Doctor’s Blog

Weekly blog by Dr. Steven Goldstein. Dr. Goldstein is a highly respected Houston based neurologist and the founder of the Houston Healthcare Initiative CO-OP.

What Walmart Health Centers May Mean for the Future of Healthcare

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Dark Daily, a newsletter serving clinical labs and pathology groups, recently reported that a Walmart in Calhoun, Georgia has opened the second of the retail giant’s Health Centers. The Health Center offers low-cost doctor visits along with a number of other healthcare services such as lab work and x-rays. The prices for each service are listed at the entrance to the facility. The Walmart Health Centers are providing competition to traditional healthcare providers that they might find difficult to meet, at least for patients who lack health insurance.

What Walmart Health Centers May Mean for the Future of Healthcare

For example, the cost of a typical doctor visit is about $106, though for people with insurance that is covered except for about a $25 copay. A Walmart Health Center doctor visit costs $40. The costs of other services are comparably cheaper than their traditional competitors.

Many proposed solutions to expanding access to healthcare for people who are uninsured involve variations of “Medicare for All,” a government-funded and -operated health insurance scheme that would either supplement or replace private insurance depending on which politician proposes it. The Walmart experiment suggests a free-market approach to providing healthcare, using price competition to lower the cost of certain services so that even the uninsured can readily afford them.

A recent article in Reason Magazine suggests that big retail-based healthcare services could provide a new model for private insurance. Instead of carrying insurance that would cover standard healthcare services such as doctor visits, a person might pay for those services out of pocket and carry insurance only for “catastrophic” healthcare services such as surgical procedures and cancer treatments.

Of course, a couple of questions must be asked about such an approach.

First, can traditional healthcare services learn to compete with the Walmart approach? The answer may depend on changes in government regulation that would make that easier.

Finally, how would people paying out-of-pocket for doctor visits be encouraged to go to the doctor for regular checkups? Standard health insurance provides such incentives. People paying out of pocket, even at a reduced price, may decide to forgo such a service if they feel healthy. This might mean that conditions whose symptoms are not immediately apparent would not be discovered until they are more advanced and thus harder to treat.

For more information contact us,

What The Court Ruled About Hospital Price Transparency

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This week on the Houston Healthcare Initiative podcast, Dr. Steven Goldstein takes a deeper dive into a court decision where hospitals must reveal private negotiated rates with insurers starting this coming January 1, 2021. Plus, he will provide more insight into how hospitals decide what and how much to charge us, and man is that a story. It’s all more than a little complex. The podcast is available on all the popular podcast networks including SoundCloud, iHeart, and Spotify among others.

How Are Prices Now Assessed

Hospital prices are not based on the free market. Instead, prices are agreed on via secret agreements between hospitals and insurance companies. The truth is that pricing for medical services as paid by insurance companies are artificially set and not competitive at all. Prices are agreed to in advance by the hospital and the insurance company, not disclosed to the public. “We are led to believe that our insurance providers negotiate on behalf of their policyholders,” Dr. Goldstein told his audience. This is not the case. The court has ruled that this will no longer be permitted, that hospitals will have to reveal these negotiated rates and thus hospitals must reveal private negotiated rates .

Hospitals must reveal private negotiated rates to the public.
Hospitals must reveal private negotiated rates to the public.The court ruling that upheld a Trump Administration policy that forces hospitals to reveal their prices.

Why Hospitals Object

One reason many hospitals do not list their actual prices is that, according to them, some cases are more complicated than others. “An appendectomy may go smoothly or may be complicated by other factors such as adhesions from a previous surgery that caused scarring,” Dr. Goldstein said. “This may require additional operating room time resulting in a higher cost.  Thus hospitals claim they can only give estimates.”

Alternatively, this could be handled in one of two ways. 1). Publish the price for each procedure at what the hospital perceives as the average price. Then find ways to cut costs so that average cost is lowered resulting in increased profit for the hospital.  2). Alternatively, publish a price for operating room time by the hour that would include all the ancillary charges + publish the range of operating room times for each procedure.

How Prices Are Set Now

With the use of computer technology, hospitals are able to establish a charge for each product or service, no matter how small. “Every aspirin, every blood test, every x-ray, every bandage, every suture has a charge; Dr. Goldstein said. “Some of these charges beg credulity e.g. the $20 aspirin. All these charges are added up to give the total hospital charge. Of course, this doesn’t include multiple physician charges that are separate.” This all resulted in the Trump administration’s order that hospitals must reveal private negotiated rates to the public.

But the final charge is the “sticker price”. The insurance companies never pay this price. They have a secret, negotiated price based on the Medicare price for those services.

