Viewpoints: Paul Ryan And High Risk Pools; Why Is Congress Delaying Zika Funding?

A selection of opinions on health care from around the country.

Longer Looks: Madness, The Robot Revolution And Traumatic Births

Each week, KHN's Shefali Luthra finds interesting reads from around the Web.

Outgoing Valeant CEO Tells Senators That Drug Price Boost Was 'A Mistake'

Appearing before the Senate Special Committee on Aging, J. Michael Pearson tells lawmakers that he regrets significantly raising the price of certain drugs. Also testifying are Valeant investor and board member William Ackman and former CFO Howard Schiller.

Viewpoints: Extending Sanders' Health Mission; The Future Of Single-Payer?

A selection of opinions on health care from around the country.

Viewpoints: The Trump View Of Medicare And Social Security; Employers As Insurance Companies

A selection of opinions from around the country.

Some Firms Save Money By Offering Employees Free Surgery

Lowe's home improvement company, like a growing number of large companies nationwide, offers its employees an eye-catching benefit: certain major surgeries at prestigious hospitals at no cost to the employee.

How do these firms do it? With “bundled payments,” a way of paying that's gaining steam across the health care industry, and that Medicare is now adopting for hip and knee replacements in 67 metropolitan areas, including New York, Miami and Denver.

Here's how it works: Lowe's and other employers pay one flat rate for a particular procedure from any of a number of hospitals they've selected for quality, even if they are a plane ride away. And, under the agreement, the hospital handles all the treatment within a certain time frame - the surgery, the physical therapy and any complications that arise - all for that one price.

It was Bob Ihrie, senior vice president for compensation and benefits at Lowe's, who came up with the idea in 2010. When he told managers at other companies about it, he said, “The first question was always, 'Oh, this is just for executives, right?' And I said no, absolutely not, this is for any Lowe's employee in the Lowe's health care plans.”

The program is optional for employees. They can still use their local surgeon, if they prefer, and pay out-of-pocket whatever their insurance doesn't cover. But more than 700 Lowe's employees have taken the company up on its offer, Ihrie said.

It's a great deal for patients, he said, and for his company.

“We were able to get a bundled price, which actually enables us to save money on every single operation,” Ihrie says.

This story is part of a partnership that includes WFAE, NPR and Kaiser Health News. It can be republished for free. (details)

The Pacific Business Group on Health negotiates that price for Lowe's, Walmart and a number of other large employers. Associate Director Olivia Ross oversees these deals, and said her team is able to negotiate rates that are 20 to 30 percent below what the companies used to pay for the procedures.

“We're seeing savings at the front end,” she said, because Lowe's pays less for the surgery. And, because the hospital is responsible for all that care, the institution has a strong incentive to be careful and thorough, Ross added.

That means “huge savings on the back end,” she said, “from things like reduced re-admissions, reduced return to the O.R. and lower rates of blood clots. Those are hugely expensive, preventable complications.”

Lowe's comes out ahead, even after paying for the patient's travel, Ihrie confirmed.

Participating hospitals win, too, by attracting more patients, said Trisha Frick, who handles such negotiations on behalf of Johns Hopkins Medicine in Baltimore.

“It's new business for us,” Frick said. “And, for the most part, the reimbursement is acceptable; we believe that we can provide that, within that amount of money.”

Medicare, the health insurance program for people 65 and older, started using bundled rates for hip and knee replacements this month. Medicare had some early evidence from pilot programs that “the model works well,” according to Rob Lazerow, a health care consultant with The Advisory Board Company.

“Medicare is saving something like $4,000 on orthopedic cases,” he said.

Medicare's deal is somewhat different than Lowe's. Patients may pay something out of pocket, depending on the type of Medicare policy that insures them. And while the few hospitals selected in Lowe's program can bank on increasing their revenue and the number of surgeries they'll get, the rates established by Medicare's bundled payment system hold for every hospital in a participating area.

“Entire markets are selected for participating,” Lazerow explains. “If you're in the San Francisco market or you're in the New York market, all of the hospitals are actually participating in the program.”

