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Many Children Lack Health Insurance

Source:  WebMD Health

Many children don't have health insurance, even if their parents do, according to a new study published in The  Journal of the American Medical Association. This phenomenon -- uninsured children with at least one insured parent -- is particularly prevalent in low-income and middle-income families.

Jennifer DeVoe, MD, DPhil, from Oregon Health and Science University, and colleagues looked at records of 39,588 children and teenagers and found that 3.3% fell into the category of being uninsured (for part or all of the year) with at least one insured parent.

The data came from the Medical Expenditure Panel Survey, which is nationally representative. Researchers pooled data from 2002 to 2005.

The characteristics most commonly associated with uninsured children with an insured parent: low-income and middle-income households, parents with less than a high school education, Hispanic ethnicity, single-parent households, geographic residence in the south or west, and having a parent with private insurance coverage.

Children with parents who had public health coverage were 36% less likely to be uninsured than children whose parents had private insurance.

More than 9 million children in the United States lack health insurance. That number doubles if you include, as this study does, children who have gaps in coverage during the year. Gaps in coverage result in poorer health long-term, the authors write.

"When entire families have access to health insurance, children and adolescents not only benefit from more consistent insurance coverage but also have improved access to a regular source of care and higher rates of preventive services," the authors write.

The authors estimate that more than 1 million children had no coverage for the entire year, and 3 million children had some lack of coverage despite having one parent with full coverage. The authors assert that many adults may be able to afford employer-sponsored health insurance for themselves but not for their children. Because the cost of insurance relative to income is projected to rise, this could be an even larger problem in the future.

The authors write, "The question of whether the employer-based model is sustainable may need to be revisited. In this study, the private system did not do a good job of providing coverage for entire families."

Healthcare Premiums Expanding Faster Than Wages

By: John Mangan, Cincom Systems

In Michigan, healthcare premiums rose more
than 17 Times Faster than Earnings

We are getting used to the frequent references to soaring healthcare costs in the US where 55 % of those with healthcare insurance report that they are experiencing higher costs. I’m almost immune to these oft-quoted numbers. Whereas troubling, you get used to them after awhile.

But an October 2008 report of soaring healthcare premiums in Michigan woke me up. The premiums Michigan workers pay for healthcare rose 17 times faster than their wages from 2000 – 2007.

According to a Families USA study Premiums versus Paychecks:
A Growing Burden for Michigan’s Workers, median earnings in Michigan rose 4.6% in the first eight years of the millennium compared to the worker’s share of the healthcare premium which went up 78.2% (17.1 times wage increases).. That’s hard to imagine, but it gets worse.

• Actual wages may have gone up a puny 4.6 % from 2000-20007, but real wages (wages adjusted for inflation) didn’t go up at all.

• And today’s higher premiums get you less benefits with higher deductibles, copays, and co-insurance.

Compound that with rapidly rising fuel, food, and education costs and it’s a wonder anyone in Michigan ever gets out of bed.

Check out healthcare costs in you own state
The Families USA report, Premiums versus Paychecks, is based on data from the U.S. Census Bureau, the Department of Labor, and the Department of Health and Human Services. You can access reports specific to your state, just click on (Access the reports).

How Innovation Can Help Hospitals to Improve Their Revenue Cycle

By Chris Woodhead, Cincom Systems

If you have ever received treatment at a hospital in the US you have probably been exposed to some of the admin complexity that this entails. Such are the innefficiencies in the administration processes that according to the American Hospital Association sixty percent of hospitals lose money providing patient care.

To be precise, Healthcare Providers lose $60bn per year because of administrative errors. To put this into perspective this equates to the 2007 cost of providing universal healthcare through the National Health Service to 25 million people in the United Kingdom.

Problems begin right at the registration point. It always amazes me just how much information must be gathered and processed at patient registration time; information such as insurance plan code, insurance eligibility, demographics, credit risk, charity availability, deductible amount and much more. Patient registration not only involves the creation of the patient's medical record, which must be accurate in order to provide appropriate treatment and care, but, in addition, a healthcare provider's ability to collect payments directly correlates to an efficient and accurate registration process.

An innovative approach to improving the registration process is to enable hospitals to not only access the information needed, but to customize the information to fit the required process, and then intelligently and automatically guide the patient-facing employees to use the information effectively through on-screen interactive guides.

To understand what I mean by the patient-facing employees being ''intelligently guided'', let's examine one of the many registration processes that are key to the hospital's overall revenue cycle: the insurance verification process. When a registrar has gathered enough information for the insurance verification process to be carried out, a message is sent to the appropriate data source to validate that the patient does have that particular insurance plan and it is in force at that point. The system then validates the terms of the plan and what the copay amounts are. During the registration, it sends that information back to the registrar, who would be automatically prompted to use that information, and then be guided to the next set of relevant questions.

With other methods, the information received from the different sources is not readily available in an easy-to-use format. The registrar has to interpret the information and glean whatever information is relevant. On the other hand, with a system like the one described here, the data is automatically interpreted and the appropriate set of prompts is shown to the registrar to seamlessly continue to the next step in the registration process.

An additional requirement for such a system is that it seamlessly integrates with a healthcare provider's existing patient registration system, thus allowing the hospital to have a patient registration system that determines who is going to pay for the treatment and in what shares it is going to be paid - part insurance, part Medicare, part Medicaid or part co-pay or if it is the growing number of people who are self-paid or self-insured. And when there are multiple insurance companies, the claim needs to be submitted in the right order.

