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Daily Archives: August 20, 2013

An Alaska-Sized Price Difference: A Circumcision In Anchorage Hospitals Can Cost $2,110 or $235

It’s not just patients who are stunned to see what a hospital charges for services. 

Two groups of pediatricians in Anchorage are taking a stand after learning that one of the city’s hospitals, Alaska Regional Hospital, is charging $2,110 for a circumcision, almost 10 times more than the $235 that Providence Hospital, the city’s other major health facility, charges. Those prices are on top of the doctor’s bill.

“We were, I think, shocked by the price we were hearing,” says Dr. Charles Ryan, one of the physicians at Anchorage Pediatric Group. He and his partners no longer perform circumcisions at the 250-bed Alaska Regional. Another pediatric practice, LaTouche Pediatrics, also has stopped most of its circumcisions there. 

Dr. Charles Ryan holds an infant after a circumcision (Photo by Annie Feidt/APRN).

Ryan now performs the procedure in his office for $700, the same as he charged in the hospital. He says Alaska Regional is a good hospital but its price for circumcisions is “wildly abnormal.” The hospital provides a small tray of sterilized and reusable instruments for the doctor and a nurse to help take care of the baby during the short procedure.

Kjerstin Lastufka, a spokeswoman for Alaska Regional, says in an e-mail that the cost is based in part on the hospital’s need to be ready to treat medical emergencies. She also points out that insurance companies generally negotiate better rates with the hospital so the average amount that the hospital collects for the procedure is $340. 

Ryan says the doctors in his group had no difficulty deciding to move the circumcisions to their offices. “There was no long discussion,” he says, noting that it took the doctors about two minutes to come to agreement.

“Health care dollars are limited and we like to see them spent in ways that really provide good health care for people and necessary health care for people,” Ryan says. “And when the health care dollar is being milked off by charges … those are dollars that can’t be used for more essential things.”

Yet, even doctors can have difficulty finding out what hospital care costs, says Dr. Jack Percelay, a New Jersey pediatrician who also chairs the American Academy of Pediatrics Committee on Hospital Care. Doctors are speaking up when they think a hospital is charging too much, he says, although most talk to hospital administrators behind closed doors.

“Oh I’m sure there are many private discussions in terms of setting what seems to be reasonable fees,” Percelay adds. “I have not heard of people boycotting services at one hospital based on charges previously.”

Ryan says the incident has convinced him he needs to at least try to be better informed on hospital prices for all kinds of procedures. “Neither hospital is out there trying to put that information right in front of us,” he says. “And sometimes it’s hard information to get if you ask.”

This story is part of a reporting partnership that includes APRN, NPR and Kaiser Health News.

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Implementation of multifaceted hypertension quality improvement program associated with increase in blood pressure control rates

Implementation of a large-scale hypertension program that included evidence-based guidelines and development and sharing of performance metrics was associated with a near-doubling of hypertension control between񎧑 and 2009, compared to only modest improvements in state and national control rates, according to a study in the August 21 issue of JAMA. “Hypertension affects 65 million adults in the United States (29 percent) and is a major contributor to cardiovascular disease…

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Higher urinary albumin excretion associated with increased risk of coronary heart disease among black adults

In a large national study, higher levels of the urinary albumin-to-creatinine ratio was associated with greater risk of incident but not recurrent coronary heart disease in black individuals when compared with white individuals, according to a study in the August ǵ issue of JAMA. “Increased urinary albumin excretion is an important marker of kidney injury and a strong risk factor for cardiovascular disease…

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Lateral wedge insoles not associated with improvement of knee pain in osteoarthritis

Although a pooling of data from 12 studies showed a statistically significant association between use of lateral wedge insoles and lower pain in medial knee osteoarthritis, among trials comparing wedge insoles with neutral insoles, there was no significant or clinically important association between use of wedge insoles and reduction in knee pain, according to a study in the August 21 issue of JAMA. “Osteoarthritis of the knee is a common painful chronic disease whose prevalence is increasing and for which there are few efficacious treatment options…

