Medstar Washington Offers Transparency Example for Hospitals

Dr. Steven Goldstein discussed the spirit of the law that requires hospitals to make their pricing known to the public on his February 5, 2021 podcast, Medstar Washington Offers Transparency Example for Hospitals. You can listen to that podcast by clicking here: Hospital Price Transparency Podcast.

In late 2020, the Department of Health and Human Services issued the final rules on price transparency for healthcare providers. Prior to the release of these new rules, health insurance companies, and healthcare providers like hospitals negotiated prices for all the things they do for patients and did not make any of this information public.

According to Dr. Goldstein what the spirit of these new rules intended and what is happening in practice are not quite the same. As of January 1, 2021, hospitals are required to make prices, those payer-negotiated rates for their services, available online in a readable format.

The big idea here was to make all of those different rates, payer specific rates all more available and more transparent to patients. Sounds easy enough. But, according to the healthcare industry, procedures and services are often not as cut and dried as placing a price tag on a service and charging your insurance.

According to them, some procedures can affect patients differently, causing them to have different levels of care and other needs that all have different prices. Many healthcare providers also cannot say upfront what exactly the price will be, because doctors do not know the extent of the services until they begin offering care.

But there is one shining example of what looks like full compliance. MedStar in Washington posted its prices in an Excel sheet on its website. It is presented in a way that people can see the charges for various procedures from different insurance companies. It looks like what the spirit of these new rules really intended and an example for others to follow.

Some hospital networks haven’t published their price lists yet because they claim they need more clarification from the federal government on how best to translate complex insurance contracts into straightforward prices for consumers.

They also say they are concerned that a lack of standardization in how hospitals approach job of making prices public will make it impossible for people to accurately compare prices between different systems.

Some hospital networks haven’t published their price lists yet because they claim they need more clarification from the federal government on how best to translate complex insurance contracts into straightforward prices for consumers.

They also say they are concerned that a lack of standardization in how hospitals approach job of making prices public will make it impossible for people to accurately compare prices between different systems and honor the law the way that the podcast describes, Medstar Washington Offers Transparency Example for Hospitals.

All that said, Medstar Washington made a credible attempt to comply with the letter and spirit of the law. Hopefully others will follow this example.

Healthcare: mRNA vaccine could become a new, effective treatment for MS

The Pfizer and Moderna vaccines against the Covid-19 virus use an mRNA technique to guard human beings against the disease. The technique “teaches” human cells to make a protein that triggers an immune response, hence antibodies that attack the virus. Now, according to The Week, BioNTech has developed a treatment using the same approach that appears to stop multiple sclerosis in mice. If the same treatment can be made to work in humans, it could be a game-changer in treating the debilitating disease.

Healthcare: mRNA vaccine could become a new, effective treatment for MS

MS causes the immune system to attack the myelin, a protective sheath that covers nerves and spinal cords. Depending on how the disease progresses, patients can lose the ability to walk, speak, see, or perform other functions. No cure exists for MS, but current treatments can stave off the disease’s progression and help recovery from attacks. However, these treatments can compromise the immune system, placing patients at risk for infections.

The mRNA treatment for MS has been shown to stop the symptoms of the disease in mice and prevented further deterioration of the test subjects. Mice that were given a placebo exhibited typical symptoms of MS.

According to Healthline, roughly one million people in the United States and two and a half million worldwide are living with MS. The progression of the disease cannot be well predicted. It often makes itself apparent, then goes into remission, only to manifest later. Twice as many women as men suffer from MS. Scientists do not well understand what causes the disease.

If a treatment such as has been developed by BIONTech can be brought into a clinical setting, people suffering from MS may be able to live far more normal lives than before. It may not be a “cure” in the sense that it is one and done. Further research needs to happen to determine how long a treatment can stop MS. But anything that can treat the disease without side effects will be a boon to humankind.

For more information contact us,

Hospital Price Transparency & The Creative Ways Hospitals Find To Avoid Posting Their Prices For The Public

Lacking transparency
Lacking transparency for hospitals and healthcare.

