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.

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.

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.

Why Did Haven Healthcare Fail?

Haven
With the resources of three large and very successful companies, Haven will cease operations in late January, 2021.

Why Did Haven Healthcare Fail? Because they focused and worked on the wrong thing. That is the topic and lesson from Dr. Steven Goldstein on the latest edition of the Houston Healthcare Initiative Podcast.

Haven was a joint venture of Amazon, Berkshire Hathaway, and JPMorgan.  It was formed three years ago to better manage healthcare for the one million employees of these three large, successful and high tech companies. After three years and approximately $100 million Haven will cease operations. Dr. Goldstein tells his podcast audience the reason for the shortfall had nothing to do with resources, talent or intention and everything to do with trying to fix the wrong thing. The people at Haven were approaching the challenge with trying to fix the existing system.

But according to Dr. Goldstein, the existing 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. Ours is a volume-based system of reimbursement for getting paid. There is no tie to healthier outcomes for patients or incentives for those same patients to take better care of themselves. It’s just more of the same.” 

The strategies Haven pursued was to leverage the scale of all those employees for better rates and prices. With over a million employees it seems like that might have worked. But it did not because the healthcare industry is not governed by the free market. Instead, it is governed by lobbyists from the hospital, pharmaceutical and insurance industries all who work together to help make sure that little meaningful change is ever introduced never mind adopted. “The focus is not on improving the population’s health, Dr. Goldstein said. “And ultimately that was the biggest mistake the people at Haven made. They were focused on the wrong problem. They might have been able to make a bad system work somewhat better, but it is still a bad system.”

 It was a shame that so much money and time went into this laudable goal but yielded no good outcome.  A common sense approach to managing the public’s health and is exactly what the insurance, hospital, and drug companies do not want. Given the collective influence (deep pockets) of these businesses and their lobbyists, the American public will continue to get the bill for a medical industry that puts maintaining the status quo as its priority. 

 

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In The Global Covid-19 Pandemic Who Suffers Most?

In The Global Covid-19 Pandemic Who Suffers Most?

January 5, 2021 – In the midst of an ongoing and worsening global pandemic, there are those who are more likely to be sicker and die than others. This according to respected neurologist Dr. Steven Goldstein, founder of the Houston Healthcare Initiative. He told his regular podcast audience that the mortality rate from the Covid-19 infection was greater for patients with obesity, chronic lung disease, diabetes and hypertension and that the older a patient was, the greater the mortality.  “The Covid-19 pandemic teaches us that improving public health should be a priority in reforming healthcare,” Dr. Goldstein said. The Houston Healthcare Initiative podcast can be heard on Backtracks,SoundCloud, Libsyn, Listen Notes, iHeart Radio, Spotify, Stitcher, Apple Podcasts and the Houston Healthcare Initiative web site.

When things are uncertain
Americans remain in the midst of the Covid-19 pandemic. What can we learn from it and how can this influence our thinking when it comes to personal lifestyle choices and healthcare reform?

Mayo Clinic Data

According to the Mayo Clinic web site, risk of severe Covid-19 is highest based on age; older people are at higher risk than those who are younger. Other conditions include type 2 diabetes, severe obesity and serious heart diseases. The site states, “obesity and diabetes both reduce the efficiency of a person’s immune system. Diabetes increases the risk of infections in general. The risk of infections, including COVID-19, can be reduced by keeping blood sugar levels controlled and continuing your diabetes medications and insulin.”

What Individuals Can Control

Dr. Goldstein said that people can take control of their own health by leading a healthier lifestyle. “By this I mean maintaining a modicum of physical fitness and being compliant with medical treatment if you have a chronic illness like diabetes and hypertension,” Dr. Goldstein told his audience. These and other voluntary measures like quitting smoking, moderating alcohol consumption and eating sensibly will help prevent an infection of Covid-19 or keep one from being more serious.

Freedom & Responsibility

Dr. Goldstein believes that in the New Year, the congress should find a balance of individual freedom, responsibility and monetary incentives for a better, national outcome. “People should have the freedom to adopt any lifestyle they wish as long as they do not interfere with anyone else. But, along with that freedom comes the responsibility to pay for it,” Dr. Goldstein said.   He mentioned how the government frequently uses its power to promote lifestyle choices. “For example, they impose high taxes on cigarettes to discourage tobacco use. But it does not outlaw the use of cigarettes. If anyone wants to lower their healthcare costs, they can adopt a healthier lifestyle.”