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Study examines genetic associations for gastrointestinal condition in infants

Researchers have identified a new genome-wide significant locus (the place a gene occupies on a chromosome) for infantile hypertrophic pyloric stenosis (IHPS), a serious gastrointestinal condition associated with gastrointestinal obstruction, according to a study in the August 21 issue of JAMA. Characteristics of this locus also suggest the possibility of an inverse relationship between levels of circulating cholesterol in neonates and IHPS risk…

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Junk food in pregnancy linked to childhood mental disorders

During pregnancy, it can be hard not to give in to those cravings for unhealthy foods. But researchers have found that mothers who eat junk food while pregnant are more likely to have children with mental health problems. Researchers from Deakin University in Australia, alongside researchers from Norway, analyzed more than 23,000 mothers who were a part of the Norwegian Mother and Child Cohort study…

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Eating fruit cut risk of abdominal aortic aneurysm in study

Eating our daily quota of fruits and vegetables should be a no-brainer by now, as we have long heard of the health benefits accompanying a balanced diet. And now researchers in Sweden have discovered that eating more fruit could lower risks for an often-lethal form of aortic aneurysm. The researchers, led by Dr. Otto Stackelberg of the Karolinska Institute, published their findings in the American Heart Association’s journal Circulation…

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Restaurants 'should help tackle obesity' through apps and websites

Researchers have suggested that restaurants could help tackle obesity by expanding and improving calorie listings and “healthy eating” options on their websites and mobile apps, encouraging customers to self-monitor what they eat. The study, published in the journal PLOS ONE, analyzed the top 100 US chain restaurants’ websites to assess the availability and ease of access to calorie information. According to the Centers of Disease Control and Prevention (CDC), between 2007 and 2010, adults consumed around 11.3% of their daily caloric intake from fast food…

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Family Insurance Premiums Rise 4 Percent For 2nd Year In Row, Survey Finds

For the second year in a row, health insurance premiums for job-based family coverage rose a relatively modest 4 percent, reflecting slowed health spending.

Nonetheless, workers are likely to feel an increased pinch from health care costs:  More than a third have annual deductibles of at least $1,000 this year before their insurance kicks in, while wages continue to grow far more slowly than health insurance costs.

The average family plan premium topped $16,000 for the first time, with workers paying on average $4,565 toward that cost, not counting copays and deductibles, according to a survey of about 2,000 employers released Tuesday by the Kaiser Family Foundation and the Health Research & Educational Trust. (KHN is an editorially independent program of the foundation.)

The average cost of a single employee’s insurance premiums rose 5 percent, to $5,884, with workers paying an average of $999, the survey found.  Workers’ wages increased 1.8 percent on average, while general inflation rose 1.1 percent. The survey was done between January and May of this year.

“The premium increase this year is very moderate, but the pain factor for health insurance cost has not disappeared,” said Drew Altman, president and CEO of the foundation. “Over time, what people pay for health care has dramatically eclipsed both their wages and inflation.”

The increases documented in the report, moderate by historic standards, come amid ongoing debate over the federal health law’s ability to rein in health care costs. In July, the Obama administration granted a one-year delay, until 2015, in the requirement that employers with 50 or more workers offer coverage or face a fine, prompting Republicans to call for a similar delay in the rule requiring most individuals to carry coverage.  Critics and opponents have also sparred over whether the health law will slow premium growth. All sides may find fodder in the report, observers say.

“You will have the administration and the Democrats saying, ‘Look how the health law is helping moderate health cost increases,’ and Republicans and those against the law will say, ‘It hasn’t done anything because costs are still four times inflation,'” said Paul Fronstin, director of the Health Research and Education Program at the Employee Benefit Research Institute, a nonpartisan Washington think tank.

