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Make Transparent Health Care Prices A Price Of Any Future Aid To The Health Care Industry

The country’s leaders are understandably focused on policies to help American businesses and workers deal with the ramifications of the coronavirus recession. In addition to broad-based relief, Congress has targeted aid to hospitals, health care providers, and clinical laboratories, despite their relative wealth. Two bills enacted in March provided a nearly $175 billion bailout for hospitals and providers.

On May 15, the House of Representatives passed a bill that would add another $100 billion to this bailout and provide substantial taxpayer funds to health insurers through a full subsidy for employee COBRA coverage, an increase in Affordable Care Act subsidies, and a provision that would largely offset any insurer losses in 2020 and 2021 with taxpayer money.

It’s time for Congress to stop focusing its efforts on supporting the wealthy health care and health insurance industries and it’s time for these industries to help American families and businesses and drop their fight against health care price transparency. This starts by equipping Americans—both families and employers—with tools to be better purchasers of health care. Specifically, Congress should lock in the Trump administration’s price transparency rules to end the legal battles over them and to give the American people the information they need to make smarter decisions about their health care and coverage. Enhanced shopping will increase competitive pressures in health care markets and lead to lower prices and enhanced quality of care.

Read the full article at Health Affairs.

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The shocking reason hospitals keep their prices a secret from you

Congress has provided hospitals with nearly $200 billion of our hard-earned tax dollars to help them weather the coronavirus pandemic. House Democrats just passed a bill adding another $100 billion. Now it’s time to stop bailing out hospitals and start helping financially stressed families get better health care at lower costs.

In health care, most prices are hidden. Earlier this month, big, profitable hospital systems were in court to make sure that American patients remain in the dark, challenging a Trump administration rule that would require them to publicize prices, including those negotiated with insurance companies.

No other industry is fighting to hide prices from consumers. When given pricing information, people know how to shop for value. With websites like Amazon and Kayak, Americans use price information to secure the best deals. This forces providers to compete by lowering prices and improving quality. Health-care markets don’t work like this.

Read the full article at the New York Post

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Coronavirus shutdown highlights need for health care reform

The U.S. health care system was broken and expensive before the novel coronavirus pandemic, the Texas Public Policy Foundation (TPPF) says.

And now, “COVID-19 has exacerbated the brokenness and lack of affordability in healthcare,” David Balat, director of health care initiatives at the TPPF, told The Center Square.

Before Gov. Greg Abbott took steps to close businesses deemed nonessential and suspend elective surgeries to ensure enough hospital beds remained open to treat COVID patients, Balat and several legislators proposed reform measures.

“Texans are largely frustrated by the way we pay for and deliver health care services,” Balat said. “Costs are skyrocketing, people are paying tens of thousands of dollars before coverage kicks in, insurance companies are failing patients, and too many communities are seeing their medical providers close up shop.”

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The ‘Marshall Plan’ to Save Primary Care

Primary care physicians are facing challenges that threaten their very existence, and despite pivoting to virtual health and making other changes, they face a massive drop in volume and revenue. As a result of the financial cliff, some physicians are pushing for a new way to pay for primary care.

“I am convinced that when we get on the other side of the pandemic, the care delivery system is fundamentally going to change, but it is going to be a really painful trip getting through the pandemic,” says Tom Banning, Texas Academy of Family Physicians CEO, who has been working on what he calls a “Marshall Plan” to save primary care. 

Dallas-based Merritt Hawkins surveyed physicians and found that 21 percent of physicians have been furloughed or experienced a pay cut, 14 percent plan to change practice settings as a result of COVID-19, 18 percent plan to retire, temporarily close their practices, or opt out of patient care, and 16 percent have or will cut reduce staff. Around one-third of physicians (32% percent) said that they will change practice settings, leave patient care roles, temporarily shut their practices or retire in response to COVID-19.  

Read the full article at D Magazine

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Primary care needs a new operating system

Primary care was meant to be the front door to the healthcare system: the one-stop-shop we rely on for all of our general healthcare needs, and to help us navigate the rest of the convoluted care delivery ecosystem.

But as a front door, it’s pretty broken.

