By George W. Chapman
A survey by NRC Health, which focuses on researching and providing consumer data to the industry, found that 87 percent of consumers felt their provider treated them with courtesy and respect, but only 67 percent felt the same about the office staff. Seventy-seven percent of respondents were generally dissatisfied with waiting times. Yet, while expressing satisfaction with providers on one hand, a staggering 80 percent of the respondents said they would switch providers for convenience alone. In defense of medical office staff, they are typically the ones who have to explain why the doctor is running behind and then may have to explain why the patient’s insurance doesn’t cover something. Once in the exam room, most patients tend to be more demure with their provider and don’t voice their concerns. Rather than leaving the practice altogether, filing a polite suggestion, (versus an angry grievance), will prove more valuable to the practice and you.
ACA Deemed Unconstitutional
A federal judge in Texas has ruled that the Affordable Care Act is unconstitutional by virtue of the individual mandate that requires you to have health insurance or suffer a penalty if you don’t. Because the individual mandate is so essential or “inseverable” to the act, the judge concluded the entire law to be invalid. By striking down the law, components like expanded Medicaid, premium subsidies/tax credits, pre-existing condition protections, value based payments to hospitals and physicians, and cost reductions are also wiped out. There is far more in the ACA than meets the average consumer’s eye. Hospital systems and physicians have invested heavily to comply with the ACA. An appeal may well reach the Supreme Court. The ACA is still law of the land and the exchanges remain open for business because the judge issued a declaratory decision versus an injunction. The major healthcare trade associations, including the American Hospital Association, America’s Health Insurance Plans and the American Medical Association have all expressed their disapproval of the ruling. Neither Congress nor the Trump administration has plans for a viable alternative.
Older Americans Worried About Coverage
According to a poll conducted by the University of Michigan, people between the ages of 50-65 are, understandably, worried about their health coverage as they head toward retirement and Medicare. Twenty-seven percent of respondents fear they won’t be able to afford their employer-provided insurance next year and almost half — 45 percent — fear they won’t be able to afford their insurance after they retire. Thirteen percent said they postponed or delayed a medical procedure because of the related out-of-pocket costs. Twenty percent said they would keep working past 65 to retain employer-sponsored insurance. Researchers found that fears are stoked by the lack of consistent policies from Washington, the constant attacks on the ACA without viable alternatives and threats by Congress to balance the budget by cutting funding for Medicare and Medicaid which most likely means decreased benefits coupled with increased premiums.
Specialty Drug Costs
Insurers say they are disproportionately driving up the cost of care and premiums. According to the California Department of Insurance, specialty drugs accounted for just 3 percent of all prescriptions, but accounted for 50 percent of total drug costs. Major insurers including Aetna, Anthem, Cigna and United spent $606 million on specialty drugs in 2017. That works out to about $81 per member per month or almost $1,000 per member per year. Depending on your plan, that $1,000 is about 16 percent of the total annual premium. On average, specialty prescriptions were $2,361 per script. Brand name scripts averaged $236 and generics averaged just $29 per script. The most frequently prescribed specialty drugs are the HIV drug Truvada, the immunosuppressant drug Humira, the diabetes drug Victoza and the hormonal drug Androgen. Despite the limited audience for these drugs, most of us recognize these drugs from the ubiquitous ads on TV.
About 5.7 million Americans are afflicted with the disease. It is the sixth leading cause of death in the U.S. and there still is no cure. However, there is some heartening news coming out of a study conducted by the University of Kentucky. Our “cognitive good health” has been expanding further beyond 65, which means any signs of dementia are presenting later and later in life. According to the researchers, about 10 percent of those over 65 will actually contract dementia, or its most common form — Alzheimer’s. About 20 percent to 25 percent of seniors will suffer only mild impairment. The researchers are not sure why the onset is occurring later in life. Here are the common symptoms of Alzheimer’s: trouble completing easy tasks; difficulty solving problems; change in mood or personality; withdrawal from family and friends; problems communicating; confusion about people, places, events; trouble understanding images.
George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at firstname.lastname@example.org.