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Texas Home Health seeking health care professionals

  • Due to expansion within the company, Texas Home Health — part of AccentCare — is seeking to add health care professionals to its team.



Texas Home Health, a leader in home health care, personal care, hospice, and care management services, is looking to add qualified, passionate health care professionals to its team.

“Texas Home Health is growing rapidly and so is the health care population we serve. The vast majority of seniors prefer care delivery at home, and our innovative and proprietary programs make the home a very viable and convenient care setting,” said Tammy Steele, chief people officer at AccentCare, the parent company of Texas Home Health and a national leader in post-acute home health care services.

Part of AccentCare

Texas Home Health has been dedicated to improving the quality of living for its patients in Texas for more than 45 years, and its qualified teams work closely with community health care providers, patients and their families to compassionately deliver quality care to all those served. Texas Home Health is part of the AccentCare family, which offers a broad continuum of care services to meet a wide variety of patient and client needs.

Better training can help professionals in Intensive Care Units (ICU) avoid errors in treatment – which can have serious consequences. Teleprometheus brings information technology and health care together, allowing ICU professionals in Greece (Crete) and Cyprus to follow short online courses and find information at the touch of a screen.

Heleni Nikolau, who works in Nicosia General Hospital’s ICU department, explains how it helps in her daily life.

“When I first came to this department they told me about Teleprometheus. I actually had one patient who needed a specific procedure, so it took me around five or ten minutes using the platfoms to find out what I had to do.”

“Some 400 healthcare professionals in two hospitals in Cyprus and Greece use this €650,000 e-learning system, which is largely financed by Europe’s Cohesion Fund.

Teleprometheus provides on-demand multimedia training material for nurses, doctors, psychologists… working in the ICU, but is also an interactive tool to share cases with other professionals abroad.

Dr Marinos Michaelides, an anaethesiologist, says: “We can receive information from other centres which I’ve never had the chance to visit or discuss with doctors patients’ cases, but with this kind of system, what is essential, the important thing, is to break down barriers and distances.”

The interactive platform will soon be working at full strength. There are two Teleprometheus screens in the ICU and another one just outside for patients’ families. Hundreds have already benefited from the service, where they can see exactly what treatment their loved ones are receiving at hospital, and even at home.

Nikolau adds: “The information is in a language which is easy for them to understand. It doesn’t use confusing medical terms. It’s very easy for them to understand what is their relative’s medical problem.”

Media: Euronews

“AccentCare’s wide variety of innovative services ranges from personal, non-medical care to skilled nursing, rehabilitation, hospice and care management. Headquartered in Dallas, AccentCare has over 20,000 compassionate professionals in more than 150 locations, collectively serving over 90,000 individuals across 11 states,” Steele said.

AccentCare is a leader in the home health industry, with a focus on avoidance of unplanned re-hospitalizations, faster starts of care and quality performance, earning a 4.3-star rating for quality from the Centers for Medicare Medicaid.

All AccentCare hospice locations are Community Health Accreditation Partner-accredited, many with designations from the We Honor Veterans program.

“Texas Home Health has a culture of caring, integrity and collaboration. Working in home health allows clinicians to build relationships with their patients, supporting them throughout the duration of care and optimizing both their patients’ health and independence in the comfort of their homes,” Steele said. “And our employees are supported, too. We offer a team-driven environment, excellent training, recognition programs and career ladder plans.”

The company offers a comprehensive benefits plan that includes health, dental and vision coverage; life insurance; disability; 401(k); paid holidays and paid time off; and more.

“We operate, and are continuously growing, across the state. Our Texas organizations are expanding at a rapid pace in the areas of home health, hospice and personal care. We are consistently adding talented nursing and therapy professionals to our dedicated teams to deliver exceptional care in the communities we support,” Steele said.

Specifically, Texas Home Health is looking for registered nurses, licensed vocational nurses, physical therapists, physical therapy assistants, occupational therapists, certified occupation therapy assistants and home health aids, among other positions.

All opportunities with Texas Home Health are available online at

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Lake Health presses on as finances turn around

Following years of consolidation in Northeast Ohio’s health care market, Lake Health System is one of the few independent systems left standing.

And it intends to stay that way.

Despite a recent rating downgrade and two consecutive years of operating losses, Lake Health officials are optimistic about the future.

“We believe that being independent creates a home for independent physicians and like-minded physicians as well as keeps us supporting the community,” said Rick Cicero, senior vice president of marketing and business development for Lake Health. “Even though we’re a nonprofit, we generate significant tax dollars in this community. Being independent and directing the growth that we do in Lake County helps the county overall.”

In 2015 and 2016, the system reported a $30 million loss, which officials said was a one-time writedown stemming from problems with an IT system conversion. It represents both the added implementation costs and the results of billing delays that affected the system’s ability to collect services. In 2017, Lake Health posted a $4.8 million operating loss, significantly better than the $22.8 million loss the year prior.

