Advocacy and the Hand Surgeon: Why and How.

This article explains and gives examples of the importance of political advocacy for hand surgeons at the federal and state levels. Two health care leaders who are also hand surgeons, one now serving as a state Senator and one a former President of the American Medical Association, give their perspective on participation in the political process. The article covers avenues for advocacy for hand surgeons as individuals and as members of medical organizations, including suggestions about effective communication with legislators. There is discussion of the unique role of the American Society for Surgery of the Hand in representing hand surgeons.

Stricter chargemaster regulations needed to rein in healthcare pricing.

Many states don't regulate hospital chargemasters, but rising prices on the itemized lists are lading to higher healthcare costs.

California's Hospital Fair Pricing Act reduced the prices actually paid by uninsured patients.

California's Hospital Fair Pricing Act, passed in 2006, aims to protect uninsured patients from paying hospital gross charges: the full, undiscounted prices based on each hospital's chargemaster. In this study I examined how the law affects the net price actually paid by uninsured patients--a question critical for evaluating the law's impact. I found that from 2004 to 2012 the net price actually paid by uninsured patients shrank from 6 percent higher than Medicare prices to 68 percent lower than Medicare prices; the adjusted collection ratio, essentially the amount the hospital actually collected for every dollar in gross price charged, for uninsured patients dropped from 32 percent to 11 percent; and although hospitals have been increasingly less able to generate revenues from uninsured patients, they have raised the proportion of services provided to them in relation to total services provided to all patients. The substantial protection provided to uninsured patients by the California Hospital Fair Pricing Act has important implications for federal and state policy makers seeking to achieve a similar goal. States or Congress could legislate criteria determining the eligibility for discounted charges, mandate a lower price ceiling, and regulate for-profit hospitals in regard to uninsured patients.

What happens when Medicare cuts hospital prices? Assessing the impact on inpatient discharges among the elderly.

Key findings. (1) Between 1995 and 2009, growth in Medicare inpatient prices varied widely across hospital markets. Faster growth typically occurred in less urban areas that had a large market share of for-profit hospitals. (2) By 2008-2009, elderly patients were going to the hospital at the same rate as in the mid-1990s, but their stays were much shorter, and they received much more intensive services. (3) Medicare price cuts, largely attributable to the Balanced Budget Act of 1997, were associated with a decrease in the num­ber of elderly discharges and a decrease in the number of staffed hospital beds, highlighting possible effects of hospital price cuts under health reform.