Kaiser settled 2014 patient-dumping class-action suit earlier this year

Michael McCough
The Sacramento Bee
Originally posted December 20, 2018

Kaiser Foundation Health Plan recently settled a 2014 class-action lawsuit stemming from two allegations that it dumped patients with severe mental illness.

Plaintiffs Douglas Kerr and Barbara Knighton alleged that in separate incidents, Kaiser psychiatrists told them their sons needed to be transferred to locked residential facilities called IMDs (institutions for mental disease) for treatment, according to court documents. Knighton and Kerr claimed they were both told they should remove their children from their Kaiser health plans in 2014 to be transferred to these county-run institutions — a change that shifted the costs of treatment from Kaiser to government-funded programs such as Medi-Cal.

Despite the settlement, Kaiser said in a statement it continues to dispute some of the claims included in the lawsuit.

“In certain relatively rare cases, Kaiser Permanente members entered a specialized type of locked mental health facility that often preferred Medi-Cal coverage to private insurance,” Kaiser Vice President of Communications John Nelson said in an emailed statement. “In some of these cases, cancellation of Kaiser Permanente coverage was required to enter the facility. However, this was not Kaiser Permanente’s requirement, and we cover many members’ care at such facilities. Any decision to cancel coverage was made by a court-appointed conservator.”

The info is here.

Health Insurers Are Vacuuming Up Details About You — And It Could Raise Your Rates

Marshall Allen
ProPublica.org
Originally posted July 17, 2018

Here are two excerpts:

With little public scrutiny, the health insurance industry has joined forces with data brokers to vacuum up personal details about hundreds of millions of Americans, including, odds are, many readers of this story. The companies are tracking your race, education level, TV habits, marital status, net worth. They’re collecting what you post on social media, whether you’re behind on your bills, what you order online. Then they feed this information into complicated computer algorithms that spit out predictions about how much your health care could cost them.

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At a time when every week brings a new privacy scandal and worries abound about the misuse of personal information, patient advocates and privacy scholars say the insurance industry’s data gathering runs counter to its touted, and federally required, allegiance to patients’ medical privacy. The Health Insurance Portability and Accountability Act, or HIPAA, only protects medical information.

“We have a health privacy machine that’s in crisis,” said Frank Pasquale, a professor at the University of Maryland Carey School of Law who specializes in issues related to machine learning and algorithms. “We have a law that only covers one source of health information. They are rapidly developing another source.”

The information is here.

Feds probing psychiatric hospitals for locking in patients to boost profits

Beth Mole
Ars Technica
Originally published May 24, 2017

At least three US federal agencies are now investigating Universal Health Services over allegations that its psychiatric hospitals keep patients longer than needed in order to milk insurance companies, Buzzfeed News reports.

According to several sources, the UHS' chain of psychiatric facilities—the largest in the country—will delay patients' discharge dates until the day insurance coverage runs out, regardless of the need of the patient. Because the hospitals are reimbursed per day, the practice extracts the maximum amount of money from insurance companies. It also can be devastating to patients, who are needlessly kept from returning to their jobs and families. To cover up the scheme, medical notes are sometimes altered and doctors come up with excuses, such as medication changes, sources allege. Employees say they repeatedly hear the phrase: “don’t leave days on the table.”

The Department of Health and Human Services has been investigating UHS for several years, as Buzzfeed has previously reported. UHS, a $12 billion company, gets a third of its revenue from government insurance providers. In 2013, HHS issued subpoenas to 10 UHS psychiatric hospitals.

But now it seems the Department of Defense and the FBI have also gotten involved.

The article is here.

Merge Away!!!

By Art Caplan
The Health Care Blog
Originally posted September 14, 2015

Here is an excerpt:

The Times and every other commentator who has weighed in including the AMA has warned that diminished competition is not good for taxpayers or consumers. They want the Justice Department to take a long hard look at these latest mergers to insure that consumers are not stuck with higher premium costs as many parts of the country turn into markets with only one insurance provider.

The critics are wrong. Blocking these deals is a terrible idea. The mergers should be allowed to continue. In fact they should proceed until there is only one private insurer left. Only, at that point should the government step in, declare the last company standing to be required to merge with Medicare thereby letting the free market produce what many reformers have only been able to dream of—a single payer system.

The entire article is here.

Doctors Tell All—and It’s Bad

By Meghan O'Rourke
The Atlantic
Originally published October 14, 2014

Here is an excerpt:

But this essay isn’t about how I was right and my doctors were wrong. It’s about why it has become so difficult for so many doctors and patients to communicate with each other. Ours is a technologically proficient but emotionally deficient and inconsistent medical system that is best at treating acute, not chronic, problems: for every instance of expert treatment, skilled surgery, or innovative problem-solving, there are countless cases of substandard care, overlooked diagnoses, bureaucratic bungling, and even outright antagonism between doctor and patient. For a system that invokes “patient-centered care” as a mantra, modern medicine is startlingly inattentive—at times actively indifferent—to patients’ needs.

