JustCare

Tag: Hospitals

  • Three steps to prepare for an at-home emergency

    Three steps to prepare for an at-home emergency

    Jancee Dunn reports for the New York Times on how to prepare for an at-home emergency. When the ambulance arrives, in many instances, speed can be life-saving. If you or someone you love has suffered a heart attack or stroke, your brain can suffer irreparably within minutes.

    How to get emergency services at home: Sometimes, you’ll have to call 911. But, sometimes, you’ll be able to contact the ambulance company directly. So, before any emergency arises, contact the hospital you’d want to be admitted to in an emergency to learn which ambulance company you should use to get there, write down the company’s name and phone number and put it in a safe place.

    Keep your costs down: Double-check with your insurer that your health insurance will cover that ambulance.

    Keep in mind that hospital emergency rooms are not equal. Some are far better than others. Make sure you choose an emergency room that will meet your needs.

    If you call 911, let the ambulance company know the hospital you want to be taken to. The ambulance generally will take you to the nearest hospital. But, if you live in a city, there might be several hospitals within a short distance. If so, the ambulance should be able to take you to the hospital of your choice.

    Three steps to prepare for a trip to the ER:

    1. Put together your personal information–your name, birthdate and information about your health, including your blood type, the medications you are taking. Share the document with family and friends.
    2. If you’re home alone, make sure that your personal and health information is easy for a stranger to locate. Tape it to your front door. Enter it on your mobile phone medical ID page. Medical ID information does not require a password to access.
    3. If an ambulance is coming to your home, if possible, unlock the front door so it’s easy to enter.

    Here’s more from Just Care:

  • Why can’t people know their health care costs before receiving care?

    Why can’t people know their health care costs before receiving care?

    Health care should not be a commodity; it should be a right. But, so long as our country treats health care like a commodity, people should be able to know what they’ll be charged before receiving health care. Instead, it feels as if hospitals and physicians can make up their charges and insurers can make up what they cover; patients have little choice but to pay what they are billed or end up in medical debt.

    At a recent Senate hearing, policy experts explained why the current health care system isn’t working. Hospitals are supposed to post their prices, but many still don’t and, honestly, it probably would be of no help to patients if they did. The issue is not simply the costs of different services, but which services are delivered, over both of which patients have little control.

    The only solution for protecting people against high health care costs is an all-payer rate-setting system with regulated prices and public health insurance that covers them. Medicare for all. Once corporate insurers are in the mix and hospitals and physicians can charge what they please, as we know, your health care costs can be through the roof.

    The Senate Special Committee on Aging heard from witnesses about how impossible it is for patients to shop for health care effectively. Senator Mike Braun called provider behavior monopolistic. But, his solution, explained in a report, is simply for more price transparency, which will never address the problem of high prices.

    Hospitals also now get away with charging “facility fees,” which can be super high and are always unpredictable. Moreover, consolidation in the health care space is driving up prices, without any evidence of improved quality of care. But, Congress remains unwilling to address health care costs in a meaningful way.

    Congress did cap prescription drug costs for people with Medicare Part D at $2,000 a year beginning in 2025. But, that legislation continues to allow pharmaceutical companies to charge what they will for their prescription drugs. That’s not a meaningful solution. It will drive up Part D premiums further.

    For their part, hospitals argue that they need to increase prices because insurers too often refuse to pay them for the services they deliver. In addition, many patients can’t afford to pay their hospital bills, so hospitals are forced to absorb the cost of the services they deliver.

    Here’s more from Just Care:

  • Do you qualify for hospital charity care?

    Do you qualify for hospital charity care?

    Back in October 2021, I wrote a post for Just Care on how to lower your hospital costs if your income is low. Many people who qualify for charity care are unaware that they might qualify for a free or low-cost hospital care under a hospital’s policy. If you are able, before going to the hospital, find out whether it offers charity care, and, if so, who qualifies and whether any physicians are excluded from their charity care policy.

    The Affordable Care Act requires non-profit hospitals to offer charity care to people with low incomes. They might reduce their charges or, in some cases, cancel them altogether if your income is below a certain level. But, most people don’t know about this requirement, and hospitals don’t often tell you about it.

