Health care costs and documenting social needs

Prognosis
Doctors Propose New Diagnosis: ‘Unable to Pay for Prescriptions’

Outlier Health Care Spending- by John Tozzi published in Bloomberg

The U.S. spends less on social services, but makes up for it in medical costs

If you get struck by lightning or bitten by a pig, a physician can record that information with a code shorter than your phone number.

But if you can’t afford your bills, doctors and health plans have no consistent way to document that.

Now, the biggest U.S. insurance company and the country’s most influential association of doctors want to create new ways to better capture information about patients’ social conditions. It’s part of a shift in the health-care industry to address aspects of people’s lives that influence their well-being beyond medical care, so-called social determinants of health.

“Having a standardized diagnosis allows for everyone in the system to understand that there’s an unmet social need,” said Sheila Shapiro, a senior vice president at UnitedHealthcare. The company, a unit of Minnetonka, Minnesota-based UnitedHealth Group Inc., announced the plan Tuesday with the American Medical Association.

Just as medical diagnoses trigger prescriptions or referrals to labs and specialists, the proposed codes are meant to help clinicians refer patients to assistance for food, housing, transportation or other needs.

Since 2017, UnitedHealthcare’s Medicare Advantage plans have made more than 700,000 referrals to outside social-service programs. The insurer’s Medicare plans cover about 4.9 million people.

Among the more than 20 new codes under consideration:

• unable to pay for prescriptions
• unable to afford child care
• worried about losing housing
• unable to count on family and friends
• feeling unsafe in current environment

Having standard designations for such conditions would let doctors, hospitals and health plans share the information through medical records and insurance claims forms.

“Everyone can start reading from the same sheet of (medical!) music,” said Tom Gianulli, chief medical information officer at the AMA’s Integrated Health Model Initiative.

While the codes wouldn’t immediately lead to reimbursement changes, capturing data about patients’ social needs may be a step toward paying for interventions that address them.

“Collecting data is a big part of this right now, and trying to figure out what’s effective, and advocate for funding around that,” said Steve Nelson, chief executive officer of UnitedHealthcare.

Slowly Changing

Payments are still largely tied to the number of procedures clinicians perform, rather than the overall health of patients. 

That’s slowly changing, and the effort to treat social needs is part of the transformation.

For example, a diabetic who can’t get to the pharmacy to pick up medication may wind up in an emergency room with uncontrolled blood sugar. 

Traditionally, insurance would pay for the emergency room visit but not for the cab ride to the pharmacy that might have prevented it.

The taxpayers and employers who finance America’s $3.5 trillion medical system ultimately pay the cost of that hospital visit. The health-care industry and policy makers are struggling to figure out how to get people those cab rides, as well as other interventions that could make people healthier and reduce overall spending.

The industry has already taken steps in that direction. In 2016, the new codes were adopted to indicate whether a patient is homeless, poor or lacking adequate food, for example. The latest proposal would build on that effort. A federal committee will decide whether to adopt the proposal later this year.

New codes are a useful first step, but there are limits to what the health-care system can do, said Melinda Abrams, a vice president at the Commonwealth Fund, a foundation focused on health research.

Society also needs to properly finance the social-service system because inadequate funding contributes to high health-care costs, Abrams said.

“The health-care sector has had a blind eye to it.”

Opposition coalition to TrumpCare aka RyanCare is formidable

American Medical Association leads a formidable coalition to oppose the Ryan proposal while Republicans force committee votes.

American Medical Association leads an informal but strong coalition to oppose RyanCare health bill

As far as I can tell, the still growing informal but strong coalition unifying, to oppose the RyanCare (TrumpCare) overall to #denycare, by repealing the Affordable Care Act (ACA) includes the American Medical Association and:

1. American Nurses Association
2. AARP (American Association of Retired Persons)
3. American Hospital Association
4. Heritage Foundation - conservative "think tank"- calls GOP plan "bad policy"

This is a strong and diverse coalition of consumers, public policy experts and health care providers who cannot be ignored by Congress, regardless of their political party affiliations.  In fact, the time is long past for Donald Trump to realize how he cannot bully his way to force public policy. Moreover, Speaker Ryan must understand the consequences of his wrong minded approach to helping people pay for health care coverage.

American Medical Association Opposes Republican Health Plan By REED ABELSON

The American Medical Association, a powerful lobbying group representing the nation’s doctors, announced on Wednesday that it opposed the House Republicans’ proposed legislation to replace the federal health care law, saying it was concerned the bill “would result in millions of Americans losing coverage and benefits.”

The group, which provided crucial support for the Obama administration’s contentious health care legislation before it was enacted in 2010, also sent a letter to the two House committees responsible for drafting the Republicans’ bill, called the American Health Care Act. The group’s concerns echoed some others raised this week among industry organizations like hospital groups worried about the possible losses of coverage that could result from the proposed legislation that was released on Monday.

All of the major hospital groups, including the American Hospital Association, also came out against the bill. “We are very concerned that the draft legislative proposal being considered by the House committees could lead to tremendous instability for those seeking affordable coverage,” the hospitals said in a letter to Congress. The hospitals also raised concerns about Republicans’ plans to significantly alter Medicaid, which they said could result in a loss of coverage and cuts to health care services. 

The doctors’ main concern focused on the Republicans’ replacement of the subsidies now available to millions of low-income Americans with a flat tax credit for low- and middle-income people that is adjusted by a person’s age. 

The A.M.A. emphasized the need for the credits to “be sufficient to enable one to afford quality coverage,” but it also emphasized that the credits should be closely tied to an individual’s income as a way of covering more people and being a better use of taxpayer money. The doctors also voiced their opposition to the proposed rollback of Medicaid. (In MaineWriter's opinion- these tax credits are only as good as the beneficiaries' ability to pay out of pocket for the coverage and most middle income Americans won't be able to afford them given the premiums are adjusted based on age...stupid!)
Even as the Republicans seemingly rush to pass a bill that would undo much of the current law, the doctors and hospitals urged them to be careful about whatever changes they made. 

The Congressional Budget Office (CBO) has not yet weighed in with estimates of how many people the new legislation will cover and what the cost of the plan might be.

“As you consider this legislation over the coming days and weeks, we hope that you will keep up most in your mind the potentially life altering impact your decisions will have on millions of Americans who may see their public, individual or even employer-provided health care coverage changed or eliminated,” wrote Dr. James L. Madara, the association’s chief executive.

The A.M.A. had earlier endorsed Dr. Tom Price as President Trump’s choice to head the Department of Health and Human Services, provoking a split with rank-and-file doctors and nurses who opposed his nomination.

(In summary - Congress must realize how the strong coalition growing to oppose Speaker Ryan's proposed legislation must be given respect and the expertise of the group must be responded to by dumping this useless #RepealCare legislation. "DOA"- stop forcing this needless legislation on Americans and the ACA beneficiaries. Doing so is blatant ignorance because their coverage is being taken against their will.