Increased Price Transparency in Health Care — Challenges and Potential Effects | Health Policy and Reform

by Anna D. Sinaiko, Ph.D., and Meredith B. Rosenthal, Ph.D

Slowing the growth of health care costs is critical to the long-term fiscal stability of the United States and is the direct or indirect focus of most U.S. health policy initiatives today. One tactic for reducing spending is to increase price transparency in health care — to publish the prices that providers charge or those that a patient would pay for medical care — with the aim of lowering prices overall. More than 30 states are considering or pursuing legislation to increase price transparency (see table). Most initiatives focus on publishing average or median within-hospital prices for individual services, though information on total and out-of-pocket costs for episodes of care across different sites are available in some markets (e.g., New Hampshire). At the federal level, three bills designed to increase transparency were introduced in Congress in 2010 and attracted some early bipartisan support. In addition, several commercial health insurance plans release information to their members about the prices charged by hospitals and physicians for common services and procedures.

At one level, it’s the wide variation in medical prices within U.S. markets that creates an opportunity for transparency to reduce spending. This variation exists even for relatively common procedures. In New Hampshire in 2008, the average payment for arthroscopic knee surgery was $2,406 with a standard deviation of $1,203 in hospital settings and $2,120 with a standard deviation of $1,358 in nonhospital settings.¹ In Massachusetts, the median hospital cost in 2006 and 2007 for magnetic resonance imaging (MRI) of the lumbar spine, performed without contrast material, ranged from $450 to $1,675.²

Since consumers are generally ignorant of such price differences, publishing price information could both narrow the range and lower the level of prices, in part by permitting consumers to engage in more cost-conscious shopping and select lower-cost providers and in part by stimulating price competition on the supply side, forcing high-priced providers to lower their prices (or accept smaller annual increases) in order to remain competitive. Proponents argue that consumers have price information and compare costs when purchasing just about any other good (imagine buying a car, a house, or a computer without knowing its price) and that health care should be no different.

Health care does differ from other consumer goods in a few important ways, however, that are likely to affect patients’ responses to price information.
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Free Webinars for Consumers: The Mental Health Parity and Addiction Equity Act

SAMHSA's Partners for Recovery Initiative invites you to two free webinars on the new Federal parity law.

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Parity 101  |  February 17, 2011  |  1 to 2 p.m. Eastern Time
The webinar will provide a general overview of MHPAEA and the recently released Interim Final Rule. The webinar, which is directed to consumers, will be presented by health policy experts from the Legal Action Center.
Register for Parity 101 Webinar

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Parity 201  |  March 10, 2011  |  1 to 2 p.m. Eastern Time
The webinar, designed for states and providers, includes a detailed discussion about implementation of MHPAEA. This discussion will provide details on state-level implementation efforts, interplay between the Federal parity law and state parity laws, and anticipated additional pieces of regulatory guidance.
Register for Parity 201 Webinar

Home Equity Conversion Mortgage (HECM) Program

AoA has added a new page to www.aoa.gov that provides information about a new role for Aging Network professionals in working with HUD HECM reverse mortgage holders who may be delinquent with certain property cost payments. 

Beginning in January HECM mortgagees who are delinquent in property cost payments will receive a letter from their lender regarding payment of these costs.  Many of these older mortgagees may turn to the Aging Network for assistance.  This new web page is designed to assist Aging Network professionals in understanding the issue and how they may assist.  Resources available on the web page include background information, summary information, and an FAQ that may be used with consumers.  As new resources become available, the AoA HECM web page will be updated to include them.

The new web page can be found under AoA Programs, Special Projects at http://aoa.gov/AoARoot/AoA_Programs/Special_Projects/index.aspx   

The Health Care Blog: The Myth of Consumer-Directed Health Care

By JANE SARASOHN-KAHN

The theory behind “consumer-driven health care” is that when the health care user has more financial ‘skin in the game,’ they’ll become more informed and effective purchasers of health care for themselves and their families. That theory hasn’t translated into practice, based on data from the Employee Benefits Research Institute’s (EBRI) latest Consumer Engagement in Health Care Survey.

