Category: Healthcare

Hidden From View: The Astonishingly High Administrative Costs of U.S. Health Care

It takes only a glance at a hospital bill or at the myriad choices you may have for health care coverage to get a sense of the bewildering complexity of health care financing in the United States. That complexity doesn’t just exact a cognitive cost. It also comes with administrative costs that are largely hidden from view but that we all pay.

Because they’re not directly related to patient care, we rarely think about administrative costs. They’re high.

A widely cited study published in The New England Journal of Medicine used data from 1999 to estimate that about 30 percent of American health care expenditures were the result of administration, about twice what it is in Canada. If the figures hold today, they mean that out of the average of about $19,000 that U.S. workers and their employers pay for family coverage each year, $5,700 goes toward administrative costs.

Such costs aren’t all bad. Some are tied up in things we may want, such as creating a quality improvement program. Others are for things we may dislike — for example, figuring out which of our claims to accept or reject or sending us bills. Others are just necessary, like processing payments; hiring and managing doctors and other employees; or maintaining information systems.

That New England Journal of Medicine study is still the only one on administrative costs that encompasses the entire health system. Many other more recent studies examine important portions of it, however. The story remains the same: Like the overall cost of the U.S. health system, its administrative cost alone is No. 1 in the world.

hospital

Using data from 2010 and 2011, one study, published in Health Affairs, compared hospital administrative costs in the United States with those in seven other places: Canada, England, Scotland, Wales, France, Germany and the Netherlands.

At just over 25 percent of total spending on hospital care (or 1.4 percent of total United States economic output), American hospital administrative costs exceed those of all the other places. The Netherlands was second in hospital administrative costs: almost 20 percent of hospital spending and 0.8 percent of that country’s G.D.P.

At the low end were Canada and Scotland, which both spend about 12 percent of hospital expenditures on administration, or about half a percent of G.D.P.

Hospitals are not the only source of high administrative spending in the United States. Physician practices also devote a large proportion of revenue to administration. By one estimate, for every 10 physicians providing care, almost seven additional people are engaged in billing-related activities.

It is no surprise then that a majority of American doctors say that generating bills and collecting payments is a major problem. Canadian practices spend only 27 percent of what U.S. ones do on dealing with payers like Medicare or private insurers.

Another study in Health Affairs surveyed physicians and physician practice administrators about billing tasks. It found that doctors spend about three hours per week dealing with billing-related matters. For each doctor, a further 19 hours per week are spent by medical support workers. And 36 hours per week of administrators’ time is consumed in this way. Added together, this time costs an additional $68,000 per year per physician (in 2006). Because these are administrative costs, that’s above and beyond the cost associated with direct provision of medical care.

In JAMA, scholars from Harvard and Duke examined the billing-related costs in an academic medical center. Their study essentially followed bills through the system to see how much time different types of medical workers spent in generating and processing them.

At the low end, such activities accounted for only 3 percent of revenue for surgical procedures, perhaps because surgery is itself so expensive. At the high end, 25 percent of emergency department visit revenue went toward billing costs. Primary care visits were in the middle, with billing functions accounting for 15 percent of revenue, or about $100,000 per year per primary care provider.

“The extraordinary costs we see are not because of administrative slack or because health care leaders don’t try to economize,” said Kevin Schulman, a co-author of the study and a professor of medicine at Duke. “The high administrative costs are functions of the system’s complexity.”

Costs related to billing appear to be growing. A literature review by Elsa Pearson, a policy analyst with the Boston University School of Public Health, found that in 2009 they accounted for about 14 percent of total health expenditures. By 2012, the figure was closer to 17 percent.

One obvious source of complexity of the American health system is its multiplicity of payers. A typical hospital has to contend not just with several public health programs, like Medicare and Medicaid, but also with many private insurers, each with its own set of procedures and forms (whether electronic or paper) for billing and collecting payment. By one estimate, 80 percent of the billing-related costs in the United States are because of contending with this added complexity.

Read More:https://www.nytimes.com/2018/07/16/upshot/costs-health-care-us.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region&region=top-news&WT.nav=top-news

Why Your Brain Tricks You Into Doing Less Important Tasks Yet again, your brain is working against you, and it’s because of a phenomenon called the urgency effect.

