Monthly Archives: March 2015

03.26.15
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High-Deductible Plans Bring Lower Costs Now, But Will They Mean Pricey Consequences?

Got a high-deductible health plan? The kind that doesn’t pay most medical bills until they exceed several thousand dollars? You’re a foot soldier who’s been drafted in the war against high health costs.

Companies that switch workers into high-deductible plans can reap enormous savings, consultants will tell you — and not just by making employees pay more. Total costs paid by everybody — employer, employee and insurance company — tend to fall in the first year or rise more slowly when consumers have more at stake at the health-care checkout counter whether or not they’re making medically wise choices.

Consumers with high deductibles sometimes skip procedures, think harder about getting treatment and shop for lower prices when they do seek care.

What nobody knows is whether such plans, also sold to individuals and families through the health law’s online exchanges, will backfire. If people choose not to have important preventive care and end up needing an expensive hospital stay years later as a result, everybody is worse off.

A new study delivers cautiously optimistic results for employers and policymakers, if not for consumers paying a higher share of their own health care costs.

Researchers led by Amelia Haviland at Carnegie Mellon University found that overall savings at companies introducing high-deductible plans lasted for up to three years afterwards. If there were any cost-related time bombs caused by forgone care, at least they didn’t blow up by then.

“Three years out there consistently seems to be a reduction in total health care spending” at employers offering high-deductible plans, Haviland said in an interview. Although the study says nothing about what might happen after that, “this was interesting to us that it persists for this amount of time.”

The savings were substantial: 5 percent on average for employers offering high-deductible plans compared with results at companies that didn’t offer them. And that was for the whole company, whether or not all workers took the high-deductible option.

The size of the study was impressive; it covered 13 million employees and dependents at 54 big companies. All savings were from reduced spending on pharmaceuticals and doctor visits and other outpatient care. There was no sign of what often happens when high-risk patients miss preventive care: spikes in emergency-room visits and hospital admissions.

The suits in human resources call this kind of coverage a “consumer-directed” health plan. It sounds less scary than the old name for coverage with huge deductibles: catastrophic health insurance.

But having consumers direct their own care also requires making sure they know enough to make smart choices like getting vaccines, but skipping dubious procedures like an expensive MRI scan at the first sign of back pain.

Not all employers are doing a terrific job. Most high-deductible plan members surveyed in a recent California study had no idea that preventive screenings, office visits and other important care required little or no out-of-pocket payment. One in five said they had avoided preventive care because of the cost.

“This evidence of persistent reductions in spending places even greater importance on developing evidence on how they are achieved,” Kate Bundorf, a Stanford health economist not involved in the study, said of consumer-directed plans. “Are consumers foregoing preventive care?  Are they less adherent to [effective] medicine? Or are they reducing their use of low-value office visits and corresponding drugs or substituting to cheaper yet similarly effective prescribed drugs?”

Employers and consultants are trying to educate people about avoiding needless procedures and finding quality caregivers at better prices.

That might explain why the companies offering high-deductible plans saw such significant savings even though not all workers signed up, Haviland said. Even employees with traditional, lower-deductible plans may be using the shopping tools.

The study doesn’t close the book on consumer-directed plans.

“What happens five years or ten years down the line when people develop more consequences of reducing high-value, necessary care?” she asked. Nobody knows.

And the study doesn’t address a side effect of high-deductibles that doctors can’t treat: pocketbook trauma. Consumer-directed plans, often paired with tax-favored health savings accounts, can require families to pay $5,000 or more per year in out-of-pocket costs.

Three people out of five with low incomes and half of those with moderate incomes told the Commonwealth Fund last year their deductibles are hard to afford. Many households simply lack the resources to make out-of-pocket health costs, shows a recent study by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the Foundation.)

As in all battles, the front-line infantry often makes the biggest sacrifice.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

03.26.15
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Sutter’s Fine – What Else Are They Hiding at Alta Bates?

More than a dozen nurses from Sutter corporation’s Alta Bates Summit Medical Center gathered outside the facility’s Oakland hospital Wednesday afternoon to alert the public to ongoing safety problems at the hospital – even after it was slapped with a maximum fine by the California Division of Occupational Safety and Health (Cal/OSHA).

Cal/OSHA hit Sutter with a $71,275 fine, following a stipulated settlement, for willful safety violations for placing two dozen suspected tuberculosis patients in airborne isolation rooms that were inoperable, potentially exposing scores of staff, other patients, and visitors to TB or other serious infectious diseases.

Speaking out on the violation, Summit ICU RN Mike Hill refuted the hospitals statements to press that the Sutter management “immediately took steps to correct these violations,” and that no patients or staff were put at risk.”

Sutter’s actions, said Hill, “could have potentially exposed” the nearly two dozen patients housed in the inoperable ICU isolation rooms surveyed by Cal/OSHA in late 2012 “and others to TB or other serious infectious diseases.”

Further, hospital officials “had falsely told staff for some time prior to the investigation that the rooms were functioning properly despite engineering documentation indicating otherwise.”

When the California Nurses Association alerted the media to the fine March 24, the hospital “sent out a memo to employees, physicians, and volunteers,” Hill noted, “that they had immediately taken steps back in November of 2012 to correct the violations following the Cal/OSHA investigation.”

But, said Hill, “the Medical Center knew long before this investigation that these rooms were not functioning and willfully chose to ignore those safety violations, exposing patients, staff and visitors. Since the citation violation (was first issued) in 2012, over two years ago, the Medical Center has taken no actions to repair these rooms to full operation and only recently made attempts to provide some additional although inadequate equipment to protect staff.”

In addition to the fine – the maximum the state can levy for a “serious, willful” violation, Sutter is required to rebuilt to code the isolation room in the Summit ICU, which it has not done yet. It is also required to “provide a sufficient number of Powered Air Purifying Respirators in every unit to meet the needs of all staff so as to protect them from high hazard procedures performed on suspected or confirmed patients requiring airborne isolation.”

CNA associate executive director Bonnie Castillo, RN, praised the Sutter RNs for their consistent efforts at whistleblowing safety violations in order to protect public, patient, and staff safety.

Hill also reminded nurses and the press about the history of Alta Bates Summit’s safety violations. That includes a 2012 fine of $84,450 for willful misconduct in dangerously exposing staff to a serious illness that resulted in permanent disabilities for a respiratory tech and an Oakland police officer, a “2013 sewage failure that resulted in human waste dripping from the ceiling onto staff and the sewer fly infestation throughout ICU coming from the longtime non-functioning toilets.”

“This continuous attitude of catch me if you can by Sutter,” said Hill, “raises concerns about what other violations have yet to be uncovered at this and other Sutter facilities in the future.”

“Hopefully this fine and other required actions,” Hill concluded, “will put Sutter on notice that workplace safety protections need to be a top priority. These protections are in place to not only protect the staff but the patients and visitors from the community that Sutter says they are here to serve.”