“If you look at the ’17 versus ’16, we did have about an $18 million turnaround from an operating income standpoint, so we are definitely, obviously heading in the right direction there,” said Bob Tracz, chief financial officer for Lake Health.

The system is aiming for a 1% operating margin in 2018, which would equate to a $3.5 million to $4 million operating income, Tracz said. To achieve this, Lake is looking at its supply side, health care benefits and revenue cycle improvements, he said.

This month, Moody’s downgraded Lake Health from A3 to Baa1 and revised the outlook from negative to stable. Moody’s said that the system’s margins “will likely improve but remain lower than historical levels given labor cost and payer pressures.” Following the 2017 budget shortfall, these pressures will “challenge the hospital to return to historical margins.”

As Lake Health’s credit strengths, Moody’s cited strong liquidity, a defined contribution pension plan and moderate operating leases and the system’s leading market share.

Despite Cleveland Clinic and University Hospitals dominating the Northeast Ohio health care scene overall, Lake Health still enjoys a 52.9% market share in Lake County as the only hospital provider there. According to Moody’s, the system’s growth and physician alignment strategies “will continue to support a leading market position in a very competitive region.”

Lake Health is also embarking on a new venture with a group of independent physicians constructing a specialty, acute care hospital in Beachwood. Lake has a 51% controlling ownership interest in the project, which is a 69,800-square-foot hospital with 25 patient beds, operating and procedure rooms, emergency room services, diagnostic services and physical therapy.

The move expands Lake Health’s geography and creates another access point for the system, said Cicero.

“As we’re working closely with the payers and with employers, a location for us in Cuyahoga County becomes a critical addition to a network within our clinically integrated network,” he said. “It aligns us with a whole new group of surgeons that historically did not work at Lake Health. And it really becomes that opportunity in that kind of setting to help to continue to develop a high-quality, lower-cost option in the market.”

Moody’s notes that the project, if successful, could generate profitable business for Lake Health, but it may bring startup risks depending on the pace of the ramp-up.

Given costs, competition and changing reimbursement models, maintaining independence can be challenging, which makes it all the more important to collaborate with other players, said Tom Campanella, director of the health care MBA program at Baldwin Wallace University. This new hospital is an example of such collaboration.

“On paper, in theory, it could be successful,” he said. “But like anything else, theory is great, paper is great, but it really is how it’s actually put together. Do they have the right type of physicians? Are they able to meet the needs of the market? Are they able to successfully get their message out to the market, both to employers as well as to consumers and insurance companies that they have something that may be different out there in the marketplace … It’s not like field of dreams if you build it, they will come. You need to be able to know your market and find a way to make sure that, like in any industry, that you have something that is potentially attractive to the marketplace.”

Lake Health also has been seeing “nice growth” in its Perrico Health Campus in Willoughby, which opened last year, and its Mentor Wellness Campus, which opened in January, Cicero said.

The other area of growth Lake has seen has been in its physician recruitment. The system has been adding 15 to 20 physicians a year.

“The bottom line is Lake has a strong reputation, and they do have historically a good relationship with independent physicians,” Campanella said. “And I think they position themselves to — based on that — to be potentially successful in the new marketplace that we’re seeing out there in health care.”

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Health care numbers moving in the wrong direction

  • This screen grab shows the main page of the website in Washington, on May 21. A new study says fewer people are insured. Photo: /Associated Press /



More people are uninsured in Texas and across America.

Those are the findings of a recent Commonwealth Fund tracking survey. About 15.5 percent of adults ages 19 to 64 lack health insurance. That’s up from 12.7 percent in 2016. That represents about 4 million people who went from insured to uninsured.

What’s particularly distressing is these numbers are moving the wrong way when the economy is strong. Unemployment is low. Consumer confidence is high. And, yet, the uninsured rate is up.

The study did not offer state-specific data. But it found the biggest increases in the ranks of uninsured were happening in Republican-led states, the South and states that did not expand Medicaid. All three apply to Texas.

And Texas indeed leads the way in the number of uninsured. As the Houston Chronicle’s Jenny Deam reported, about 4.5 million Texans lack health insurance. This includes 700,000 kids. Not a top ranking to be proud of.

This increase in the uninsured is as unnecessary as it is unsurprising. Under President Donald J. Trump, the Affordable Care Act’s coverage mandate has been repealed, the window of time to sign up for coverage has been cut in half and promotion of the Affordable Care Act has been slashed. Congress has failed to stabilize marketplaces, meaning rates are likely to continue to rise.

There is no benefit, or freedom, in having fewer people insured. It’s an invitation for financial ruin and failed health.

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Maternal mental health problems – the impact in numbers

As many as one in five women develop a mental health problem during pregnancy or in the first year after the birth of their baby. The distress this causes women and their families, the negative impact on their health and well-being, and the economic costs to individuals, the NHS and the nation are considerable.

