A survey reveals only 36% of respondents have researched prices for healthcare services and when they do, it's usually not through providers.
It's payers, not providers, that most Americans turn to when seeking out pricing information for healthcare services, according to a survey on price transparency.
The poll, conducted by YouGov on behalf of AI for healthcare operations company AKASA, highlights the need for both insurers and providers to follow pricing regulations for the sake of the patient experience.
Of the 2,026 adults surveyed nationally in March, just 36% indicate they have researched prices for services, of which 60% say they would look to their insurance company for pricing information.
When seeking out information through a payer, 44% would look on the insurer's website and 29% would call their insurer.
When looking to a provider for information, 39% would visit a physician or hospital website, while 34% would call their physician or hospital. A remaining 32% would access a patient portal for prices.
However, respondents say information from payers isn't always available, with 44% answering their insurance company does not provide pricing information for local providers. Another 34% don't know if this information is available.
CMS now requires payers to disclose pricing information and comply with price transparency regulations, as of July 1. This includes providing machine-readable files containing in-network rate files for all covered items and services between the health plan and in-network provider, as well as the allowed amount file for billed charges from out-of-network providers.
Hospitals, meanwhile, have been required to follow the price transparency rule since its implementation on January 1, 2021, by providing a machine-readable file with all items and services, and a display of shoppable services in a consumer-friendly format.
Though the onus has so far mostly fell on providers to provide patients with pricing information, the survey and recent regulations show insurers must do their part.
"As the data indicates, patients are most often either turning to their insurance company or to their care provider through a variety of platforms to understand their price of care," said Ben Beadle-Ryby, co-founder of AKASA. "Clearly, both providers and payers have a critical role to play, and the healthcare industry as a whole must work together to holistically improve price transparency, which is a key piece of the puzzle to improving the overall patient financial experience."
A survey finds that organizations outsourcing their revenue cycle management are generally very satisfied with the outcomes.
Among revenue cycle leaders who manage their inpatient revenue cycle management (RCM), 22% outsource some of their outpatient or ancillary services, according to a survey conducted by the Healthcare Financial Management Association (HFMA).
The poll, done on behalf of XIFIN, gauges the interest in and opportunity to outsource outpatient RCM for more efficient processes, which has the potential to ease administrative burden and improve outcomes.
In addition to more than one in five leaders outsourcing some of their RCM, 12% of respondents want to employ this approach in the future. When they do, the survey found that organizations are generally very satisfied with the outcomes.
To gather the data, 302 HFMA members were given a 21-question online survey in 2021, with 157 sending in complete responses. Respondents varied in hospital size, from fewer than 100 employees (6%) to 10,000 or more employees (31%).
According to the responses, the top three business drivers that guide the approach to outpatient RCM are patient experience, process optimization, and revenue generation.
The most challenging aspects of RCM not currently addressed by people, processes, technology or services are denials and appeals management, prior authorization, and payor relations.
In analyzing the data, the authors of the survey note that the respondents show a significant need for more efficient and effective RCM and reporting optimization.
"There is pressure on hospital teams to effectively manage expanding outpatient sources of revenue and expenses," said Bill Voegeli, HFMA head of custom research and president of Association Insights. “Many of today's healthcare financial and RCM teams lack the necessary time, information and/or staff resources to fully understand the opportunities or implications for RCM automation beyond their electronic health record (EHR).
"Our research with XIFIN gives credence to the notion that healthcare finance professionals will benefit by staying up-to-date about ways to optimize the growing area of outpatient RCM and gives RCM executives insight into new avenues for optimization."
The insurer said in its earning call it will expand its subsidiary myNEXUS nationwide over the next six to 12 months.
Elevance Health experienced a slight dip in year over year profit for the second quarter as the company continues to diversify its offerings.
In its Q2 earnings report, the insurer announced net income of $1.65 billion for the past three months, an 8.4% decline from the $1.8 billion it profited over the same period in 2021. Revenue, meanwhile, rose 14.1%, from $33.8 billion to $38.6 billion.
Elevance Health saw strong growth in membership with 2.7 million new enrolees, a 6.1% rise from the second quarter of last year, to bring the total to 47.1 million members. Much of that was due to the 1.6 million new enrolees in the government business, spurred by growth in Medicaid.
During the company's earnings call, the insurer also stated its plans for subsidiary myNEXUS, a recently launched post-acute care program for Medicare members in Indiana. Elevance Health president and CEO Gail Boudreaux said the plan is to expand the program nationwide over the next six to 12 months, which will help optimize levels of care post inpatient discharge, improve the patient-provider experience, and grow Carelon, the company's healthcare services brand subsidiary.