To my surprise, I’ve now learned that patients aren’t alone in feeling that doctors are failing them. Behind the scenes, many doctors feel the same way. And now some of them are telling their side of the story. A recent crop of books offers a fascinating and disturbing ethnography of the opaque land of medicine, told by participant-observers wearing lab coats. What’s going on is more dysfunctional than I imagined in my worst moments. Although we’re all aware of pervasive health-care problems and the coming shortage of general practitioners, few of us have a clear idea of how truly disillusioned many doctors are with a system that has shifted profoundly over the past four decades. These inside accounts should be compulsory reading for doctors, patients, and legislators alike. They reveal a crisis rooted not just in rising costs but in the very meaning and structure of care. Even the most frustrated patient will come away with respect for how difficult doctors’ work is. She may also emerge, as I did, pledging (in vain) that she will never again go to a doctor or a hospital.

The entire article is here.

Kentucky’s Rush Into Medicaid Managed Care: A Cautionary Tale For Other States

By Jenni Bergal
Kaiser Health News, in conjunction with the Washington Post
Originally published July 15, 2013

Here is an excerpt

Ever since Kentucky rapidly shifted patients from traditional Medicaid to private health plans that manage their care for a set price, problems have been widespread.

Patients complain of being denied treatment or forced to travel long distances to find a doctor or hospital in their plan’s network. Advocates for the mentally ill argue the care system for them has deteriorated. And hospitals and doctors say health plans have denied or delayed payments.

Experts warn that what happened in Kentucky should be a cautionary tale for other states that rush to switch large numbers of people in Medicaid, the state-federal program for the poor and disabled, to managed care in hopes of cutting costs and improving quality. Nearly 30 million Americans on Medicaid now belong to a private health plan, as states move away from the traditional program that paid doctors and hospitals for each service they provided.

The entire story is here.

Poor Prognosis for Privacy

By Melinda Beck
The Wall Street Journal
Originally published May 1, 2013

The sharing of Americans' health information is set to explode in coming years, with millions of patients' medical records converted to electronic form and analyzed by health-care providers, insurers, regulators and researchers.

That has prompted concerns over privacy—and now, new federal rules that aim to give patients more control over their information are posing technical and administrative problems for the doctors and hospitals that have to implement them.

Information-technology experts say the challenges illustrate how difficult it may be to protect sensitive patient information as digitization of the health-care industry expands.

"The reality is, our ability to exchange electronic information is already well beyond our ability to control it," says John Leipold, CEO of Valley Hope Technology in Norton, Kan., which makes electronic record systems for behavioral-health providers.

The new rules are part of a revision of the 1996 Health Insurance Portability and Accountability Act, known as HIPAA. They went into effect in March, but providers have until Sept. 23 to comply.

One key new provision requires doctors and hospitals not to disclose medical information to a patient's insurer if the patient requests it and pays for the services out-of-pocket. The information can be noted in the patient's medical file, but stopping it being revealed to insurers inadvertently may be difficult, some health-care providers say.

The entire story is here.

You will likely hit a pay-wall for this story.

Proof That Obamacare 'Rate Shock' Is An Ugly Insurance Company Deception

By Rick Unger
Forbes - Op Ed
Originally published on March 26, 2013

Over the past few months, the nation’s largest health insurance companies have been hard at work selling a narrative claiming that the Affordable Care Act is about to result in dramatically larger premium costs for a significant number of Americans. Indeed, the warnings have become so worrisome that the massive increases they are predicting have taken on a frightening descriptor all its own—rate shock.

At the heart of the health insurers’ retelling of the Chicken Little story is a regulation promulgated by the Department of Health and Human Services a few months back limiting what a health insurer can charge a 64 year old to three times what they charge a 21 year old. Currently, the average bump for older participants is typically five times that of the younger customers—although there are examples where the increase can reach ten times what is paid by the young immortals buying coverage.

As a result of the lower premium prices that will be paid by older participant, the expectation—one created by the large insurance companies—is that the youngest participants will have to pay significantly more to make up the difference.

Now, The Urban Institute—an organization so clearly bi-partisan that even the most suspicious partisan would encounter extreme difficulty making a case for bias—is out with a study that states that the ‘rate shock’ argument is “unfounded”, particularly when applied to the millions of Americans in the individual market.

The entire Op Ed is here.

The study debunking the "rate shock" rumor is here.

Bitter Pill: Why Medical Bills Are Killing Us

By Steven Brill
Time: Health & Fitness
Originally published February 20, 2013

Here are some excerpts:

I got the idea for this article when I was visiting Rice University last year. As I was leaving the campus, which is just outside the central business district of Houston, I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.

When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.

Yet those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?

What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?

The entire story is here.

Dealing With Doctors Who Take Only Cash

By PAUL SULLIVAN
The New York Times
Originally published: November 23, 2012

Here is an excerpt:

The next day, he drove an hour from Brooklyn to our house. He then spent an hour and a half talking to us and examining our daughter in her nursery. He prescribed some medicine for her and suggested some changes to my wife’s diet. Within two days, our baby was sleeping through the night and we were all feeling better.

