In the leadup to, and aftermath from, Supreme Court hearings over the Affordable Care Act, the Internet has been rife with speculation as to what would happen if the individual mandate, or even the entire health care reform law, was struck down. The New York Times recently focused on how reversing two years of policy would affect a specific industry – health insurers.
Based on the comments of the articles’s interviewees, there’s a fair amount of hand-wringing going on:
And here at MedBen? While we’re certainly keeping an eye on judicial developments, whatever the outcome should be, it’s essentially business as usual. As nothing in the law acts to reduce the cost of care, we continue to do precisely what we’ve always done: Find ways to provide leading-edge administrative services that increase efficiency while reducing client costs.
MedBen has never been a company to take a wait-and-see attitude. So rather than sit idly by, we remain at all times proactive. For instance, in 2010 we developed Partners Community Health Plan – a unique benefits package in which local hospitals and providers play an equal role in its management. Partners is currently available for fully-insured and self-funded businesses in Southeastern Ohio and Southwestern Kentucky, with more regions soon to come.
“Business as usual” really means that MedBen is constantly looking out for your best interests – through varied benefit offerings, innovative cost controls, on-line and in-house technologies, and outstanding customer service – regardless of circumstances.
As more preventive services are covered in full by health insurance, the range of treatment costs from one provider to another has received increased scrunity. USA Today reports that a new study demonstrates just how great the difference can be.
According to research group Change HealthCare, costs for some preventive services can vary as much as 700%. A review of 15,000 consumers found cost differences of hundreds of dollars charged for the same tests. Colonoscopy costs, for example, ranged from $786 to $1,819.
The U.S. Department of Health and Human Services has developed a list of preventive services covered under the Affordable Care Act, and predicts a 1.5% increase in insurance premiums to cover the costs. But whether that’s a conservative estimate or not ultimately depends on the consumer’s choice of medical provider.
Bottom line: Even when you ensue no direct out-of-pocket expenses, it’s a good idea to know how much you’re spending for preventive care, and how it compares to average costs in your area. Such websites as myMedicalCosts.com, Outofpocket.com and Pricedoc.com can help you with your research.
Many of us are so conditioned to getting by with less than seven hours of sleep a night that we ignore the warning signs our body sends when it wants more rest. But failure to take notice can lead to a myriad of health problems, including high blood pressure, obesity, depression, and decreased concentration and reaction times.
Men’s Health highlights six signs that you need to turn in earlier. We summarize them below, but you can check out the complete list at their website.
Avastin users may want to take extra precautions to ensure that their physicians and pharmacists are giving them the proper version. For the second time this year, the Food and Drug Administration has uncovered counterfeits of the injectable cancer drug.
AFP reports that the latest counterfeits are labeled by the name under which Avastin is approved in Turkey, Altuzan, but contain no active ingredient. Genentech, a subsidiary of the Swiss pharmaceutical giant Roche, markets the only FDA-approved version of Avastin in the United States.
The agency “is alerting healthcare professionals that another cancer drug, originating from a foreign source and purchased by US medical practices, has been determined to be counterfeit,” said the FDA in a statement.
In February, the FDA warned that as many as 19 US medical practices had potentially purchased and used counterfeit Avastin from Quality Specialty Products (QSP), a foreign supplier also known as Montana Health Care Solutions.
Avastin is used to treat colorectal, lung, kidney, breast and ovarian cancer.
In an effort to reduce wasteful spending without harming patients, nine medical societies have compiled a list of tests and treatments their members should no longer automatically order. MSNBC reports that the groups, which include the American Academy of Family Physicians, the American Society of Clinical Oncology and the American College of Cardiology, represent nearly 375,000 physicians.
Each of the specialty societies created a list of “Five Things Physicians and Patients Should Question". The 45 tests and procedures considered to be overused include:
Complete lists are available at the “Choosing Wisely” website.
In spite of rumblings that the Supreme Court could strike down the entirety of the Affordable Care Act, President Obama is confident that the health care reform law will stand, the New York Times reports. On Monday, he said that it would be an “unprecedented, extraordinary” step to overturn legislation passed by the “strong majority of a democratically elected Congress.”
