DAILY TRIFECTA: A United State Of Denial About Healthcare
You can't always get what you need, either
THE SET-UP: The Kaiser Family Foundation (KFF) just released its Health Tracking Poll and while the economy still tops the list of voters’ concerns, healthcare registers specifically with Democrats:
Individual health care issues … loom larger for Democratic voters, as they are more than twice as likely as Republican voters to select abortion, Medicare and Social Security, or health care costs as their most important voting issue (25% v. 11%). One in five independent voters also chose a health care issue as their most important voting issue. In addition, women voters are about twice as likely as men to choose a health care issue as their most important voting issue this fall (25% vs. 12%). Vice President Harris … holds a narrow lead on trust to handle health care costs (48% vs. 39%). Independent voters give Harris an even bigger edge on health costs.
On abortion, they found:
Abortion resonates most with Democratic women voters of reproductive age (under age 50). About one in five (21%) in this group name abortion as their top voting issue.
Democratic women voters of reproductive age overwhelmingly (90%) say the presidential election will have a major impact on abortion access – up 31 percentage points from six months ago. The vast majority (93%) of this group of voters say that abortion should be legal in all or most cases.
Among all voters, Vice President Harris holds a large advantage over former President Trump on who they trust to do a better job on the abortion issue (53% vs. 34%). That’s a bigger lead on the issue than President Biden enjoyed earlier this year on a similar question before he dropped out of the race.
But the economy looms:
Meanwhile, former President Trump holds a large trust advantage among all voters on two major non-health issues: the economy and inflation (52% vs. 37%) and immigration and border security (54% vs. 36%). Independents also give the edge to former President Trump on these issues.
TAKEAWAY: Abortion may blunt Trump’s notable advantages on inflation and immigration, but the larger issue of “healthcare” and its mounting challenges, like the cynically-run Medicare Advantage program, are unlikely to play a significant role in this election. - jp
TITLE: Sepsis, Delayed Chemo, a Canceled Liver Transplant: Study Shows Abortion Bans Cause Substandard Care
https://www.jezebel.com/canceled-liver-transplants-sepsis-forced-birth-study-shows-abortion-bans-are-causing-substandard-care
EXCERPT: In one state where abortion is banned, a patient who was 19 to 20 weeks pregnant was sent home from the hospital, despite doctors determining that she was experiencing painless cervical dilation and protrusion of the amniotic sac through her cervix. The next day, she returned in severe pain and advanced labor. According to one physician familiar with the situation, multiple members of her health care team declined to be involved because of the state’s active abortion ban, fearing prosecution. “Anesthesiology colleagues refused to provide an epidural for pain,” the physician recounted. “They believed that providing an epidural could be considered [a crime] under the new law.”
They continued, “I will never forget this case because I overheard the primary provider say to a nurse that so much as offering a helping hand to a patient getting onto the gurney while in the throes of a miscarriage could be construed as ‘aiding and abetting an abortion.’” The physician called this “a gross violation of common sense and the oath I took when I got into this profession to soothe my patients’ suffering.”
This testimony is one of 86 physician stories that the research organization ANSIRH (Advancing New Standards in Reproductive Health) of the University of California, San Francisco collected between September 2022 and August, from states with abortion bans. The new study, published Monday, details dozens of similarly horrific anecdotes and concludes that, since 2022, abortion bans have led to pregnant people receiving substandard, sometimes life-threatening medical care.
Dr. Daniel Grossman, the lead author of the study, told the Guardian that ANSIRH began collecting this research amid all the alarming stories in the immediate aftermath of Dobbs. “One question that we had was: were the changes that we were seeing initially related to the initial shock of the Dobbs decisions and the laws that then went into effect? Would clinical protocols kind of adjust and healthcare providers would figure out how to provide high-quality care? Would these poor-quality cases disappear?” But through their research, Grossman and his team found that “these cases are continuing to happen.”
In states with abortion bans, doctors are denying or delaying emergency care due to the ambiguity around the bans’ medical exceptions, particularly around what qualifies as “life threatening,” forcing many doctors to wait until patients are on the brink of death to act. Texas and Louisiana, for example, threaten doctors with life in prison and up to 15 years in prison, respectively, if they provide abortion care to a patient who’s condition is later deemed not life-threatening enough. Delayed care can lead to loss of fertility, chronic pelvic pain, or even heart attack and stroke related to uncontrolled hypertension—not to mention long-term impacts on mental health, ANSIRH researchers concluded.
In some cases, the complications stretch beyond reproductive care: Doctors canceled a liver transplant for a patient in a state that banned abortion because they discovered she was pregnant, even though she didn’t want to be. In a similar case, a woman who learned she was pregnant after being diagnosed with breast cancer was told she couldn’t start chemotherapy until she had an abortion—but abortion was banned in her state. At that point, she was six weeks pregnant; it took her seven additional weeks to obtain an abortion in a nearby state.
