In this week’s summary: Several stories detailing the latest developments in the implementation of the Affordable Care Act; a new report highlights the increasing costs of medical bills for consumers; and USA Today has an expose on the alarming number of people undergoing needless surgeries, all that and more in this week’s health news!
Affordable Care Act & Health Exchanges
Reuters writes about a public education campaign by the Department of Health and Human Services to connect directly with 2.7 million Americans with limited or no health coverage in the months before implementation of a key piece of the Affordable Care Act (ACA). The effort mostly will focus on male, largely nonwhite 18-to-35-year-olds. People who are young and uninsured are considered the most crucial population for ACA’s success (Morgan, 6/15).
The Wall Street Journal writes that government officials have missed several deadlines in setting up new health-insurance exchanges for small businesses and consumers—a key part of the federal health overhaul—and there is a risk they won’t be ready to open on time in October, Congress’s watchdog arm said. The Government Accountability Office said federal and state health officials still have major work to complete (Radnofsky and Needleman, 6/19).
The New York Times profiles how the health insurance exchanges under the Affordable Care Act will vary from state to state. Consumers in different states will see a variety of different plans as well a range of rates among the options available in the insurance exchanges. While some states such as California, Colorado and Maryland have signed on many insurers in their exchanges, others — including some reluctant to embrace the law and others whose populations are not attractive to insurers — will offer only a few options (Abelson, 6/16).
Reports & Investigations
Patients shoulder almost 24% of their medical bills on average, according to the American Medical Association’s annual report on health insurers and the accuracy, transparency and timeliness of claims processing. The report, which is the latest to indicate the rapid increase in consumers’ share of the bills, also found that the insurance claims of patients are incorrectly processed 7% of the time.
The New York Times reports that pharmaceutical companies that have agreements with other pharmaceutical companies to keep less-expensive generic versions of drugs off the market can expect greater federal scrutiny after a Supreme Court ruling on Monday. In a 5-to-3 vote, the justices effectively said that the Federal Trade Commission can sue pharmaceutical companies for potential antitrust violations (Wyatt, 6/17).
Tens of thousands of times each year, patients are wheeled into the nation’s operating rooms for surgery that isn’t necessary, a USA Today review of government records and medical databases finds. Some patients fall victim to practitioners who enrich themselves by bilking insurers for operations that are not medically justified. Even more turn to doctors who simply lack the competence or training to recognize when a surgical procedure can be avoided, either because the medical facts don’t warrant it or because there are non-surgical treatments that would better serve the patient (Eisler and Hansen, 6/20).
The Associated Press highlights the findings of a new study from the IMS Institute for Healthcare Informatics regarding the use of prescription drugs. The study finds that an estimated $200 billion could have been saved last year if patients and clinicians improved the way they use medications. Medication nonadherence, misuse of antibiotics and other so-called “avoidable costs” lead to millions of unnecessary hospital admissions, outpatient and emergency room visits and prescriptions (AP, 6/19).
The Times Union reports that Congressional Representative Issa, head of the U.S. House Committee on Government Oversight, is examining alleged actions by high level staff within the New York Office of Medicaid Inspector General to stifle staff member’s cooperation with the Committee’s investigation into New York’s Medicaid system. The committee has been looking into waste and abuse within New York’s $56 billion Medicaid program, and is concerned about ineffectiveness of the OMIG to weed out fraud and overpayments (Odato, 6/17).
New York’s medical community worries that adding 1.1 million people to insurance rolls under the federal health care overhaul will overwhelm primary care physicians, many of whom are already swamped. Federal data showed nearly 18,000 physicians providing primary care at the start of 2011 in a state with 19.6 million residents. That was the 11th-best ratio among states (AP, 6/19).