Here’s a list of things I did before starting this newsletter: I filled out the documents to renew my passport; clipped my cat’s nails; bought some household items; responded to a few Instagram DMs; and ate a snack because I was hungry.

Sound familiar?

Some of those tasks were relatively urgent — I need to get my passport in order soon, and those Instagram DMs were weighing on me. But none of those tasks were as important as writing this newsletter. I know I needed to get this done, but the call of those minor-yet-urgent tasks was too strong.

lightbulb

To all of my procrastinators out there, I offer an explanation: Your brain is working against you, and it’s because of a phenomenon called the urgency effect.Our brains tend to prioritize immediate satisfaction over long-term rewards (you probably remember this from the famous marshmallow experiment). But a study from February found that subjects were more likely to perform smaller-but-urgent tasks that had a deadline than they were to perform more important tasks without one. This was true even if the outcome of the smaller task was objectively worse than that of the larger one.“Normatively speaking,” the researchers wrote, “people may choose to perform urgent tasks with short completion windows, instead of important tasks with larger outcomes, because important tasks are more difficult and further away from goal completion, urgent tasks involve more immediate and certain payoffs, or people want to finish the urgent tasks first and then work on important tasks later.”

In other words: Even if we know a larger, less-urgent task is vastly more consequential, we will instinctively choose to do a smaller, urgent task anyway. Yet again, thanks for nothing, brain.

So what are we to do? To answer that, let’s talk about boxes — specifically, one developed by our 34th president, Dwight D. Eisenhower.

Picture a 2×2 square with four boxes. At the top of the square are two labels: Urgent and non-urgent. On the left are two other labels: Importantand not important.On any given day, try to put every task you have to do into one of those four boxes. You’ll quickly see that the things tied to approaching deadlines are quite often not the most important things you have on your plate. Accordingly, schedule time to finish them later or, if possible, delegate them.

Similarly, it’s very likely you’ll wind up with tasks that don’t have a deadline and aren’t important. Immediately and aggressively remove them from your to-do list.

Two crucial bits I’ll leave you with:

Why People With Disabilities Want Bans On Plastic Straws To Be More Flexible

It was a hot day at the zoo when Jordan Carlson’s son, who has motor-planning delays, got thirsty. “We went to the snack bar and found out they had a ‘no straw’ policy,” Carlson says. “It was a hot day and he couldn’t drink.”

Their only option was to leave the park and look for a business that sold drinks with a straw. Without one, her son can’t drink beverages. At home they use reusable straws and she tries to keep some on hand when they leave the house, but “I’m human and sometimes I forget,” Carlson explains. People with disabilities have to be much more conscious of what businesses and communities offer, Carlson says.

On social media, many people are ecstatic about the crush of cities and businesses pledging to ban plastic straws once and for all. Ever since a video showing a sea turtle with a straw stuck up its nose went viral, campaigns like #StopSucking for a strawless ocean have gained considerable traction. Seattle this month implemented a citywide ban on plastic straws, Starbucks announced on Monday that it will phase out the use of plastic straws by 2020, and many other municipalities and businesses are likely to follow suit. As one Twitter user posted, “My waiter asked ‘Now, do we want straws OR do we want to save the turtles?’ and honestly we all deserve that environmental guilt trip.”But for many people with disabilities, going without plastic straws isn’t a question of how much they care about dolphins or sea turtles; it can be a matter of life or death.

gettyimages-675605831-5315302713a65b636cc85b7039110b506b2807a8-s800-c85

There are many alternatives to plastic straws — paper, biodegradable plastics and even reusable straws made from metal or silicone. But paper straws and similar biodegradable options often fall apart too quickly or are easy for people with limited jaw control to bite through. Silicone straws are often not flexible — one of the most important features for people with mobility challenges. Reusable straws need to be washed, which not all people with disabilities can do easily. And metal straws, which conduct heat and cold in addition to being hard and inflexible, can pose a safety risk.