Maternal mental health problems can range from anxiety, low mood and depression to psychosis. Depression and anxiety are the most common mental health problems during pregnancy, with around 12% of women experiencing depression and 13% experiencing anxiety at some point; many women will experience both. Depression and anxiety also affect 15-20% of women in the first year after childbirth.

Between one and two in 1,000 women who have given birth are affected by postpartum psychosis, a serious mental illness. Symptoms vary and can change rapidly. They can include high mood (mania), depression, confusion, hallucinations and delusions. In some of the most extreme cases, there is a risk of suicide – it is estimated that a quarter of all maternal deaths are related to mental health problems.

Some women will have suffered these mental health problems before, but for others, symptoms are new and frightening. Rarer problems include panic disorder, obsessive compulsive disorder and exacerbation of eating disorders. Domestic violence is also now increasingly recognised as a risk factor for perinatal depression, anxiety and post-traumatic stress disorder (PTSD).

The impact of maternal mental health problems goes further. The symptoms may lead to poor bonding with the baby and difficulties with breastfeeding (which can itself lead to distress, anxiety and low mood). Maternal depression can have far reaching consequences on the development of the baby, with problems extending into childhood and adolescence. Research has shown potential impacts on cognitive development, including language development, conduct and school performance.

One in eight partners also report mental health problems and describe a lack of support. Paternal mental health problems can also impact negatively on child development.

Read more:
Postnatal depression: men get it too

Depression has an impact on the whole family.

Maternal mental health problems are estimated to cost the UK £8.1 billion each year. A recent working paper also suggested that postnatal depression can still have a direct effect on maternal employment five years after birth – even when the effects of low mood are no longer present.

Is help readily available? The short answer is no. It has been suggested that only 7% of women who experienced mental health symptoms were referred to specialist mental health care. Yet when mental health problems are diagnosed early, these effects can be mitigated.

A woman comes into contact with midwives, health visitors, general practitioners and obstetricians during the course of her pregnancy. It is vital that all of these health care professionals are alert to the possibility of problems and are aware of how common they are. Health care professionals need to enquire about mood at every contact, and refer the women for psychological support as early as possible. And women should feel supported by their health care professional to talk openly about their feelings. Support also needs to be available for partners, as part of a wider approach of treating maternal mental health and limiting the impact it has on the whole family.

A look ahead

Fortunately, the situation and awareness of the condition is getting better thanks in part to the many women who are sharing their stories and ask for help.

The Royal College of General Practitioners developed a toolkit that offers resources for GPs to facilitate the identification and management of maternal mental health problems. This toolkit also includes resources that the GP can signpost the mother and her partner to. A report from the Royal College of Midwives highlighted the stigma around disclosing mental health problems. This stigma must be broken down – and facilitating women to raise mood problems is a vital part of this.

Following the publication of The Five Year Forward View for Mental Health report, NHS England committed to £365m in extra funding to increase access to specialised perinatal mental health support, so that by 2020-21 an additional 30,000 women will be able to receive local specialised treatment.

For all health care professionals supporting women who are pregnant, giving birth or in early motherhood, the aim should be that all women who feel unwell or have concerns about their mood can feel confident telling a health care professional how they feel, and know that they will get the support they need.

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NBPA Announces Mental Health and Wellness Program for Players

Jordan Johnson/Getty Images

The National Basketball Players Association announced the launch of a mental health and wellness program for NBA players Friday, according to Jeff Zillgitt of USA Today.

Former NBA guard Keyon Dooling, the NBPA Player Wellness Counselor since January, will be joined by a Director of Mental Health and Wellness, per the announcement.

In an article published for the Players’ Tribune on May 1, Dooling discussed his post-traumatic stress disorder.

Dooling wrote that he was sexually abused as a child, which led to a stint in a mental institution in 2012 while he was a member of the Boston Celtics.

The mental wellness conversation has recently reached the forefront in the NBA. Cleveland Cavaliers big man Kevin Love and Toronto Raptors star DeMar DeRozan both talked about their experiences in a public service announcement released by the NBA for Mental Health Awareness Month in May:

In March, Love published an article for the Players’ Tribune about having a panic attack during a game.

DeRozan spoke with Doug Smith of the Toronto Star in February regarding his struggles with depression and anxiety.

Dooling has been a life coach since retiring from the NBA in 2013.

He is a natural fit to help lead the NBPA’s new initiative due to his experience working with NBA and G League players in the field of mental health awareness.

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Why Your Health Insurer Doesn’t Care About Your Big Bills

This story was co-published with NPR.

Michael Frank ran his finger down his medical bill, studying the charges and pausing in disbelief. The numbers didn’t make sense.

His recovery from a partial hip replacement had been difficult. He’d iced and elevated his leg for weeks. He’d pushed his 49-year-old body, limping and wincing, through more than a dozen physical therapy sessions. 

The last thing he needed was a botched bill.

His December 2015 surgery to replace the ball in his left hip joint at NYU Langone Medical Center in New York City had been routine. One night in the hospital and no complications.  

