Court Rules Against the Hospital Industry Mandates Price Disclosure

Court Rules Against the Hospital Industry Mandates Price Disclosure. Hospital prices that were historically rigged by the medical business along with the insurance industry, and kept secret from the public, will see the light of day January 1, 2021. This because on June 23, 2020 a federal judge in Washington D.C. dismissed a suit brought by the American Hospital Association (AHA) that challenged the Department of Health and Human Services rule mandating hospitals to disclose their privately negotiated prices with health insurance companies.  This ruling, and what it means for doctors, patients and the industry, is the subject of the latest edition of the Houston Healthcare Initiative podcast. The Houston Healthcare Initiative podcast can be heard on SoundCloud, iTunes, iHeart, Spotify and on the Houston Healthcare Initiative website.

Court Ruling Allows Transparency

Hospital Price Transparency
Court Rules Against the Hospital Industry & Mandates Price Disclosure.

The court ruled that an executive order from the Trump administration requiring hospitals to disclose pricing was legal. A federal judge upheld a policy that requires hospitals and health insurers to publish their negotiated prices for health services, numbers that are typically kept secret. The policy is part of a major push by the Trump administration to improve transparency in health care. Insurers and health providers usually negotiate deals behind closed doors, and patients rarely know the cost of services until after the fact.

Healthcare Industry Public Relations Offensive

The meaning of the ruling and what will happen are different. As Dr. Goldstein told his audience, “there will be an appeal accompanied by a full court public relations press by the hospital industry to derail this effort.” Dr. Goldstein went on to say, “if the battle can be dragged out until after the presidential election, hospitals and insurance companies can hope a new administration will rescind the executive order.”

Four organizations are now urging the Department of Health and Human Services to delay implementation of the price transparency rule until after the appeals court makes a decision in the case. The American Hospital Association, the Federation of American Hospitals, the Association of American Medical Colleges and the Children’s Hospital Association made their request in a letter to HHS Secretary Alex Azar on June 29, five days after these associations and others filed an appeal against the ruling which would implement a rule on price transparency on January first. The groups said the rule would ‘pose a burden to hospitals and health systems responding to the COVID-19 public health emergency.’ Thirty-four hospital groups have already urged HHS to delay the start of the price disclosure.

In an article published in “Becker Hospital Review” AHA General Counsel Melinda Hatton said, “the proposal does nothing to help patients understand their out-of-pocket costs.” She added, “it also imposes significant burdens on hospitals at a time when resources are stretched thin and need to be devoted to patient care. Hospitals and health systems have consistently supported efforts to provide patients with information about the costs of their medical care. This is not the right way to achieve this important goal.”

About The 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. Court Rules Against the Hospital Industry Mandates Price Disclosure.

What The Court Ruled About Hospital Price Transparency

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.

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

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.

Job Losses Equal Employer Funded Health Insurance Loss

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.

 

Follow-Up To Help Prevent the Spread of Coronavirus/Covid19 Patients Benefit From Telemedicine Appointments

Follow-Up To Help Prevent the Spread of Coronavirus/Covid19 Patients Benefit From Telemedicine Appointments

March 19, 2020 — Until a couple of weeks ago, the use of telemedicine was mostly for convenience. Now, it is a necessity as people work to keep their collective distances from each other. As announced previously, Houston neurologist Dr. Steven Goldstein will offer his diagnostic and medical skills via virtual or ‘telemedicine’ appointments for both new and existing patients.  “As long as Houstonians are suffering from the effects of the pandemic, I will waive copayments for those who have health insurance and significantly lower fees for those without insurance,” Dr. Goldstein said. With so many working hard to prevent the increase of the virus, using an existing technology without sacrificing access to himself or staff is a beneficial service.

Looser Rules Benefit Houstonians

On Friday March 13, 2020, when Gov. Greg Abbott declared a state of emergency, he made it possible for state agencies to use telemedicine. The Texas Medical Board also allowed for the medical community to use telemedicine, including the use of phone only, to see patients.