“Disabled people have to find ways to navigate through the world because they know it was not made for us,” says Lei Wiley-Mydske, an autism activist who has autism herself. “If someone says, ‘This does not work for me,’ it’s because they’ve tried everything else.”

“Also, what if you decide on the spur of the moment to go have a drink with friends after work but forgot your reusable straw that day?” adds Lawrence Carter-Long, communications director for the national Disability Rights Education & Defense Fund. “[That] doesn’t leave a lot of room for spontaneity — something nondisabled folks get to largely take for granted.”

On social media, many people have responded to claims that people with disabilities need plastic straws by asking what people did before plastic straws were invented. “They aspirated liquid in their lungs, developed pneumonia and died,” says Shaun Bickley, co-chair of the Seattle Commission for People with DisAbilities, a volunteer organization that’s supposed to advise the city council or agencies on disabilities issues.

How much plastic straw and stirrer pollution is out there? Scientific estimates vary. One report suggests they make up more than 7 percent of the plastics found in the U.S. by piece. By comparison, the same report found plastic bottle caps alone accounted for nearly 17 percent. But straws make up a much smaller percentage of pollution by weight.

Environmentalists have latched onto a figure stating that Americans use over 500 million plastic straws every day — a number that was derived from phone calls made by a 9-year-old boy in 2011. Despite its frequent repetition, there’s uncertainty over the accuracy of that figure.

In a post detailing how the plastic straw became the cause du jour for those who love the oceans, Dune Ives, executive director for the Lonely Whale Foundation, wrote, “We found plastic water bottles too endemic, plastic bags already somewhat politicized, and no viable alternative for the plastic cup in ALL markets.” So they chose plastic straws, a “playful” alternative and a “‘gateway plastic’ to the larger and more serious plastic pollution conversation.”

Most of the plastic in the ocean does come from land, says Darby Hoover, senior resource specialist for the Natural Resources Defense Council. She notes that because plastic breaks up into smaller and smaller particles, it can be hard to tell what it used to be in some cases.

“Straws are maybe not the biggest source of either plastic pollution or disposable plastic we consume, but they’re in there,” Hoover says.

And for many people who want to consume less plastic, she saysstraws are low-hanging fruit.

Yet in general Hoover says that she’s wary of outright bans on things. “I personally think we as a country use way too many disposable water bottles. That said, there are times when I’m caught somewhere, don’t have a reusable bottle, and want the option to have water and not a sugary drink.”

“They key is breaking habits,” Hoover says. “Is something a habit because you truly need it or because you got used to doing it that way?”

Carter-Long says he’s sympathetic to environmental concerns about plastic pollution, but any public policy aiming to reduce the use of straws needs to make accommodations for people who might need them. Ideally, he says, “each restaurant owner [would] follow their own conscience, maybe keep a stockpile of plastic straws in their store rooms for people to use who need them.”

A spokesman for Seattle Public Utilities confirmed to NPR that the city’s new plastic straw ban does include a waiver allowing restaurants to give disposable, flexible plastic straws to customers who need them for physical or medical reasons. But Carter-Long and Bickley say there doesn’t seem to be widespread awareness of the exemption.Bickley says he asked over a dozen Seattle chain restaurants – including McDonald’s and Chipotle – “if they had plastic straws available for people with allergies or need, and they told me no.”

And just because an exemption is written into law doesn’t mean businesses will comply, even if they know about it. “So many businesses try to get around already ignoring things with ADA [the Americans With Disabilities Act] until someone says, ‘I need a ramp or wider hallway or ramp in bathroom or Braille menu,’ ” says Jordan Carlson. “Sometimes you need to bring a lawsuit just to have your voice heard.”

Although Bickley serves on a commission that is supposed to advise Seattle’s city agencies on disability issues, he says no one consulted the group before passing the plastic straw ban.

Dianne Laurine, who lives in Seattle, has cerebral palsy, is quadriplegic and has no use of her extremities. “She is old enough to remember a time before plastic and everybody just used rubber straws,” Laurine’s caretaker, Bill Reeves, says on her behalf, since she has a severe speech impediment.