He was even supposed to get a deal on the cost. His insurance company, Aetna, had negotiated an in-network “member rate” for him. That’s the discounted price insured patients get in return for paying their premiums every month.

But Frank was startled to see that Aetna had agreed to pay NYU Langone $70,000. That’s more than three times the Medicare rate for the surgery and more than double the estimate of what other insurance companies would pay for such a procedure, according to a nonprofit that tracks prices.

Fuming, Frank reached for the phone. He couldn’t see how NYU Langone could justify these fees. And what was Aetna doing? As his insurer, wasn’t its duty to represent him, its “member”? So why had it agreed to pay a grossly inflated rate, one that stuck him with a $7,088 bill for his portion?

Frank wouldn’t be the first to wonder. The United States spends more per person on health care than any other country. A lot more. As a country, by many measures, we are not getting our money’s worth. Tens of millions remain uninsured. And millions are in financial peril: About 1 in 5 is currently being pursued by a collection agency over medical debt. Health care costs repeatedly top the list of consumers’ financial concerns. 

Experts frequently blame this on the high prices charged by doctors and hospitals. But less scrutinized is the role insurance companies — the middlemen between patients and those providers — play in boosting our health care tab. Widely perceived as fierce guardians of health care dollars, insurers, in many cases, aren’t. In fact, they often agree to pay high prices, then, one way or another, pass those high prices on to patients — all while raking in healthy profits.

ProPublica and NPR are examining the bewildering, sometimes enraging ways the health insurance industry works, by taking an inside look at the games, deals and incentives that often result in higher costs, delays in care or denials of treatment. The misunderstood relationship between insurers and hospitals is a good place to start.

Today, about half of Americans get their health care benefits through their employers, who rely on insurance companies to manage the plans, restrain costs and get them fair deals.

But as Frank eventually discovered, once he’d signed on for surgery, a secretive system of pre-cut deals came into play that had little to do with charging him a reasonable fee.

Michael Frank’s insurance company agreed to pay a high price to the hospital where he had his hip operation. Neither the hospital or his insurer would justify the costs to him, no matter how hard he pressed.
(Annie Tritt, special to ProPublica)

After Aetna approved the in-network payment of $70,882 (not including the fees of the surgeon and anesthesiologist), Frank’s coinsurance required him to pay the hospital 10 percent of the total.

When Frank called NYU Langone to question the charges, the hospital punted him to Aetna, which told him it paid the bill according to its negotiated rates. Neither Aetna nor the hospital would answer his questions about the charges. 

Frank found himself in a standoff familiar to many patients. The hospital and insurance company had agreed on a price and he was required to help pay it. It’s a three-party transaction in which only two of the parties know how the totals are tallied.

Frank could have paid the bill and gotten on with his life. But he was outraged by what his insurance company agreed to pay. “As bad as NYU is,” Frank said, “Aetna is equally culpable because Aetna’s job was to be the checks and balances and to be my advocate.”

And he also knew that Aetna and NYU Langone hadn’t double-teamed an ordinary patient. In fact, if you imagined the perfect person to take on insurance companies and hospitals, it might be Frank. 

For three decades, Frank has worked for insurance companies like Aetna, helping to assess how much people should pay in monthly premiums. He is a former president of the Actuarial Society of Greater New York and has taught actuarial science at Columbia University. He teaches courses for insurance regulators and has even served as an expert witness for insurance companies.

The hospital and insurance company may have expected him to shut up and pay. But Frank wasn’t going away. 

Patients fund the entire health care industry through taxes, insurance premiums and cash payments. Even the portion paid by employers comes out of an employee’s compensation. Yet when the health care industry refers to “payers,” it means insurance companies or government programs like Medicare. 

Patients who want to know what they’ll be paying — let alone shop around for the best deal — usually don’t have a chance. Before Frank’s hip operation he asked NYU Langone for an estimate. It told him to call Aetna, which referred him back to the hospital. He never did get a price.

Imagine if other industries treated customers this way. The price of a flight from New York to Los Angeles would be a mystery until after the trip. Or, while digesting a burger, you’d learn it cost 50 bucks.

A decade ago, the opacity of prices was perhaps less pressing because medical expenses were more manageable. But now patients pay more and more for monthly premiums, and then, when they use services, they pay higher co-pays, deductibles and coinsurance rates.

Employers are equally captive to the rising prices. They fund benefits for more than 150 million Americans and see health care expenses eating up more and more of their budgets. 

Richard Master, the founder and CEO of MCS Industries Inc. in Easton, Pennsylvania, offered to share his numbers. By most measures MCS is doing well. Its picture frames and decorative mirrors are sold at Walmart, Target and other stores and, Master said, the company brings in more than $200 million a year. 

But the cost of health care is a growing burden for MCS and its 170 employees. A decade ago, Master said, an MCS family policy cost $1,000 a month with no deductible. Now it’s more than $2,000 a month with a $6,000 deductible. MCS covers 75 percent of the premium and the entire deductible. Those rising costs eat into every employee’s take-home pay.