But there are similarities, too, and Medicare may learn some lessons from Lowe's experience. Lowe's initially had trouble wrangling all a patient's medical records from local doctors. And the company found that patients who had questions weeks or months after an operation sometimes had trouble following up with the out-of-town doctor who had performed the surgery.

“You have some setbacks, and things happen, and you just have questions,” Ihrie said. “So what we give every patient now is a little card with the doctor's name and direct phone line and the nurse's name and direct phone line. And all of a sudden, things were a lot better.”

Another lesson was startling, Ross said. In addition to cutting the cost of procedures, another chunk of savings to the companies came from avoiding surgeries that probably shouldn't happen in the first place.

“We're seeing up to 30 percent - close to 30 percent of cases - who should not be moving forward with the joint replacement,” Ross said.

What typically happens in these cases, she said, is that employees get a recommendation from a local doctor that they should have surgery, only to have physicians at the selected hospitals deem the operation inappropriate.

In some cases that may be because the employee hadn't first tried less invasive treatments, such as physical therapy, Ross said. Or the employee may need to lose weight first, to make the surgery safer.

Ihrie said what heartens him most about his company's program is that Lowe's employees are now taking a more active role in decisions about their care.

“What treatment you receive is not always very black and white,” he said. “The mere fact that people now think about what they're doing helps us control costs across the board.”

This story is part of a reporting partnership with WFAE, NPR and Kaiser Health News.

Medicare Delays Plans For New Star Ratings On Hospitals After Congressional Pressure

Bowing to pressure from the hospital industry and Congress, the Obama administration on Wednesday delayed releasing its new hospital quality rating measure just a day before its planned launch.

The new “overall hospital quality” star rating aimed to combine the government's disparate efforts to measure hospital care into one easy-to-grasp metric. The Centers for Medicare & Medicaid Services now publishes more than 100 measures of aspects of hospital care, but many of these measures are technical and confusing since hospitals often do well on some and poorly on others. The new star rating boils 62 of the measures down into a unified rating of one to five stars, with five being the best.

But this month, 60 senators and 225 members of the House of Representatives signed letters urging CMS to delay releasing the star ratings. “We have heard from hospitals in our districts that they do not have the necessary data to replicate or evaluate CMS's work to ensure that the methodology is accurate or fair,” the letter from the House members said.

In a notice sent Wednesday morning, CMS told Congress it would delay release of the star ratings on its Hospital Compare website until July. “CMS is committed to working with hospitals and associations to provide further guidance about star ratings,” the notice said. “After the star ratings go live in their first iteration, we will refine and improve the site as we work together and gain experience.”

But in a conference call with hospital representatives, CMS officials said they might delay release of the ratings past July if they are still analyzing or revising the methodology, according to people who participated in the call.

Mortality, readmissions, patient experience and safety of care metrics each accounted for 22 percent of the star rating, while measures of effectiveness of care, timeliness of care and efficient use of medical imaging made up 12 percent in total.

The hospital industry for months has been urging this delay, arguing that many of the measures will not be relevant to patients seeking a specific service. For instance, a hospital's death rate for Medicare patients might be irrelevant for a woman trying to decide where to give birth.

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The industry's major trade groups said in a letter to CMS that some hospitals perform poorly because their patients tend to be lower income and don't have the support at home. Many of the nation's most prestigious hospitals have been bracing for middling or poor ratings.

Rick Pollack, president of the American Hospital Association, said in a statement that “the delay is a necessary step as hospitals and health systems work with CMS to improve the ratings for patients, and the AHA commends CMS for their decision.“

Last year, CMS created a star rating to represent the views of patients in surveys. Two sets of researchers recently determined that hospitals with more stars in patient experience tended to have lower death and readmission rates.

Hospital Compare received 3.7 million unique page views last year, according to a paper published this month in the journal Health Affairs. The author, analyst Steven D. Findlay called the traffic “not at a level commensurate with [the] stature and potential” of the federal government's health care facility comparison sites.