Obama defended his signature legislative achievement, and cautioned right-leaning justices not to practice partisan politics from the bench:
“I’d just remind conservative commentators that for years what we’ve heard is the biggest problem on the bench is judicial activism or a lack of judicial restraint – that an unelected group of people would somehow overturn a duly constituted and passed law. Well, here’s a good example. And I’m pretty confident that this court will recognize that, and not take that step.”
The severity of the President’s comments rubbed some politicians and pundits the wrong way – even those who support the law. In The Washington Post, op-ed columnist Ruth Marcus called his words “unsettling“:
“To be clear, I believe the individual mandate is both good policy and sound law, well within Congress’ powers under the Commerce Clause… And yet, Obama’s assault on ‘an unelected group of people’ stopped me cold. Because, as the former constitutional law professor certainly understands, it is the essence of our governmental system to vest in the court the ultimate power to decide the meaning of the constitution. Even if, as the president said, it means overturning ‘a duly constituted and passed law.’”
No doubt aware of how his remarks had been received, Obama gave a more measured critique at a press luncheon on Tuesday:
“[T]he point I was making is that the Supreme Court is the final say on our Constitution and our laws, and all of us have to respect it, but it’s precisely because of that extraordinary power that the Court has traditionally exercised significant restraint and deference to our duly elected legislature, our Congress. And so the burden is on those who would overturn a law like this.”
All-metal hip replacements have gotten a lot of bad press lately. Studies calling into question their effectiveness, plus a major recall following recipient reports of pain and joint dislocation, have cast doubts on whether metal-on-metal (MOM) is preferable to plastic or ceramic joints.
Recognizing the controversy, the Food and Drug Administration has announced that an advisory panel will meet this June to review the benefits and risks of MOM replacements. Reuters reports that scientists, researchers, patients and medical practitioners will advise the agency whether new testing standards should be implemented before an implant device can be sold in the United States.
There is some good news for MOM recipients, however. According to HealthDay News, a British study of people with all-metal hip replacements found a slightly lower risk of developing cancer after surgery than those who received traditional implants.
A 60-year-old male MOM recipient with moderate health had a 6.2% chance of being diagnosed with cancer in the five years after surgery, compared to 6.7% with a hip replacement made with other materials. For women, the risk was 4% for MOM replacements and 4.4% for other types.
On his blog, Dr. Wes offers a common-sense approach for how we proceed with health care reform should the Supreme Court strike down the Affordable Care Act:
“Fix what’s broken first.
“Rather than creating a new, larger government health care system based on an 2700-page nearly unreadable health care law that creates at least 115 new agencies and winds between countless government agencies and disconnected bureaucracies, we should move to fix what’s broken with Medicare and Medicaid first with an eye toward fixing what matters most to Americans.
“If we’ve got waste, fraud, and abuse to the extent we are told, then fix it. We don’t need new agencies to do so.
“Admit there are limits to what can and will be paid for, set a budget, and stick to it […]
“Rather than trying to fixing exerything that ails our system all at once, take it piece by piece. Vet the issues openly rather than behind closed doors. Since prices are the priority, make prices for elective procedures and medical equipment available online to patients AND doctors. Patients must be the priority to our new initiatives, not special interests. Most of all, make the lower cost of health care and quality of health care the priorities and stop promising that the quantity of care we provide can remain unlimited to all.
“Improvise. Adapt. Who knows: we might just overcome our current health care crisis bit by little bit.”
Despite repeated warnings about prolonged exposure to the sun and the dangers of tanning beds, skin cancer has risen among young adults over the past four decades.
AFP (via Yahoo! Health) reports that between 1970 and 2009, the rate of melanoma among women increased eightfold and quadrupled among men, according to research by the Mayo Clinic. Mayo experts based their findings on a study of medical records for a county in Minnesota over that timespan.
“We anticipated we’d find rising rates, as other studies are suggesting, but we found an even higher incidence than the National Cancer Institute had reported,” said lead investigator Jerry Brewer, M.D., a Mayo Clinic dermatologist. Particularly troubling, he noted, was a “dramatic rise in women in their 20s and 30s.”