The insurer displayed its commitment to diversifying when it changed its name earlier this year from Anthem to better reflect their goal of offering a wide range of health-related services.
"The disciplined execution of our strategy, and the balance and resilience of our diversified portfolio of businesses has enabled us to deliver another quarter of strong organic growth, and we have raised our outlook for 2022 earnings per share as a result," said Boudreaux.
"Our recent name change to Elevance Health and the broader rebranding strategy underscores our transformation to a lifetime, trusted health partner and our diversified set of businesses that lend resilience in any business environment. We are uniquely well-positioned for growth in the future as we remain focused on meeting the needs of our clients and customers."
The analysis reviewed 72 insurers and found a median proposed premium increase of 10%, with only four of the payers filing negative premium changes and the remaining 68 insurers requesting premium increases.
Most of the insurers are requesting premium changes that fall between 5% and 15%, while 19 payers are between 0% and 5%, and eight are at least 20%.
While most of the insured population is enrolled in employer plans, the relatively small percentage enrolled in ACA Marketplace plans is at its highest. Based on a report by HHS, a record 14.5 million people signed up for coverage through the Marketplace during the 2022 special enrollment period, a 21% increase from the previous year.
While individuals with Marketplace plans should brace for costly changes, researchers of the study note that the premium increases are preliminary and the actual rates will not be known until the fall as data for every state is not yet available. The analysis compiles data from insurers across 13 states and the District of Colombia: Georgia, Indiana, Iowa, Kentucky, Maryland, Michigan, Minnesota, New York, Oregon, Rhode Island, Texas, Vermont, and Washington.
Researchers found that a large chunk of the premium increases stem from rising health prices and utilization of healthcare. Insurers project their health cost trend—a combination of prices paid to hospitals, doctors, and pharmaceutical companies, along with the increase of decrease in use of services —to be 4% to 8% for 2023.
As far as the impact of the COVID-19 pandemic, about half of the insurers reviewed publicly quantified the pandemic's effect on premiums, with most saying it would only have an impact of plus or minus 1%.
Meanwhile, just under half of the payers reviewed quantified an impact of the American Rescue Plan Act subsidies expiring on premium changes. Of those, about half said the expiration would have a neutral effect, with the other half saying it would have a slight upward impact on costs, but no more than around 1%.
Only a couple insurers pointed to the No Surprises Act going into effect, and only one payer mentioned the Family Glitch implementation, showing that policy changes as a whole are having little impact on premium changes.
The payer's Q2 results were highlighted by revenue growing from $71.3 billion to $80.3 billion year-over-year, while earnings from operations were $7.1 billion, representing a growth of 19% year-over-year.
"Customers are responding as we build on our five growth pillars, enabling us to move into the second half of 2022 with strong momentum serving ever more people more deeply," said Andrew Witty, UnitedHealth Group CEO.
UnitedHealthcare saw a growth of 280,000 patients served in Q2 thanks to community-based and senior offerings, which raises the total people served in 2022 to over 600,000. In domestic commercial benefit offerings, patients served grew by 80,000 in the Q2 and over 250,000 in the past year.
Member expansion resulted in revenue growth of nearly 12% year-over-year for UnitedHealthcare, increasing from $55.5 billion to $62.1 billion.
For Optum, revenue per patient increased 30% year-over-year, as people served under value-based care arrangements and continued expansion of the care services offered experienced growth.
Expansion in comprehensive managed services for health systems and a widening suite of information technology and data analytics propelled a revenue backlog increase of $2.3 billion.
On the Rx side, Optum reported 10% growth in Q2 behind new people served and expansion of pharmacy care services, including specialty and community pharmacy.
Overall, Optum's Q2 revenue increased from $38.3 billion to $45.1 billion, representing 18% year-over-year growth.
The No Surprises Act went into effect on January 1, but it hasn't fully put a stop to unexpected medical bills.
Surprises bills continue to be sprung on patients, even with a federal ban in place, with one in five adults receiving an unexpected medical charge this year, according to a survey by Morning Consult.
The No Surprises Act, which went into effect on January 1, is meant to protect patients from receiving unforeseen bills for out-of-network and emergency services after receiving treatment.
Yet 20% of respondents in the Morning Consult survey say they or their family have been charged unexpectedly, with another one in five billed after being treated by an out-of-network provider at an in-network facility.