Dr. Ashish Jha, a Harvard School of Public Health researcher, said consumers will be more likely to use the unified star ratings, but this specific mix of measures raises concerns. “The idea that dying and being readmitted to the hospital are equally important to patients seems funny to me,” he said.

UnitedHealthcare To Exit All But 'Handful' Of Obamacare Markets In 2017

UnitedHealthcare will operate only in a “handful” of health insurance exchanges in 2017, down from 34 states this year, company officials said Tuesday.

The company did not provide the anticipated details in its first-quarter earnings announcement released Tuesday morning or in a subsequent teleconference with securities analysts. But a spokesman confirmed Nevada and Virginia would be among the states where it will retain a presence. In the past week, UnitedHealthcare said it would leave Georgia, Michigan, and Arkansas.

UnitedHealth Group, the parent company, warned in November it was considering quitting most marketplaces because of escalating losses on the Obamacare plans. The company on Tuesday said it lost $475 million last year from the marketplace plans and was on target to lose $650 million in 2016.

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UnitedHealth is the nation's largest health insurer overall, but it's not the biggest in the individual insurance markets that the exchanges serve.

Even so, UnitedHealth's plan to dramatically curtail involvement in the exchanges would severely limit competition in parts or all of about 10 states - mostly in the South and Midwest, according to an analysis from the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.) That could mean higher premiums for consumers in states and counties left with only one or two insurers, unless another company enters those markets. Oklahoma and Kansas would be left with only one insurer if UnitedHealthcare pulls out.

Obama administration officials sought to play down the impact of the UnitedHealth's announcement saying the company was not the lowest-cost plan in many of the biggest states. For example, at least 95 percent of the populations of Florida, Illinois and Ohio live in a county where they could find a cheaper plan this year, an administration spokesman said.

So far, UnitedHealthcare is the only large carrier to announce it will leave the marketplaces in multiple states.

“We have full confidence, based on data, that the marketplaces will continue to thrive for years ahead,” said a spokesman for the U.S. Department of Health and Human Services. “The marketplace should be judged by the choices it offers consumers, not the decisions of any one issuer.”

United officials said they were unwilling to keep losing money.

“The smaller overall market size and shorter term, higher-risk profile within this market segment continue to suggest we cannot broadly serve it on an effective and sustained basis,” CEO Stephen Hemsley said in a conference call with investors Tuesday.

“Next year, we will remain in only a handful of states, and we will not carry financial exposure from exchanges into 2017,” Hemsley said.

UnitedHealthcare said it has 795,000 enrollees on the exchange plans, after adding 300,000 people since January. It expects the number to fall to 650,000 by December as people drop off or find other coverage.   The Obamacare marketplace has about 12.7 million people enrolled for 2016.

Hemsley confirmed Harken Health, the company's subsidiary that markets a boutique-style health plan, would continue next year. It currently operates in Atlanta and Chicago.

Despite the Obamacare losses, the Minnetonka, Minnesota-based company made $1.6 billion in net income on $44.5 billion in revenue in the first quarter of 2016. During the same period last year, UnitedHealth Group made $1.4 billion in net income on $35.8 billion in revenue.

Competition Suffers Most If UnitedHealth Exits Obamacare In 2017: Analysis

If UnitedHealthcare follows through on its threat to quit the health insurance marketplaces in 2017, more than 1 million consumers would be left with a single health plan option, forecasted an analysis released Monday.

A UnitedHealthcare pullout would be felt most in several states, generally in the South and Midwest, where consumers would be left with little choice of plans, the Kaiser Family Foundation reported. (KHN is an editorially independent program of the foundation.)

In most of the 34 states where United operates this year, though, the effect would be modest for premiums and the number of plan options, Kaiser said.

Kaiser's analysis was made public a day before UnitedHealth Group, the insurer's parent, is expected to announce 2017 plans for the Affordable Care Act's marketplaces that provide coverage to individuals who shop for their own health insurance.

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In the past week, state officials confirmed UnitedHealth was withdrawing from marketplaces in Arkansas and Michigan and partially leaving Georgia. In Atlanta and Chicago, a new UnitedHealthcare subsidiary, Harken Health, began operating this year and is expected to remain.