    Since it became law, many nonprofit hospitals have made it a lot more difficult for people struggling to pay for their hospital care to get charity care. Moreover, some physicians who provide you care at the hospital might not be covered under the hospital’s charity care policy, reports Filipa Carvalho for the Lown Institute. However, hospitals must disclose their financial assistance policy (FAP), including which physicians are covered and which are not.

    If your income is low, it’s wise to ask your hospital about its policy for providing charity care and for an application before you are admitted to the hospital. You might want to see about using a different hospital if it appears that it will be challenging to get charity care.

    When using a hospital offering charity care (a non-profit hospital), even if your income is higher than the hospital’s income limit, you should still apply, if paying the bill will put you in medical debt. You have 240 days from receiving a hospital bill to apply, and it could save you thousands of dollars.

    If the hospital sends a collection agency after you, call the hospital and let the staff know you are applying for charity care and you’d like them to stop the collection agency from trying to get you to pay.

    Here’s more from Just Care:

  • Is Medicare’s Hospital at Home program here to stay?

    Is Medicare’s Hospital at Home program here to stay?

    Since the Covid-19 pandemic, Medicare has been paying hospitals to treat patients at home, instead of in hospital, under its Hospital at Home program. Medicare pays hospitals the same rate for the care of these patients as it pays for hospital patients, including a facility fee. But, is the Hospital at Home program delivering benefits to patients?

    Under the Hospital at Home program or H@H, patients with 60 acute conditions, such as pneumonia, urinary tract infections or congestive heart failure can sometimes opt to get their hospital care at home, reports Richard Eisenberg for Fortune. The goal of H@H is to provide a more comfortable and safer care environment to patients. Patients are prone to fall in the hospital as well as to experience delirium.

    H@H has been around a long time both in and outside the United States, but it is only recently that Medicare has adopted it. Hospitals appear to value the hospital at home program for people with Medicare. After all, they are generating the same revenue through the program that they would receive if patients were in hospital, without the facility costs.

    But, unless Congress acts, the program will end in December of this year. The American Hospital Association is arguing for a five-year extension of the program. It offers little data to demonstrate the value of the program.

    Congress is likely to extend Medicare’s Hospital at Home program another five years even though there’s no good data to show better patient outcomes from the program and it is not saving the Medicare program any money, reports Jessie Hellmann for Roll Call.

    The Medicare Payment Advisory Commission reports that the program is not structured to deliver meaningful information on health outcomes and costs or to allow comparisons between patients treated at home and patients treated in a hospital facility. It wonders whether patients in the program are falling less frequently than patients in the hospital and whether they are experiencing fewer infections.

    How does the Hospital at Home program work? Hospitalized patients at participating hospitals can decide whether they want H@H. Generally, they are in need of four or five more days of hospital care. Participating hospitals are required to send clinicians to your home twice every day. A physician must “see” the patient each day as well, though the physician can do so remotely. Patients must be able to reach the hospital 24 hours a day. And hospitals must be able to respond to patient emergencies within 30 minutes,

    Among other things, H@H can provide IV antibiotics and infusions to patients at home. They can receive EKGs and X-rays. The hospital can monitor their blood pressure. And, they can get oxygen therapy.

    The program is still relatively small. Since its inception, just 328 hospitals in 37 states have participated, and 23,000 patients have been discharged from hospital into the program.

    National Nurses United does not support the H@H program. It calls it “Home All Alone.” Indeed, people can be sent home for their hospital care without a caregiver to be with them. That leaves them without the round-the- clock nursing care they receive in the hospital. And, what if the remote monitoring technology misfunctions or there’s an emergency and the patient can’t get the prompt attention that’s needed?

    Here’s more from Just Care:

  • Save money, avoid hospital-owned outpatient facilities

    Save money, avoid hospital-owned outpatient facilities

    One of the ways hospitals are generating more revenue is through ownership of doctors’ practices, outpatient surgical clinics and diagnostic centers. Hospitals can charge far higher fees for care you receive at these hospital-owned providers, even though they have no evident tie to the hospitals. You literally can save thousands of dollars on an outpatient service by seeing physicians who are not part of a hospital system; Medicare could save billions by paying outpatient facilities the same rate as independent facilities.

