Author: WorkCompAcademy

Most people in the U.S. with health insurance don’t use the patient portals that are increasingly provided by doctors for online communication, a new study suggests. In a nationally representative survey, researchers found that nearly two-thirds of insured participants had not used an online medical portal in the past year.

Disparities among those who said they’d been offered portal use, and among those who chose to use it, suggest this technology can become a source of unequal access to healthcare, the study team writes in Health Affairs.

“Previous research has shown there are real benefits to portal use. Patients become more engaged in their own health and really stick to their treatments,” said senior author Denise Anthony of the University of Michigan in Ann Arbor.”However, new treatments in health care, and new technologies in general, can end up increasing inequality,” she told Reuters Health by email.

Anthony and her colleagues analyzed data on 2,325 insured patients who participated in the 2017 Health Information National Trends Survey and who had a medical visit during the year before the survey. The researchers wanted to understand the characteristics of portal users and nonusers and the reasons, such as technology issues or security concerns, why many patients don’t use online sites to access their medical records.

Overall, 63 percent of survey participants reported not using a patient portal during the past year, and 60 percent reported not having been offered access to a portal.

Nonusers were more likely to be men, aged 65 or older, to be unemployed, live in a rural location, have public insurance through Medicaid, have a high school diploma or less education and to lack a regular doctor. Similar characteristics, as well as being non-white, were seen among people who said they weren’t offered access to a patient portal.

Among the reasons participants gave for not using online portals, 25 percent mentioned issues with internet access, 32 percent said they had no online medical record, 70 percent said they preferred to speak directly to the doctor, and 22 percent were concerned about privacy issues.

“We also know from our previous research that privacy concerns can affect patients’ relationships with physicians, including how they communicate and trust their doctors, so these concerns are important beyond portals,” Anthony said.

“The underlying assumption is generally a ‘Build it and they will come’ mentality about technology, but this study gives great perspective about both who is offered/using the portal as well as why certain groups experience barriers,” said Courtney Lyles of the University of California, San Francisco, who wasn’t involved in the study.

“Everyone is generally interested in online tools to make life more convenient, but we can’t separate that from the skills and relationships that surround technology use,” she told Reuters Health by email.

Future studies should consider the role of digital inclusion and digital literacy, Lyles added. Doctors will need to do more to help patients use portals during visits, as well as connecting them to resources for digital support such as local libraries and community groups.

Limited information exists on the characteristics of US physicians who have been excluded from Medicare and state public insurance programs for convictions of health care fraud, crimes related to health care delivery, or substance abuse.

Common fraud schemes include billing for services not rendered, filing duplicate claims (including the unbundling of bundled services), and misrepresenting dates and locations where services were provided. Health crimes involve the provision of medically unnecessary procedures, illegal patient admittance and retention practices, the making of false statements (including physician medical identify theft), and the gross violation of professionally recognized standards of care.

Researchers decided to to examine the characteristics of physicians excluded from Medicare and state public insurance programs for fraud, health crimes, or unlawful prescribing of controlled substances. Alice Chen, PhD, MBA, from the University of Southern California in Los Angeles, and colleagues conducted a cross-sectional study to examine the characteristics of physicians excluded from Medicare and state public insurance programs for fraud, health crimes, or unlawful prescribing of controlled substances between 2007 and 2017.

“We found that the number of physicians excluded from participating in public health insurance has grown substantially over time and that excluded physicians were concentrated in specific regions of the United States,” the authors write.

The researchers found that 2222 physicians were temporarily or permanently excluded from Medicare and state public insurance programs during 2007 to 2017. On average, there was a 20% increase per year in fraud, health crimes, and substance abuse exclusions (from 236 convictions in 2007 to 670 in 2017). Researchers found the highest exclusion rates in the West and Southeast. The state with the highest exclusion rate was West Virginia, with 5.77 exclusions per 1000 physicians, while there were no exclusions in Montana. Exclusions were more likely for male physicians, physicians with osteopathic training, older physicians, and physicians in specific specialties.

Physicians in the West and Southeast were most likely to be excluded for fraud, substance abuse, or health crimes. Although California, New York, Florida, and Texas had the highest absolute counts of excluded physicians from 2007 to 2017, they also had the largest physician populations.