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.

Photo Caption: Americans remain in the midst of the Covid-19 pandemic. What can we learn from it and how can this influence our thinking when it comes to personal lifestyle choices and healthcare reform?

The Case for Healthcare Reform in Unsettled Times

Unsettled Healthcare
2021 starts with healthcare no less unsettled than it ended in 2020.

Healthcare reform in unsettled times. That times are troubled was never truer than in 2020 and 2021 will start out that way. But in an unsettled time with so much of the nation’s attention turned to medical care, could it be the time to really push healthcare reform and what might that reform look like? Americans remain in the midst of the Covid-19 pandemic. What can we learn from it and how can this influence our thinking when it comes to healthcare reform? Or is it all too big for any of us to do anything meaningful? Here to share his insight with us is respected neurologist and founder of the Houston Healthcare Initiative, Dr. Steven Goldstein.

For These Uncertain Times What Type of Health Insurance Is Best?

In wake of the election which insurance is best?
Three in ten uninsured adults in 2019 went without needed medical care due to cost. 

In wake of the 2020 election outcome…

For These Uncertain Times What Type of Health Insurance Is Best?

November 24, 2020 – According to Dr. Steven Goldstein, founder of the Houston Healthcare Initiative, “with the current system we have, I would buy a policy that has a high deductible,” he told his podcast audience. “This is sometimes known as ‘catastrophic’ health coverage. Then I would pay cash for my health expenses.”

That times are unsettled was never truer than in 2020. With the U.S. House and the presidential election settled, the majority of the senate remains undecided and will stay that way until the two runoff elections for both Georgia senate seats on January 5, 2021. The implications for the U.S. healthcare system are many. What can or should Americans do in the near term? Listen to “The Houston Healthcare Initiative Podcast to find out. The Houston Healthcare Initiative podcast can be heard on SoundCloudGoogle PlayLibsyn FeedStitcheriHeartRadioSpotify, and the Houston Healthcare Initiative web site.

Cash & Catastrophic Coverage

According to Dr. Goldstein, cash payments are accepted for most if not all medical charges and prescription drugs. Do not try to get the ‘insured’ rate to put against your deductible. Paying cash is much less desirable with the insured rate. “Most people will never reach their deductible amount anyway,” he said. “This arrangement is the best value for people under the current system. So, while at the doctors’ office show them your insurance card but tell them you are paying cash.”

Return of the Mandate?

Most Americans get their health insurance through their employer. The Affordable Care Act, also known as Obama Care, made more choices for insurance available and penalized people who did not purchase health insurance. While not ideal, it was a way to get more people covered by private insurance than before. Plus, it offered subsidies for those who could not afford insurance.  But at the same time, it was the mandate and accompanying monetary penalty that seemed to make the policy so unpopular with many. “The overall insurance industry and its approach to paying for healthcare are very flawed in fundamental ways,” Dr. Goldstein told his listeners. “We can spend time and money to make a bad system work better and that is probably what will happen in the near term.”

Likely Short-Term Changes

Some near-term changes are likely to be mandates for private firms and their employees to provide for and buy health insurance. The cost of care for uninsured workers is often passed along to the insured through taxes and other mechanisms. There are employed people now who go without health insurance and keep the part of their pay that would go to health insurance. One economic rationale for employer mandates is that the cost of care for uninsured workers is often passed along to the insured through taxes and other mechanisms. Mandates are, in part, an attempt to eliminate those who opt out of available coverage.

American Attitudes About Caring for Each Other

Generally, Americans have decided that we will treat sick and injured people who do not have insurance, but that treatment is not free. “So, we have all these schemes for the uninsured, or others to make people buy insurance,” Dr. Goldstein said. “While caring for the sick and injured is laudable, paying for it is another matter, like with the Obama Care mandate.”

Three in ten uninsured adults in 2019 went without needed medical care due to cost. Studies repeatedly demonstrate that uninsured people are less likely than those with insurance to receive preventive care and services for major health conditions and chronic diseases. Not having insurance is generally a financial issue and one that leads to unhealthier people. “With the catastrophic coverage, patients are able to be seen as many practices will not see anyone without insurance,” Dr. Goldstein said. “Paying cash for services and not applying them to the deductible will both save money and result in a healthier population.”

About 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.

Are There Alternatives To Traditional Health Insurance?

Alternatives to Health Insurance

November is health care selection month…

Are There Alternatives To Traditional Health Insurance?