The study details numerous cases of pregnant patients in the middle of urgent medical emergencies forced to travel across state lines for time-sensitive care; in one such case, a physician wrote, “[The patient’s] condition worsened during the duration of transport time. The patient was separated from family and resources. Astronomic hospital costs. … This delay in care was a ‘near-miss’ and increased morbidity.”
In addition to PPROM [preterm premature rupture of membranes]and other fetal conditions, other patients suffering a miscarriage weren’t immediately able to receive standard medication to stop the bleeding, resulting in life-threatening blood loss and hemorrhaging. Patients with ectopic pregnancies, which are nonviable and occur when a fertilized egg develops outside the uterine wall, had to travel out of state or chance receiving delayed care; some patients with ectopic pregnancies initially feared seeking any health care at all, believing they could be prosecuted.
“This study shows that abortion bans are fundamentally degrading medical care—not just in a single state or for a certain type of patient but for people with a range of health conditions living anywhere these bans are in place,” Dr. Kari White, a study co-author, said in a statement.
TITLE: Increased claims denials, staff shortages worry health system rev cycle heads, survey finds
https://www.fiercehealthcare.com/providers/increased-claims-denials-staff-shortages-worry-health-system-rev-cycle-heads-survey-finds
EXCERPTS: Health system executives in charge of their organization’s revenue cycle are fretting about their dealings with payers, with many noting elevated denial rates across the board and within Medicare Advantage specifically, according to a new analysis.
Also on their minds are revenue cycle staffing shortages, which they say are weighing down their organizations’ ability to secure payments, as well as plans to prioritize investment in revenue cycle automation technology, per survey responses collected by the Healthcare Financial Management Association (HFMA) analyzed by consultancy firm Guidehouse.
“Roughly 40% of respondents reported struggling with elevated fatal denial rates, with more than half dealing with elevated Medicare Advantage denial rates,” Timothy Kinney, Guidehouse partner and finance and revenue cycle advisory leader, said in a release on the data. “Many payers have increased requirements for prior authorizations, leading to more denials and increased cost to collect due to appeal activities.”
Over three quarters of respondents said they are either fully or partially outsourcing revenue cycle to help manage tasks, and most said they are satisfied with their vendor relationship.
Meanwhile, more than three quarters of the executives said they will invest in revenue cycle automation technologies, such as AI or machine learning, within the coming year to help fill the gaps. Only a tenth said they had made any investments in this area to date.
Other analysis of revenue cycle performance data have outlined an uptick in claims denials, and the hospital industry hasn’t been shy about pointing the finger at payers looking to offset their increased utilization expenses. Over 100 provider organizations wrote to the government earlier this year urging a tougher stance on Medicare Advantage plans’ denial practices.
TITLE: New Biden Administration Rules Aim to Hold Insurers Accountable for Mental Health Care Coverage
https://www.propublica.org/article/biden-administration-strengthens-mental-health-care-protections
EXCERPT: Although nearly all Americans have health insurance, millions still can't access mental health care. ProPublica found that insurance companies have interfered with patient care, deployed aggressive audits and set reimbursement rates so low that providers felt they had no choice but to quit insurance networks. Our reporting also documented how consequences can be fatal when patients can’t find therapists or mental health treatment.
Federal regulators have struggled to police insurance companies. Nearly all of the recent reports that the Department of Labor has collected from insurers and health plans have lacked enough detail to determine companies’ compliance with the law, the department reported to Congress last year. Some states have passed laws to close those gaps in information, but we found mental health protections often depend on where one lives.
The new rules require insurers to collect and turn over outcomes data, like denial rates, to measure how often patients access care. The companies will have to disclose details on insurance networks, which may include how regularly patients go out of network for mental health treatment and how reimbursement rates are calculated for mental health providers.
The rules also clarify that patients have the right to access this data and require insurers and health plans to furnish records within 30 days of a request.
Republican U.S. Rep. Virginia Foxx, R-N.C., who chairs the Committee on Education and the Workforce, said the rules are too burdensome. “These rules do nothing to improve mental health care access and instead put paperwork over patients,” she said in an emailed statement.
But former U.S. Rep. Patrick J. Kennedy, who sponsored the 2008 parity bill and co-founded the mental health advocacy nonprofit The Kennedy Forum, said the new rules will protect access for patients. “This is an opportunity for consumers to finally have a seat at the table,” he told ProPublica.
The law applies to 175 million people who have private health insurance. Under the new rules, these protections will also cover people with health insurance through state and local governments, about 120,000 additional Americans.
The finalized regulations came after a yearlong review process, in which three departments — Treasury, Health and Human Services, and Labor — collected thousands of public comments. The departments had initially published proposed rules in August 2023. Some of the provisions will go into effect on Jan. 1, said Lisa Gomez, the assistant secretary of employee benefits security at the Department of Labor.
“People living with mental health conditions and substance use disorders continue to face greater barriers,” she said. “That’s not fair, it’s not right and it’s against the law.”