Secret Revealed on Pricing Practices of Health Insurance Companies & Hospitals

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The actual price of what a medical test, procedure, exam and often prescription cost and how charges are assigned is not based on the free market. Instead, prices are agreed on via secret agreements between hospitals and insurance companies. This is the subject of the Houston Healthcare Initiative podcast with Dr. Steven Goldstein. To hear the Houston Healthcare Initiative podcast, please visit: SoundCloud, Apple Podcasts, iHeart, PlayerFM, or the Houston Healthcare Initiative web site. Secret Revealed on Pricing Practices of Health Insurance Companies & Hospitals.

Pay More Attention

Price Transparency
Price transparency from insurance companies and medical companies is a rare thing.

Most people get health insurance from their employer which is the reason, so few pay much attention to the price of the medical services and pharmaceuticals that Americans purchase. Employer funded insurance pays for most of what is charged with individuals picking up a smaller deductible. But according to neurologist Dr. Steven Goldstein, it is past time to start devoting attention to not just what is charged but how the health insurance companies, and the medical community decides what to charge and why. Spoiler Alert: it is not based on the free market.

The idea that pricing for medical services as paid by insurance companies are artificially set and not competitive at all. They are agreed to in advance by the hospital and the insurance company, not disclosed to the public, and we are all led to believe that our insurance providers were negotiating on behalf of the people that pay the premiums.

It Is Expensive But…

The fact that the charges for visits to the doctor, hospital and pharmacist are mostly paid for by employer funded insurance does not make us any less likely to get both overcharged and underserved. It is a lack of transparency that makes medical costs so high. It was not wrong to believe that research, new equipment, and pharmaceutical discovery were what was behind the increase in healthcare prices; they account for some. “The issue is that patients do not know the actual price of services,” Dr. Goldstein told his listeners. “The list price is the price charged to patients without insurance. Each insurance company negotiates a discounted price.”

Thus, there are multiple discounted prices depending on the insurance company plus a different price for Medicare and Medicaid. These prices have traditionally been secret. There is no competition between hospitals based on price. “Medicare sets the price standard based on costs,” he said. “Thus, hospitals are cost plus operations with little incentive to reduce costs.”

Why Not Just Pay Cash?

Cash prices are often much less than what is charged even to the insurance companies. People often can secure better deals if they don’t use their insurance. A 2016 Wall Street Journal investigation found that hospitals frequently offer far better deals for people who pay in cash rather than use their insurance. “Price transparency allows individuals to shop for the best nonemergency deal. It would also force hospitals to compete, thus saving consumers money. It gives them a choice,” Dr. Goldstein said. The way any of us chooses to spend our money is the most democratic thing anyone can do.

Price transparency allows individuals to find the best non-emergency deal. It would also force hospitals to compete, thus saving consumers money. “If prices were known, posted in public, people could shop for the non-emergency services,” Dr. Goldstein said.

About Houston Healthcare Initiative

Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America.Secret Revealed on Pricing Practices of Health Insurance Companies & Hospitals

 

Why Healthcare Insurance & Hospitals Do Not Want You To Know About Pricing

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Medical Price Transparency
Why Healthcare Insurance & Hospitals Do Not Want You To Know About Pricing

Transparency and the need for it in different industries is a word and requirement we hear a lot about. It should not surprise anyone that some insurers and hospital groups are working to block the implementation of federal rules that make hospital pricing transparent. They argue these will confuse consumers and potentially lead to higher costs. But there is good news. According to the New York Times, a federal judge has upheld a Trump administration policy that requires hospitals and health insurers to publish their negotiated prices for health services, numbers that are typically kept secret.

Most of us have our health insurance provided by our employers and we do not pay as much attention to the price of medical care as we do the cost of other consumer items. But maybe we should pay more attention? The fact that the charges for our visits to the doctor, hospital and pharmacist are mostly paid for by our insurance does not make us any less likely to get both overcharged and underserved. In fact, it is a lack of transparency that makes medical costs so high.

The issue is that patients do not know the actual price of services. The list price is the price charged to patients without insurance. Each Insurance company negotiates a discounted price. Thus there are multiple discounted prices depending on the insurance company plus a different price for Medicare and Medicaid. These prices have traditionally been secret. There is no competition between hospitals based on price. Medicare sets the price standard based on costs. Thus, hospitals are cost plus operations with little incentive to reduce costs.

Learn more by listening to the podcast.

For Those Who Lost Their Employer Funded Health Insurance; Resources Are Available

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Provided at no charge by the Houston Healthcare Initiative.  