Some of the most creative writing in business lately are the ‘reasons’ why hospitals and other healthcare providers are not able to post their prices, as the law requires. Respected Houston based neurologist and founder of the Houston Healthcare Initiative, Dr. Steven Goldstein, understands the letter and intent of the new rules on price transparency for healthcare providers and hospitals. Specifically, all the new rules that call for these medical suppliers to essentially post their price list. What the spirit of these new rules intended and what is happening in practice are not quite the same. To hear all of his insights tune to the Houston Healthcare Initiative podcast on SoundCloud, Apple Podcasts, Radio.Com,LibSyn, Spotify, Podcast Addict, iHeartRadio, Stitcher, Backtracks, Podbay, Podbean, and other places where podcasts are syndicated.

Claiming They Do Not Know

The big idea here was to make all of the prices, different rates, payer specific costs charged by insurance companies all more available and more transparent to patients. Sounds easy enough. But, according to the healthcare industry, procedures and services are often not as cut and dried as placing a price tag on a service and charging your insurance. According to them, some procedures can affect patients differently, causing them to have different levels of care and other needs that all have different prices.

Many healthcare providers also cannot say upfront what exactly the price will be, because doctors do not know the extent of the services until they begin offering care. “Hospitals do not want to be pinned down on prices other than to say, ‘it depends’ which is not much of an explanation,” Dr. Goldstein told his audience. “Some hospitals only posted price estimates, uploaded files in difficult to use formats, or promised to release information only after someone enters their insurance information. In New York City, a published investigation found only a handful of hospitals in that city complying while the rest were less than upfront.”

More Reasons To Not Comply

There are other reasons cited for non-compliance. Like the American Hospital Association claim that staff who would help with compliance are stretched thin because of the Covid-19 pandemic. “But the bottom line is that price competition only works if those involved are really competing, Dr. Goldstein said. “Without price disclosure, competition remains very elusive.”

Price Transparency Background

As of January 1, 2021, hospitals are required to make prices, those payer-negotiated rates for their services, available online in a readable format. In late 2020, the Department of Health and Human Services issued the final rules on price transparency for healthcare providers. Prior to the release of these new rules, health insurance companies, and healthcare providers like hospitals negotiated prices for all the things they do for patients and did not make any of this information public. What this arrangement meant was that patients did not know what they would pay for treatment, tests, surgery, drugs and everything else until after they were treated and received the bill. “There is a lot of potential benefit for the American public when or if these rules are fully adopted and made more available for the public,” Dr. Goldstein said.

About The Houston Healthcare Initiative

The Houston Healthcare Initiative (HHI) is a member owned, non-profit medical co-op. Led by Houston based neurologist Dr. Steven Goldstein, the HHI will replace traditional health insurance for qualified individuals and families and provide incentives for members to adopt healthier lifestyle habits. HHI will provide affordable medical coverage through a combination of negotiated rates, low monthly payments, personal accountability and lifestyle incentives. The medical co-op promises to save qualifying individuals and families money on health insurance. At the same time, HHI will help uphold quality care by asking members to bear some responsibility and individual accountability for maintaining their personal health.

 

Hospital Price Transparency Podcast

Hospital Price Transparency Podcast

How Some Hospitals Are Balking At These New Rules And One That Is Not

This week respected Houston based neurologist Dr. Steven Goldstein will discuss the price’s patients are charged by doctors and hospitals. Specifically, on the new rules about healthcare price transparency. Specifically, on the new rules about healthcare and price transparency. What needed to change on disclosing prices and is anything different as a result? Of course, there are ways that the hospitals are playing around with the information. But there is one shining example of what looks like full compliance.

Electronic Medical Record (EMR)

The EMR has several advantages over the paper charts that it replaced. It is legible, cannot be misplaced and it eliminated paper prescriptions and paper orders. However, the current iterations have several disadvantages. 

Electronic Medical Record (EMR)

  1. The information density is very low in that a physician trying to understand the clinical course of the patient finds it difficult to access the relevant facts. It is laced with legal documents, consent forms, appointment verifications and other administrative information.
  2. The physician has become a data entry clerk. In addition to doctoring the patient he/she has to doctor the chart. It contributes to physician burnout and raises the cost of medical care.
  3. The information quality is poor in that physicians are poor data entry clerks and much of the physician’s notes are copied and pasted to save time and are thus inaccurate.
  4. As each provider be it doctor, hospital or imaging center has its own EMR, the patient’s medical record is scattered about. A physician trying to care for the patient almost never has full information. Much time and effort is necessary to acquire information from the various sources. This also increases the cost of care.
  5. The EMR is expensive with monthly fees paid by providers.
  6. The patient has no access to his records.                  