Brewer added that while the study didn’t focus on reasons for the increase, prior research has shown that people who use indoor tanning beds are 74% more likely to get melanoma than non-tanners.
The Mayo study also found that death rates from melanoma fell during the same period, possibly due to earlier medical intervention to treat the disease.
In a city where secrets have a short shelf life, the Supreme Court takes every precaution to ensure that no one in Washington D.C. knows what’s being said behind the chamber door.
Today the nine justices are expected to determine the fate of the Affordable Care Act. And as in all Supreme Court hearings, they follow an established and rigid procedure. The Street website explains how it works:
“The justices will confer in a room by themselves – no one else is legally allowed to be present except for the nine men and women appointed by current and past presidents – seated in order of seniority as the chief justice heads the discussion…
“[E]ach justice, starting with the most senior (which is the Chief Justice), states an uninterrupted opinion about the arguments for the specific case. Each justice may speak only once to state his or her comments, which, once completed, concludes that justice’s opportunity to speak again.
“The next justice in seniority then confers his or her opinion about the case; that order repeats until the most junior – Kagan – completes her statements.
“Once all justices have stated a case, [Chief Justice] Roberts will then hold a vote for where they intend to side on a case. The “majority” opinion refers to the side that garners – at least in the Obamacare case – five votes, while the “dissenting” opinion is the minority.”
Even though the vote occurs today, only the justices will know the outcome until June. In the meantime, majority and dissenting opinions are written.
“The senior justice in the majority will then decide who writes the majority opinion, and, traditionally, the senior justice among the dissenters will decide who writes a primary dissenting opinion,” said Greg Magarian, a Washington University in St. Louis law professor who clerked for former Justice John Paul Stevens. “Although anybody can write a dissent, and anybody in the majority can write a separate concurrence explaining why they… partially agree and partially disagree.”
A Medicare experiment to pay hospitals for quality performance, rather than quantity, apparently did not have the desired effect, Kaiser Health News reports.
Between 2003 and 2009, the Medicare Premier Hospital Quality Incentive Demonstration (HQID) awarded bonuses to participating hospitals based on such performance metrics as mortality rates for heart attack and heart bypass surgery. But a study comparing the mortality rate of the 252 HQID hospitals to those of 3,363 non-participants found the mortality rate to be virtually the same in both groups.
“Pay for performance is really important,” said Ashish Jha, a professor at the Harvard School of Public Health and lead author of the study. “This says to me that we haven’t figured out the pay part, or the performance part.”
Premier healthcare alliance, which oversees quality improvement efforts for its membership of hospitals and health systems, saw the results differently. It estimated the project saved the lives of 8,500 heart attack patients over five years, while also noting that lowering mortality wasn’t the primary goal of the demonstration project.
“The goal of HQID was to determine whether incentives would improve care processes in hospitals and it did do that, there’s no question,” said Blair Childs, a senior vice president at Premier.
HQID serves as the model for the Hospital Value-Based Purchasing Program, a provision of the health care reform law expected to begin in 3,000 hospitals this fall.
Cancer deaths continue to fall, but obesity and inactivity are keeping overall numbers higher than they should be, WebMD reports.
A new joint report from Centers for Disease Control and Prevention and leading cancer groups concluded that there is a link between obesity and increased risk for colorectal and postmenopausal breast cancers, as well as cancers of the esophagus, kidney, pancreas, and uterus. Additionally, a lack of physical activity was linked to increased risk for colon cancer and “probable” increased risk for postmenopausal breast and uterine cancers.
Cancer rates did decrease in the U.S. by an average of 1.6% per year between 2004 and 2008. The report said the downward trend reflects progress in prevention, screening, early detection, and the treatment of cancer.
MedBen Worksite Wellness promotes prevention of cancer and other chronic diseases by emphasizing physician office testing using the plan member’s primary care provider. This eliminates the logistical headaches and potential redundancy of on-site screenings. Plus, individualized disease monitoring and nurse coaching is available for high-risk members.