“They ended up being disgusting, hard to clean. The advent of plastic in the 1950s changed her life,” Reeves says.

When asked what it felt like when the straw ban went into effect without consulting those with disabilities, Laurine audibly repeated one word, “Awful. Awful. Awful.”

“You’re putting this burden on disabled people to come up with a solution. You’re not asking companies that manufacture straws to come up with a version that works for us,” autism activist Wiley-Mydske says. “You won’t even take the bus instead of driving your car somewhere,” she says, adding, “How many of you are willing to die for the environment?”

The Senate’s Unaffordable Care Act

aidspicIt would be a big mistake to call the legislation Senate Republicans released on Thursday a health care bill. It is, plain and simple, a plan to cut taxes for the wealthy by destroying critical federal programs that help provide health care to tens of millions of people.

The Senate majority leader, Mitch McConnell, and other Republicans have pitched the bill as a fix for the Affordable Care Act, or Obamacare. But their true ambition is not to reform Obamacare, which, whatever its shortcomings, has given 20 million Americans access to health insurance. If passed in its current form, the Senate bill would greatly weaken Medicaid, the federal-state program that provides insurance to nearly 69 million people, more than any other government or private program. It would do this by gradually but inexorably shifting more of the financial burden of Medicaid to states, in effect, forcing them to cover fewer people and to provide fewer services. Over all, the Senate would reduce federal spending by about $1 trillion over 10 years and use almost that much to cut taxes for rich families and health care companies.

In the days ahead, while the Congressional Budget Office totes up the bill’s cost, and before a floor vote, some Republicans, President Trump included, might be tempted to see the Senate bill as an improvement over the draconian House measure passed in May that would take insurance away from 23 million people. Mr. Trump previously expressed the hope that the Senate version would be less brutal. It isn’t. True, Mr. McConnell and his colleagues have made a few superficial improvements; the rollback of Obamacare’s intended expansion of Medicaid would proceed more slowly than under the House’s timetable. But the long-term damage might be worse. That is because the Senate bill would cap federal spending on Medicaid on a per-person basis. Currently, federal spending varies from year to year based on demand for medical services and the cost of care. Starting in 2025, the cap would be allowed to increase at the rate of inflation in the economy. But the overall inflation rate has typically been much lower than the inflation rate for medical services; in 2016, the overall inflation rate was 1.3 percent, whereas medical costs increased by 3.8 percent. Over time, this would means states will get a lot less money than they do under current law. The inevitable shrinkage in Medicaid will be particularly devastating to older Americans. Contrary to what many people think, the program does not just benefit the poor. Many middle-class seniors depend on it after they have exhausted their savings. Medicaid pays for two-thirds of the people in nursing homes. The disabled and parents who have children with learning disabilities also rely on Medicaid. The program covers nearly half of all births in the country. And in recent years, it has played a very important role in dealing with the opioid epidemic, especially in states like Kentucky, Massachusetts, Maryland, Ohio and West Virginia. Medicaid pays between 35 percent and 50 percent of the cost of medication-assisted addiction treatment, according to two professors, one from Harvard and one from New York University.

Like its House counterpart, the Senate bill would also hurt millions of non-Medicaid beneficiaries of Obamacare, those who buy insurance on federal and state marketplaces. It would greatly reduce federal subsidies that help low-income and middle-income families buy health coverage, while allowing insurers to increase deductibles, forcing people to pay more for medical services. It would let states waive rules that now require insurers to cover essential health services like maternity care, cancer treatment and mental health care, which is likely to happen because this will be the only way that states can lower premiums. In sum, it will make health insurance more expensive and less useful, to the great misfortune of the poor, elderly and sick.

Mr. McConnell seems determined to steamroll this travesty through the Senate before July 4, despite complaints by conservatives and moderates. Expect him and his colleagues to try to buy support of wavering lawmakers by offering sweeteners like a few billion dollars for addiction treatment and some extra cash for states with high medical costs. Republican senators like Susan Collins of Maine, Lisa Murkowski of Alaska, Shelley Moore Capito of West Virginia, Rob Portman of Ohio and Dean Heller of Nevada ought not to fall for these cheap gimmicks. Instead, they should vote no on a bill that will take a devastating toll on millions of Americans and that no amount of tinkering around the edges can make better.