There are many benefits as so many people are staying away from public spaces during the Coronavirus/Covid19 outbreak. Here are a few of those advantages:

  • With telehealth services, patients avoid unnecessary office or hospital visits, hopefully lowering their risk for contracting or spreading Coronavirus/Covid19.
  • Through an emergency declaration under the Stafford Act and the National Emergencies Act, Medicare coverage will now include three types of virtual services: Medicare telehealth visits, virtual check-ins, and e-visits.
  • Virtual check-ins allow Medicare beneficiaries to communicate from their home with a provider.
  • Those who must rely on public transportation will not have to venture outside their homes to come in contact with other people and surfaces where the virus can remain for some time.

Medical Specialties

All of the medical news is about the spread or containment of Coronavirus/Covid19. But people will still need to be seen by specialists, including neurologists like Dr. Goldstein. For those with symptoms that suggest a neurologist, Dr. Goldstein is available. Some symptoms include:

  • severe headaches,
  • seizures,
  • numbness,
  • weakness,
  • double vision,
  • dizziness,
  • passing out,
  • tingling,
  • trouble with movement,
  • memory challenges or confusion,
  • and trouble sleeping.

How To Be Seen

To be seen by Dr. Goldstein via ‘telemedicine’ call his office and make an appointment, just like always;  give the patients’ email address and then go to the App Store and download Zoom Cloud Meeting. Zoom is free. Dr. Goldstein will email a link to the patient to use during the time of the appointment. Dr. Goldstein can diagnose, order tests, and prescribe medication via the Zoom link. To make an appointment call (713) 451-5421, or (281) 481-4236.

Zoom App Information

Zoom is available for Apple, Google Play and Windows. For all the ways to download and use Zoom go to their download page here: https://zoom.us/download.

Follow Dr. Goldstein from his Facebook page at: https://www.facebook.com/Houston-Healthcare-Initiative-192537484753616/?modal=admin_todo_tour. Or his website address: https://houstonhealthcareinitiative.org.

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To Help Prevent the Spread of Coronavirus/Covid19 Houston Neurologist Makes Telemedicine Appointments Available

Houston, TX. (March 19, 2020) – As a result of the Coronavirus/Covid19 outbreak and efforts to contain exposure, long time Houston neurologist Dr. Steven Goldstein will offer his diagnostic and medical skills via virtual or ‘telemedicine’ appointments for both new and existing patients.  As long as Houstonians are suffering from the effects of the pandemic, Dr. Goldstein will waive copayments for those who have health insurance and significantly lower fees for those without insurance. “With so many of us all working hard to prevent the increase of this virus, I wanted to leverage existing technology and keep access to myself and my staff available without putting any of us or our patients at unnecessary risk,” Dr. Goldstein said. “It seemed like a pretty good way to be of service here in the greater Houston area during such a challenging time.” Those who do not have insurance pay $75.00 for a first time visit and $35.00 for any needed follow-up visit.  Virtual office visits are conducted via the free Zoom Cloud Meeting app. Payments via debit or credit card are available through the office.

To Help Prevent the Spread of Coronavirus/Covid19 Houston Neurologist Makes Telemedicine Appointments Available

Telemedicine

The use of technology along with the reduced price makes Dr. Goldstein’s expertise available to people who cannot come to his office or afford to see a specialist like him or both. “Virtual medicine is nothing new, but it has not caught on like other remote services have,” Dr. Goldstein said. “This way of seeing patients now may be a turning point for the use of remote communications technology during this health crisis, with positive implications into the future.”

Treat Patients & Prevent the Spread of Coronavirus/Covid 19

The focus of the medical world now is on the prevention of Coronavirus/Covid 19. But there are plenty of people with symptoms a neurologist needs to diagnose and treat. Some symptoms include:

  • severe headaches,
  • seizures,
  • numbness,
  • weakness,
  • double vision,
  • dizziness,
  • passing out,
  • tingling,
  • trouble with movement,
  • memory challenges or confusion,
  • and trouble sleeping.