For additional information about worksite wellness, contact MedBen Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.
The Food and Drug Administration has issued new dosing and use recommendations for the popular antidepressant Celexa, Medical Xpress reports. The change comes following concerns that the drug may cause potentially fatal abnormal heart rhythms in patients with preexisting heart conditions.
Here are the latest FDA recommendations:
MedBen prescription plan members can get more information about Celexa and other antidepressents at the RxEOB website. Just use the convenient link under the “My Rx Claims” section on the MedBen Access website.
The third and final day of Supreme Court health care reform hearings gave rise to a real possibility that not only could the individal mandate be found unconstitutional, the entire Affordable Care Act may be nullified.
The Los Angeles Times reports that while the outcome of the case, which concluded its arguments yesterday, won’t be known until this summer, the court’s five-member conservative majority appeared to view the health care reform law in an unfavorable light – giving opponents just enough votes to strike it down altogether.
“One way or another, Congress is going to have to reconsider this,” said Justice Antonin Scalia, a conservative. “Why isn’t it better to have them reconsider it in toto?” In response, liberal Justice Ruth Bader Ginsburg said said the court should do a “salvage job” rather than undertake a “wrecking operation.”
Solicitor Gen. Donald Verrilli Jr., the Obama administration’s top lawyer, pleaded with the court for restraint. “[The Affordable Care Act] was a judgment of policy that democratically accountable branches of this government made by their best lights, and I would encourage this court to respect that judgment,” he said in his cloisng arguments.
The court also heard arguments Wednesday on expanding the Medicaid health insurance program – a provision of the law that would also get cut if the law were voted down.
The Supreme Court website has posted transcripts of the oral arguments from Day One and Day Two of the health care reform law hearings (formally, The Department of Health and Human Services v. Florida).
While the transcriptions are lengthy, they’re definitely worth a read or a skim-through. And if you’re interested in specific comments from the proceedings, both offer indices of common terminology.
UPDATE: Day Three of the Supreme Court hearing included arguments as to whether the health care reform law could stand without the individual mandate (National Federation of Independent Business v. Sebelius) and the constitutionality of the law’s Medicaid expansion (Florida v. Department of Health and Human Services). Transcripts and audio versions are available for both on the Supreme Court website.
MedBen clients with questions regarding the hearings are welcome to send them to firstname.lastname@example.org. Responses will be sent directly to the client and may also be reproduced here.
“Can you create commerce in order to regulate it?” Justice Anthony M. Kennedy asked the question to Solicitor General Donald B. Verrilli Jr. in the early moments of today’s Supreme Court hearings. Verrilli, lawyer for the Obama administration, was defending the constitutionality of the individual mandate – the provision in the Affordable Care Act that would require most Americans to purchase health insurance coverage.
According to The New York Times, almost all the nine justices had questions and comments about the mandate during the two-hour session. Only Clarence Thomas refrained from making inquiries.
“May failure to purchase something subject me to regulation?” asked Justice Antonin Scalia. Chief Justice John Roberts Jr. and Justice Samuel Alito Jr. wondered if the government could force people to buy cellphones and burial plots, respectively.
Justice Kennedy also asserted the need for such intense scrutiny, saying that as the requirement to obtain insurance was unprecedented, it required “a heavy burden of justification.” To this Verilli responded that as most Americans would almost certainly need health care services in their lifetime, the federal government was well within their constititutional authority.
Other members of the court joined the administration in supporting the law. Justice Ruth Bader Ginsburg said the individual mandate was necessary to ensure that all individuals paid their fair share for health care. And Justice Sotomayor noted that Americans would not stand for a system in which children in danger of dying were turned away from emergency rooms.
New research promises to spur a lot of dialogue about the benefits of weight reduction surgery. The Wall Street Journal reports that studies in the U.S. and Italy found that surgical procedures to reduce the size of the stomach in obese patients proved more effective in treating Type 2 diabetes than medication and weight-loss counseling.