Last year, UnitedHealthcare said it was losing hundreds of millions of dollars on the Obamacare plans and would decide its future participation by mid-2016. Health plans need to begin notifying states by May whether they plan to sell in marketplaces next year.

More than one in four counties where UnitedHealthcare participates nationally would see a drop from two insurers to one if the company exits and isn't replaced by a new entrant, and a similar number would go from having three insurers to two, the Kaiser analysis found.

In total, 1.8 million enrollees would go from having a choice of three insurers to two, and another 1.1 million would go from having a choice of two insurers to one, the report said.

A UnitedHealth withdrawal would leave marketplace enrollees in Kansas and Oklahoma with only one insurer if another company does not move in, Kaiser said.

Its analysis cited the potential impact in other states if UnitedHealthcare drops out:

• In Alabama, about two-thirds of enrollees - those living in 60 counties - would go from having a choice of two insurers to a single insurer, and the remaining 33 percent of enrollees in seven counties would have two insurers to pick from.


• In Mississippi, 43 percent of enrollees in 50 counties would drop to just a single insurer and the remaining 57 percent in 32 counties would still have two.


• In Arkansas, there would be a drop from four insurers to three insurers in every county if a new insurer did not replace the company.


• In Georgia, nearly 50,000 marketplace enrollees, or 8 percent of the total, would be left with a choice of two insurers. Another 20,000 enrollees, or 3 percent, would have only one insurer if no new entrants replaced UnitedHealthcare.

Nationally, UnitedHealthcare's participation on the exchanges had a relatively small effect on average premiums, based on Kaiser's analysis of 2016 insurer premiums.

The company was less likely to offer one of the lowest-cost silver plans, where most enrollees sign up. When it did offer a low-cost option, its pricing was often close to its competitors. As a result, the weighted average premium for a benchmark silver-level plan would have been about 1 percent higher had United not participated in 2016. Federal subsidies in the marketplaces are based on the second-lowest silver premium.

Benjamin Wakana, a spokesman for the Centers for Medicare & Medicaid Services, said the government expects insurers to make adjustments in entering and exiting states.

“The marketplace should be judged by the choices it offers consumers, not the decisions of any one issuer. That data shows that the future of the marketplace remains strong.”

UnitedHealth Group will release its first-quarter earnings Tuesday morning and CEO Stephen Hemsley is scheduled to discuss the results with analysts and investors at 8:45 a.m. ET.

State Highlights: Fla. Gov. Signs Law To Protect Consumers From Surprise Medical Bills; Ohio Steps Up Suicide Prevention Efforts

News outlets report on health issues in Florida, Ohio, Georgia, Michigan, Missouri, Minnesota, California, North Carolina and Colorado.

Longer Looks: Clinical Trials; Soldiers On Drugs; 'Hollywood's Medicine Man'

Each week, KHN's Shefali Luthra finds interesting reads from around the Web.

Viewpoints: Examining Obamacare Premium Increases; The Pros And Cons Of Making Patient Surveys Transparent

A selection of opinions from around the country.

State Highlights: In Arizona, Legislative Debate Over Kids' Health Care Intensifies; Medical Records Breached At Florida Health Department

News outlets report on health issues in Arizona, Florida, Wisconsin, North Carolina, Missouri, North Dakota, New Hampshire, Tennessee, South Carolina, Maryland, Nebraska and Hawaii.

Hospitals Weigh Cost Of Fortifying Cybersecurity In Wake Of Ransomware Attacks

Cybersecurity experts say that business is booming as hospitals consider upgrades to their information systems. Meanwhile, health institutions and medical schools in Maryland are teaming up to try to block potential hacks.

Viewpoints: The Unexpected Costs Of Expanding Medicaid; The Tricky Landscape Of Health Care Consumerism

A selection of opinions from around the country.

Viewpoints: Fixing The Medicare Fee Schedule; Are Patients Left Behind With Hospitals' Digital Records?

A selection of opinions from around the country.