Economist Priyanka Anand of George Mason University said employers nationwide are passing rising health care costs on to their workers by asking them to absorb a larger share of higher premiums. Anand studied Bureau of Labor Statistics data and found that every time health care costs rose by a dollar, an employee’s overall compensation got cut by 52 cents. 

Master said his company hops between insurance providers every few years to find the best benefits at the lowest cost. But he still can’t get a breakdown to understand what he’s actually paying for.

“You pay for everything, but you can’t see what you pay for,” he said.  

Master is a CEO. If he can’t get answers from the insurance industry, what chance did Frank have?  

Frank’s hospital bill and Aetna’s “explanation of benefits” arrived at his home in Port Chester, New York, about a month after his operation. Loaded with an off-putting array of jargon and numbers, the documents were a natural playing field for an actuary like Frank.

Under the words, “DETAIL BILL,” Frank saw that NYU Langone’s total charges were more than $117,000, but that was the sticker price, and those are notoriously inflated. Insurance companies negotiate an in-network rate for their members. But in Frank’s case at least, the “deal” still cost $70,882.

The charges on the bill NYU Langone sent to Frank contained red flags, including services he says he never received.
(Annie Tritt, special to ProPublica)

With a practiced eye, Frank scanned the billing codes hospitals use to get paid and immediately saw red flags: There were charges for physical therapy sessions that never took place, and drugs he never received. One line stood out — the cost of the implant and related supplies. Aetna said NYU Langone paid a “member rate” of $26,068 for “supply/implants.” But Frank didn’t see how that could be accurate. He called and emailed Smith Nephew, the maker of his implant, until a representative told him the hospital would have paid about $1,500. His NYU Langone surgeon confirmed the amount, Frank said. The device company and surgeon did not respond to ProPublica’s requests for comment. 

Frank then called and wrote Aetna multiple times, sure it would want to know about the problems. “I believe that I am a victim of excessive billing,” he wrote. He asked Aetna for copies of what NYU Langone submitted so he could review it for accuracy, stressing he wanted “to understand all costs.”

Aetna reviewed the charges and payments twice — both times standing by its decision to pay the bills. The payment was appropriate based on the details of the insurance plan, Aetna wrote.

Frank also repeatedly called and wrote NYU Langone to contest the bill. In its written reply, the hospital didn’t explain the charges. It simply noted that they “are consistent with the hospital’s pricing methodology.”

Increasingly frustrated, Frank drew on his decades of experience to essentially serve as an expert witness on his own case. He gathered every piece of relevant information to understand what happened, documenting what Medicare, the government’s insurance program for the disabled and people over age 65, would have paid for a partial hip replacement at NYU Langone — about $20,491 — and what FAIR Health, a New York nonprofit that publishes pricing benchmarks, estimated as the in-network price of the entire surgery, including the surgeon fees — $29,162.

He guesses he spent about 300 hours meticulously detailing his battle plan in two inches-thick binders with bills, medical records and correspondence. 

ProPublica sent the Medicare and FAIR Health estimates to Aetna and asked why they had paid so much more. The insurance company declined an interview and said in an emailed statement that it works with hospitals, including NYU Langone, to negotiate the “best rates” for members. The charges for Frank’s procedure were correct given his coverage, the billed services and the Aetna contract with NYU Langone, the insurer wrote. 

Frank chronicled his battle with the hospital where he had his surgery and his insurance company in two large binders filled with documents and letters.
(Annie Tritt, special to ProPublica)

NYU Langone also declined ProPublica’s interview request. The hospital said in an emailed statement it billed Frank according to the contract Aetna had negotiated on his behalf. Aetna, it wrote, confirmed the bills were correct.

After seven months, NYU Langone turned Frank’s $7,088 bill over to a debt collector, putting his credit rating at risk. “They upped the ante,” he said.

Frank sent a new flurry of letters to Aetna and to the debt collector and complained to the New York State Department of Financial Services, the insurance regulator, and to the New York State Office of the Attorney General. He even posted his story on LinkedIn. 

But no one came to the rescue. A year after he got the first bills, NYU Langone sued him for the unpaid sum. He would have to argue his case before a judge.

You’d think that health insurers would make money, in part, by reducing how much they spend.

Turns out, insurers don’t have to decrease spending to make money. They just have to accurately predict how much the people they insure will cost. That way they can set premiums to cover those costs — adding about 20 percent to for their administration and profit. If they’re right, they make money. If they’re wrong, they lose money. But, they aren’t too worried if they guess wrong. They can usually cover losses by raising rates the following year.

Frank suspects he got dinged for costing Aetna too much with his surgery. The company raised the rates on his small group policy — the plan just includes him and his partner — by 18.75 percent the following year.

