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.

Understanding Washington: a nephrologist's perspective from inside the Beltway.

The major principles that drive U.S. federal health policy-making are: (1) fixed or reduced costs, (2) ensured outcomes (or no evidence of undertreatment), (3) streamlined administration, and (4) political viability. A corollary is that providers are uniquely sensitive to financial incentives. Understanding these principles is vital to understanding federal health policy. Critically, these principles are nonpartisan and have been supported and used by all administrations since President Reagan. This article examines the end-stage renal disease (ESRD) prospective payment system, colloquially called "The Bundle," in the context of these major principles. Successful health policy, successful legislation, and successful regulation building all require executive leadership, mutual trust, and compromise. This is demonstrated by the events surrounding the passage of the Medicare inpatient prospective payment system, which governs hospital reimbursement for Medicare beneficiaries, including those not covered in the ESRD program. Given that the ESRD benefit consumes 6.3% of the Medicare budget for approximately 2% of Medicare beneficiaries, if nephrology is to experience future success, we must change how both policymakers and the wider field of medicine perceive our specialty. Understanding the major principles behind health care policy may facilitate this goal.

The hidden cost of private health insurance in Australia.

The provision of health services in Australia currently is primarily financed by a unique interaction of public and private insurers. This commentary looks at a loophole in this framework, namely that private insurers have to date been able to avoid funding healthcare for some of their policy holders, as it is not a requirement to use private insurance when treatment occurs in Australian public hospitals.

Proposed regs address new hospital tax-exemption requirements.

Proposed regulations set forth detailed rules for implementing the new tax-exemption requirements of Section 501(r) of the Internal Revenue Code for not-for-profit organizations operating hospital facilities. The proposed regulations provide guidance on the written financial assistance policies (FAPs) that hospital facilities are required to establish. The regulations propose methodologies for determining the amounts that a hospital facility can charge FAP-eligible individuals for emergency and other medically necessary care. They prescribe procedures that hospital facilities would be required to follow before engaging in extraordinary collection actions against an individual.

Protecting uninsured patients from high hospital charges: lessons from California.

Key findings. (1) In 1997, the amount California hospitals billed uninsured patients was more than twice the amount hospitals received from Medicare for the same services. By 2010, billed charges had grown to be five times what Medicare paid, which trans­lated into a gap of more than $10,000 per day in the hospital. (2) Five years after the passage of the state's Hospital Fair Pricing Act, most California hospitals had financial assistance policies in place to make care more affordable for the state's uninsured population. (3) As of 2011, 81 percent of California hospitals reported charging low-income uninsured patients prices that were at or below Medicare rates. (4) While not required by the law, nearly all California hospitals reported offering free care to uninsured patients with incomes at or below 100 percent of poverty.

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.

Economic factors converge: force hospitals to review pricing strategies.

The US hospital service price structures are complex and tend to be significantly higher than the actual cost to provide the service. Health care consumers have been given more authority to drive health care decisions. Transparency in health care is forcing hospitals to critically review and substantiate service prices. It is vital that US hospitals review their pricing strategies in order to continue as strong leaders in the health care market.

[The new hospital reimbursement system: a chance and a challenge to child and adolescent psychiatry or «much ado about nothing¼?]. / Das neue Entgeltsystem.

New legislation in the financing of psychiatric hospitals in Germany stipulates the introduction of a new reimbursement system for psychiatric child and adolescent psychiatric and psychosomatic hospitals in Germany by 2013. In several steps norms are to be empirically defined and services to be documented, and the current per diem system of hospital charges has to be replaced by a more specific system reflecting differences in the level of distinct patient groups. This discussion paper gives an overview of the legal framework as well as the risks and chances of the new system. An increased effort in documentation will be one of the clear consequences of the new system («much ado¼ ...). Psychiatric inpatient treatment will be much more transparent in detail, though it is not yet clear whether there will be a real improvement for patients (... «about nothing¼). The new system also offers the chance to introduce modern treatment concepts like home treatment. Such chances for innovation should be implemented to the benefit of patients.

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.