Among seniors with Medicare and additional public coverage such as Medicaid, inflation-adjusted out-of-pocket payments for medical care decreased from an average of $1,253 in 2000 to $427 in 2014. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #500: Out-of-Pocket Health Care Expenses for Medical Services, by Insurance Coverage, 2000-2014.)
Direct-To-Consumer Telehealth May Increase Access To Care But Does Not Decrease Spending, Study FindsMartina Dolan | March 9, 2017
The use of direct-to-consumer telehealth, in which a patient has access to a physician via telephone or videoconferencing, is growing rapidly. A key attraction of this type of telehealth for health plans and employers is the potential savings involved in replacing physician office and emergency department visits with less expensive virtual visits. However, findings from a new study published in Health Affairs show increased convenience may tap into unmet demand for health care, and new utilization may increase overall health care spending. The authors used commercial claims data on over 300,000 patients from three years (2011–13) to explore patterns of utilization and spending for acute respiratory illnesses. They estimated that 12 percent of direct-to-consumer telehealth visits replaced visits to other providers, and 88 percent represented new utilization. Net annual spending on acute respiratory illness increased $45 per telehealth user. Direct-to-consumer telehealth may increase access by making care more convenient for certain patients, but it may also increase utilization and health care spending.
Read more: Direct-To-Consumer Telehealth May Increase Access To Care But Does Not Decrease Spending. Health Affairs. March 2017.
The Guardian writes: Consumers Health Forum of Australia has called for a comparison service for specialists’ fees after a study in the Medical Journal of Australia found some Australians are paying five times more than others to see a specialist depending on their need and location. The comparison service would resemble services including MySchool, which rates primary and secondary schools around the country, and petrol price comparison sites run by several state governments.
HCUP statistical brief: Characteristics of Emergency Department Visits for Super-Utilizers by Payer, 2014Martina Dolan | March 2, 2017
The Healthcare Cost and Utilization Project (HCUP) has posted a new statistical brief on the following: Characteristics of Emergency Department Visits for Super-Utilizers by Payer, 2014. Emergency department (ED) super-utilizers were defined as those patients with the highest number of ED visits in 2014, by payer: four or more visits for privately insured patients aged 1–64 years or Medicare patients aged 65 years and older; six or more visits for Medicaid or Medicare patients aged 1–64 years. In 2014, although super-utilizers constituted a relatively small proportion of all patients seen in the ED (2.6 to 6.1 percent, depending on the payer-age group), they accounted for a large share of all ED visits (10.5 to 26.2 percent).
Among adults with health care expenses in 2014, those treated for multiple chronic conditions had average out-of-pocket expenses that were more than three times as high as expenses for adults with one or no chronic condition ($13,031 versus $3,579). (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #498: Out-of-Pocket Expenditures for Adults with Health Care Expenses for Multiple Chronic Conditions, U.S. Civilian Noninstitutionalized Population, 2014.)
A new data brief from the Health Care Cost Institute (HCCI) reports on spending and utilization in populations likely unable to shop for a hospital prior to seeking care. For this data brief – Non-Shoppable Health Care Services: Inpatient Hospitalizations – the authors compared spending and length-of-stay (LOS) for individuals who were admitted through the emergency department (ED) to that of individuals who needed ambulance services the day of their admission through the ED. Using their national claims data base, the authors anaylzed spending and LOS of inpatient hospital services in the employer-sponsored insurance (ESI) and Medicare Advantage (MA) populations. Findings from the study showed the average inpatient spending in the ESI population was higher for patients that arrived to a hospital by ambulance than those who did not, but LOS was similar. In the MA population, average inpatient spending and LOS were similar for patients that arrived to a hospital by ambulance and those who did not.
Read more: Non-Shoppable Health Care Services: Inpatient Hospitalizations. HCCI
First-In-The-Nation Cost Comparison Highlights Differences In Healthcare Spending Across the CountryMartina Dolan | January 27, 2017
A first-ever comparison of what commercial insurers are paying for healthcare in different regions shows wide variation in spending. The report from the Network for Regional Healthcare Improvement (NRHI), a national organization of local groups working to improve healthcare, analyzed spending by commercial health insurance plans in five regions nationwide (Oregon, Utah, Maryland, St. Louis, and Minnesota). Analysts found a $1,080 yearly difference in the amount plans spend, on average, per enrollee. This study aggregates data from seven Oregon health plans and includes one-third of commercially-insured Oregonians, the most of any study of its kind. When compared with data from other regions, Oregon’s use of health care resources is lower than average; however, Oregon’s prices are the highest of the five regions – 17% above average – which results in an overall higher total cost of care.
- Related press release: http://www.nrhi.org/news/first-nation-cost-comparison-highlights-differences-healthcare-spending-across-country/
The Agency for Health Care Administration (Agency) has announced the selection of the Health Care Cost Institute (HCCI) as the vendor partner that will create an online health care transparency tool for Florida where consumers can find and compare the price of common health care services in their area. The tool will calculate prices based on data from actual insurance claims that have been paid to Florida health care providers, and will help consumers estimate their out of pocket costs before they receive a health care service. The tool will allow visitors to the Agency’s existing health care information website, FloridaHealthFinder.gov, to compare health care providers based on both price and quality so they can make more informed decisions when seeking health care services.
CMS has posted the second annual release of the Skilled Nursing Facility Public Use File (Skilled Nursing Facility PUF) with data for 2014. The Skilled Nursing Facility PUF presents summarized information on services provided to Medicare beneficiaries by skilled nursing facilities. It contains information on utilization, payment (Medicare payment and Medicare standardized payment), submitted charges, and beneficiary demographic and chronic condition indicators organized by CMS Certification Number (6-digit provider identification number), Resource Utilization Group (RUG), and state of service. The new 2014 PUF has information for 15,026 skilled nursing facilities, almost 2.5 million stays, and over $27 billion in Medicare payments for 2014. New in the 2014 data is the demographic and chronic condition information. CMS protects beneficiaries’ personal information in all public data releases.
Read more: The updated 2014 data and supplemental information can be accessed at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/SNF2014.html
CMS has posted the second annual release of the Home Health Agency Public Use File (Home Health Agency PUF) with data for 2014. The Home Health Agency PUF presents summarized information on services provided to Medicare beneficiaries by home health agencies. It contains information on utilization, payment (Medicare payment and Medicare standardized payment), submitted charges, and demographic and chronic condition indicators organized by CMS Certification Number (6-digit provider identification number), Home Health Resource Group (HHRG), and state of service. The new 2014 PUF has information for 10,882 home health agencies (down from 11,062 in 2013), over 6 million claims, and almost $18 billion in Medicare payments for 2014. New in the 2014 data is the demographic and chronic condition information. CMS protects beneficiaries’ personal information in all public data releases.
The updated 2014 data and supplemental information can be accessed at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/HHA.html