The bills have been especially costly in some cases, as 22% of respondents say their charges were over $1,000.
Unexpected charges haven't just been an issue after the fact. The survey found about one in four adults delayed or skipped medical care because they were concerned with receiving a surprise bill. Emergency room care suffered the most in this facet, with 14% of respondents saying they did not seek care, while another 14% say they hesitated but ended up receiving care.
Emergency room bills are also what respondents feel they would be least confident in knowing up front, with 45% of adults expressing suspicion. Meanwhile, 71% say they are confident in knowing primary care costs.
When it comes to addressing an unlawful surprise bill with a provider or insurer, 63% of respondents—including 61% of those who have previously received an unexpected charge—express confidence.
Those who answered they are less sure about resolving a surprise bill pointed to distrust in both healthcare companies and the system to make it right.
Finally, only 16% of adults say they've either seen, read or heard about the No Surprises Act.
While not completely stopping surprising billing, the law is reportedly alleviating the problem somewhat.
In the first two months after going into effect, the ban prevented more than two million surprise bills, according to a survey from AHIP and Blue Cross Blue Shield Association.
The Predatory Debt Collection Act, which would put a cap on interest rates for medical debt, collected over 500,000 signatures in its quest to reach the ballot.
Healthcare Rising Arizona, with the support of the Fairness Project, cleared a significant hurdle in the pursuit of placing a measure on the November ballot to curb harmful medical debt collection practices in the state.
The Predatory Debt Collection Act cleared 500,000 signatures, easily surpassing the requirement of 237,645 signatures needed to qualify for the election, giving the campaign serious legs in its aim to protect patients and oppose abusive creditors.
The signatures for the Predatory Debt Collection Act must now be validated by the Arizona secretary of state and county recorders to reach the ballot.
Along with placing a cap on interest rates for medical debt, the proposed measure would shield individuals' assets from creditors.
The Fairness Project and its partners have previously led successful initiatives to fight predatory lending, with ballot campaigns won in Nebraska in 2020 and in Colorado in 2018. In addition to Healthcare Rising Arizona, the Fairness Project is also striving to pass a measure in Michigan this year.
"No one should have to declare bankruptcy, be harassed by debt collectors, or lose their home because
they sought treatment for an illness or injury. This is a matter of basic economic justice," Fairness Project executive director Kelly Hall said in a statement. "If passed, this ballot measure will provide direct relief to Arizona families whose lives are upended by medical debt. It will also help to ensure people don’t avoid getting care they need out of fear of going into debt — something that is essential while we are still in a pandemic.
"Fairness Project has a record of supporting successful ballot measures in several states to protect borrowers from predatory lending, increase people’s access to health care, and put more money in people’s pockets — and Arizona is next."
Medical debt is an issue that is affecting patients all across the nation. According to a study by Kaiser Family Foundation, four in 10 adults currently have some sort of medical debt. Of those, one in eight (12%) say they owe at least $10,000.
A survey finds that 70% of large employers are planning health and benefit enhancements for 2023.
Over two-thirds of employers are planning to improve their health and benefit offerings in 2023 to attract and retain workers amid a competitive labor market, according to a study by Mercer.
The survey polled 708 organizations ranging in size, from fewer than 500 employees to 5,000 or more workers. Among large employers, 70% said they are planning on health and benefit enhancements in 2023, while 61% of all employers are conducting surveys on employee benefit preferences.
"In today's competitive labor market, employees are able to leave jobs for others offering only slightly higher pay," said Tracy Watts, senior partner and national leader for US Health Policy at Mercer. "Employers are looking to create a stronger bond with this workforce by offering health and well-being benefits and resources that their employees will value."
With health benefits being a priority for many workers, employers are revamping their health plans to appeal to talent.
The survey found 41% of employers will provide a health plan option with a low deductible or no deductible, such as a copay-based plan, while 11% are considering it.
Additionally, 11% offer free employee-only coverage for at least one plan option, and another 11% are considering it.
Over half of large employers (52%) said they will offer virtual behavioral healthcare, with 40% offering a virtual primary care physician network service.
When it comes to fertility treatment coverage, nearly a third of large employers will offer benefits such as adoption and surrogacy, while another third are considering it.
Family-friendly benefits are also a priority, with 70% of respondents currently offering or planning to offer paid parental leave and 53% providing or planning to provide paid adoption leave.