Innovative systems like this can vastly improve the hospital's revenue cycle.

The result? Better processes which are error-free, less costs, a drastic reduction of losses and ultimately more money available to be spent where it really matters: providing a better service to patients.

Appropriate Communication

By Kari Kemper, Provider Advantage

Last week, a financial counselor in a US hospital, made a serious blunder.

A patient was admitted from the emergency department to a medical unit.  Why?  The patient tried to commit suicide by overdose.  And, as usual in all hospitals across the United States, the inpatient psychiatric unit was full.  While this patient was stabilizing medically, the psychiatrist discussed psychiatric options for this patient.  The psychiatrist deemed, due to her situation, that she did need inpatient psychiatric care vs. outpatient care as she could not commit to a safety plan outside of the hospital.

The psychiatrist prefers to have a patient willingly enter inpatient treatment vs being placed on a psychiatric hold.  Treatment is usually accepted vs resisted in this manner.

Why did the patient try to take her own life?

She was having serious financial issues that she felt she could not get out from under.

The psychiatrist told her that she would most likely stay in the medical unit for a few days until a psych bed opened up.  At that point, she could expect to stay for psychiatric treatment for approximately 2 weeks.

An hour after the patient agreed to this plan, a financial counselor from the business office entered her room.  The financial counselor told her that she did not qualify for charity care (although later, the MD found out that she was not properly assessed), nor did she qualify for Medicaid.  She asked the patient, how she planned to pay for her treatment and told her that her psychiatric stay will be expensive (but did not give her an actual $$ figure).

As expected, the patient melted down and decided to cancel her inpatient treatment.

Four hours later, the psychiatrist convinced her to stay, telling her he would figure out something. 

The psychiatrist was not amused.  In fact, he was quite angry.  This financial counselor comprimised the safety of his patient.  He went up the ladder and demanded an answer as to why a financial counselor would ever approach a psychiatric patient, let alone one who tried to take her life due to financial issues.

And the answer?

"We will make sure our staff is trained."

He asked how.

They said via meetings.

Seems as though perhaps process change needs to happen.  Make it a rule that while collecting upfront is ideal, with psychiatric patients it is not. 

And enforcing this rule via "meetings" will not guarantee compliance.  Perhaps an alert in the registration system based on admission code that states, "Psychiatric Patient.  Do not approach for payment."

And the patient?  When the MD brought this situation to the forefront, the business office discovered that the patient was not properly screened for Medicaid/Charity care.  She did qualify.  And the financial counselor with the psychiatrist present met with the patient and assured her that her stay was covered.

It Makes You Sick!

by: John Mangan, Cincom Systems

Americans are Having a Harder Time Paying
Medical Bills, and It’s Making Them Sick (Literally)

I know that isn’t surprising. We all have been feeling the healthcare pinch due to increased premiums and higher deductibles coupled with the insidious co-insurance. But because of these increased costs, some Americans are discouraged to access adequate healthcare.

According to a new national study by the Center for Studying Health System Change (HSC), Trade-Offs Getting Tougher: Problems Paying Medical Bills Increase for U.S. Families, 2003-2007, published in September 2008, the percentage of Americans in families with problems paying medical bills increased from 15.1 % in 2003 to 19.4 % in 2007. That’s more than 57 million Americans who have problems paying for healthcare - an increase of more than 14 million since 2003.

The scary part is that this trend is not just hurting our wallets, it’s effecting our health. The Kaiser Family Foundation survey, April 2008, Survey Brief: Economic Problems Facing Families, reports that 42% of those surveyed postponed healthcare procedures or medication in the past year because of cost. And even more troubling, 66% who postponed healthcare recommendations actually got sicker.

There is no remedy in sight. Healthcare reform is being pushed to back the burner. Early in this year’s US presidential campaign, healthcare reform was one of our top concerns. It seemed that finally healthcare was going to get addressed no matter who got elected. But now only 5% of Americans feel that healthcare is still a top issue. It has long been replaced by the economy. Once the government bails out Wall Street, there will be little left to address healthcare. Americans will continue to see their health costs grow and will postpone or avoid the care and services they need.

Glossary of Consumer Directed Products

Source:  PricewaterhouseCoopers and HealthLeaders

Flexible Spending Accounts (FSAs)

• An employer bookkeeping account for medical expenses generally funded by employee pretax contributions
• Often offered as a separate component of a cafeteria plan (a plan that provides employees with a choice between taxable cash and nontaxable benefits for unreimbursed medical or dependent care expenses)

Health Reimbursement Arrangements (HRAs)

• Medical plan funded entirely by the employer that reimburses the employee for qualified medical expenses.  Cannot be offered through a cafeteria plan

High-Deductible Health Plan (HDHP)

• A health insurance plan with a deductible requirement of typically at least $1,000 for health plan coverage
• The HDHP must meet certain legislative and regulatory requirements in order for plan participants to become eligible to contribute to MSAs and HSAs

Health Savings Accounts (HSAs)

• A portable, personal account for the payment of qualified medical expenses
• Individuals must be covered by a high-deductible health plan to contribute to an HSA
• Account's earnings are not taxed
• Not available to individuals covered by Medicare, persons who can be claimed as a tax dependent, and those covered by a health plan that is not a HDHP
• Can be funded by an employer, employee or other individual