Hospital Accountability on Pricing and Personal Medical Records

New Orleans   Just because a big piece of the government is shutdown and a lot of stuff at the top of the heap has been totally cray-cray doesn’t mean that there is no good news to be found anywhere at the federal level.  Maybe it takes a bit of searching, but even with the attack on the Affordable Care Act, we seem to all still believe that healthcare institutions require some accountability.

For example, as of January 1st, 2019, all hospitals in the country are required to post a list of their standard charges for all of their services as well as for the drugs and tests they provide.  Furthermore, they are required by the federal government to post these charges in a way that you can download them on your computer at home and review them, even before you are under the knife or undergoing some treatment.

There are a couple of caveats of course.  One is the reminder that the charges hospital’s list may not be the real cost to the consumer’s pocketbook.  Insurance payments would impact that as well, but at least you will know the retail or sticker price that they are trying to get for a band aid, a transplant, or a new baby.

The other warning is that they are posting this on their websites.  Anyone who has ever been on their local hospital’s websites, knows that this gives them additional pains in several well-regarded body parts.  Additionally, it goes without saying that you would need internet and computer-style access in order to do the download, and many of the families that need this information the most are also numbered in the huge masses in our cities and rural areas that lack such access.

Another part of this new federal rule taking effect now is supposed to make your electronic medical records available to you.  The same problems exist there, but it’s still a good rule.  The government has spent billions helping hospitals make their information and records digital and available.

I’m skeptical whether many of these institutions are ready for prime time and the turn of the calendar.  I had occasion to need to make an appointment at my billion-dollar local nonprofit hospital, Ochsner for example.  Calling them, you are harangued about going on your computer to quicken the process.  Doing so is a horror.  Over a half-hour I was kicked off the site four times and told a dozen times that the hospital’s server was not accepting communications about scheduling – or anything else.  I called them and got an appointment on the old school telephone blower within minutes.

Another bunch of emails instructs you to go on-line and fill out your medical and other history before you show up to speed the process.  Having just done that for my annual physical and still being forced to fill out the form, I wasn’t going to be fooled by those messages a second time.  Sure enough when I showed up, they tried to give me the form to fill out again.  I said I would only do it if they can show me that my history wasn’t already in the computer since I had filled it out online and on paper previously.  The nurse said, “well this is so that the doctor has it in front of them.”  I said, “the computer is in front of them.”  Anyway, she looked and nada.  My record on past illnesses and family history wasn’t there.

In recent months Atul Gawande, the Boston-based author and doctor, wrote an amazing article in The New Yorker questioning whether computerization was helping or hindering doctors after his hospital system, the famous Partners nonprofit, had spent a billion or so making everything electronic.  Doctors were spending more time on their computers than with their patients.

Their computers might have worked, and they actually had computers at home and at work.  Both of those things might be a couple of steps ahead of many of us, but this rule will definitely be a step forward once we can catch up to it, and if there are real penalties for hospitals not complying.

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Arkansas Playing Gotcha with the Poor to Cut Them Off of Medicaid

New Orleans  In a sordid and shameful episode a few weeks ago Arkansas Governor Asa Hutchinson pridefully announced that the state had managed to bar 4300 people from health care support through Medicaid because of its new work requirement policies.  Seema Verma the head of the federal Center for Medical Services (CMS) who had approved this draconian attack on the poor played clueless cheerleader.

As more information come forward the real evil that underlies this shame emerges.  Let’s look at the facts.

Arkansas began the experiment by exempting two-thirds of the eligible recipients from having to report work hours, knowing this was going to be a problem.  30,000 people were then required to report.  16,000 didn’t report any qualifying activities to the state, either work, training or volunteer time.  In fact, according to the New York Times, “only 1200 about 2% of those eligible for the requirement, told the state they had done enough of the required activities in August, according to state figures.”  That’s pickle-poor!  It screams to a state failure not a people failure, and it foretells thousands more that will be denied coverage.

State officials tried to cover their rear ends, claiming they had done everything possible:  mailings, calls, and even putting out fliers some places where Medicaid patients congregate.  Even more ridiculously they touted the fact that they send emails and posted on social media sites.  Who are they trying to fool?  Arkansas ranks 48th among all of the states in the US in terms of connectivity and 30% of the population is underserved.  230,000 people in Arkansas don’t have any wired internet providers available where they live.  Who wants to guess whether embedded in these sorry statistics lie most of these lower income Medicaid recipients?

Shockingly, the Times then quoted Amy Webb, the chief communications and engagement officer for the Arkansas Department of Human Services saying, “If there’s something we are not doing to reach people, if someone will tell us how to do that, we will do it.”  Yeah, really?  She doesn’t mention that the state legislature forbade any use of media to increase enrollment under the Affordable Care Act.  Nowhere do they claim they were on the television or radio airwaves.  As the manager of KABF, a 100,000-watt noncommercial smack dab in the middle of the state with more than 50,000 listeners per week, more than half of them lower income, I can absolutely tell you we never received a public service announcement from them, much less any support for a real information promotion of the program.

Every other indication is one of abysmal failure.  The state conceded even when they had email address, only 20 to 30% opened the email.  Call centers said many didn’t answer their phones.  A professor from New York visited three counties in August and interviewed 18 people and 12 were unaware that work requirements even existed.  Other experts noted that an incentive system, even a punitive one trying to get more people into the workforce, won’t work if people don’t know about it.  Duh!

Adding injury to injury, all of the work hours are required to be submitted through the internet.  That’s the same internet thing that hundreds of thousands of Arkansans are not able to access, and even with access are not necessarily all-pro at using the state’s clunky website.

State officials in Arkansas need to start some truth telling.  These so-called work requirements are nothing of the kind.  This a pure and simple way to push eligible people off of Medicaid.  Hopefully a coming court hearing will stop this hypocrisy.

In the meantime, this is a scandal that none of us should be able to stomach.

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Please enjoy Johnny Guitar from Twisted Wheel.

Thanks to KABF.

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