    What’s going on? Hospitals are permitted to add a “hospital facility fee,” to your doctors’ charges or the charges at an outpatient facility that they own. The hospitals consider these facilities “outpatient hospital departments.” And, the charges can be $154.52 for a visit to the doctor to get a flu test or $15,000 for some services at some hospitals, reports Jessica Glenza for The Guardian.

    United States of Care, a non-profit organization, just released a report, Behind the Bill, on these hospital upcharges. It’s one way that consolidation in the health care sector is driving up costs.

    The American Hospital Association (AHA) supports facility fees and has helped to ensure they remain part of a patient’s bill at an outpatient facility owned by a hospital. The AHA argues that hospitals have a lot of unfunded costs, such as emergency room care they provide, regardless of whether patients are insured. The facility fee helps offset these costs.

    As recently as two years ago, more than four in ten doctors were connected with a hospital. A decade earlier, three in ten doctors had hospital ties. Charges for physician services keep rising. One researcher found that hospitals charge 150% more for the same outpatient services as ambulatory surgical centers in the same region that are not hospital-owned.

    Another study found that when a physician group merged its practice with a hospital, charges increased 14.1 percent on average. But, don’t think you can predict them; no one discloses them. They depend entirely on the hospital adding them to the bill and bear no relation to the cost of a service. 

    Medicare payment policy has fueled hospitals’ purchase of outpatient facilities. Medicare pays the same price for a service performed in hospital as in an outpatient facility owned by a hospital, even though the outpatient facility service should cost a lot less. Though some in Congress want to address this issue, nothing has been done to date.

    The AHA blames insurers for health care cost increases. But, hospitals are also responsible. Politics clearly has kept Medicare from adjusting its payments for outpatient services at facilities owned by hospitals down to the same level as it pays for outpatient services at facilities that are independent.

    Here’s more from Just Care:

  • Want surgery? Some hospitals make you pay upfront

    Want surgery? Some hospitals make you pay upfront

    Melanie Evans reports for the Wall Street Journal on the rise of hospitals requiring patients to pay upfront  for their surgery. In one case, a hospital wanted $2,000 from a patient’s mother. It said it would postpone her daughter’s surgery if she could not come up with the money. While the patient is insured, she has a high deductible so her insurance would not cover the treatment.

    The good news: If you have Medicare, you should never have to pay upfront for your care. Upfront payment issues are greatest for insured Americans with high-deductible health plans. That said, one recent study by the Consumer Financial Protection Bureau found that older adults owe $54 billion in medical debt.

    Paying upfront is a challenge for millions of working Americans. In a Kaiser Family Foundation survey, half of adults said they could not pay an unexpected bill for $500 for their care without having to borrow money. GoFundMe is too often a solution. People do not have enough savings.

    Some hospitals have essentially flipped the way they do their billing. Rather than waiting until after a procedure to bill a patient, they are refusing to perform the procedure without a payment in advance. They don’t want to be dealing with patients who won’t or can’t pay the bill after they have been treated.

    Many people are in a bind, without the money they need to get care for themselves and their families. Sometimes they must delay critical care. Other times they find that the hospital overcharged them and need to spend their time getting the refunds they are due.

    People giving birth, needing knee replacements and CT scans are increasingly being asked to pay in advance for these services.

    Which hospitals are requiring these upfront payments? It appears that hospitals owned by UnitedHealth are among them. While hospitals cannot turn away patients who need emergency care, they can refuse to treat people needing elective care.

    Today, hospitals collect nearly a quarter (23 percent) of patient bills in advance of treatment. That’s up from one fifth (20 percent) just two years ago.

    Hospitals do not want to be forced to write off debt. And, even patients with insurance today are not able to cover their costs. Advance payments are how hospitals are getting around this issue to the detriment of many patients and their families.

    Some claim the benefit to these upfront charges is that they let the patients know their costs so that they can possibly comparison shop. That is generally an impossible task, as it can mean switching doctors or traveling too great a distance to get needed care.