Health Myth: Do Men Really Hit Their Sexual Peak at 18?

Image

Chances are you’ve heard that men hit their peak at 18. But is it really true that men are at the height of their sexual prowess when they’re too young to know what to do with it? It depends on your definition of peak. Around age 18, a guy’s organs (read: his testicles) are producing the most sex-revving testosterone they ever will, according to Ava Cadell, Ph.D., a Los Angeles sexologist and founder of LoveologyUniversity.com. Research shows that barely legal men have the fastest and firmest erections and are the best equipped for encore performances. But it takes about a full decade after your peak output to actually reach your max testosterone levels, meaning a guy’s sexual desire doesn’t actually spike until he’s around 30 years old.

What about the gals? At around 30 years old, women achieve their Big O with more ease than they will at any other age, according to Cadell. Contrary to what’s going on below guys’ belts, women’s sexuality is more psychological than physiological. “As women mature, they become more comfortable in their own skin and gain sexual confidence to communicate their wants, needs, and desires,” she says. Interestingly, a recent survey of more than 12,000 people found that women have the best sex of their lives at 28. Men, on the other hand, reported 33 to be the best sexual age.

Still, it’s important to remember that sexual peaks—whether they’re based on performance or satisfaction—vary from person to person depending on genetics, hormones, relationship quality, and psychological factors.

“The easiest way to reach your sexual peak, regardless of age, is to invest in your health outside of the bedroom,” Cadell says. “Diet and exercise can go a surprisingly long way to improving your sex life—and not just because you’ll look hotter. They can increase testosterone levels, cut stress, and promote healthy blood flow to . . . you know what.” And remember, your bed is for more than just sex. According to a study published in Brain Research, logging enough sleep can help keep your testosterone levels and sex life at their best.

Read More http://www.details.com/blogs/daily-details/2013/06/health-myth-do-men-really-hit-their-sexual-peak-at-18.html#ixzz2cWuNXmvq

The State of HIV/AIDS in Black America

ImageThere is some good news and not-so-good news to report on National Black HIV/AIDS Awareness Day. The good news: The number of new infections has finally stabilized at about 50,000 new cases per year in the USA since the mid-1990s.The bad news: The epicenter of the epidemic is Black America. African-Americans and other Black communities represent only 12% of the nation’s population but account for nearly half—some 44%—of all new HIV infections, report the Centers for Disease Control and Prevention. Black gay and bisexual men suffer the highest new infection rates in the country. “African-Americans account for about half of the more than one million people living with HIV/AIDS in the United States,” Donna Hubbard McCree, PhD told EBONY.com. Dr. McCree is the Associate Director for Health Equity of the CDC’s Division of HIV/AIDS Prevention. “And about half of those who die from AIDS every year.” “African-Americans tend to have sex with other African-Americans. So even with less risky behavior their chances are much higher of meeting are partner who is infected,” adds Dr. McCree. But there is some good news on Black women. Recent data show that new infections—these are called seroconversions—among Black women are declining for the first time in over a decade. “New HIV infections among Black women [decreased by] 21 percent between 2008 and 2010,” CDC reported in December 2012. “We are cautiously optimistic about that,” said Dr. McCree. “But Black women continue to account for more HIV infections among women than any other race or ethnicity. African-American women account for more than 60 percent of all infections among women.” Infection rates among Black women are nearly 15 times higher than those among White women. Seroconversions among Black women are rising the fastest in the South and rural states. Those states also are predominately poorer than the rest of the country—and the state governments are overwhelmingly conservative and against expanding health care access, the Black AIDS Institute reported in November.

Meanwhile: The number of new infections have been particularly “alarming” among young Black gay and bisexual men aged 13 to 19, according to CDC. New seroconversions have increased by almost half between 2006 and 2009.  The crisis is so severe in some American cities that “one in two Black men who have sex with other men is HIV positive,” according to a report released by the Black AIDS Institute last July at AIDS 2012 in Washington.