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How to Talk to Your Doctor, Understand Medical Information, Health Literacy - AARP Bulletin

by: Carolyn M. Clancy, M.D in AARP Bulletin

There is a truism in health care: When you don't fully understand or can't act on information about your health care, you are more likely to be in poorer health.

Nearly all of us, about nine of every 10 American adults, have some problems with health literacy.
Health literacy is not only about reading. It's about understanding difficult health terms and issues. Even highly educated people can have trouble understanding health care information.
For example, health literacy plays a role in how well:
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Analysis from the Fifth National Survey of Older Americans Act Service Recipients

Mathematica Policy Research, recently released analysis from the Fifth National Survey of Older Americans Act Service Recipients. The resulting brief confirms that the Administration on Aging (AoA) is effectively reaching those most at risk of institutionalization and that Title III services play an important role in helping elderly adults remain in their community.

To read the brief in its entirety, please go to http://www.aoa.gov/AoARoot/Program_Results/docs/AoA-issue1_Nursing%20Homes.pdf

To learn more about Mathematica Policy Research, please go to http://www.mathematica-mpr.com/

Drug Info Pamphlets Inconsistent from MedPage Today

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By Kristina Fiore, Staff Writer, MedPage Today

The content, formatting, and word count of leaflets pharmacies hand out with medicines are inconsistent and should be subject to FDA guidance, researchers say.

Among written instructions given out with prescriptions of lisinopril (Prinivil, Zestril) and metformin (Fortamet, Glucophage, Glumetza, Riomet), about half failed to include directions on use and raised questions about comprehensibility, Almut G. Winterstein, PhD, of the University of Florida, and colleagues reported in the Aug. 9/23 issue of Archives of Internal Medicine.

"Private sector initiatives to provide useful [consumer medication information] have failed," they wrote. "Research is needed on effective information selection and presentation in terms of effects on comprehension, retention, and appropriate patient actions to derive optimal drug benefit."

The FDA regulates label information and guides that accompany drugs with safety concerns but not the content and format of consumer medication information (CMI) documents. The agency does, however, have a set of eight standards for CMI leaflets:

• State drug name and indication
• List contraindications
• Include directions about use
• Note precautions and potential harms
• List symptoms of possible adverse reactions
• Include general information and encourage patients to ask questions
• Be scientifically accurate
• Be comprehensible and legible

To assess the consistency of these documents, "professional shoppers" filled prescriptions for lisinopril and metformin in a national sample of 365 independent and chain pharmacies.

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"Forced Institutionalization of People With Disabilities Is Illegal" - DOJ and Federal Court Ruling

Steve Gold's Information Bulletin #317 (6/2010)    

By Gail Zoppo - Jun 25, 2010 reprinted from DiversityInc.

The U.S. District Court in Jacksonville, Fla., ruled this week that Michele Haddad must be provided with services that will allow her to stay in her home. Haddad, who has a spinal-cord injury caused by a motorcycle accident with a drunk driver three years ago, was at risk of being forced into a nursing home because of changes in her caregiver situation. Although the 49-year-old woman has been on the waiting list for Medicaid community-based waiver services for two years and had alerted the state of her need, she was told that the requested services would only be available if she was admitted to a nursing home for 60 days.

In Haddad v. Arnold, the plaintiff argued that she would suffer irreparable harm if forced to enter a nursing home.

The court agreed, ordering the state to offer Haddad community-based services. The reason: Segregating people with disabilities is a form of discrimination, as found in Olmstead v. L.C. This landmark disability-rights decision determined that isolating people with disabilities in institutional settings deprives them of the opportunity to participate in their communities, interact with individuals who don't have disabilities and make daily choices. The ruling also acknowledged that unnecessary institutionalization stigmatizes people with disabilities.