    Before you pay a hospital bill upfront:

    • Ask about other options. Non-profit hospitals must offer charity care for people who can’t afford to pay. Dollar For is a non-profit that can assist you in getting charity care.
    • If the cost is high, ask whether there is a way to pay a lower price or to pay in installments with no interest.

    Here’s more from Just Care:

  • Hospitals delay care for older adults in ERs, causing them needless harm

    Hospitals delay care for older adults in ERs, causing them needless harm

    Judith Graham reports for KFF Health News on the plight of older adults in hospital emergency rooms. Hospitals often keep older adults in their ERs for extended periods before getting them admitted to the hospital. Hospitals could benefit financially from these delays, but patients can suffer.

    The evidence shows that older adults often can wait more than a day to be admitted to the hospital, although their doctors have recommended a hospital admission long before. In the ER, patients often are not getting their care needs met. They are prevented from moving much, and they are usually not well fed or hydrated.

    The problem is only getting worse, according to ER physicians. And, older adults appear to be kept in ERs longer than most other people. But, there’s little data to understand how common ER boarding is and which hospitals are the worse offenders. Hospitals do not need to report this data. It’s also not clear which hospitals do not have adequate space for patients.

    Why are some people spending so much time in ERs? In some cases, hospitals are short-staffed. In other cases, people needing care that is highly profitable get preferential treatment and are moved out more quickly than those who need less profitable care. In still other cases, hospitals don’t have enough beds because they are unable to discharge patients for home health care or to a nursing facility as quickly as they should be able to.

    In an ER, older adults can quickly see their conditions worsen. They lose muscle from sitting or lying all day. They may not be taking their medicines. They may become delirious.

    Unnecessary stays in the ER can mean longer hospital stays and more health issues for older adults. Patients generally don’t get proper care in the ER, except to address an immediate crisis. They can fall, get hospital-acquired infections, bedsores and worse. They are more likely to die in the hospital if they spend the night in the ER needlessly.

    What to do if you’re admitted to the ER? Don’t go alone. Make sure you have a family member or friend or caregiver with you to speak out on your behalf, ensure you are fed properly, and otherwise well cared for. Bring a list of your medicines and bring a bag with the medicines you take, if possible.

    Also, protect yourself against delirium. Bring your hearing aids and glasses to avoid being disoriented and some food and drink. If you can get up and move around, do so.

    Here’s more from Just Care:

  • UnitedHealth care delays, denies and grows ever bigger

    UnitedHealth care delays, denies and grows ever bigger

    At the same time that UnitedHealth is growing its Medicare Advantage business, it is growing many of its other businesses and controlling a sizeable portion of the health care sector, often to the detriment of patients and providers. Dan Diamond, Christopher Rowland and Daniel Gilbert report for the Washington Post on the attention Congress is now giving to UnitedHealth. Will Congress rein in UnitedHealth and hold it accountable for its bad acts. Can the federal government break up UnitedHealth at this point, or is it too big to fail?

    Chairman Ron Wyden, who heads the Senate Finance Committee, is holding a hearing with Sir Andrew Witty, UnitedHealth’s CEO. United is now a $400 billion company, with $22 billion in profits in 2023, and the biggest health insurer, as well as the biggest employer of physicians in the US; it employs about 10 percent of providers. It also processes about a third of provider claims for reimbursement through its Change Healthcare subsidiary. Recently, its cybersecurity system was hacked, and UnitedHealth forced tens of thousands of physicians and hospitals to go without pay; some providers were forced to take out loans and some patients had to pay out of pocket for care.

    It is not at all clear why UnitedHealth did not address grave gaps in Change Healthcare’s security when it acquired the company a few years ago. Nor is it clear that UnitedHealth is holding anyone at the corporation accountable for this failure.

    How can Congress help ensure UnitedHealth appropriately covers care and coverage and hold the corporation account when it fails to do so? In the words of Don Berwick, former head of the Centers for Medicare and Medicaid Services, “They’ve grown too big for this country’s good, and for their own good.” “They became the best at playing the game of charging the federal government more and using that wealth to gain political power, advertising power, some changes in benefits.” Some say UnitedHealth presents an economic and national security risk.