Why is this? It surely is not a technical problem. We can understand the problems better when we realize that the main purpose of the EMR is to facilitate billing. The rule is “If you did not document it, you didn’t do it.” and thus you will not be paid. We need an EMR that is patient centered and not connected to billing at all. Such an EMR will not work with the current insurance system. 

An employee owned healthcare cooperative can correct most of the problems of the current EMR. If the cooperative maintained the EMR, all patient records would be in one place. The various providers could access and add to the EMR with no cost to the provider. Patients could have access. The information could be arranged with ease of access by providers the primary goal. With modern technology, the office visit could be recorded including the Chief complaint (reason for the visit) and the history. The physician could orally record the pertinent positive and negative physical findings and the conclusions. The recorded discussion with the patient about further testing and procedures would complete the visit. A data entry clerk working for the cooperative can then enter the diagnoses on a diagnosis list and record new medications on a medication list; Vital signs can be entered by the doctor’s office as well as by patients. Sections for lab and imaging would be maintained by clerks. No longer would doctors be adding data; they would be free to spend more time with patients. The copy and paste repetition of data would not clog the record. Administrative data would not be part of the EMR and could be stored independently by each provider.

 

 

Healthcare is Necessary for Wellbeing and Contentment

Healthcare: What is it?

Healthcare is simply taking care of a person’s health. The complexity of healthcare comes from the individual as a whole. Healthcare differs from one person to another. Some may require more attention and some, not as much. Everyone who is concerned about their body from the physical, to the mental and emotional aspects of well-being, tend to stay on top of what it means to them, to take care of themselves. Healthcare differs in regions as well. Depending on where a person is located, good healthcare may not be accessible. Getting good healthcare is trivial sometimes when it comes to preexisting conditions as well as onset of health issues that are unexpected. Sometimes it may be difficult to choose the best route of insurance if you do not do your research. It is necessary to check the resources that are available so that you can receive the best healthcare possible.

Healthcare is Necessary for Wellbeing and Contentment

Regular Doctor Visits

Being healthy begins with getting regular check-ups, and following the advice from your healthcare professional. Doctors, specialists, and others in the medical field, usually do their best to give the most beneficial support to their patients. If you are in need of a good physician, there are many reviews online and sometimes, through word-of-mouth, you can find what you are looking for in a doctor. Sometimes people are not so keen on going to the doctors out of fear of what may be brought to their attention. It is understandable to take the approach of “I’d rather not know.” If you want to have a better chance at living a life of clarity in terms of your health and possibly, an even longer life, it is best to know if there are any health issues present that need addressed.

Take Control Now

In most states, you can locate healthcare for your physical, mental, and biological wellness. For the physical aspect of your healthcare, it is necessary to have a personal care physician and you are entitled to choose one that best fits your needs. For the mental health care for an individual, for problems such as depression, anxiety, etc., a mental health clinician can be located in your county or city’s directory. You can also search on Google for a list of reviews for the clinicians that you find. Getting physical exams, tending to your mental health and getting blood work conducted are great ways to stay on top of your health care and engage in a life of good health and well-being. When you take responsibility for your own health, you take less chances of having negative health outcomes in your future.

Contact us today for more information.

How Haven Failed at Repairing America’s Healthcare System

How Haven Failed at Repairing America’s Healthcare System. The reason that healthcare and associated costs for medical treatment are so high is the way pricing is established, managed care. Making healthcare more affordable and accessible was what Haven was supposed to do.  Its failure to address how prices are kept artificially high via managed care was among its biggest failures.

The lessons available from this epic ‘bellyflop’ are the subject of the latest Houston Healthcare Initiative podcast, hosted by respected Houston based neurologist Dr. Steven Goldstein. The Houston Healthcare Initiative podcast can be heard on: SoundCloud, Radio.com, Spotify, ListenNotes, iHeartRadio, Podcast Addict, Stitcher, BackTracks,PlayerFM, and the Houston Healthcare Initiative web site.

Resource Rich but Still A Bust

Haven was a joint venture between Amazon, Berkshire Hathaway and JPMorgan-Chase. Its purpose was to use the leverage of its tens of thousands of employees and its expertise in technology to improve the healthcare system.

Managed Care Keeps Prices High

Haven Failed to Fix Healthcare
How Haven Failed at Repairing America’s Healthcare System. Haven was a $100 million bellyflop of a failure, as represented here.

