Nearly half of respondents ages 50-64 with mounting medical expenses report taking on credit card debt to pay bills.
Relentless annual increases in health insurance premiums and deductibles are outpacing wage growth for many working older Americans with employer-sponsored health plans, a new Commonwealth Fund study shows.
The study finds that more than half (54%) of low-income adults and nearly one-third of adults with moderate incomes are underinsured, and face higher out-of-pocket costs which nearly half of respondents say led them to skip or delay care.
Among the findings:
Nearly half (47%) of low-income older adults, and more than one-third (35%) of those with moderate income, said it was very or somewhat difficult to afford their premiums.
54% of those with low income and nearly one-third with moderate income were underinsured, meaning that they had high out-of-pocket costs and/or deductibles relative to their income.
Nearly half of those with low income reported skipping or delaying needed care because of cost.
Difficulties paying medical bills and paying off medical debt loads affected 44% of older adults with low income and two of five of those with moderate income.
Nearly two-thirds (63%) of those struggling with medical bills and debt were not confident they have enough money to retire — more than double the rate for older adults without problems paying their medical bills.
Nearly half (46%) of respondents with medical bill problems reported taking on credit card debt to pay off their bills, one-third received a lower credit rating because of their bills, and more than a quarter exhausted their savings to pay their bills.
The data was taken from the Commonwealth Fund’s 2022 Biennial Health Insurance Survey of more than 8,000 adults ages 19 or older and conducted by the research firm SSRS.
The analysis focused on 1,978 respondents ages 50-64 with low and moderate incomes. Low income is defined as less that 200% of the federal poverty level or $27,180 for an individual and $55,500 for a family of four in 2022. Moderate income is between 200% and 400% of poverty, or $54,360 for an individual and $111,000 for a family of four.
The partnership gives Amazon employees and their partners free access to Maven's clinicians.
Women's and family telehealth provider Maven Clinic announced Tuesday that it is partnering with Amazon to bolster the on-line retail giant's healthcare offerings for its full- and part-time employees in 50 countries beyond the U.S. and Canada.
"We're delighted to support Amazonians around the world as they plan and grow their families," Kate Ryder, founder / CEO of New York-based Maven Clinic, says in a media release.
"There are too many barriers to care in healthcare systems that were not built around the needs of women and families, and Amazon is cutting through that complexity by making it exceptionally easy for their employees to access high-quality, personalized care in their own language at any hour of the day or night."
The partnership will give Amazon employees and their partners free access to Maven's board-certified reproductive endocrinologists (fertility doctors), obstetricians, gynecologists, nutritionists, mental health providers, adoption coaches, and other care providers.
Amazon employees can access free local support through a “care advocate” who will help them navigate fertility services, provide referrals, and advise them on local family-building guidelines.
The virtual care is available in 35 languages, using video or message chat with doctors, nurses, coaches, and other experts.
Lian Neeman, global director of benefits at Amazon, says the new offering “takes the guesswork out of the family-building process, which can often be confusing and overwhelming."
"Our benefits are designed to care for all our employees' needs, and that means ensuring they have the resources they need to live their best lives, regardless of their personal circumstances,” Neeman says. “Maven's approach to fertility and family building supports our employees around the world and is tailored to each person."
Countries where Maven is now offered as a free benefit to Amazon employees and their partners:
Asia / Pacific: Australia, India, Indonesia, Japan, South Korea, Malaysia, New Zealand, Philippines, Singapore, Thailand, Vietnam
Latin America: Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru
Middle East and Africa: Bahrain, Egypt, Israel, Jordan, Kenya, Kuwait, Mauritius, Morocco, Nigeria, Saudi Arabia, South Africa, Turkey, United Arab Emirates
However, OIG wants more details on what telecommunications platforms are used.
A federal watchdog is offering mixed reviews in its audit of telehealth for end-stage renal disease (ESRD) during the public health emergency.
The Department of Health and Human Services' Office of the Inspector General found that most of the claims for telehealth ESRD care "generally met certain Medicare requirements."
That finding comes with a caveat.
"Most medical records for sampled claim lines included documentation identifying that the service was provided via telehealth but did not include documentation that would allow us to determine whether the services were provided using 1) audiovisual interactive technology and 2) technology that was non-public-facing," the audit states.
The audit covered a stratified random sampling of $38 million in Medicare Part B payments for 179,952 ESRD-related telehealth services provided between March and December 2020, volume that OIG says represents a 10,000% increase over pre-pandemic 2019.
One stratum included 75 claim lines for telehealth services provided to in-center dialysis patients, and the other included 25 claim lines for telehealth services provided to at-home dialysis patients.
OIG says it conducted the audit to "verify whether providers complied with Medicare requirements, determine what telehealth-related information was documented in the medical records, and further inform policymakers and other stakeholders as they consider permanent changes to telehealth policies."
"Providers documented limited information related to telehealth services in the medical records, but the ESRD-related telehealth service claim lines generally met certain Medicare requirements," the audit states.
OIG made no recommendations in the report but says "it would be beneficial for the medical records to document the type of telecommunications system used to perform the telehealth visit. This information may be beneficial to CMS and OCR when considering future oversight mechanisms or changes regarding remote communication products."