"Employers need to be really thoughtful and specific about their benefits enhancements to ensure they will get a return on their investment," said Watts. "This requires an understanding of the values and needs of their unique workforce."
Physician groups are upset by the proposed change in the Medicare Physician Fee Schedule, which includes a $1.53 decrease in the conversion factor for 2023.
Providers face costly cuts to Medicare reimbursements in the 2023 Physician Fee Schedule proposed rule by CMS.
The newly released proposed rulefeatures a decrease of $1.53 to the calendar year (CY) 2022 conversion factor of $34.61, resulting in a conversion factor of $33.08 for CY 2023.
CMS states that the change reflects the expiration of the 3% increase in Physician Fee Schedule payments for CY 2022 as required by the Protecting Medicare and American Farmers From Sequester Cuts Act, along with a 0% conversion factor update and a budget-neutrality adjustment. The 3% bump was put in place by Congress to help providers offset the expenses of the COVID-19 pandemic.
Physician groups have expressed their displeasure and frustration with the proposed rule, suggesting that the cuts not only damage providers, but patients as well.
"It is immediately apparent that the rule not only fails to account for inflation in practice costs and COVID-related challenges to practice sustainability, but also includes a significant and damaging across-the-board reduction in payment rates," Jack Resneck Jr., MD, president of the American Medical Association, said in a statement. " Such a move would create long-term financial instability in the Medicare physician payment system and threaten patient access to Medicare-participating physicians."
The Medical Group Management Association (MGMA), meanwhile, pointed to the additional 4% in cuts coming under Congress' Pay-As-You-Go (PAYGO) law, which calls for cuts to counterbalance an increase in federal spending.
"These proposed cuts, coupled with the 4% PAYGO sequestration scheduled to take effect on Jan. 1, 2023, will have a detrimental impact on group practices, with 58% of recently surveyed groups indicating they are considering limiting the number of new Medicare beneficiaries served should the cuts take effect," said Anders Gilberg, senior vice president of government affairs at MGMA.
The Surgical Care Coalition, which consists of 14 surgical professional associations representing more than 180,000 surgeons across the U.S., also blasted the proposed rule.
"The current Medicare Physician Fee Schedule is broken. It fails to incentivize collaboration and pits doctor against doctor every year," said Joseph C. Cleveland Jr., MD, chair of The Society of Thoracic Surgeons Council on Health Policy and Relationships. "It's crucial that Congress work to address these cuts and create a more sustainable payment system. Failure to do so presents a serious risk to patients during a time of declining access to surgical care and rising prices for services and treatments."
Comments on the proposed rule are due September 6.
The analysis, which examines 230.9 million in-network claims across 144 major insurers for that year, finds that the average in-network claim denial rate was 18.3% (42.3 million). Denial rates ranged from 1% to 80% depending on the payer.
Additionally, researchers of the study found that individuals rarely appealed denied claims, at a rate of just one-tenth of 1%, and when they did insurers upheld their original decision 63% of the time.
Under the Affordable Care Act, marketplace plans are required to report transparency data, which includes claim denials, claims payment policies and practices, and more. The researchers, however, point to the data not being audited or used to develop other tools to help individuals compare plans, while also omitting information that could better protect consumers.
"Twelve years after enactment of the ACA, limited transparency in coverage data collected by the federal government is notable for what it doesn’t show, perhaps even more than for what it does reveal," the authors write.
The analysis found that of the 144 studied insurers, 28 had a denial rate of less than 10%, 52 died between 10% and 19%, 36 denied 20-30%, and 28 denied more than 30%.
Insurers that denied over one-third of claims included Celtic in five states (Arizona, Indiana, Missouri, Tennessee, and Texas), Molina in six states (Missouri, Mississippi, Ohio, South Carolina, Utah, and Wisconsin), and QualChoice in Arkansas and Ambetter in North Carolina, Oscar in seven states (Arizona, Florida, Mississippi, Missouri, Tennessee, Texas, and Virginia), and Meridian in Michigan.
Reasons for denying claims varied, with about 16% denied because the claim was for an excluded service, 10% due to lack of preauthorization or referral, and about 2% based on medical necessity. Among 2% of claims identified as medical necessity denials, while one in five were for behavioral health services. The majority of denials (72%) were for 'all other reasons.'
With the insurer marketplace running on competition between plans, the authors state, it's important individuals can access all of an insurer's features, including how reliable plays pay claims.
"More robust transparency data reporting, while potentially more burdensome to insurers, could provide data useful to both regulators and consumers," the researchers write.