The impact of COVID-19 has shown us this more than ever before—primary care’s already overburdened system has crumbled under the pressure, with patients left to self-diagnose without lab tests or in-person visits, wait in eternal telephone queues for callbacks that may or may not happen. In short, the very place in the healthcare system that was supposed to help catch illness soonest, in fact, created barriers.

The truth is, though, it may have never been set up for success in the first place, given its extremely broad mandate.

Just consider the number of billing codes primary care has to manage: more than five times the number of billing codes (the mix of services that can be billed for and reimbursed through insurance) than the next specialty. Despite the fact that primary care physicians (PCPs) are the ones handling the vast majority of visit volume (52% of ~1B annual outpatient visits), primary care has been both underappreciated and under-compensated—only 5%-8% of overall healthcare spend (PDF), and the lowest annual income amongst all specialties (PDF).

Read the full article at Fierce Healthcare

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COVID-19 shows Direct Primary Care model’s strengths

As a family physician for R-Health Yardley, I am fortunate to be able to stay connected to my patients as we navigate and adjust to the current changes our community is facing. As a Direct Primary Care Provider, I am proud to be there for my patients, helping ease their anxieties as they cope with the concerns of COVID-19 and what it means for them and their families.

Direct Primary Care is an alternative to traditional primary care. It is a model that truly focuses on the patient-physician relationship and has been proven to promote positive health outcomes. Individuals who receive this type of healthcare, whether it is offered through their employer or they chose to enroll on their own for a flat monthly fee, have access to unique care opportunities. Direct Primary Care offers the same general medical care and chronic disease management but with so much more than what traditional primary care can offer. Our offices offer onsite labs and immunizations and coordinate care with specialists. However, the real benefits of Direct Primary Care are what make us unique. Our patients have little to no wait time for an appointment and we usually see them same day if needed. As a physician, I am not pressured to see a certain number of patients a day and don’t have an overwhelming stack of paperwork or billing to complete. This leaves me with more time to connect with my patients, getting to know them and listening to all their concerns.

Read the full article at The Intelligencer

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How COVID-19 Is Changing The Debate Over Health Reform

A revolution is occurring in the way medical care is being delivered in the United States. It is happening almost overnight.

People have stopped going to hospital emergency rooms. They have stopped going to doctors’ offices. Most of the nation is self-isolating. Doctors and patients are no exception.

They are communicating by means of phone, email, Skype, Zoom and other devices. Last December, Zoom was the host of 10 million video conferences a day. Last week, the company was hosting 200 million a day. Many of those were patient/doctor communications.

If you are like a great many people, you are probably wondering why it took so long.

Answer: government.

Read the full article on Forbes

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How Direct Primary Care shines a light during pandemic

In our previous piece, we discussed how the lack of price transparency in the American healthcare system has become an addictive painkiller — the “opiate of the masses.” Protection from the pain of prices that are hidden (opaque) dulls our thinking just enough so that we don’t get too worked up.

There’s a different model for the practice of medicine that is gaining increasing support among physicians and patients.

Direct Primary Care (DPC) is a timely subject because physicians using this model are among the best equipped, best prepared, and most effective on the front lines of the fight against the pandemic.

Pennsylvania is the first state to begin educating the general public, business groups, and medical schools about this model, and the first state to receive a grant from its medical society for that purpose. But DPC practices are springing up all over the country, with general practitioners leading the way, although specialists have started to follow.

Read the full article at the Courier Times

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Disney Plus — for Health Care?

Over 10 million people have signed up for Disney Plus since it launched last year. It’s easy to understand why. The service gives subscribers access to hundreds of movies and television shows for just $7 a month — no cable plan required.

Imagine if we applied that model to health care. For a flat monthly fee, subscribers could get everything from flu shots to lab tests “on demand” — no expensive, cumbersome insurance plan required.

This model already exists. It’s called direct primary care — and Americans young and old, rich and poor alike are increasingly turning to it as a means of securing affordable, high-quality health care.

Under direct primary care, a patient pays a doctor a subscription-style fee in exchange for access to an array of services. Just a decade ago, there were only a handful of direct primary care practices scattered across the country. Today, over 1,000 serve around half a million people in 49 states.

Read the full article at The Desert Review

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