The award recognizes providers for excellence in their supply chain processes.
Patient safety watchdog ECRI this week named the 12 winners of its 2023 Healthcare Supply Chain Excellence Award.
The Healthcare Supply Chain Excellence Award, now in its twelfth year, recognizes members of ECRI's portfolio of supply chain services who "demonstrate exemplary utilization of services across the procurement lifecycle, including budgeting, benchmarking, technology assessment, and strategic development."
ECRI evaluated candidates' 2022 spend management and market analytics for capital medical devices, supplies, physician preference items, service contracts, and reagents.
"We're proud to award twelve healthcare systems with our prestigious award this year. These top-performing organizations have successfully navigated ongoing disruptions in the global supply chain market using ECRI's data-driven, evidence-based services," says Marcus Schabacker, MD, PhD, president / CEO, ECRI. "We are honored to partner with them in delivering high-quality, cost-effective patient care."
The winners, listed in alphabetical order, are:
Adventist Health System/West | Roseville, CA
Broward Health | Fort Lauderdale, FL
Children's Health | Irving, TX
Hawai'i Pacific Health | Honolulu, HI
Jackson Health System | Miami, FL
MaineHealth | Portland, ME
MultiCare Health System | Tacoma, WA
Northeast Georgia Health System | Gainesville, GA
Northwell Health | New Hyde Park, NY
RWJBarnabas Health | West Orange, NJ
University of Miami Health System | Miami, FL
Wellstar Health System | Marietta, GA
More than 3,000 U.S. hospitals and health systems are members of ECRI's strategic sourcing and supply chain programs. ECRI has analyzed nearly $60 billion in supply and capital spend over the past year.
Tim Browne, vice president, supply chain solutions, ECRI, noted that this year's winners "have faced post-COVID supply chain challenges, but their adherence to using data analytics, best practices, and leadership engagement has enabled them to overcome obstacles and make strategic, evidence-based decisions without sacrificing quality or patient care."
Starting Nov. 27, all drugs must be able to be tracked electronically on the unit level.
A bipartisan group of 28 members of Congress is urging the US Food and Drug Administration to address drugmakers' concerns that they may not fully comply with the Drug Supply Chain Security Act when it takes effect in late November.
Under DSCA, starting on Nov. 27, all drugs must be able to be tracked electronically on the unit level. Drugs that do not comply cannot be distributed or dispensed to patients.
In a letter this week to FDA Commissioner Robert M. Califf, MD, the lawmakers expressed support for DSCSA and write that it "will ultimately improve the ability to trace pharmaceutical products and remove potentially dangerous products from the pharmaceutical supply chain."
"However, it is our understanding that some supply chain participants are facing difficulties meeting DSCSA's full implementation requirements," the letter states. "Based on what we are hearing from healthcare supply chain stakeholders about readiness for the November 27th deadline, absent government intervention, there will likely be disruptions that could lead to patient access problems and further drug shortages."
They're urging the FDA to ensure that DSCSA requirements do not disrupt the drug supply chain.
The members issued a joint press statement, which includes support from the nation's major supply chain and pharmacy associations.
The letter is endorsed by the Healthcare Distribution Alliance, American Pharmacists Association, National Association of Boards of Pharmacy, National Community Pharmacists Association, and National Association of Chain Drug Stores.
Kristen Freitas, director of Federal Government Affairs for the Healthcare Distribution Alliance (HDA), praised lawmakers for pressing "the FDA to ensure that the final implementation of DSCSA is done efficiently and effectively to minimize the very real, yet avoidable, risk to patient care if the supply chain is disrupted."
More than 83% of patients in the study completed multiple remote urine screenings within the first 30 days of entering treatment.
Telehealth urine screenings are an effective, accurate and easily accessible method for monitoring patients battling opioid use disorder, according to a new study published Friday in JAMA Health Forum.
The study, conducted by opioid addiction care provider Ophelia and led by company CMO Robin Williams, MD, found that more than 83% of the 3,395 patients living in 14 states who were involved in the two-year study completed multiple urine drug screenings (UDS) within the first 30 days of entering treatment. That number increased to 97.6% after 90 days and 99.7% after six months.
The patients self-administered a UDS off-screen during telehealth visits and clinicians visually inspected results and discussed them with the patient in real-time over video.
The validity of urine specimens was assessed by confirming that temperature, creatinine, nitrite, pH, oxidants, glutaraldehyde, and specific gravity were all within normal ranges, the study says.
Ophelia CEO / Founder Zack Gray says "the findings clearly show that remotely administered UDS is feasible and associated with low rates of unexpected results."
"This is consistent with the premise that long-standing and stringent requirements such as requiring in-person visits and frequent drug testing in order to receive buprenorphine can be relaxed without jeopardizing the quality or safety of care for most patients," he says.
Drug testing is common in opioid use disorder care mainly because of payer reimbursement mandates. However, patients frequently complain that the routine drug tests are invasive and demeaning.