For Those Who Lost Their Employer Funded Health Insurance Resources Are Available

Because of the Coronavirus/Covid-19 pandemic, 25–43 million people could lose their jobs and their health insurance. People who had a serious illness before the outbreak and job loss could be dealt a literally fatal blow. Others who had symptoms and even serious accidents while unemployed and without insurance could suffer more than they would have if their insurance were in place. But there are resources available as described this week on the Houston Healthcare Initiative podcast. To learn more, go to www.houstonhealthcareinitiative.org. To hear about this on Dr. Goldstein’s podcast, please visit: Job Losses Equal Employer Funded Health Insurance Loss.

  • Testing for the Coronavirus/Covid-19 illness: testing for the Coronavirus/Covid-19 virus is free. But if the test is positive and you have the virus, the treatment for it can get expensive. Fortunately, most people recover at home. However, an estimated 15% of infected people may end up hospitalized, according to the Kaiser Family Foundation. Recent data suggests that patients who go to intensive care stay there for an average of 20 days. The Castlight Covid-19 test site finder will provide information on Coronavirus testing near you: https://my.castlighthealth.com/corona-virus-testing-sites/.
  • The Health Insurance Exchange: Open enrollment typically runs from November to January, depending on the state in which you live. But people are allowed a change in coverage when experiencing a life altering event. One such event is the loss of a job and employer sponsored health insurance. You can shop for health plans through your state’s insurance marketplace. But don’t wait around, there are 30 to 60 days to sign up after a qualifying life event before the end of that special enrollment period. Go to this link and find out if you qualify for coverage: https://www.healthcare.gov.
  • Medicaid: Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities in all fifty states.  In some states the program covers all low-income adults below a certain income level. But do not assume that you do or do not qualify. There are online resources available from the U.S. Department of Health and Human Services along with state references to guide you. Visit the official U.S. government Medicaid site to see of you are eligible: https://www.medicaid.gov.
  • CHIP: CHIP stands for Children’s Health Insurance Program. If your children need health coverage, they may be eligible for the Children’s Health Insurance Program (CHIP). CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers pregnant women. Each state offers CHIP coverage and works closely with its state Medicaid program. Get all the details, go to: https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/.
  • Faith Based Cooperatives: Faith-based plans are designed to provide essential coverage for the good health and physical well-being of their members. In return they expect members to live faith-based lives in adherence to the principles behind such plans. As such, faith-based plans will not cover hospital costs that stem from activities they deem immoral or unessential. Faith based plans most often share expenses among members. Each member pays a monthly premium. When one of the members becomes ill or needs treatment for an injury, his or her contributions cover the expenses, in conjunction with the collective input of fellow members. As such, the premiums are lower in comparison to those of traditional health care. These operate with exemptions to the mandates of the Affordable Care Act, also known as Obama Care. There are several options. Here are a few:Medi-Share, Liberty HealthShare, Samaritan Ministries,  OneShare, Christian Healthcare Ministries.

This is not an exhaustive list for those who lost their employer funded health insurance but is some go the most popular ones that are available.

About Houston Healthcare Initiative And Dr. Steven Goldstein

Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America.

The Healthcare Not Received During the Coronavirus/Covid-19 Pandemic

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From Heart Attacks to Cancer Screenings and Chemotherapy

During the Coronavirus/Covid-19 pandemic, people who did not have symptoms of the disease put themselves at risk as those with chronic conditions missed treatments, skipped appointments and chose not to report serious symptoms; this is the healthcare not received during the coronavirus/covid-19 pandemic. Many who lost their employer funded health insurance also missed schedules and treatments. Add to this the fear of visiting a doctor’s office or clinic with reported cases of Coronavirus/Covid-19 on the uptick, another health crisis may be on the horizon.

This was one of the issues affecting the American public discussed by Houston based neurologist Dr. Steven Goldstein on his regular podcast. The Houston Healthcare Initiative podcast can be heard on: Soundcloud, iHeart, Spotify, or iTunes. To learn more about the Houston Healthcare Initiative, go to www.houstonhealthcareinitiative.org.

Cancer Screenings Plummet

No Visitors
Patients who may need to be seen in the office are choosing not to go to the doctor for lots of reasons.

In March and April, patients were asked to postpone appointments that were not urgent. According to a white paper published by ‘Epic Health Research Network’ cancer screenings for cervix, colon, and breast cancer decreased between 86% – 94% in March, 2020. Care for heart attacks, organ transplants, high blood pressure and diabetes fell in March and remain significantly lower compared to the same time in 2019. “There is a 20% decrease in the number of interactions between patients and their oncologists during the COVID-19 pandemic,” Dr. Goldstein told his listeners. “Anytime a screening is delayed, it means that detection and early treatment are too, plus important therapy on advanced cancer are not administered.