The Affordable Care Act kept profit margins in check by requiring companies to use at least 80 percent of the premiums for medical care. That’s good in theory but it actually contributes to rising health care costs. If the insurance company has accurately built high costs into the premium, it can make more money. Here’s how: Let’s say administrative expenses eat up about 17 percent of each premium dollar and around 3 percent is profit. Making a 3 percent profit is better if the company spends more.

It’s like if a mom told her son he could have 3 percent of a bowl of ice cream. A clever child would say, “Make it a bigger bowl.”

Wonks call this a “perverse incentive.”

“These insurers and providers have a symbiotic relationship,” said Wendell Potter, who left a career as a public relations executive in the insurance industry to become an author and patient advocate. “There’s not a great deal of incentive on the part of any players to bring the costs down.”

Insurance companies may also accept high prices because often they aren’t always the ones footing the bill. Nowadays about 60 percent of the employer benefits are “self-funded.” That means the employer pays the bills. The insurers simply manage the benefits, processing claims and giving employers access to their provider networks. These management deals are often a large, and lucrative, part of a company’s business. Aetna, for example, insured 8 million people in 2017, but provided administrative services only to considerably more — 14 million. 

To woo the self-funded plans, insurers need a strong network of medical providers. A brand-name system like NYU Langone can demand — and get — the highest payments, said Manuel Jimenez, a longtime negotiator for insurers including Aetna. “They tend to be very aggressive in their negotiations.”

On the flip side, insurers can dictate the terms to the smaller hospitals, Jimenez said. The little guys, “get the short end of the stick,” he said. That’s why they often merge with the bigger hospital chains, he said, so they can also increase their rates. 

Other types of horse-trading can also come into play, experts say. Insurance companies may agree to pay higher prices for some services in exchange for lower rates on others. 

Patients, of course, don’t know how the behind-the-scenes haggling affects what they pay. By keeping costs and deals secret, hospitals and insurers dodge questions about their profits, said Dr. John Freedman, a Massachusetts health care consultant. Cases like Frank’s “happen every day in every town across America. Only a few of them come up for scrutiny.”

In response, a Tennessee company is trying to expose the prices and steer patients to the best deals. Healthcare Bluebook aims to save money for both employers who self-pay, and their workers. Bluebook used payment information from self-funded employers to build a searchable online pricing database that shows the low-, medium- and high-priced facilities for certain common procedures, like MRIs. The company, which launched in 2008, now has more than 4,500 companies paying for its services. Patients can get a $50 bonus for choosing the best deal.

Bluebook doesn’t have price information for Frank’s operation — a partial hip replacement. But its price range in the New York City area for a full hip replacement is from $28,000 to $77,000, including doctor fees. Its “fair price” for these services tops out at about two-thirds of what Aetna agreed to pay on Frank’s behalf.

Frank, who worked with mainstream insurers, didn’t know about Bluebook. If he had used its data, he would have seen that there were facilities that were both high quality and offered a fair price near his home, including Holy Name Medical Center in Teaneck, New Jersey, and Greenwich Hospital in Connecticut. NYU Langone is one of Bluebook’s highest-priced, high-quality hospitals in the area for hip replacements. Others on Bluebook’s pricey list include Montefiore New Rochelle Hospital in New Rochelle, New York, and Hospital for Special Surgery in Manhattan.

ProPublica contacted Hospital for Special Surgery to see if it would provide a price for a partial hip replacement for a patient with an Aetna small-group plan like Frank’s. The hospital declined, citing its confidentiality agreements with insurance companies.

Frank arrived at the Manhattan courthouse on April 2 wearing a suit and fidgeted in his seat while he waited for his hearing to begin. He had never been sued for anything, he said. He and his attorney, Gabriel Nugent, made quiet conversation while they waited for the judge.

In the back of the courtroom, NYU Langone’s attorney, Anton Mikofsky, agreed to talk about the lawsuit. The case is simple, he said. “The guy doesn’t understand how to read a bill.”

Frank’s hospital sued him when he refused to pay his bill. It argued that his insurance company had agreed to the amount.
(Annie Tritt, special to ProPublica)

The high price of the operation made sense because NYU Langone has to pay its staff, Mikofsky said. It also must battle with insurance companies who are trying to keep costs down, he said. “Hospitals all over the country are struggling,” he said. 

“Aetna reviewed it twice,” Mikofsky added. “Didn’t the operation go well? He should feel blessed.”

When the hearing started, the judge gave each side about a minute to make its case, then pushed them to settle. 

Mikofsky told the judge Aetna found nothing wrong with the billing and had already taken care of most of the charges. The hospital’s position was clear. Frank owed $7,088.

Nugent argued that the charges had not been justified and Frank felt he owed about $1,500.

The lawyers eventually agreed that Frank would pay $4,000 to settle the case. 

Frank said later that he felt compelled to settle because going to trial and losing carried too many risks. He could have been hit with legal fees and interest. It would have also hurt his credit at a time he needs to take out college loans for his kids. 

