Healthcare: The high cost you’ll never see

The United States has taken an important step in reducing the cost of health care by mandating price transparency. Unfortunately, people are not incentivized to care about the actual cost of health care under the current system of insurance and care plans. This lack of incentive is one of the major reasons why the cost of health care has risen to its current height. People are allowed to focus solely on the price of their deductible, copay, and out-of-pocket maximum for their insurance instead of the actual cost of care. However, focusing on these things doesn’t change the price of their care or the fact that someone needs to pay it in full. Let’s discuss the effect this has on people who require care.

Healthcare: The high cost you'll never see

There are typically two types of people who use the health care system, those who avoid the system until they need it, and those who rely on it regularly. Both types of people are relatively insensitive to the actual cost of their health care.

Those who avoid it until they need it usually have very little experience with the health care system, and typically only rely on it for emergencies. They may have little knowledge of how it works and what everything costs, but prices are of little concern to most people in an emergency. These people focus on insurance premiums, deductibles, and their copay rather than the actual price of the emergency care they’ll receive, and they rarely will (or can) shop around for the best price.

Those who rely on the health care system regularly are people who need care for extended periods of time or have chronic illnesses. These people have much more experience with the health care system but are still relatively insensitive to the actual price of their care. This is because instead of focusing on the price of care, they only have to focus on their deductibles and the out-of-pocket maximum of their insurance plan. After paying the out-of-pocket maximum, their care is paid for entirely by their insurance for a period of time.

In both cases, the health care system doesn’t incentivize people to care about what the actual cost of care will be. Price transparency can be very helpful for people (mostly those who fall somewhere between the two types of people described above), but it can only go so far in helping the problem. Creating coordinated health systems that stop the fragmentation of care for chronically ill patients can drastically reduce the actual cost of care for each patient. In addition to this, proper preventative care can reduce the overall cost of care for those who avoid the health care system.

Houston Healthcare Initiative (HHI) is an organization of physicians and other medical professionals that is actively trying to fix this problem by increasing coordination, being transparent about our pricing, and much more. Contact HHI today for more information.

Did The Covid-19 Pandemic Cost You Your Job and Health Insurance?

In a time when so many lost their jobs because of the Covid-19 Pandemic….

Job & Health Insurance Loss Come and Go Together; How To Find Affordable Coverage

March 2, 2021 — In December 2020, 66% of Americans who answered a survey said they fear they won’t be able to afford health care this year. Of the 41% of respondents who are very or moderately concerned about health-care costs, 53% are parents with children. The amount of people who were and remain unemployed because of the Covid-19 pandemic remains high. Since most individuals get their health insurance with their jobs, those same folks are also in need of medical coverage.

On his regular podcast, Houston based neurologist and founder of the Houston Healthcare Initiative Dr. Steven Goldstein has immediate and affordable medical insurance solutions for those who need coverage. To hear the podcast visit: Apple Podcasts, Radio.com, iHeartRadio, SoundCloud, and the Houston Healthcare Initiative web site. Job & Health Insurance Loss Come and Go Together.

Use the Obama Care National Marketplace

People who lost their jobs due to the pandemic have the burden of finding work and paying for healthcare. As most people’s healthcare is tied to their jobs. “There are alternatives for people who lost both their jobs and accompanying health insurance,” Dr. Goldstein told his audience. “The key for those people to get covered is to act quickly.”

One reason for this is that job loss qualifies Americans for a special enrollment period in the health insurance marketplace regulated by the U.S. government, but it only lasts 60 days. “Normally the enrollment period for this is in the month of November, but job loss allows an exception. Just remember the 60-day deadline,” Dr. Goldstein said.

Private Health Insurance

Private health insurance will sometimes offer more flexibility than standard coverage. For example, short-term policies lasting up to one year are available in many states. There are differences between health insurance and private health insurance. People buy private health insurance many times because their place of employment does not offer it. In the case of people who lost their employer provided health insurance, purchasing it like this is an option. Private health insurance is often an option for those who work part time, are self-employed, or own a small business.

Health Co-Ops

Health insurance co-ops are private health insurance plans that serve a small group of people and are owned and operated by the members of that group. The health co-operative or co-op is a member owned not for profit corporation. They are run democratically by the members.

The real benefit of health insurance co-ops are they are significantly cheaper than regular health insurance. “The monthly fees are called membership fees, not premiums, Dr. Goldstein said. “The average cost of a co-op membership is about $40 to $90. To put that into perspective, regular COBRA insurance premiums can cost as much as $650 per month.”

Job loss is unnerving enough at any time. Losing health coverage during a pandemic makes that level of anxiety even higher. Because no one wants to be without medical insurance when a previously unseen virus is spreading.  It could make you or a loved one sick at the worst possible time. Fortunately there are reasons to be optimistic about getting health insurance that is affordable and obtainable if action is taken sooner than later.

The amount of information about this and other similar issues grows ever higher at the Houston Healthcare Initiative web site and its social media sites. To learn more about the Houston Healthcare Initiative go to www.houstonhealthcareinitiative.org.

Job & Health Insurance Loss Come and Go Together.

Job & Health Insurance Loss Come and Go Together; How To Find Affordable Coverage

In a time when so many lost their jobs because of the Covid-19 Pandemic….

Job & Health Insurance Loss Come and Go Together; How To Find Affordable Coverage

Affordable Fixes for Health Insurance
Many Americans lost their jobs and health insurance all at once and are looking for affordable, practical alternatives. That is the subject of this podcast.

March 2, 2021 — The Pandemic Cost Me My Job And Health Insurance Now What? In December 2020, 66% of Americans who answered a survey said they fear they won’t be able to afford health care this year. Of the 41% of respondents who are very or moderately concerned about health-care costs, 53% are parents with children.

The Pandemic Cost Me My Job And Health Insurance Now What?

The amount of people who were and remain unemployed because of the Covid-19 pandemic remains high. Since most individuals get their health insurance with their jobs, those same folks are also in need of medical coverage. On his regular podcast, Houston based neurologist and founder of the Houston Healthcare Initiative Dr. Steven Goldstein has immediate and affordable medical insurance solutions for those who need coverage.

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.