Haven worked at the edges of what really made medicine expensive and avoided the fundamental challenge of the managed care model. “We need a system that enables hospital systems to profit from the improved health of the population rather than the amount of ‘sick care’ delivered,” Dr. Goldstein told his podcast audience. “Innovative ideas need to focus first on improving health. The only way for this to happen is for hospital systems to profit from this outcome.”

How?

One example of how to accomplish this, is for hospitals to offer Medicare pricing to patients without insurance at Medicare rates. In return for the discounted prices, patients would pay the hospital a monthly fee. They would also pay a monthly fee into a savings account in order to pay the hospital bill. In this scenario, the hospital would collect the monthly fee even if no patients were admitted to hospital. If patients were kept well, the need for hospitalizations would decrease. “In this environment, the innovative ideas of Haven would have found a much warmer reception,” Dr. Goldstein said.

No Reason for Change or New Ideas

Haven also failed to understand why the medical business was not interested in new, innovative ways to provide and charge for medicine. The reasons were simple. Insurance companies and providers make lots of money from the current way of doing things,” Dr. Goldstein said. “There are few enticements for them to change and why should they when money is pouring in and there is no pressure to do things differently.”

Thanks, But No

Would the ‘industry’ be open to creative ideas and problem solving when it comes to pricing, service delivery or an emphasis on making the public healthy and not just treating illness? “Probably not,” Dr. Goldstein reported. “The current system of managed care frowns on innovation. It controls innovation by only paying for services that have codes. It likes to use words like usual and customary. Medicine lags behind the tech world by approximately 25 years. So no, in a change averse industry I would not look for any creative approaches to take place except over long periods of time.”

About Dr. Steven Goldstein and the Houston Healthcare Initiative

The Houston Healthcare Initiative (HHI) was founded by respected, Houston neurologist Dr. Steven Goldstein. Like many Americans, Dr. Goldstein is concerned about the state of the U.S healthcare system and the sorry state of the public’s health. The Houston Healthcare Initiative web site is an aggregator of news, healthcare pricing information, and resources for those who want to help drive reform for the healthcare industry. HHI’s emphasis for reform is on free market innovation and personal responsibility.

The goal of the Houston Healthcare Initiative is to be a catalyst for change in the way Americans receive and pay for medical treatment. To cause change the site aggregates information, tools, and targets for the reform of the healthcare industry with an emphasis on free market innovation and personal responsibility.

Why Haven Failed To Fix Healthcare

Forever Closed
Haven is closed forever. Why it went so wrong is the subject of Dr. Goldstein’s podcast.

A healthcare company blessed with lots of money, high tech abilities and really smart people will close up the end of January. Of course, this was Haven, the joint venture between Amazon, Berkshire Hathaway and JPMorgan-Chase. Its purpose was to use the leverage of its tens of thousands of employees and its expertise in technology to improve the healthcare system. What lessons can we learn from its failure to accomplish its mission. Here to help reset the focus of reforming healthcare is respected Houston neurologist, Dr. Steven Goldstein.

With Haven in the rearview mirror… Failures to Reform U.S. Healthcare System Are Because the System Is the Problem

Haven Failure
In spite of the high tech ability and deep pockets of the joint venture partners, Haven went out of business on January 31, 2021.

Big fail. Haven, a joint venture between Amazon, JPMorgan-Chase, and Berkshire Hathaway, booted the chance to reform their collective employee health insurance, in part, by not working on the correct challenge, according to respected neurologist Dr. Steven Goldstein.  Dr. Goldstein hosts the Houston Healthcare Initiative podcast with a focus on reforming the highest priced healthcare system in the world. Haven is the most recent, but likely not the last, story of corporate good intentions not delivering what was hoped. So, what’s the right challenge?

The System Is the Problem

“Our current healthcare system is focused on treating sick people, not preventing illness,” Dr. Goldstein told his audience, and he gave an example. “The more people there are in hospital beds, the more money is made by the hospitals, doctors and everyone else involved in patient care.” The U.S. healthcare industry is a volume-based scheme of reimbursement for getting paid. Better patient health is not part of the current equation.

More of the Same

The business system Haven tried to disrupt offers no tie to healthier outcomes for patients or incentives for those same people to take better care of themselves. “It’s just more of the same,” Dr. Goldstein said. “Haven failed at reforming their collective employee health insurance in part by not working on the correct challenge but instead ‘worked on the fringes’ of a non-competitive business.”

