BLOG Medicine

For an Operator, Please Press...

We've all experienced it -- calling customer service only to be put on never-ending hold, or, worse, having to listen to the numerous prompts, pressing all the appropriate keys only to be disconnected.

Paul English, founder of Gethuman.com, figured out a better way.  He and his core group of supporters tracked down and have published the shortcuts that cut out the computerized telephone middle-man and get you to a human operator.

English's site allows you to jump to specific categories (e.g., Insurance) as well as sort individually through the more than 500 companies to find both toll-free telephone numbers and the shortcuts that get you off hold and connected to a live person.  The site also has a link if you prefer a printer-friendly format rather than electronic version of the information.

In a corporate world dominated by impersonal, unhelpful, computerized interactive voice response, English's site is much-needed relief for an all-too-human frustration.■

Uninsured Americans, By the Numbers

A recently revised U.S. Census Bureau report states that some 45 million Americans, or about 15% of the population, were without health insurance in 2005, while health care spending hit $2 trillion, more than any other industrialized nation.  Texas had the highest percentage of uninsured, followed by New Mexico, Florida, Oklahoma, and California.

At face value, the numbers can appear frightening; however, lacking context, the numbers lose their meaning.  Reporting of such statistics, without context or requisite analysis, is unnecessarily provocative.  All such reports should be read with a discerning eye, include a review of the original data, and adhere to acceptable standards of critical thinking.  Such important societal issues must not be allowed to be reported with the same shoddy tabloid journalism as a pop princess rehab stint.■

Is Total Compensation For Managed Care Executives Out of Control?

In a word -- yes.

On 10 May 2007, PRNewsire reported that publically traded managed care companies increased 2006 compensation to top executives while decreasing reliance on stock-option grants.

CIGNA Corp. CEO H. Edward Hanway received the highest incentive cash pay of any publically traded managed care company executive in 2006, receiving $11.2 million in cash incentives, a $1.1 million salary and a grant of 64,000 stock options (estimated by the company to be worth $2.8 million).  In 2005, Hanway received a bonus of $3 million, a salary of $1.1 million and 136,000 stock options.  (As of 11 May 2007, individual shares of publically-traded CIGNA stock were valued at approximately $160.)

Aetna Inc. CEO Ron Williams received $7.7 million in bonus payments in 2006, $1.1 million in salary, and a grant of 605,000 stock options.  In 2005, he was paid $1.7 million bonus, $1 million in salary, and 744,000 stock options.  (As of 11 May 2007, individual shares of publically-traded Aetna stock were valued at approximately $50.)

According to the National Coalition on Health Care, employer health insurance premiums increased 7.7 percent - two times the rate of inflation - in 2006.  Since 2000, empoyment-based health insurance premiums have increased 87 percent, compared to cumulative inflation of 18 percent and cumulative wage growth of 20 percent during the same period.■

U.S. Hospitals Cost Uninsured More

Uninsured patients on average are billed 2 1/2 times more than what the insured are billed through health plans according to a recent study authored by Gerard F. Anderson, director of the center for hospital finance and management at Johns Hopkins University's school of public health.  The study, appearing in the May/June 2007 issue of the journal Health Affairs, has been condemned by the American Hospital Association (AHA), which represents the nation's 5,000 or so hospitals, as out-of-date and methodologically flawed.

Anderson has been throwing around condemnations of his own, stating that "hospitals shouldn't be charging three times Medicare rates, especially from poor people who are uninsured," according to the 8 May 2007 Los Angeles Times.  In California, a law that has only recently gone into effect requires hospitals to offer discounts to uninsured patients who earn as much as 350% of the federal poverty income level, about $70,000 for a family of four.

In 2006, the AHA outlined voluntary guidelines (that include an allowance for discounts to uninsured patients) intended to strengthen a hospital's relationship with its community and to reassure patients, regardless of their ability to pay, of hospitals' commitment to caring.  More than 4,290 hospitals, nationwide, have confirmed their commitment to the AHA's Hospital Billing and Collection Practices: Statement of Principles and Guidelines.