After the hearing, Nugent said a technicality might have doomed their case. New York defendants routinely lose in court if they have not contested a bill in writing within 30 days, he said. Frank had contested the bill over the phone with NYU Langone, and in writing within 30 days with Aetna. But he did not dispute it in writing to the hospital within 30 days.

Frank paid the $4,000, but held on to his outrage. “The system,” he said, “is stacked against the consumer.”

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Rotten teeth health warning on sugary drinks could deter buyers

Graphic health warnings like those on cigarette packets, showing rows of rotten teeth on cans of cola and other sugary drinks, could deter some young adults from buying them, a study has shown.

Sugary drinks are blamed for fuelling the obesity epidemic, but in spite of the large quantities of sugar they contain – nine teaspoons in a can of Coca Cola – they do not carry a red traffic-light warning, which is voluntary in the UK. Sugar taxes, like that recently introduced in the UK, may reduce sales, but obesity experts believe more action is needed.

Prof Anna Peeters from Australia’s Deakin University and colleagues looked at the feasibility of introducing health warnings about the links between sugary drinks and obesity, type 2 diabetes and tooth decay. They tried out four different kinds of warnings – from plain text about the disease risk, number of teaspoons of sugar, to a picture of rotten teeth.

The researchers showed the drinks with the warnings to 994 young adults, aged between 18 and 35. Participants were asked to imagine they were entering a shop, a cafe, or approaching a vending machine to choose one of 15 drinks to buy, some sugary and some unsweetened. Some of the sugary drinks had no label. Others carried a warning or a health star rating.

The effect was bigger than Peeters expected. All the warnings reduced the inclination of the subjects to buy the drinks, but there was a 20% drop in imagined purchases of those drinks bearing a picture of rotten teeth.

“If there was political palatability for graphic warnings, that [one] had the strongest effect, so that’s the one I would go for,” said Peeters at the European Congress on Obesity, where she was presenting her research.

“You are going to get pushback from the industry and possibly the community,” she said. “If you had good social acceptance of graphic warnings, you’d go for that. But if government found that too difficult the other three are pretty good too.”

In the study, there was a 20% drop in imagined purchases of sugary drinks bearing a warning picture of rotten teeth. Photograph: Handout

A written warning about the raised risk of type 2 diabetes as a result of obesity would not have quite the same impact as the picture, she said, “unless you go for amputations”, which can be a consequence of the disease.

Peeters said the study showed the potential of front-of-pack warnings to change people’s behaviour. “While no single measure will reverse the obesity crisis, given that the largest source of added sugars in our diet comes from sugar-sweetened drinks, there is a compelling case for the introduction of front-of-pack labels on sugary drinks worldwide,” she said.

Prof Jason Halford of Liverpool University, treasurer of the European Association for the Study of Obesity, said there was a need for manufacturers and retailers like the supermarkets to bring in traffic-light warnings on sugary drinks. If they do not, “We’d have to adopt something regulatory and the regulatory might be this. And it might be the most effective,” he said.

Barbara Crowthers, a Children’s Food Campaign coordinator, said: “There is definitely a role for honest and clear health labelling in discouraging people from consuming too many sugary drinks, alongside other measures such as product reformulation, marketing and advertising restrictions, tackling portion sizes and introducing price disincentives such as the UK’s new sugary drinks tax. Whilst, as we’ve seen on cigarettes, not everyone will be put off by graphic labels, making it clearer that consuming sugary drinks may also lead to the dentist’s drill could provide an additional powerful deterrent for many young people.”

Gavin Partington, director general at the British Soft Drinks Association, said sugar intake from soft drinks was already dropping. “Experience in the UK suggests that the action industry is taking – around reformulation, portion size and switching advertising spend to low/no calorie products – is having ample effect in changing consumer behaviour,” he said.

“In fact, sugar intake from soft drinks in the UK has fallen by almost 19% since 2013 – five times as much as other categories according to latest PHE data – and no- and low-calorie beverages now account for the largest category in the UK soft drinks sector.”

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Lifetime risks, loss of life expectancy, and health care expenditures for 19 types of cancer in Taiwan

Video abstract presented by Tzu-Yi Wu.

Views: 9

Tzu-Yi Wu,1 Chia-Hua Chung,2 Chia-Ni Lin,3 Jing-Shiang Hwang,2 Jung-Der Wang3,4

1Institute of Economics, Academia Sinica, Taipei, Taiwan; 2Institute of Statistical Science, Academia Sinica, Taipei, Taiwan; 3Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 4Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

