The Obama administration on Monday began requiring health insurers to provide user-friendly guides to patients that explain their benefits, aiming to make buying insurance nearly as easy as scanning packages of food for nutrition facts. Under President Barack Obama's healthcare reform law, employers and insurers must provide a summary of benefits and coverage in a clearly worded, standardized format that allows the private insurance market's 163 million beneficiaries to make side-by-side comparisons of plan offerings. The benefit guides will also factor into the creation of new state-based health insurance markets due to begin offering subsidized, private coverage to moderate-income consumers in January 2014.
The months-long Center for Public Integrity investigation into the Medicare program has uncovered a textbook example of the expensive consequences of what's known as "regulatory capture." Doctors and hospitals are likely being overpaid billions of dollars, which is hastening the depletion of the Medicare trust fund, because lawmakers and regulators put lobbying and professional groups representing healthcare providers in charge of writing the rules that determine reimbursement. And to make matters worse, to maximize revenue and profits, some doctors and hospitals have figured out how to game the system to their financial advantage by abusing what has been held out as a means to improve care and reduce administrative costs—electronic health records.
It's hard to imagine a successful accountable care organization (ACO) that doesn't rely heavily on IT. ACOs require that clinicians meet a long list of quality measures to prove that they're acting in an accountable way to reduce costs without reducing the quality of medical services. And most of those metrics are best tracked with software. But the very foundation upon which ACOs are built could be shaky, making software tools only so effective. If genuine accountability is your goal, technology gets you only halfway there. Providers need a proven structural model to make an ACO cost effective, and at least one prominent thought leader questions whether the current approach will do the trick.
Every year, an estimated 4,000 cases of "retained surgical items," as they are known in the medical world, are reported in the United States. The vast majority are gauzelike sponges used to soak up blood. During a long operation, doctors may stuff dozens of them inside a patient to control bleeding. In recent years, new technology and sponge-counting methods have made it easier to remedy the problem. But many hospitals have resisted, despite the fact that groups like the Association of Operating Room Nurses and the American College of Surgeons have called on hospitals to update their practices. As a result, patients are left at risk, said Dr. Verna C. Gibbs, a professor of surgery at the University of California, San Francisco.
Hospitals in Minnesota are experiencing a new wave of consolidation. Sixteen independent hospitals have become affiliated with health systems like Sanford Health, Essentia Health and Mayo Clinic since 2005, according to the Minnesota Hospital Association. A 17th, in Virginia, is set to join Essentia in November. The trend is especially prevalent outstate, since much of the urban consolidation happened a decade or more ago. Of the 148 hospitals in Minnesota, according to the hospital association, only 42 remain independent. The push toward consolidation seems inevitable. But in the communities where it took place there is disagreement over whether such mergers were good or bad for patients.
More than 200 trauma centers have opened since 2009 in more than 20 states, and another 75 hospitals are seeking approvals, according to data collected by Kaiser Health News from state health agencies. States with the greatest number of new centers include Texas, Alabama, Arizona and California. The growth reverses more than a decade of closures in the 1990s and early 2000s. Leading the trend is Nashville-based HCA, according to state data. Since 2009, it has added or is planning to add about 20 trauma centers, including almost a dozen in Texas and Florida, as part of an expansion of its emergency room business. Another for-profit hospital chain, Community Health Systems, added seven trauma centers in the past three years.