For the past 10 to 15 years, virtual health has been heralded as the next disrupter in the delivery of care, but there has been minimal uptick in adoption. The COVID-19 pandemic is pushing against structural barriers that had previously slowed health system investment in integrated virtual health applications.
“As this epidemic makes clear, at any moment, any of us could become sick, could become hospitalized, could be on a mechanical ventilator,” said Adam Gaffney, an ICU doctor in Boston. “And that, in the United States, could mean potentially ruinous healthcare costs.”
With over 21,000 people dead and more than a 547,000 infected with the coronavirus in the US the last question on a person’s mind should be how they will pay for life-saving treatment.
There were 27.9 million people without health insurance in 2018, and record-high unemployment will increase that figure by millions
But as the death toll mounted, a patient who was about to be put on a ventilator in one of New York City’s stretched to capacity intensive care units had a final question for his nurse: “Who’s going to pay for it?”
HCCI Releases 2018 Health Care Cost and Utilization Report
Per-Person Health Care Spending Grew 18% from 2014 to 2018, Driven Mostly by Prices
The report examines four groups of health care services and dozens of sub-categories. Of the four major categories, outpatient visits and procedures saw the highest 2018 spending increase (5.5%). Other notable trends include:
Per-person spending on inpatient admissions rose 11.4% between 2014 and 2018
Within each sub-category of inpatient admissions, average prices grew steadily between 2014 and 2018 while utilization trends varied. However, the 2.0% price increase in 2018 was lower than the near 4% annual increases from 2014 to 2017.
Increases in prices and use led to a 16% increase in spending from 2014 to 2018.
ver that period, ER visit spending increased 32% and spending on observation stays went up 29%.
Spending increased 16% and growth accelerated over the 5-year period, driven by office visits and administered drugs.
Psychiatry also saw strikingly high spending growth of 43% from 2014 to 2018, which was driven mostly by increased use.
Generic drugs accounted for 88% of all prescriptions. .
Out-of-pocket payments for prescriptions for generic drugs was less than one-fifth of out-of-pocket payments on brand drugs.
From a JAMA Network online study (February 11, 2020):
In this analysis of commercially insured patients who had undergone elective surgery with an in-network surgeon at an in-network facility, approximately 1 in 5 received an out-of-network bill, with a mean potential balance bill of $2011.
In this retrospective analysis of 347 356 surgical episodes among commercially insured patients who had undergone elective surgery with in-network primary surgeons and facilities, 20% of episodes involved out-of-network charges.
The patterns of out-of-network bills varied with the clinical scenario. Simpler ambulatory procedures that tend to involve 1 surgeon (arthroscopic meniscal repair, breast lumpectomy) had fewer out-of-network bills (13%-15% of cases), whereas inpatient procedures (hysterectomy, knee replacement, colectomy, CABG surgery) had more frequent out-of-network bills (24%-33% of cases). These more complex procedures were also associated with larger potential balance bills, in the range of $2000 to $4000.
From a The BMJ Views and Reviews article by David Oliver (February 5, 2020):
Last year the Lancet published a paper on the impact of wearing gowns, surveying 928 adult patients and carrying out structured interviews with 10 patients. Over half (58%) reported wearing the gown despite feeling uncertain that it was a medical necessity. Gown design was considered inadequate, with 61% reporting that they struggled to put it on or required assistance and 67% reporting that it didn’t fit. Most worryingly, 72% felt exposed, 60% felt self-conscious, and 57% felt uncomfortable wearing the gown.
I’ve often wondered why on earth we routinely put so many patients into hospital gowns within minutes of their arrival at hospital.
Sometimes referred to as “dignity gowns,” such dignity as they afford is only in comparison to being stark naked. They don’t come in a wide range of sizes or lengths, and they’re open along the back. You tend to get what you’re given and make do. The effect is to leave patients with lots of exposed flesh, with underwear or buttocks intermittently displayed and a feeling of extreme vulnerability, not to mention being cold if they have no other layers to wear.
In rural towns across the U.S. hospitals are in crisis. Since 2010, 121 rural hospitals have closed. And, the National Rural Health Association says more than one-third of all rural hospitals in the U.S. are at serious risk of shutting down.
But not all hospitals are losing money. A series of mergers and acquisitions that began in the 1990’s has created massive hospital groups. Many of these hospital consortiums are turning huge profits every year by offering high priced services to well insured patients.
From a JAMA Network online article (February 4, 2020):
High medical prices and billing practices may reduce public trust in the medical profession and can result in the avoidance of care. In a survey of 1000 patients, 64% reported that they delayed or neglected seeking medical care in the past year because of concern about high medical bills. The field of quality science in health care has developed measures of medical complications; however, there are no standardized metrics of billing quality.
A recent study found that only 53 of 101 hospitals were able to provide a price for standard coronary artery bypass graft surgery. Notably, among the hospitals that provided a price, the price ranged from approximately $44 000 and $448 000 and was not associated with quality of care as measured by risk-adjusted outcomes and the Society of Thoracic Surgeons composite quality score.
In the same way that there is wide variation in pricing, aggressive collection tactics also can be highly variable by institution. In a recent analysis, 36% (48/135) of hospitals in Virginia garnished wages of patients with unpaid medical bills, and 5 hospitals accounted for 4690 garnishment cases in 2017, representing 51% of all cases.7 In total, 20 054 lawsuits were filed in Virginia against patients for unpaid debt. For many hospitals that sue patients, legal action follows multiple attempts to contact patients through letters and calls, and some hospitals may offer to set up payment plans or even negotiate charges.
This week on Prognosis, we look at one startup that’s trying to redesign care for some of the most vulnerable patients, taking into account the complex realities of their lives. The company is trying to improve care for people and communities the medical system often fails – and it believes that fixing those failures will not only make people healthier, it will also save money.
In America, poverty is linked to shorter lifespans. The wealthiest 1% of Americans live more than a decade longer than the poorest 1%, and the longevity gap has expanded in recent years. The medical community is increasingly examining the role that poverty and difficult social circumstances play in illness. Some people are asking whether the health care system could do more to address the things that influence people’s health beyond their medical care.
The World Economic Forum is the International Organization for Public-Private Cooperation. The Forum engages the foremost political, business, cultural and other leaders of society to shape global, regional and industry agendas. We believe that progress happens by bringing together people from all walks of life who have the drive and the influence to make positive change.
Becoming an Age-Friendly Health System entails reliably acting on a set of four evidence-based elements of high-quality care and services, known as the “4Ms,” for all older adults. When implemented together, the 4Ms represent a broad shift to focus on the needs of older adults:
(1) What Matters: Know and align care with each older adult’s specific health outcome goals and care preferences including, but not limited to, end-of-life care and across settings of care;
(2) Medication: If medication is necessary, use Age-Friendly medication that does not interfere with What Matters to the older adult, Mobility, or Mentation across settings of care;
(3) Mentation: Prevent, identify, treat, and manage dementia, depression, and delirium across settings of care; and
(4) Mobility: Ensure that older adults move safely every day to maintain function and do What Matters
The Age-Friendly Health Systems movement, initiated in 2017, recognizes that an all-in, national response is needed to embrace the health and well-being of the growing older adult population. Like public health, health systems, including payers, hospitals, clinics, community-based organizations, nursing homes, and home health care, need to adopt a new way of thinking that replaces unwanted care and services with aligned interventions that respect older adults’ goals and preferences. Becoming an Age-Friendly Health System entails reliably acting on a set of four evidence-based elements of high-quality care and services, known as the “4Ms,” for all older adults.