The Olmstead decision, which marks its 11th anniversary this week, is not the first such case that the U.S Department of Justice has filed briefs. The DOJ is involved in several other cases in Illinois and New Jersey, as part of its mission to end discrimination against people with disabilities.

"In the Olmstead case, the court recognized that the unnecessary segregation of individuals with disabilities stigmatizes those individuals as unworthy of participation in community life," stated Assistant Attorney General for the Civil Rights Division Thomas E. Perez. "By supporting Ms. Haddad in this case, we seek to ensure that individuals with disabilities can receive services in the most integrated setting appropriate, where they can participate in their communities, interact with individuals who do not have disabilities and make their own day-to-day choices."

The Department of Justice's involvement in these cases reinforce the Obama administration's national efforts to protect the rights of all people.

"This work is a priority for the Civil Rights Division, and we are committed to aggressive enforcement of Olmstead so that we can build upon progress made over the last 11 years," said Perez earlier this week. "But our work is only one piece of a larger, administration-wide effort to make the promise of Olmstead a reality for individuals with disabilities nationwide. Real reform requires a holistic approach. As a lifelong public servant, I recognize that the most vexing problems a government faces are those that require unprecedented interagency collaboration and coordination. The unnecessary and illegal institutionalization of individuals with disabilities who would be better served, and better able to contribute to their communities, if they were provided services in integrated settings, is one of those problems."
   
Disability Advocates:

    Are there Michele Haddad's in your States?

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at
http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. 

To contact Steve Gold directly, write to stevegoldada@cs.com or call
215-627-7100.

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Steve Gold, The Disability Odyssey continues

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Social Security: An Appreciation - The New Old Age Blog - NYTimes.com

By PAULA SPAN

Got a good-news story about the role Social Security has played in your life, your family’s history or your community? The Frances Perkins Center, a young nonprofit organization that honors the first woman to serve in a presidential cabinet (Perkins was the secretary of labor under Franklin Delano Roosevelt) and maintains her family homestead in Newcastle, Me., wants to hear it — or see it.

To mark the 75th anniversary of the Social Security Act, which Roosevelt signed into law in August 1935, the center hopes to collect 1,000 written stories (400 words or less) and short videos (three minutes or less). Most of the stories will appear on the group’s Web site, but some will be collected in a commemorative book to be published in August.

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Consumer Choice Technology Hearing

Tuesday, June 29, 2010  |  8 a.m. to 5:15 p.m.

Grand Hyatt Hotel
1000 H Street, N.W., Washington, DC 20001
Meeting Location: Constitution Ballroom, Constitution Level

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Held by the Privacy and Security Tiger Team, the meeting will be a discussion about technologies that enable consumers to choose whether or not to share their information in a health information exchange. The morning session will be devoted to hearing testimony from current users of these technologies, followed by developer demonstrations.

The afternoon session will feature testimony and demonstrations by developers of "cutting edge" technologies that may, in the future, be useful in the clinical care setting. After both sessions, a panel of experts will ask questions of the presenters. The Tiger Team will also have time to ask questions of the presenters and the experts. The hearing is open to the public, and there will be time in both the morning and afternoon for public testimony and questions. A preliminary agenda (subject to change) and Web registration form are available on the hearing Web site.

Register Now  |  View Agenda   (50.3 KB)  |  Get Hotel Information 

A Consumer Advocacy Group Refutes The Anti-Health Reform Myths – Health Affairs Blog

by Steven Findlay and Lynn Quincy

At long last, health reform legislation appears headed for a series of final votes in the next few weeks. The ultimate outcome in treacherous political waters is uncertain. What should happen, from the perspective of a consumer advocacy organization, is abundantly clear: Congress should pass legislation this year to begin dramatically improving health care access, delivery, payment, and cost management in the United States.

What drives our position is the widely recognized and urgent need of individual consumers and families, the economy, and public health for this reform. There is also one argument we find particularly compelling: virtually every major federal health care program that has been enacted over the last fifty years—from Medicare and Medicaid to COBRA, SCHIP, and the Medicare Part D drug benefit—has improved the health, financial security, and well-being of the U.S. population and, ultimately, has been embraced and supported by the public.