    Republicans and Democrats agree that the size and power of UnitedHealth raises serious concerns. Senator Wyden, a Democrat, wants Witty to explain his company’s use of prior authorization, which too often keeps people from getting needed care. He is concerned with the ways UnitedHealth increases health care costs. Congressman Buddy Carter, a Republican, says “It needs to be busted up.” Here, here!

    The Justice Department has tried to prevent some of UnitedHealth’s mergers and acquisitions, but UnitedHealth has put up legal challenges and tends to prevail. Hayden Rooke-Ley, a senior fellow at the American Economic Liberties Project, an antitrust-focused nonprofit, explains the consequences: “What we are seeing now is there are really significant risks of letting a company like United own a physician group, ambulatory surgical centers, a mail order pharmacy, home health providers … and claims processing and revenue cycle management.”

    The fact remains that a number of Democrats and Republicans receive significant campaign contributions from UnitedHealth, which they depend upon. Moreover, many policymakers receive veiled threats from UnitedHealth if they don’t support the corporation. For now, you can expect UnitedHealth to grow and our healthcare system to remain at serious risk of higher costs and inappropriate denials of care as a result.

    Here’s more from Just Care:

  • What’s happening to our hospitals?

    What’s happening to our hospitals?

    Small independent hospitals are being acquired by large hospital systems across the US or, worse still, they are shutting down. What does that mean for the future of hospitals and for their patients? Little, if anything, good. Caitlin Owens reports for Axios on what some experts are saying about the US hospital system.

    Many experts believe that there will be fewer hospitals and that people in remote areas will have to travel further to get hospital care. That seems evident. In the last several years, many small rural hospitals have closed. They have been losing too much money. Or, they have been acquired by larger hospital systems.

    Already, a lot of hospital systems have stopped providing care that they determine is not profitable, such as maternity care. Some hospitals have been forced to close other departments, if not to close altogether. Their physicians and staff do not have enough work. They cannot afford to support a small local population.

    Many hospitals are struggling because insurers offering Medicare Advantage plans are denying critical care and not paying hospital bills after treatments have been provided.

    Many experts are deeply concerned about all the hospital consolidation. They want to see some hospitals providing basic care and other hospitals providing specialty care. If this were the case, many patients would have to travel a lot further to receive hospital care.

    Hospitals serving the most vulnerable patients and that rely on government support for their services are at particular risk of closing down. These at-risk patients could find it even harder to get care than they already do.

    Hospitals should not be focused on profits but on patient care. What will it take to return to hospitals putting patients first?

    Here’s more from Just Care:

  • Want to live longer? See a doctor who’s female

    Want to live longer? See a doctor who’s female

    A new study finds that women live longer when they see female doctors. This study adds to a body of research that finds women and minorities who see female doctors have better health than their counterparts, reports Liz Szabo of NBC News.

    The study published in the Annals of Internal Medicine found that women who are hospitalized are more likely not to face a hospital readmission and not to die within 30 days of hospital discharge if they are being treated by a female doctor.

    The study looked at almost 800,000 hospitalized people with Medicare who were over 65. A statistically significant higher percentage of them died within 30 days if they were treated by a male doctor than if they were treated by a female doctor, 8.38 percent v. 8.15 percent. That difference amounts to 5,000 lives that could be saved.

    Of note, the gender of the doctor did not affect the lives of men who were hospitalized or their readmission to the hospital. Women and minorities have been found to get worse medical care than white men from male physicians.

    It’s not clear why women fare better when they are treated by female doctors. But, it could be that women are better able to communicate with female doctors. There is less likelihood of misunderstanding and bias and of having pain and other symptoms overlooked.

    Another study found that women and people of color who see male doctors have between a 20 percent and 30 percent greater likelihood of misdiagnosis than white men.

    This Just Care post reports on several studies showing that people who see female doctors appear to have better health outcomes. The research suggests that female doctors might be better listeners and hew more closely to clinical guidelines. A 2016 Harvard study looked at 1.5 million Medicare patients who were in hospital. They found that the male and female patients who had female doctors had a reduced risk of death as well as a reduced likelihood of being rehospitalized after discharge than patients treated by male doctors.

    Here’s more from Just Care: