A report in HealthAffairs says that California’s Hospital Fair Pricing Act, enacted in 2006, was meant to shield uninsured people from paying the full, undiscounted prices as determined by each hospital’s chargemaster’s decision. The author found that from 2004 to 2012 ”the net price actually paid by uninsured patients shrank from 6 percent higher than Medicare prices to 68 percent lower than Medicare prices.” The author deems the law a big success.
He looks at four initiatives:
• The team approach.
• Patient engagement positions.
• Group appointments.
• Telehealth technologies.
But the little hospitals are under much stress from, as he notes, longevity, industry consolidations, advances in medical technology and dramatic changes in payments for services.
And the trend of “inadequate Medicaid and Medicare reimbursements will continue. Almost every time the hospitals make cost reductions to meet lower reimbursement rates, the rates get lower again.”
Thus Waterbury Hospital, St. Mary’s Hospital, in Waterbury, Bristol Hospital, Manchester Memorial Hospital and Rockville General Hospital, all nonprofits, are imperiled.
Meanwhile, political, ideological and regulatory pressures have repelled such out-of-state for-profit hospital chains as Tenet that could save some or all of these little hospitals if they’d buy them.
But human trials are probably two to three years away and it could be five years before the drug is commercially available, reported FierceHealthcare.
She notes that in a 2014 survey of U.S. physicians by Deloitte that 80 percent oppose a change in reimbursement, including economic incentives, “although many acknowledge that the current system does not offer {adequate?} value to those it serves.”
”These survey results support the theory that if physicians are to actively focus on the key objectives of value-based care (quality/outcomes and cost/price), then processes of care and systems need to be aligned with appropriate care provider teams, organizational structures to facilitate communication and coordination, and data to support analysis and process change from both a clinical and financial perspective.”
Note that even when such records are required by the Feds, these companies make it difficult to track this spending.
As they note: “Many boards and executive teams have pursued an affiliation and undertaken the exhaustive due diligence process requisite in a merger, only to find that ‘softer’ issues — cultural alignment, board members’ compatibility and preferred business styles, physician willingness to combine clinically, or a lack of shared vision for the future — cause their newfound partnership to collapse. ”
Here are some of the specific challenges they address:
”Blending governing boards.
”Joining the clinical engines.
”Developing a shared vision.”
Sigmund Freud, M.D., died of oral cancer caused by cigar smoking.