Many of these programs were politically contentious and took years to enact. But today, few people outside Washington and health policy circles remember or care about the political blood on the floor, how many pages the bill was, or the final vote tally. All they know is that they gained new options and benefits. In the end, it’s not about the political process; it’s about programs and policies that make people’s lives better.

We strongly believe that enacting a comprehensive and integrated health care bill this year would unfold in the same way.

Reform opponents have ceaselessly hammered away on several talking points over the last year, ramping up the volume in recent weeks. We’ll take this (hopefully one last) opportunity to quickly address them:
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THE FIRST ANNUAL “EXCELLENCE IN ACTION” AWARDS

On Tuesday, February 23, 2010, the Administration on Aging held its first annual Excellence in Action Awards program to formally acknowledge exceptional work performed during the past year by Aging and Disability Resource Centers (ADRCs), Community Living Programs (CLPs), and Veteran-Directed Home and Community-Based Services programs. The awards were presented at the Administration on Aging/Centers for Medicare & Medicaid Service (CMS) 2010 National Grantee Conference entitled “Changing Systems, Changing Lives.”

Eligible nominees were State Units on Aging (SUAs), Area Agencies on Aging (AAA), Centers for Independent Living (CILs), State Independent Living Councils (SILC), Aging Disability Resource Centers (ADRC), Community Living Programs (CLP) and their partners or networks of these programs. Winners demonstrated exceptional commitment, creativity, leadership and success in achieving goals related to the conference theme.” Awards were given in the following categories:
•Changing Systems Award
•Changing Lives Award
•Exemplary Partnership Award

The 2010 Excellence in Action awardees:

Changing Systems Award - Agency on Aging of South Central Connecticut, New Haven, Connecticut

Changing Lives Award - Central Texas AAA/ADRC & Alamo Service Connection/Bexar Area Agency on Aging

Exemplary Partnership Award - Hawaii County Office on Aging, Hilo, Hawaii

Description of Each Award and Awardee

Bad Investment Advice Can Turn a Free Meal Costly - NYTimes.com

By MILT FREUDENHEIM

While the advisers deny misleading the Johnsons, Mrs. Johnson said she and her husband were not in a position to make well-informed decisions.

“We were frugal but not very smart about money,” she said. “We didn’t have the right knowledge to ask the right questions.”

The Johnsons, who were living on his retirement, lost most of their money. They were hardly alone.

“Financial fraud is the No. 1 consumer protection issue for AARP,” said Andres Castillo, who heads an AARP program that monitors free lunch seminars and similar presentations. In an AARP survey last year of people 55 and older, 9 percent said they had attended a free financial seminar within the last three years. That translates into approximately 5.9 million people, the group said.

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Consumer Focus: Consumer Direction is No Cakewalk « The Future of Aging Blog

by Katie Sloan

If you’re looking for a “hot topic” in the field of long-term services and supports, “consumer direction” is probably the hottest.

Consumer direction is about empowerment. Organizations that support it take great pains to make sure consumers get to decide how they will live their daily lives, what kind of services and supports they will receive and where they will receive them. Sounds simple, right?

Actually, consumer direction isn’t always a cakewalk for the organizations that support it. After all, consumers who direct their own care may want to take risks that make us “experts” uncomfortable. They may thumb their noses at our regimented meal schedules or dress codes. They may want to hire their own caregivers, rather than depending on us to do it for them. And, at the end of life, they may just say “no” to interventions that we think are medically necessary.