Worthy Goal but Poor Execution

At Haven, the published goal was improving healthcare services and lower costs for the three companies’ employees. With a heavy reliance on ‘big data’ and the ability to analyze patient information in big amounts, Haven promised to make primary care easier to access, prescription drugs more affordable and render insurance benefits easier to understand. While essentially getting nowhere but costing a lot of money to get there, Haven shut down without affecting the healthcare industry at all.

Healthcare as a Commodity?

The best way to ensure an adequate supply of anything at the lowest possible price is to permit the laws of supply and demand to work. “But as we also know, that is not what we have and not the way costs are assigned or managed by insurance companies, hospitals and pharmaceutical companies that assign prices,” Dr. Goldstein said.

Employee & Patient Voices Heard for a Change?

The public has little to say about how pricing is determined but could have a great deal to say with the right type of organization. The correct method available to everyone is via the non-profit, employee-owned healthcare cooperative.

The cooperative or ‘co-op’, can replace traditional health insurance for qualified individuals and families. Co-ops can also provide incentives for members to adopt healthier lifestyle habits. Financial incentives based on lifestyle would result in lower healthcare costs by decreasing utilization. Ownership of the cooperative would pass the savings from the cooperative to the employees. Co-ops can allow employees to remain members even if they leave the company. By transferring ownership of the cooperative to the employees, companies are no longer responsible for healthcare and can concentrate on their core business.

How Co-ops Work

Co-ops provide affordable medical coverage through a combination of negotiated rates, low monthly payments, personal accountability and lifestyle incentives. “By organizing their workers and families, businesses of any size can overcome this less than efficient way of doing things,” Dr. Goldstein said. “For example, financial incentives based on choices about diet and exercise will result in lower healthcare costs by decreasing utilization. The ownership of the cooperative will pass the savings from the cooperative to the employees. But there are other benefits that will make those employees healthier.”

About the Houston Healthcare Initiative

The Houston Healthcare Initiative podcast with Dr. Steven Goldstein is an information vehicle for people who want to know all medical options for themselves and are interested in reforming the healthcare industry. To learn more about the Houston Healthcare Initiative please visit www.houstonhealthcareinitiative.org.

Fixing Healthcare Pricing by Using New Healthcare Models

Many models are being put forth to reduce the cost of healthcare in the United States right now. Two of these models include the reference-based pricing healthcare system and the value-based pricing healthcare system. Let’s briefly discuss each of these models.

Fixing Healthcare Pricing by Using New Healthcare Models

Reference-Based Pricing Healthcare

In a reference-based pricing healthcare system, insurers define a reference price for medical procedures and allow their members to choose a healthcare provider that offers that service under that reference price. The price of a procedure is often determined by some percentage, usually around 120 percent to 300 percent, of what Medicare would pay. An increase of 20% – 200% may seem like a lot, but it’s important to consider the fact that Medicare typically reimburses hospitals at a much lower rate than other insurers do. This can sometimes be as low as ¼ the amount other insurers must pay.

When this model is implemented, prices tend to fall as hospitals in the area compete to maintain or gain market share. However, it is important to note that this system will have little to no effect on the cost when the patient doesn’t have the luxury of shopping for the best price. This includes emergency medical attention, locations that have little or no competition between hospitals, and areas where hospitals are not transparent about their pricing.

Value-Based Pricing Healthcare

Under the value-based pricing healthcare system, healthcare providers are paid for the quality of the care they provide rather than the number of services they provide. This system would emphasize the organization of a medical facility and its ability to maximize the value it provides its patients. Value-based pricing would also make the innovation of new technologies at lower costs a must as healthcare providers would ensure that patients received the most efficient therapies available.

For this system to work, a significant amount of work on the infrastructure of the healthcare system needs to be done to monitor both the outcomes of treatment and what factors caused those outcomes. A physician or drug manufacturer should not be held responsible for the outcome of treatment if the patient decides not to take their treatment as prescribed. Unfortunately, without the requisite infrastructure to ensure that treatment is being administered properly, determining their pay based solely on the outcome of treatment can do just that.

There are many more models that could potentially reduce the cost of healthcare being proposed and tested today. Keep yourself updated on the future of healthcare by continuing to read our content, and feel free to contact us if you have any questions.