When considering the rate of physician exclusions per 1000 physicians, only Florida remained in the highest category of exclusion rates. West Virginia had the highest exclusion rate, with 5.77 exclusions per 1000 physicians (32 exclusions among 5720 physicians), while Montana had 0 exclusions during this period.

There were several explanations for the observed increase in exclusions, and rates of identified health care fraud, waste, and abuse. First, this finding could be evidence that regulators, who have been aided by recent public policies targeting the reduction of fraud and waste, may be getting better at identifying perpetrators of fraudulent activity.

Physician exclusions were more common in certain states in the West and Southeast. Many of these regions had Medicare Fraud Strike Force Teams, which were established in “hot spots” of unexplained high Medicare billing levels (Florida, California, Michigan, Texas, New York, Louisiana, Florida, and Illinois as of 2017).

In addition, the growth in physician exclusions could also be due, at least in part, to growth in the total number of US physicians participating in public insurance.

The California Thoroughbred Business League (CTBL), responsible for overseeing funds utilized for providing workers’ compensation insurance relief to horsemen, has seen steadily increasing workers’ compensation rates in the state of California.

The cost of the 2019 program is expected to increase by 3% over 2018, or by more than $13.7 million for Thoroughbreds.

Per-start fees will be increased from $100 to $106 to cover the owners’ portion of funding. As before, the per-start fee will be automatically deducted from the owner’s paymaster account every time that owner starts a horse, effective Jan. 1.

The Thoroughbred Owners of California (TOC) board voted unanimously to increase Guaranteed Participation Purses by $6 per start to offset the costs.

In addition, starting Jan. 1, owners of horses who finish fifth or beyond – whenever their share of purse money is less than the Guaranteed Participation Purse – will be paid $300 per start at Golden Gate Fields and $351 per start at Southern California tracks to include increased costs for third party Lasix administration and jockey fees.

Three sources of revenue are utilized to cover workers’ compensation costs in California, according to Brad McKinzie of the Finish Line Self Insurance Group, which has managed workers’ compensation accounts for Thoroughbred horsemen in California since 2011.

Owners pay a fee per starter to cover jockeys, trainers pay a daily fee to cover exercise riders and stable staff, and one-half of 1 percent of the takeout on handle from exotic wagers on California races is dedicated to a fund to pay workers’ compensation costs.

Legislation passed in 2004 allowed for the increase in takeout to offset worker’s compensation costs.

The deduction from takeout amounts to approximately $6.5 million annually, McKinzie said. Owners and trainers pay the remaining costs. The fee paid by a trainer amounts to approximately $100 per month per horse in their stables.

The TOC is part of the California Thoroughbred Business League, a consortium of racetracks, horsemen’s groups, and fair organizations that oversees a program to provide workers’ compensation subsidies to owners. The Finish Line Group has handled workers’ compensation for Thoroughbred horsemen in California since 2011. McKinzie founded the Finish Line Group. He is also the general manager of the Los Alamitos Thoroughbred meetings.

Prices hospitals charge for their services will all go online Jan. 1 under a new federal requirement, but patient advocates say the realities of medical-industry pricing will make it difficult for consumers to get much out of the new data.

A new federal rule requires all hospitals to post online a master list of prices for the services they provide so consumers can review them starting Jan. 1.

The health care industry nationally has a reputation for having little price transparency, which can make it difficult for consumers to price compare. But the hospital’s master list prices, sometimes called a chargemaster, is also not a complete look, consumer advocates say.

That’s because the final bill a patient receives is almost never the same as the sticker price for the services they received. Insurance companies negotiate discounts on the sticker prices. Co-pays, co-insurance, deductibles also add other layers of complexity that bring discounts or increased costs before a final charge is determined.

“The list prices are so high that the vast majority of hospitals don’t even try to collect list prices from uninsured patients,” said Benedic Ippolito, with the American Enterprise Institute, who has researched hospital list prices.

The federal rule is being brought out as a measure to improve competition and help educate consumers.

“We are just beginning on price transparency,” Seema Verma, head of U.S. Centers for Medicare & Medicaid told the Associated Press. “We know that hospitals have this information and we’re asking them to post what they have online.”