Background: The mortality rates for different cancers are no longer an efficient tool for making national policy. The purpose of this study were to quantify the lifetime risks, life expectancies (LEs) after diagnosis, expected years of life lost (EYLL), and lifetime health care expenditures for 19 major cancers in Taiwan.
Methods: A total of 831,314 patients with 19 pathologically proven cancers were abstracted from the Taiwan Cancer Registry from 1998 to 2012. They were linked to the National Mortality Registry (1998–2014) and National Health Insurance reimbursement database (1998–2013) for survival and health care costs. We estimated the cumulative incidence rate for ages 0–79 years and the lifetime survival function for patients with different cancer sites. The EYLL was calculated by subtracting the LE of each cancer cohort from that of the age- and sex-matched referents simulated from national life tables. The estimated lifetime cost was calculated by adding up the product of survival probability and mean cost at the corresponding duration-to-date after adjustment for the inflation to the year of 2013.
Results: There were 5 cancers with a lifetime risk exceeding 4%: colorectal, liver, lung, and prostate in males, and breast and colorectal in females. Cancers with EYLL of 10 years were: esophageal, intrahepatic bile ducts, liver, pancreas, oral, nasopharyngeal, leukemia, lung, and gallbladder, extrahepatic bile ducts and biliary tract in males, and intrahepatic bile ducts, pancreas, nasopharyngeal, lung, esophageal, leukemia, liver, gallbladder, extrahepatic bile ducts and biliary tract, ovary, and stomach in females. Cancers with lifetime health care expenditures exceeding US$50,000 to the National Health Insurance were as follows: leukemia, kidney, testis, renal pelvis and ureter in males, and renal pelvis and ureter, leukemia, breast, urinary bladder, kidney, ovary, and nasopharyngeal in females. All these impacts should be considered in health policy decisions.
Conclusion: The impacts of cancer in Taiwan are very large. Future studies must consider both quality of life and the entire impact from societal perspectives.

Keywords: health impacts, incidence rate, expected years of life lost, cancer prevention

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License.

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Promoting Oral Health in Childhood: A Quality Improvement Project

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If you are at an office or shared network, you can ask the network administrator to run a scan across the network looking for misconfigured or infected devices.

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FMCSA’s Martinez talks ELDs, driver shortages during House hearing

Washington — Federal Motor Carrier Safety Administration Administrator Raymond Martinez affirmed his belief in electronic logging devices, but said “additional flexibility” is forthcoming for agricultural transporters, during a May 22 hearing before the House Transportation and Infrastructure Committee’s Highways and Transit Subcommittee.

FMCSA has granted two 90-day waivers to livestock and insect haulers, and a House Transportation, Housing and Urban Development appropriations bill for fiscal year 2019 seeks to extend that.

In his opening statement, Martinez indicated that ELDs are here to stay, saying, “Since beginning my tenure with FMCSA in February, we have engaged with our industry and safety partners, working consistently to maintain the safest transportation system possible. One of the ways FMCSA is working toward these goals is helping industry transition to ELDs to address hours-of-service compliance and driver fatigue.”

He added that out of nearly 300,000 driver inspections since the beginning of April, less than 1 percent of drivers “have been cited for failing to have an ELD when they were required to have one.”

Martinez, who was confirmed Feb. 13, also indicated that his agency is looking at flexibility for HOS. Secretary of Transportation Elaine Chao said in an appropriations hearing April 12 that she has “encouraged legislation” to clarify HOS requirements.

Regarding changes to those requirements, Martinez said, “Let’s look at hours of service and see whether some modifications – that is not extending the hours – but providing some flexibility in the current rules. We are engaging with our stakeholders in the regulated community on this and safety advocates to say what would be acceptable.”

Martinez said proposed changes to the Compliance, Safety, Accountability program were not submitted in December as mandated but are undergoing final review.

“It’s not holding us up in implementing recommendations and moving forward with corrections,” he said.

Pilot program to boost number of interstate CMV drivers to start in 2019

Martinez said a pilot program intended to help expand the pool of interstate commercial motor vehicle drivers will begin early next year.

FMCSA’s pilot program would allow 18- to 21-year-olds who are current or former military members to drive across state lines in CMVs if they have received specific training and are sponsored by a participating motor carrier. A bill introduced by Rep. Claudia Tenney (R-NY) would change those requirements for drivers in that age group to have a valid commercial driver’s license; a driving record free of citations, violations or other safety infractions; and who have completed a training program or similar qualifications.

The program should ease the industry’s driver shortage, Martinez said. However, some industry organizations deny that a driver shortage exists and say changes to current restrictions are unnecessary.

Rep. Duncan Hunter (R-CA), the sponsor of another bill that would establish an apprenticeship program for CDL holders who are younger than 21, asked why drivers who are 18 to 21 can transport goods the roughly 500 miles from San Diego to Sacramento in his state, but cannot go the nearly 500 miles from New York to North Carolina.

“I believe that’s something that deserves exploration,” Martinez said. “Those who have a CDL [are] probably safer than the general population. The problem is the general population of that age group are disproportionately involved in crashes, injuries and fatalities.”

The Owner-Operator Independent Drivers Association, along with 13 other organizations, sent a letter to lawmakers expressing opposition to Hunter’s and Tenney’s bills – both of which at press time were with the Highways and Transit Subcommittee.

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