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This Week in Health Care Reform: September 6th, 2019

Providers threaten to derail consumer-friendly surprise medical billing legislation; meanwhile, hospitals are shown to account for the largest share of health care expenditures; a new survey finds providers fall short of meaningfully providing health data to their patients; and, addressing social factors is an integral component in the ongoing effort to improve our health system.

Week in Review

Surprise Medical Billing: While there’s general agreement that something needs to be done to protect consumers from surprise medical bills, what exactly that something looks like is where that agreement breaks down.  Specifically, the division comes down to the last-minute addition of an arbitration option to the legislation currently being considered by lawmakers.  Despite universal opposition to the use of arbitration from a diverse array of voices, including, patient groups, employers, payers, economists, actuaries, and other vested stakeholders, providers have dug in their heels, insisting that it be included.  However, the growing perception is that surprise medical billing has slowly trickled into the provider business model, prompting some to question whether providers even want to see a solution.

Hospital Costs: A growing chorus of leading health policy experts has begun to draw attention to the role that hospitals play as, arguably, the primary culprit behind runaway medical cost inflation.  To reinforce that viewpoint, they point to a growing body of evidence which shows that hospitals represent the biggest expenditure in our $3.5 trillion health care system, where spending is outpacing GDP, inflation, and wage growth.  For instance, spending on hospitals accounts for 44 percent of personal expenses for the privately insured.  Also, between 2007 and 2014, hospital prices for inpatient care increased 42 percent.  In fact, the average cost of a hospital stay in 2015 was $5,220 a day – but, could be as high as $17,000.

Patient Data: As consumerism continues to reshape how and when and where we interact with our evolving health care delivery model, it’s clear that data will play an increasingly larger role.  With that in mind, a new study shows us just how far we still have to go when it comes to even being able to access our own health data.  In that analysis, researchers found that many health care providers struggle to provide patients with easy, timely, complete, or cost-effective access to the data to which they are entitled by law.  In fact, of the 51 institutions analyzed, more than one-quarter failed to comply with HIPAA regulations.  Experts point out that while providers have invested heavily in digitizing their medical records, patients themselves often do not benefit from those investments.  Unfortunately, this lack of timely, cheap, or ready access to this important health information may negatively impact their health or require them to undergo repeat or costly testing

Broad changes are underway, remaking our health care system as we better understand the relationship between socioeconomic factors and health outcomes.  This focus has seen stakeholders increasingly incorporate social determinants of health (SDoH) into redesigned reimbursement and care delivery models.  While it’s believed that these approaches will help address historic and systemic health disparities in underserved populations and communities, there’s wide acknowledgment that maximizing the benefits of this newfound emphasis on SDoH will require a collaborative approach to ensure that programmatic innovations are brought to bear where they’re likely to have the greatest impact.      

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With Congress poised to return next week, there’s still time for Health Action Network members to reach out to their lawmakers to urge them to support surprise medical billing legislation that protects consumers from rising health care costs and to oppose the inclusion of an arbitration-style model into the bills being considered.  If you haven’t already, take action today!


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