Using randomized studies, researchers compared the results of weight loss through gastric bypass surgery with a regimen of drugs and diet and exercise coaching. The studies showed that surgery patients lost five times as much weight on average than those in the medical-therapy group. Surgery patients also showed much lower blood sugar levels – so much so, in fact, that many of them went off at least some of their medications even before leaving the hospital.
The findings “open the door for surgery to be considered as a more standard therapy for diabetes, particularly in the obese diabetic who isn’t well controlled with medical therapy,” said Philip Schauer, director of the bariatric and metabolic institute at the Cleveland Clinic and lead author of one of the studies.
Other doctors said further study of long-term risks and benefits was necessary before taking such a drastic step. “This is a very expensive and invasive way to control the disease,” said W. Douglas Weaver, head of cardiology at Henry Ford Health System in Detroit. “Having your blood sugar look better isn’t the same as not losing your eyes or having a heart attack.”
Should you require a hospital stay, MedBen offers a variety of tools to keep your hospital costs down – from comprehensive medical management services to a specialized surveillance system that thoroughly reviews your claims for potential savings. But there are also a few fairly simple steps you take to to reduce your hospital bill.
John Santa, MD, a medical expert with Consumer Reports, offers these useful suggestions (courtesy of WebMD):
Insist on efficiency. If you’re having surgery, ask to be admitted to the hospital the morning of your procedure rather than the night before. Also ask to be discharged as early as is safe and reasonable.
Demand focus. Be clear that you want your care to focus on the particular procedure for which you were hospitalized. “Let them know, I don’t want anybody ordering another X-ray or set of blood tests. My doctor will take care of that when I’m discharged,” Santa says.
Don’t pay for mistakes. Billing errors are common. Insist on an itemized bill and a copy of your medical record after treatment, and make sure they’re consistent. Don’t pay for any service, device, or drug you didn’t use. If hospitalization led to an infection, demand that any extra hospital days needed to treat it be removed from your bill.
The first day of Supreme Court health care reform hearings kicked off with an interesting twist – the plantiff and defendent agreed on the issue being argued.
According to The Washington Post, private attorney Robert A. Long stressed that because of the the Anti-Injunction Act, the Supreme Court cannot pass judgment on the Affordable Care Act until the individual mandate does into effect in 2014. Long was appointed by the court to argue in favor of the delay.
Both the Obama administration lawyers and those representing the 26 states challenging the law argue that the justices should should decide the question of the mandate’s constitutionality now. But the Anti-Injunction Act, a 19th-century law that prohibits legal challenges to a tax before it is collected, must first be weighed before the justices can consider whether or not the federal government has the right to require most Americans to buy health insurance or pay a penalty.
Long said the penalty, which is estimated to raise up to $6 billion a year by the end of the decade and would be collected by the IRS, looks like a tax. But Justice Stephen G. Breyer challenged that premise: Just because the penalty is “being collected in the same manner of a tax doesn’t automatically mean it’s a tax, particularly since the purpose of the Anti-Injunction Act is to prevent interference with the revenue stream.”
Finally, popcorn gets a little love!
Well, that’s not entirely correct. Popcorn has long been considered one of the healthier snack foods, so long as it’s air-popped and not slathered in butter. But now scientists report that it also contains more healthy antioxidants, called polyphenols, than some fruits or vegetables.
Medical News Today reports that polyphenols are more concentrated in popcorn, which averages only about 4% water, while polyphenols are diluted in the 90% water that makes up many fruits and vegetables.
And the hulls that get stuck between your teeth? They contain an even higher concentration of polyphenols and fiber. “They are nutritional gold nuggets,” said study co-author Joe Vinson, Ph.D. University of Scranton in Pennsylvania.
“Popcorn may be the perfect snack food. It’s the only snack that is 100% unprocessed whole grain,” Vinson noted. “One serving of popcorn will provide more than 70% of the daily intake of whole grain. The average person only gets about half a serving of whole grains a day, and popcorn could fill that gap in a very pleasant way.”
Of course, Vinson also cautioned that oil and butter can quickly negate popcorn’s benefits. And don’t drop fruits and vegetables from your diet – they contain vitamins and other vital nutrients lacking in popcorn.