The only catch was this pediatrician did not accept insurance. He had taken our credit card information before his visit and given us a form to submit to our insurance company as he left, saying insurance usually paid a portion of his fee, which was $650.

A couple of weeks later, our insurance company said it wouldn’t pay anything. Here’s how the company figured it: First, it said a fair price for our doctor’s fee was $285, about 60 percent less, because that was the going rate for our town. Then, it said the lower fee was not enough to meet our out-of-network deductible.

While we were none too happy with the insurance company, we remained impressed by the doctor: he had made our baby better and was compensated for it, all the while avoiding the hassle of dealing with insurance.

Last year, I wrote about doctors who catered only to the richest of the rich and charged accordingly. But after my experience, I became interested in doctors for the average person who take only cash. What pushes a doctor to go this route, often called concierge medicine? And how hard is it to make a living?

The entire story is here.

Health Care Flaws

To the Editor:

Originally published August 27, 2012

Re “A Reluctant Crash Course in Health Insurance 101” (The Agenda, Aug. 21): Suleika Jaouad’s dispassionate account of the added burdens imposed by our fragmented system of health insurance on those unfortunate individuals who become sick is powerful in its lack of sentimentality. With an unconscionable 45,000 excess deaths a year due to lack of health insurance, we remain the only country in the world where getting seriously ill or hurt, as if that weren’t bad enough, significantly increases one’s risk for financial ruin — even with health insurance. More than half of personal bankruptcies in the United States result from medical bills, and of those, 75 percent of the cases are people who had medical insurance when they got sick or injured.

Until the for-profit health insurance industry is replaced by a single-payer national health insurance program, Americans will continue to suffer and die for the sake of excessive corporate salaries and shareholder profits.

Elaine Fox, M.D.

Southampton, N.Y.

Good News for Mental Illness in Health Law

By Richard A. Friedman, MD
The New York Times
Originally published July 9, 2012

Americans with mental illness had good reason to celebrate when the Supreme Court upheld President Obama’s Affordable Care Act. The law promises to give them something they have never had before: near-universal health insurance, not just for their medical problems but for psychiatric disorders as well.

Until now, people with mental illness and substance disorders have faced stingy annual and lifetime caps on coverage, higher deductibles or simply no coverage at all.

This was supposed to be fixed in part by the Mental Health Parity and Addiction Equity Act of 2008, which mandated that psychiatric illness be covered just the same as other medical illnesses. But the law applied only to larger employers (50 or more workers) that offered a health plan with benefits for mental health and substance abuse. Since it did not mandate universal psychiatric benefits, it had a limited effect on the disparity between the treatment of psychiatric and nonpsychiatric medical diseases.

The entire story is here.

For Hospitals and Insurers, New Fervor to Cut Costs

By Reed Abelson
The New York Times - Health
Originally published May 23, 2012

Giselle Fernandez is only 17 but she has had more than 50 operations since she was born with a rare genetic condition. She regularly sees a host of pediatric specialists, including an ophthalmologist, an endocrinologist and a neurologist at UCLA Health System.

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After years of self-acknowledged profligacy, hospitals, doctors and health insurers say there is a strong effort under way to bring medical costs under control. Their goal is to slash the rate of growth in the nation’s $2.7 trillion health care bill by roughly half to keep it more in line with overall inflation.

Private insurers, employers and government officials are providing urgency to these efforts, and the federal health care law passed two years ago helped accelerate them.

Even if the Supreme Court decides next month to declare the entire law unconstitutional, many experts in the field say the momentum is likely to continue.

The entire story is here.

Individual Health Policies Fall Short, a Study Finds

By Reed Abelson
The New York Times - Health
Originally published May 23, 2012

More than half of all medical insurance policies sold to individuals now fail to meet the standards of coverage set by the federal health care law under review by the Supreme Court, a new study says.

Even if the law is upheld, employer-provided insurance plans are likely to continue to be more generous, but the law would significantly improve the quality of coverage for individuals in several ways, the researchers concluded.

Insurers would be required, for example, to limit how much people pay toward their own medical bills, even if they have a chronic and expensive condition. Insurers would also have to provide a comprehensive set of benefits, like maternity coverage that is now excluded by some policies, and cover pre-existing medical conditions, which may be excluded under certain policies.

The entire story is here.

NY Fines 15 Insurers over Mental Health Notices

Associated Press
The Wall Street Journal
Originally published May 9, 2012

ALBANY, N.Y. — New York regulators have fined 15 insurers $2.7 million for failing to notify small businesses they were eligible to buy special coverage for mental illnesses and children with serious emotional disturbances.

Superintendent of Financial Services Benjamin Lawsky says they are the first fines under Timothy's Law, named for a teen who committed suicide after his parents were unable to obtain needed mental health treatment. The law took effect in 2007.

The rest of the story is here.

More information on Timothy's Law is here.