Some Need To Be Seen

Many physicians, like Dr. Goldstein, ramped up their telemedicine capabilities in March and see patients that way. But there are still times when a patient needs to be seen. Instances where patients have symptoms that include shortness of breath is one. This symptom could signal heart failure, asthma, pneumonia or even the Covid-19 virus. A diagnosis like that cannot be done over the phone. “Patients and their families should err on the side of caution, contact their doctor and allow their physician the opportunity to make the right decision for the best treatment,” Dr. Goldstein said.

What Concerned Patients Can Ask

For those who believe or are told they must get in to see a doctor, and there is time available in a non-emergency, Dr. Goldstein has some potential questions to pose.

  • Does everyone on staff and patients wear masks?
  • Are the number of persons allowed in the office limited?
  • Has everyone on staff been tested for COVID-19?
  • Are cleaning protocols sufficient to manage waiting rooms, offices, and labs?
  • Has the patient taken responsibility for social distancing, hand washing and mask wearing themselves?

According to Dr. Goldstein, “we have a responsibility to our patients to provide the most appropriate and effective care possible while at the same time keeping potential exposure to the Coronavirus/Covid-19 virus to a minimum.”

About Houston Healthcare Initiative And Dr. Steven Goldstein

Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America.

How Much Does the US Spend on Healthcare?

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Healthcare prices in the United States are growing at a rate that is becoming increasingly difficult for many Americans to afford. At Houston Healthcare Initiative, we are proud to help patients find healthcare solutions that don’t break the bank. Here are some of the most important things to know about healthcare spending in the United States!

Factors That Affect Healthcare Spending in the United States

United States Healthcare Statistics

Although most countries have some form of public or private health insurance available, Americans typically spend more on healthcare each year than residents of other countries. Approximately 18 percent of the country’s GDP, or about $3.5 trillion, was spent on some form of healthcare in 2017, or more than $3,000 per person each year. This number has more than doubled since 2000, and it is expected to continue to rise significantly over the next decade.

Factors That Affect Healthcare Spending in the United States

Americans typically spend more on healthcare than people in other developed countries, much of which comes from a variety of government programs, such as Medicare, Medicaid, and the Children’s Health Insurance Program. In the United States, many healthcare premiums are rising at a faster rate than both average salaries and inflation, which means that healthcare is rapidly becoming more challenging for the average American to afford. Although Americans often directly spend more on these healthcare programs, residents of countries that utilize socialized healthcare programs also contribute a significantly increasing amount of tax dollars to funding healthcare services.

Houston Area Healthcare Data

Healthcare spending in the Houston area is above national averages. In Texas, over $43 billion, or nearly half of the state’s entire budget, has been spent on healthcare-related expenses in recent years.

At Houston Healthcare Initiative, we care about helping residents throughout the Houston area make budget-friendly healthcare decisions that meet their individual needs. Contact us today to learn more about how we can help you improve your physical and mental health without spending more than you need to on healthcare services!

Job Losses Equal Employer Funded Health Insurance Loss

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Closed for Coronavirus

Here Are Some Resources

Even with fewer jobs lost in May than anticipated Americans now experience an unemployment rate of 13.3% or 21 million people out of work due to the coronavirus/covid-19 pandemic. On top of lost income, loss of employer provided health insurance makes the cost even higher for those who through no fault of their own find themselves in a very challenging situation. On his podcast this week, Dr. Steven Goldstein describes how job losses equal employer funded health insurance loss and some available and often free resources for those who need health insurance. To listen to the podcast go to: Soundcloud, iHeart, Spotify, or iTunes. Or click here to listen:

 

Double Loss; Job and Health Insurance

Most Americans rely on their employers to provide health insurance for them and their families and when those jobs disappear so does the coverage. “It is extremely important that people get some type of coverage when they have lost their health insurance,” Dr. Goldstein told his listeners. “The available things to look into are COBRA, spouse insurance, faith-based cooperatives, enrollment on the insurance exchange (Obama Care), Medicaid and CHIP.”

COBRA Coverage

COBRA allows employees (and their families) who would otherwise lose their group health coverage due to certain life events to continue their same group health coverage. The former employee generally pays the full monthly rate and not the discounted one for their health insurance. Under COBRA, group health plans must also provide covered employees and their families with certain notices explaining their COBRA rights. The revised model notices provide additional information to address COBRA’s interaction with Medicare. The model notices explain that there may be advantages to enrolling in Medicare before, or instead of, electing COBRA.