A healthcare researcher such as Anderson knows the relationship (and difference) between, a hospital's cost of care, chargemaster, negotiated price, billed amount, charge amount, and reimbursement.  Anderson's erroneous assertion that hospitals are charging patients different amounts based on ability to pay is both reckless and unnecessarily provocative -- questionable patient advocate and evidently shoddy scholar, Anderson's approach is way off target and helps no one, except perhaps himself.■

New Orleans Health Care System's Slow Road to Recovery

This week, two separate media outlets followed up on the story of the New Orleans Health System's slow recovery.

PBS Online NewsHour provides a transcript of the two-part Jim Lehrer NewsHour interview with local healthcare authorities, while NBC's Nightly News reported on the hospitals and health clinics struggling to meet the demand for medical care more than a year and a half after Hurrican Katrina.

Nineteen months after the hurricane, 6 of 11 hospitals remain closed and fewer than one-third of the healthcare professionals have returned to the area.  Patients can wait up to 8 hours to see a physician and up to two days for a hospital bed.

Louisiana is set to receive a $15 million federal grant to provide up to $110,000 in incentive payments to primary care physicians and other health care professionals to move to New Orleans or surrounding areas.

HHS Secretary Mike Leavitt has said that no additional federal funding will be made available, but state and federal authorities are exploring alternative arrangements for caring for the uninsured.  According to a Department of Health and Human Services report conducted by LSU's Public Policy Lab, the total number of uninsured residents in the state as of fall 2006 was 657,027.  Of those without insurance, 446,645 earned below 200 percent of the Federal Poverty Level.■

Louisiana Health System - Code Blue

Prior to Hurrican Katrina, the Louisiana Health System, depended on by one in three state residents, was in serious condition; post-Katrina, the situation is critical.

The United Health Foundation, in its annual 2006 America's Health Rankings, ranks Louisiana as worst in the nation, down from 49th in 2005.  Louisiana has ranked in the bottom two states since 1990.  Louisiana was already challenged by a high prevalence of obesity, high infant mortality rate, high premature death rate, high percentage of children in poverty, an uninsured population increase of 9 percent over the last year, and low quality of care.  Now it must also contend with the shutdown, due to Hurrican Katrina's floods, of the many facilities that cared for New Orleans's poor and uninsured.

Charity Hospital, the huge downtown facility, sitas abandoned and the recently patched up neighboring hospital is usually packed to capacity.  Public hospitals from Baton Rouge to Shreveport are still full of evacuees and cases sent to them after Katrina and Hurrican Rita and there continues to be a shortage of nurses, specialists, and other health care workers.

Politicians and health experts are considering a number of recommendations to remedy the situation including improving primary and preventive care using technology to track a person's medical history and to create "medical homes," community clinics, health centers and other neighborhood facilities, to coordinate care for those who depend on the state for services.  The "medical homes" would refer patients to specialists, supply disease management, and provide a consistent system for tracking care.

That and other ideas will be considered by lawmakers this spring, but many of the financing changes proposed will need approval from federal health officials, and a strong governor to help shepherd those requests through the bureaucratic maze before they can begin.  The Louisiana health care system is on life support and BLOG Medicine will continue to closely watch and report on its progress.■

Patients Negotiate for Health Care

Facilitated by the number of such companies and the ease with which they can accessed, patients are increasingly taking advantage of web-based personal claims adjusters who review doctor and hospital bills and will negotiate on patients' behalf to get a better price.

The Centers for Medicare and Medicaid Services expects health care spending in the United States to more than double to over $4 trillion a year, a fifth of the gross domestic product, over the next decade and overall out-of-pocket expenses for consumers are expected to rise more than 5 percent every year.

Currently, more than 12 percent of working-age adults have out-of-pocket medical costs greater than 5 percent of their annual household income, according to the Center for Studying Health System Change, a Washington research group.  As a result, patients are becoming more comfortable discussing price during their doctor visit and, although pricing is increasingly available to consumers, it's the out-of-pocket expense they're really interested in.

With out-of-pocket expenses for hospital patients expected to increase 9.1 percent in 2007, alone, expect to see use of this type of web-based service increase.■