But real transparency comes when consumers can easily see what they will pay to a provider based on their insurance benefits, said Thomas Campanella, Baldwin Wallace University health care MBA program director. He said some insurance companies are providing that information through price comparison tools. “I almost see it being more of a political ‘look at what we did,’” Campanella said of the requirement to post list prices.

A benefit of having health insurance is that the insurance companies negotiate with hospitals on a discount from what is listed on the chargemaster. If a hospital is “in network” it means the insurer and hospital have an agreement on discounted rates and the insurance company typically covers a higher portion of those prices. If a patient goes to a medical provider that is out-of-network, they could be billed the difference between what the chargemaster lists as the price and what their insurance writes a check for. The practice is called balance billing or sometimes called “surprise billing.”

Miranda Creviston Motter, president and CEO of Ohio Association of Health Plans, which represents insurance companies, said as health care costs continue to rise, provider cost information is important and the association supports federal policies requiring providers to provide easy to understand cost information directly to health care consumers.

“This information supplements the cost information health plans currently offer their members. ,” she said in a statement.

Price comparison tools are becoming increasingly available through insurance companies, but they have limits in usefulness. Not all health care costs can be shopped for ahead of time, such as emergency visits, and consumers can prioritize other things besides cost, such as a doctor they trust or a hospital close to home. Only a small number of employees at two large companies with a price transparency tool used the tool and it was not associated with lower health care spending, according to 2016 study in the Journal of the American Medical Association.

Scott McGohan, CEO of McGohan Brabender, a benefits broker, said while many of the major insurance carriers have price shopping tools, it’s not always easy to know enough about medicine to know how to price shop.

Patients undergoing surgery don’t often receive practical advice about what to do and what to expect during the recovery process, says a surgeon who has been on the giving and receiving end of post-op instructions.

These directions need a more commonsense approach to rest, diet and pain, Dr. J. David Richardson of the University of Louisville School of Medicine in Kentucky writes in the Journal of the American College of Surgeons.

“We give patients these catchphrases about how they’ll feel better, but that’s not always true,” Richardson told Reuters Health.

“For a long time, surgeons have been happy with surgical outcomes as long as a big issue didn’t come up, such as an infection,” he said in a phone interview. “Patients are concerned about the small aspects of recovery, and we should be attuned to that.”

One of the most important tenets of recovery, he writes in his commentary, is that it’s not a progressive linear process. The advice that ‘You will feel better every day’ is not true, for example, and it often makes patients uneasy when they don’t recover as they believe they should.

Instead, patients tend to have a ‘stuttering progression to wellness,‘ Richardson writes, which means three steps forward and two steps back. When patients are aware of this, they’re less apprehensive and less discouraged when they have a “bad day.” Rather than measuring progress daily, he advises tracking progress from one Friday to the next.

‘Some days just don’t go that well, which is the way the body functions,’ he told Reuters Health. ‘Patients need to know that what they’re going through is normal.’

Richardson also disagrees with the advice to recovering patients about activities, “You can do what you feel like doing.” Although it sounds practical, this often backfires or discourages patients as they go through the healing process. Some feel great after waking up but then have fatigue or adverse reactions later in the day. Those who try to drive, shop or return to work too quickly may “hit a wall,” he notes.

The body needs a physical recovery as much as a mental recovery, he notes, so he often tells patients to be cautious about performing mental tasks after a significant operation. Avoid “trying to work in a fog” or making important decisions in early post-operative stages, Richardson said.

Diet is another aspect that is often misrepresented, and the advice to “Eat what you feel like eating” can be too vague. Instead, a slower progression to a full normal diet could prevent nausea, vomiting, bloating, constipation and other gastrointestinal issues that occur during the early recovery phase. This is particularly true when patients are taking new pain medications, Richardson added.

On a related note, pain management can also be misleading, he said. The opioid crisis speaks to the dangers of over-prescribing pain drugs, and points to the fact that pain is an individual response. Some patients require fewer doses, and others need heavy doses, but prescriptions are often given “by the book” where one size fits all. A more nuanced, individualized approach would help, taking into account previous pain medication use, psychotropic medication use and previous operation recovery experience.