The employer survey found that 93 percent of firms with more than 50 workers offer coverage, down from 95 percent in the񎧜 survey. Overall, 57 percent of all employers offer health insurance to their workers, down from 66 percent decade ago.  The rate of coverage by employers with 200 or more workers remained steady, with about 99 percent offering insurance.  Coverage drops off with firm size, with only 45 percent of the smallest companies offering insurance to workers, down from 55 percent in 2003.

Other findings include:

  • Workers pay 18 percent of the premium costs for single coverage on average, and 29 percent of the premium cost for family plans, rates that have changed little in a decade.
  • Health insurance premiums have risen 196 percent since 1999, with worker contributions growing 182 percent.  Meanwhile, wages have grown an average of 50 percent since 1999.
  • Thirty-eight percent of all workers with single health insurance had at least a ũ,000 annual deductible, the amount they pay before most insurance coverage kicks in. At small firms, 58 percent of those covered workers had at least a $1,000 deductible, while nearly 31 percent had deductibles of at least $2,000, up from 12 percent in 2008.

“One of the changes in this report is the growth in deductibles,” said economist Paul Ginsburg of the Center for Studying Health System Change, a nonpartisan research group in Washington.  The deductibles were likely “a factor behind the premium increase being as low as it was.”

Workers in small firms with three to 199 employees face an average annual deductible of $1,715 compared with $884 for those in larger firms.

Small businesses generally see more volatile insurance premium rates than larger firms. Scott Hauge, who runs an insurance brokerage firm in California, says his clients have seen increases averaging around 10 percent a year for the past seven years. He doesn’t dispute the findings of the survey, but added that “small businesses are not seeing those minor increases.”

Analysts say premium increases are cyclical, with periods of rapid increases, such as the double-digit hikes that marked the late 1980s and the early 2000s, followed by periods of slower growth. Since about the mid-2000s, rate increases paid by employers fell below 10 percent each year, with the smallest annual growth tracked at 3 percent in the 2009-2010 employer survey. In what surprised many analysts, rates jumped by 9 percent from 2010 to 2011 before moderating the past two years to around 4 percent.

Some employers say changes associated with the health law, such as a provision allowing adult children to stay on their parents’ plans until age 26, are adding costs.

“We’re all seeing it,” said Forrest Cook, vice president of human resources at NCP Solutions, a 350-employee company in Birmingham, Ala. “We have around a 5 percent to 6 percent increase this year. Before that, our costs held steady for about three or four years.”

Cook was also concerned with the uncertainty surrounding the health law, such as the year delay in the requirement that large employers provide health coverage or pay a penalty.

His firm does not require workers to pay a large sum before their insurance kicks in because “when you have a high deductible plan, it’s going to discourage people from using it,” Cook said.

But the firm is enthusiastic about wellness programs, as are 35 percent of employers in the survey, who consider them an effective strategy for controlling costs. Such programs range widely, from providing small gifts to employees for filling out a health risk questionnaire, to offering large reductions in premiums for workers who get screened and meet certain goals for weight, blood pressure, cholesterol or blood sugar. The federal health law allows employers to increase those financial incentives from 20 percent of the cost of the health coverage to 30 percent.

NCP offers workers financial incentives to participate in wellness programs, including getting flu shots and checking for such things as high blood pressure. Those who sign up for a stop-smoking class get credit for paid time off, Cook said.  And the firm discusses health costs with workers.

“We’re very honest about the cost of our plan,” said Cook, whose firm is self-insured. “We tell people if you control the cost of the health plan, if you’re lively and well, it will cost us less.”

Ankita Rao contributed to this story.

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3rd Annual Pharma Commercial and SFE Summit, 24-26 September 2013, Berlin

Discover how to optimize sales force effectiveness “We were born to succeed, not to fail” Henry David Thoreau 3rd Annual Pharma Commercial and SFE Summit will exchange experience with the top experts from the pharma and biotech industry. This current topic started to be the hottest issue to be discuss by successful SFE experts from pharma industry nowadays. It is a great opportunity how to optimize sales force through a customer-centric approach while remaining compliant. Sales force effectiveness (SFE) is becoming a high priority area in the global pharmaceutical industry…

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