Viewpoints: Treating Politics Like Medicine; Parsing Donald Trump's Drug-Import Policy

A selection of opinions from around the country.

Viewpoints: Research Rules Could Block Cancer 'Moonshot'; Medicare Advantage's 'Disadvantage' For Sicker Patients

A selection of opinions from around the country.

By Not Discussing Cost Issues, Doctors, Patients May Miss Chances To Lower Out-Of-Pocket Expenses

Talking about money is never easy. But when doctors are reluctant to talk about medical costs, a patient's health can be undermined. A study published in Monday's Health Affairs explores the dynamics that can trigger that scenario.

Patients are increasingly responsible for shouldering more of their own health costs. In theory, that's supposed to make them sharper consumers and empower them to trim unnecessary health spending. But previous work has shown it often leads them to skimp on both valuable preventive care and superfluous services alike.

Doctors could play a key role in instead helping patients find appropriate and affordable care by talking to them about their out-of-pocket costs. But, a range of physician behaviors currently stands in the way, according to the study.

This KHN story also ran on NPR. It can be republished for free (details).

“We need to prepare physicians to hold more productive conversations about health care expenses with their patients,” said Peter Ubel, the study's main author and a physician and behavioral scientist at Duke University.

The researchers analyzed transcripts of almost 2,000 physician-patient conversations regarding breast cancer, rheumatoid arthritis and depression treatment. They identified instances in which patients suggested that the cost of care might be difficult to afford and assessed how doctors responded.

Overall, researchers noted two ways in which doctors dismissed patients' financial woes. They either did not acknowledge the concerns patients expressed or only half-addressed them. For instance, if a patient commented on how expensive a drug was, the doctor might ignore the comment entirely or might suggest a temporary solution - like a free trial - without exploring long-term strategies to address the issue.

And, without such a long-term plan, patients may eventually stop taking the medication, or take it irregularly. That can harm their health, and even send them to the hospital.

The study doesn't measure how often doctors dismissed patient concerns - because, the researchers wrote, they didn't know how often those dismissals led to people actually foregoing needed treatments.

Still, Ubel said, it is clear doctors are not talking to patients about these expenses. He pointed to a separate analysis of those same conversations, which found that doctors discussed medical costs with patients about 30 percent of the time; and, in only about 40 percent of those discussions did doctors and patients brainstorm about ways to make medication more affordable.

“A majority of [physicians] - they don't talk about costs,” he said. “When they do talk about it, they don't talk about it productively.”

Why do physicians hesitate? For one thing, they aren't used to discussing cost barriers, and many think it's inappropriate to bring up money at all, Ubel said. When he lectures on the subject, he always encounters people who worry discussing finances will “contaminate the doctor-patient relationship.”

Plus, doctors haven't been taught to listen for patients' pocketbook concerns. If a patient comes in with heartburn and indigestion, a good internist will immediately start probing for signs of coronary disease, Ubel said. By contrast, physicians aren't primed to pick up on cues that patients may face financial strains.

“If we had that on our list to be aware of, we'd pick up the cues. If we don't, it'll be right in front of our eyes, and we'll miss it,” he added.

The idea of patients acting as consumers - weighing cost and shopping for the best health care deal - is still relatively new, the study notes. As it becomes more commonplace, patients may push doctors for more help in making cost-based decisions, Ubel said.

That said, navigating a patient's financial circumstances and medical needs in the course of a 15-minute visit is tricky, said Jonathan Kolstad, an assistant professor of economic analysis and policy at the University of California, Berkeley. Kolstad wasn't involved in the Health Affairs study but has researched how medical costs affect people's decision-making.

“It's not as though, 'Oh, it's just consumers can't figure it out.' Doctors don't know,” he said. When it comes to figuring out what a drug will cost, “doctors are in the same boat.”

Viewpoints: Taking Stock Of Obamacare; The High Court's Contraception Case Consideration Gets Messy

A selection of opinions from around the country.

Viewpoints: Taking Stock Of Obamacare; The High Court's Contraception Case Consideration Gets Messy

A selection of opinions from around the country.