State Insurance Exchange

While typically only available during certain months of the year, the state insurance exchange can open for those who experience a ‘life changing’ event. One such event is the loss of a job and employer sponsored health insurance. “You can shop for health plans through your state’s insurance marketplace,” Dr. Goldstein said. “But don’t wait around, there are 30 to 60 days to sign up after a qualifying life event before the end of that special enrollment period.”

Spouse Insurance

In households where a spouse’ employer offers health insurance; those benefits may be available. “It is easy enough to find out if a spouse’s job offers health insurance and sign on for that,” Dr. Goldstein said.

Faith Based Health Cooperatives

Faith based plans most often share expenses among members. Each member pays a monthly premium. When one of the members becomes ill or needs treatment for an injury, his or her contributions cover the expenses, in conjunction with the collective input of fellow members. “As such, the premiums are lower in comparison to those of traditional health care,” Dr. Goldstein said. “These operate with exemptions to the mandates of the Affordable Care Act, also known as Obama Care.”

Medicare

Eligibility for Medicare is based on income and the size of family. Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities in all fifty states.  In some states the program covers all low-income adults below a certain income level. “But do not assume that you do or do not qualify,” said Dr. Goldstein. “There are online resources available from the U.S. Department of Health and Human Services along with state references to help guide you.”

CHIP

CHIP stands for ‘Children’s Health Insurance Program.’ CHIP offers low-cost health coverage for children from birth through age 18. CHIP is designed for families who earn too much money to qualify for Medicaid but cannot afford to buy private health coverage. This coverage comes through the Medicaid program, which is why they are frequently seen together.

Income Qualification for Medicare

A family of four with an income of $25,750.00 at the poverty level and eligible for Medicaid or CHIP coverage. For an individual the amount was $12,490.00. The amount goes up by $4,420.00 for each additional family member. “The guidelines change every year,” Goldstein said.

The Good News

There are plenty of alternatives available to individuals and families that can be used short or for the longer term that are not all based on a job with insurance. People under age 26, may even be able to join their parents’ employer-based plan. “There are places to go and affordable resources available,” Dr. Goldstein concluded. “Any type of healthcare insurance or coverage will help protect your finances later.”

About Houston Healthcare Initiative And Dr. Steven Goldstein

Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America.

 

News About Reform and the Covid 19 Pandemic

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How the Covid-19 pandemic will leave its mark on US health care

From hospital closures to the rise of telehealth, five ways the system is already transforming.

By Dylan Scott Updated 

News About Reform and the Covid 19 Pandemic

The flaws in America’s health system have been evident for decades to anyone who cared to look, but the coronavirus pandemic has left no more room for doubt: People will die because the US refuses to treat health care as a public good and a universal right. They already are.

Our decentralized system, with independent providers and many different payers, was not nimble in responding to this stealthy pathogen. These problems weren’t the only reason more than half a million people in the United States have contracted Covid-19 and tens of thousands have died. But America was particularly fertile ground for a virus to run wild.

Only in America could a man and daughter placed under mandatory government quarantine then be hit with a $4,000 hospital bill. Only in America could somebody without health insurance — a situation, all on its own, foreign to other rich countries — receive a bill for Covid-19 treatment that tops $30,000. Only in America would a dying patient ask in his final breaths who will pay for the care that could not prevent his death. The US is the richest country in the world, and yet millions are uninsured or have insufficient benefits. It has fewer hospital beds, doctors, and nurses per capita than its economic peers.

To read the entire article please click here: How the Covid-19 pandemic will leave its mark on U.S. healthcare.

Covid-19 and the Need for Healthcare Reform

The New England Journal of Medicine 

Jaime S. King, J.D.,  Ph.D.

The Covid-19 pandemic has brought into sharp focus the need for health care reforms that promote universal access to affordable care. Although all aspects of U.S. health care will face incredible challenges in the com- ing months, the patchwork way we govern and pay for health care is unraveling in this time of crisis, leaving millions of people vulnerable and requiring swift, coordinated political action to ensure access to affordable care.

To read the entire article please click here: Covid-19 and the Need for Health Care Reform.

Weekly FDA COVID-19 update

 By Jenni Spinner

The agency continues to remain busy overseeing and approving potential treatments and tests for the virus behind the global pandemic.

To read the entire article please click the link below:

HTTPS://WWW.OUTSOURCING-PHARMA.COM/ARTICLE/2020/05/07/FDA-WEEKLY-COVID-19-UPDATES-AND-ACTIONS