How To Be Seen

To be seen by Dr. Goldstein via ‘telemedicine’ call his office and make an appointment, just like always;  give the patients’ email address and then go to the App Store and download Zoom Cloud Meeting. Zoom is free. Dr. Goldstein will email a link to the patient to use during the time of the appointment. Dr. Goldstein can diagnose, order tests, and prescribe medication via the Zoom link. To make an appointment call (713) 451-5421, or (281) 481-4236.

Zoom App Information

Zoom is available for Apple, Google Play and Windows. For all the ways to download and use Zoom go to their download page here: https://zoom.us/download.

Follow Dr. Goldstein from his Facebook page at: https://www.facebook.com/Houston-Healthcare-Initiative-192537484753616/?modal=admin_todo_tour. Or his website address: https://houstonhealthcareinitiative.org.

 

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Houston Based Neurologist Explains Reason for ‘Surprise Hospital Bills’

A Houston based neurologist, Dr. Steven Goldstein, explains the reasons patients can get very expensive hospital bills even if they went to a hospital, clinic or emergency room that is part of their insurance network on his latest podcast. The Houston Healthcare Initiative podcast can be heard on Soundcloud, iTunes, Libsyn, or on www.houstonhealthcareinitiative.org

Houston Based Neurologist Explains Reason for ‘Surprise Hospital Bills’

No Insurance Network Required for Doctors

While the insurance industry has trained patients, doctors, and hospitals that we all must have insurance and be part of an insurance network the same is not the case for doctors. While in-network doctors and hospitals have agreed with the insurance company how much procedures and tests will cost, not all doctors who work in hospitals are part of any insurance network and can charge more than what insurance will cover. To make this worse for patients and the ultimate cause of ‘surprise hospital bills’ hospitals, emergency rooms or clinics are not required to disclose this to patients or their loved ones. As Dr. Goldstein told his listeners, “behind the scenes, the in-network doctor and the hospital agreed in advance what the charges were going to be. So, the in-network doctor is paid a flat rate based on that agreement. The doctor who works at the hospital but is not part of the insurance network can charge more and get paid more. He is under no obligation to say anything about this to the patient and will not.”

How Can This Be? Private Equity Companies

Private equity companies that own staffing firms and place doctors to work in hospitals along with the American Hospital Association have stated publicly that restricting the independent pricing capability will make putting doctors in geographic or socially challenging locations much more difficult, as higher pay is the biggest incentive for going to work in rural or economically disadvantaged areas. These doctors have no incentive to join an insurer network, which would require them to cut their fees. These are the source of many surprise medical bills.

Doctor Patient Unity Unmasked

A shadowy lobbying group known as Doctors and Patients United are owned and funded by TeamHealth and Envision Healthcare, private-equity-backed companies that own physician practices and staff emergency rooms around the country. In late July, 2019 Doctor Patient Unity placed more than $28 million  in ads opposing the legislation that would ban surprise medical bill, without disclosing who was behind the ads.

Current Information on Federal Legislation

There are several committees and bills on this being considered. At this writing the following bill was being considered: S 1895: Lower Health Care Costs Act. The bill was introduced by Senator Lamar Alexander (R, Tennessee) on June 19, 2019 and reported June 26, 2019. The committees assigned to this bill sent it to the House or Senate as a whole for consideration on June 26, 2019. For resources and the information to act on this bill please go to: https://www.govtrack.us/congress/bills/116/s1895.

Well-known and respected Houston based Neurologist Dr. Steven Goldstein is dedicated to reforming healthcare in the U.S. through education and information to the people who need it most. To learn more about the Houston Healthcare Initiative please go to www.houstonhealthcareinitiative.org.

Houston Healthcare Initiative Offers Affordable Health Care Via “Cooperative” Payments

From Houston Style Magazine – A new way to fund healthcare is now available. The Houston Healthcare Initiative (HHI) is a member owned, non-profit medical co-op that is now open for business. Led by Houston based neurologist Dr. Steven Goldstein, the HHI (https://houstonhealthcareinitiative.org) will replace traditional health insurance for qualified individuals and families and provide incentives for members to adopt healthier lifestyle habits.