Consumer direction isn’t a picnic for consumers either.
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The Potential of Global Payment: Insights from the Field - The Commonwealth Fund

In the 80s and early 90s, health care providers in the managed care world were frequently paid via capitation—that is, a flat fee per patient. Use of the practice has eroded significantly, but experienced provider and plan leaders believe moving to improved models of capitation, called global payment, would result in much better care for all types of patients at more reasonable cost. In researching this report, the author interviewed 16 individuals from four geographic markets with extensive expertise managing capitation and global payment. These experts unanimously supported global payment and estimated that proper alignment of payment and quality incentives could generate a 20 percent to 30 percent cost reduction while greatly improving care quality. They believe it is now possible to resolve problems that plagued capitation in the past, such as avoidance of sicker patients and excessive risk assumption, but that environmental changes have also created new challenges.

Download Report (71 pages)

Elevator-Related Injuries And Older Adults

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from Medical News Today

In the first large-scale epidemiological study of elevator-related injuries in older adults in the United States, researchers from the Indiana University School of Medicine and an Ohio State University colleague report in the January 2010 issue of The Journal of Trauma Injury, Infection, and Critical Care on the frequency, nature and opportunities for prevention of these injuries.

Nearly 120 billion riders enter an estimated 750,000 elevators annually in the U.S. Older adults are more likely to use elevators than stairs or escalators. While elevators are one of the safest forms of transportation, they can pose a real danger for the aging population.

According to U.S. Consumer Product Safety Commission data, approximately 44,870 (about 2,640 annually) elevator-related injuries, severe enough to require a visit to a hospital emergency department, occurred in individuals 65 years and older from 1990 to 2006. Hip fracture was the most common diagnosis for the 14 percent admitted to the hospital.

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Designing Easy-To-Use Products With The Help Of Arthritis Simulation Gloves

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from Medical News Today

As the U.S. population ages, manufacturers of consumer goods are realizing that many customers may not be as nimble-fingered or sharp-sighted as they once were. To help product designers and engineers address those changing requirements, researchers at the Georgia Tech Research Institute (GTRI) have been developing evaluation methods and design techniques to identify and address the needs of all consumers, including those with functional limitations.
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Person-Centered Care: An Important Approach for 21st Century Health Care

Journal of Psychosocial Nursing and Mental Health Services Vol. 41 No. 11 November 2003

EXCERPT

Two recent Institute of Medicine (IOM) reports have moved person-centered care to the top of the list of priorities for the American health care system.Crossing the Quality Chasm (Institute of Medicine Committee on Quality of Health Care in America, 2001) identified a patient-centered approach as essential for achieving the quality of care desired by Americans. The second report, Improving the Quality of Long-Term Care (Wunderlich & Kohler, 2001), cited consumer-centered care as a working principle or value to guide provision of care and services in all types of long-term care settings, including nursing homes, assisted living facilities, adult care homes, and home care. These important works bring the individuals receiving health care into the team as important collaborators.
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Adding and Sustaining Consumer Direction in Aging Network Programs

Adding and Sustaining Consumer Direction in Aging Network Programs:

Challenges, Insights, and Successes

Tuesday, December 15, 2009 3:00-4:30 PM (EST).

This webinar is available to all Aging Network administrators and staff. It provides a brief overview of consumer direction: comparisons to traditional services, and research results; but, the majority of the content focuses on the use of consumer direction in current aging network programs. A panel of aging network staff and a consumer will discuss their experiences with consumer direction, common challenges and solutions, and the current status of their programs.

The webinar will also tour helpful websites and electronic resources. A comprehensive Resource Guide filled with additional tools and detailed information is available to accompany the webinar.

To sign up for the webinar go to: www.bc.edu/schools/gssw/nrcpds/aoawebinar.html

Finance Bill’s Fine Print May Cause Sticker Shock For Some Consumers - Kaiser Health News

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By Julie Appleby, KHN Staff Writer

Proponents of the Senate Finance Committee’s health care bill say the legislation will limit the amount that lower- and middle-income people must pay for health insurance to a maximum of 12 percent of their incomes.

But there’s a catch: The fine print shows that, over time, the premium costs could rise well beyond those caps. That’s because the cost of coverage would shift from a percentage of income to a percentage of the premium, no matter how high the premiums go.
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