The White House issues coronavirus Executive Orders; a recent study takes a look at hospital charges during the pandemic; the rise of the surgical assistant presents another front in the battle against surprise medical bills; and, interoperability has become a priority for payers.
Week in Review
E.O.s: Last weekend, the President signed a series of Executive Orders (E.O.s) after negotiations over the next COVID-19 legislative relief package between House and Senate leaders broke down. Those E.O.s attempt to extend the eviction moratorium, further suspend student loan payments, provide continued unemployment benefits, and enact a payroll tax cut. However, in circumventing Congress, questions remain regarding the constitutionality of those actions. Regardless, congressional leaders still remain open to finding their way to a legislative deal, signaling a willingness to resume negotiations.
Median Hospital Charges: Our learning curve in responding to the coronavirus pandemic has been steep. If nothing else, what we have learned is that we still have a lot more to learn, insofar as what treatments are most effective – from both a medical outcome and cost standpoint. A painful part of that learning process seems to be bearing out in a recent study that took a closer look at hospitalization costs related to patient care for COVID-19. According to researchers, the median charge for patients ranged from more than $34,000 for people between the ages of 23 and 30. For older patients – between 51 and 60 years of age – those costs went up to over $45,000. Those costs went down significantly, though, when that care was delivered in-network – by nearly half, to approximately $24,000 for people in the age 51 to 60 group, and to about $17,000 for people over the age of 70.
Surgical Assistants: Even before the coronavirus put a stranglehold on our economy and our health care system, medical costs were expected to continue their upward trend this year. But, with COVID-19 still upending the normal order of business, predictive analytics and projections about where those costs might go the rest of this year and next are kind of up in the air. One thing that has remained predictable, though, is that surprise medical bills continue to expose critical vulnerabilities throughout our health care system – vulnerabilities that have been exploited to the detriment of that system and patients. While we already knew that surgical procedures were rife with empirical evidence of surprise billing practices (with a fifth of patients receiving surprise medical bills), a new and growing trend has begun to further exacerbate the issue. Specifically, the rise of surgical assistants, who aren’t a part of a hospital’s staff or a surgeon’s practice, has quietly left vulnerable patients on the hook for unexpected costs. These surgical assistants tend to remain out-of-network, either accepting what a health plan will pay them, or billing the patient directly after surgery. Some estimates place the number of these assistants operating outside of networks at 25 percent and growing. Further, this emerging area of business is also believed to be quite lucrative, given that some of the larger surgical assistant companies are backed by private-equity interests.
Interoperability: As our health care model continues to evolve to better meet the changing dynamics of our digitally-transformed (and, transforming) world, stakeholders find themselves having to scramble to keep pace, programmatically and regulatorily. While health care provider organizations have had to implement a lot of these changes in real-time, payers have also had to operationalize new processes to ensure a more seamless remodeling. These efforts have led to increased calls for a greater focus on interoperability. By addressing long-standing obstacles to data-sharing, portability, interfacing, and compliance, patients and the system, writ large, stand to benefit, as enhanced interoperability would help to reduce systemic inefficiencies, while also improving outcomes, safety, and affordability.
The coronavirus crisis has reshaped our health care delivery and reimbursement model in the immediate. But, experts have turned their attention to what our health care system will look like post-pandemic, with digital and virtual health playing a central role in that transformation.
Stay safe and be well.
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