November 16, 2020 — With November the time many Americans are asked to choose their health insurance coverage, the cost, expense, and value are on people’s minds. Are There Alternatives To Traditional Health Insurance? Healthcare is expensive. The healthcare and medical insurance industries are massive with billions of dollars of income. They are able to buy advertising and lobbyists to gain every advantage that money can buy. As Americans try to find ways to pay for it, do any really have any chance of meaningful change for an industry that all but regulates itself? Or should we just resign ourselves to healthcare and insurance companies doing and charging what they want with little if any restriction on them?

Alternatives To Big Insurance

According to Dr. Steven Goldstein, founder of the Houston Healthcare Initiative, there are ways to be insured and save money. As he told his podcast audience, the best alternative to insurance at this time is the healthcare cooperative. The Houston Healthcare Initiative podcast can be heard on SoundCloud, Google Play, Libsyn Feed, Stitcher, iHeartRadio, Spotify, and the Houston Healthcare Initiative web site. When combined with a health savings account and a high deductible, sharing of healthcare costs will go down.

Take Care of Yourself

Of course, the best way to lower costs is to lead a healthy lifestyle. Exercise, diet, limited alcohol consumption, adequate sleep and not smoking are the best ways anyone can be healthier. But for those who refuse these, there should be consequences. “There needs to be consequences for individuals that do not take care of themselves,” Dr. Goldstein told his audience.   “For those that do nothing, laws need to be changed so that care would only be provided at charity hospitals. I know this is a radical change of thinking, but I believe it would go a long way to improving public health. Subsidizing unhealthy behavior only leads to more unhealthy behavior.”

About the Houston Healthcare Initiative Podcast

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.

Compare Democratic and Republican Healthcare Plans and What the Public Can Do About Them

Compare Healthcare By Party

Compare Democratic and Republican Healthcare Plans and What the Public Can Do About Them. The healthcare and medical insurance industries are massive with billions of dollars of income. They are able to buy advertising and lobbyists to gain every advantage that money can buy. To listen to the podcast, click below. 

Do we really have any chance of meaningful change for an industry that all but regulates itself? Or should we just resign ourselves to healthcare and insurance companies doing and charging what they want with little if any restriction on them? On this podcast, with what is a more optimistic point of view is respected Houston based neurologist and founder of the Houston Healthcare Initiative, Dr. Steven Goldstein.

Healthcare reform according to the Democrats is some form of single payer system. According to the Republicans it means more price transparency and more competition between insurance companies. The Democratic reforms will indeed lower healthcare costs by fiat and not cause any appreciable decline of public health. However it also will not improve public health. It will however make individual patients unhappy because of rationing of care. The Republican reforms will have little effect on lowering costs but will avoid the rationing of care. It also will not improve public health. No matter which reforms are adopted patients will be unhappy with the results. Also no legislation will be passed without the blessing of the insurance companies, pharmaceutical companies and hospitals.

What Can The Public Do?

Individuals and companies need to walk away from the insurance system. If enough companies  and individuals leave, the current system will collapse. The best alternative to insurance at this time is the healthcare cooperative. When combined with a health savings account and a high deductible sharing of healthcare costs we can begin to see a gradual reduction in cost. Of course, the best way to lower costs is to lead a healthy lifestyle. This will indeed improve public health. For the medicare age groups, the managed medicare plans lower costs by partial rationing of care combined with encouraging a healthy lifestyle. I do not have the statistics as to whether or not managed medicare plans improve public health.

What About Obamacare?

Didn’t the Affordable Care Act, also known as Obama Care, make more choices for insurance available and penalize people who did not purchase health insurance?Yes, but look what happened to health insurance premiums. They kept rising even faster than before. The subsidies, while allowing more people to be covered by insurance, were a boon to the insurance companies allowing for the increase of premiums and increasing the number of policies sold. This is why the insurance companies and hospitals were in favor of the bill in the first place. We can see the result- higher premiums. Things are worse than they were before. The overall insurance system is flawed in fundamental ways. We are spending time and money to make a bad system work better and that is probably what will happen in the near term.

There needs to be consequences for individuals that do not take care of themselves.             They can subsidize the government insurance by paying the government a higher premium; pay for care themselves or do nothing. For those that do nothing, laws need to be changed so that care would only be provided at charity hospitals. I know this is a radical change of thinking but i believe it would go a long way to improving public health. Subsidizing unhealthy behavior only leads to more unhealthy behavior.