the major health issues and make improvements. Morbid obesity, diabetes, and heart disease are the major solvable problems-- diet and inactivity are huge components of all of them.

Most staffers are young, and the children of middle class parents. They're generally probably still on their parents' policies. The permanent staff population is pretty small and the turnover rate among the rest is huge. Besides, the DC doctor to population ratio is the best in the nation-- narrow networks really aren't a factor here unless you're poor and black.

[dead man walking]

This aspect can be fixed in 2019.

so fix it in 2019.

it's not like congress is in a rush to solve any problem, especially when you can blame the problem on the other party.

[Turdacious]

We're from the government and we're here to help you...

Thousands of Covered California enrollees face higher-than-expected bills from their insurers because the exchange sent incorrect tax credit information to the health plans. The exchange confirmed it gave insurers wrong subsidy information for about 25,000 policy holders, resulting in inaccurate bills. Insurers are now sending out new bills correcting the errors, and in most cases that means higher premiums than consumers had initially anticipated. […] Insurers are now sending out new bills correcting the errors, and in most cases that means higher premiums than consumers had initially anticipated […] Covered California said it doesn’t know what caused the problem. […] In another mistake related to tax credits, Covered California discovered in December that about 24,000 policy holders hadn’t provided consent for the agency to verify their income, even though the agency thought they had. Without that consent, thousands of consumers lost their 2017 tax credits, at least temporarily […] Lopez said most consumers affected by the latest mistake will owe more out of pocket than they originally thought, and that health plans are entitled to bill them for the difference.

http://khn.org/news/foul-up-means-thous ... -premiums/

[TerryB]

Turd deserves an award for this thread. Consistency despite utter lack of interest. I applaud you, Turd.

[Turdacious]

Internist and public health professor at Harvard writes about his experiences with high deductible plans for family care:

Here’s my major takeaway so far from this ongoing experiment: Simply asking people to pay out of pocket for their health care doesn’t create a health care marketplace. If we are going to be serious about creating one, we have to generate much more innovation in care delivery models, including much more leeway on the scope of practice regulations, such as letting nurses do a lot of the things that only doctors can do today.

We must be much more aggressive about price transparency and make quality data ubiquitous. The way we’re doing it now, even I as a doctor and a health policy expert can’t figure out when I or my family’s needs are worth the expense. If we continue with high-deductible health plans the way they exist today, more and more people will experience what my family did — the stress of having to make medical decisions with little information and few choices. At best, we’ll have a health care system that might save a little money — but at the risk of harming the health of our citizens.

https://www.statnews.com/2017/02/06/hea ... xperiment/

[Turdacious]

The deadline for March coverage on the exchanges was January 31. Trying to get last minute answers from HHS?

CMSStuff2.PNG (70.21 KiB) Viewed 8851 times

And we're back to where we started from: http://irongarmx.net/phpBB2/viewtopic.p ... 20#p762616

[dead man walking]

turd,

having largely avoided this fog of a thread, i've got a question: have you discussed rationing care?

it is my view that there's no way we will contain health care costs unless (1) find a miracle vaccine for all cancers, (2) create high-risk pools for those with diseases resulting from unhealthy behavior--smoking, obesity, etc or (3) ration care for the old and soon-to-be dead.

(1) would result in huge savings for all. (2) would result in savings for those who behaved themselves, but as a society, we've decided shaming is not nice. (3) would result in savings for all, at the cost of geriatrics no longer getting fruitless but expensive treatment.