"At Ophelia, we use drug testing to advance our patients' goals, not to drive revenue from payers," Gray says. "We've never disenrolled someone from our treatment program due to a positive drug test. Our clinical protocols encourage the use of UDS to help assess progress and guide the care team in treatment plan adjustments, foster open communication between patient and clinician, and monitor for buprenorphine diversion."
Gray says Ophelia plans additional studies to determine the efficacy and safety of telehealth-based opioid treatments.
The settlement comes after a federal court determined that Surescripts holds a 95% 'supershare' for e-prescribing services.
The Federal Trade Commission announced Thursday that it has reached a settlement with Surescripts that bans the health information technology provider from illegal monopolistic business practices and demanding non-compete agreements with employees.
The FTC sued Surescripts in 2019, alleging that the Arlington, VA-based company used "illegal vertical and horizontal restraints" to maintain e-prescribing monopolies over routing and eligibility markets.
The settlement, which was approved by the Commission on a 3-0 vote, comes after a U.S. District Court ruling in Washington, D.C. that determined that Surescripts holds a 95% "supershare" of monopoly power in e-prescribing services.
Surescripts CEO Frank Harvey welcomed the settlement, which included no fines, but claims that the FTC's case "relied on significant factual errors about Surescripts' business and mischaracterizations about the economic realities of the e-prescribing market."
FTC Bureau of Competition Director Holly Vedova says in a media release that "the proposed order is a victory in creating a fair and competitive playing field in the e-prescription drug market."
"In large part because of Surescripts' conduct, virtually everyone today who has a prescription filled electronically does so via the Surescripts networks."
"The proposed order would eliminate the anticompetitive restraints Surescripts has imposed on its customers since 2010 and would create conditions that allow competition to flourish for the benefit of anyone who gets a prescription filled at a pharmacy," Vedova says.
The FTC alleged in its complaint that Surescripts intentionally kept e-prescription routing and eligibility customers on both sides of each market from "multihoming" competing platforms, and using strongarmed "anticompetitive exclusivity agreements, threats, and other exclusionary tactics to achieve its goal."
A federal court this past March granted the FTC's motion for partial summary judgment and referred the suit to mediation.
"Surescripts is proud to have pioneered electronic prescribing that has brought enormous value to patients and care providers alike. For more than two decades, Surescripts has delivered innovations that increase patient safety, lower costs and ensure quality care," Harvey says.
"We're pleased that this agreement brings an end to the FTC's litigation, formalizing changes to our business practices that we started several years ago, including the elimination of loyalty provisions in contracts. We are committed to continuous innovation and remain focused on serving our customers who make up the Surescripts Network Alliance and ultimately the patients they serve."
"The FTC's case relied on significant factual errors about Surescripts' business and mischaracterizations about the economic realities of the e-prescribing market," Harvey says. "Since 2009, Surescripts has reduced average E-Prescribing transaction fees by 77%, and since 2016, Surescripts has improved the accuracy of electronic prescriptions more than 200%.
"As a trusted health information network, Surescripts helps doctors, pharmacists and other healthcare providers communicate with each other as a team, sharing information to increase patient safety, lower costs and ensure quality care. We look forward to continuing to simplify health intelligence sharing and bring even greater innovation and experience to the healthcare industry."
Settlement Details
The FTC's proposed order has a 20-year term that would ban Surescripts from exclusionary conduct and expands the prohibitions beyond routing and eligibility to include Surescripts' medication history services and the company's on-demand formulary services.
The proposed order would prohibit Surescripts from:
Entering, maintaining, or enforcing contracts that impose a majority share requirement on its routing and eligibility customers, including through all-unit discounting.
Implementing other problematic provisions it has used in the past to prevent or limit the ability of customers to do business with Surescripts' competitors.
Stopping customers from promoting competitors' services; preventing and limiting customers' ability to communicate with competitors; and requiring that customers provide Surescripts a right of first refusal.
Entering into, maintaining, or enforcing agreements that prevent rivals from competing with Surescripts in routing and eligibility.
Discriminating against or threatening customers who refuse to agree to a majority share requirement.
Enforcing non-compete agreements that would prevent employees from working for a competing e-prescriber.
The three hospitals are the 120-bed Bravera Health Brooksville in Brooksville, 128-bed Bravera Health Seven Rivers in Crystal River, and 124-bed Bravera Health Spring Hill.
The deal is expected to close this year, pending regulatory approvals and closing conditions.
The divestiture of the hospitals was previously announced as a potential deal by CHS in its Q1 earnings call, when it also reported a $51 million net loss on revenue of $3.1 billion.
The three not-for-profit hospitals are in Citrus and Hernando counties, neighboring Tampa / Hillsborough County, and combined provided care for more than 300,00 patients last year.
John Couris, president and CEO of not-for-profit, private Florida Health Sciences Center, DBA Tampa General, says that "with this acquisition, TGH is not only expanding its geographic footprint to meet the needs of our state’s growing population, but TGH is also increasing access for Floridians to the world-class rare and complex specialized care we offer."
The sale leaves Franklin, TN-based CHS with seven hospitals in Florida. The for-profit hospital chain has shed more than 100 community hospitals since 2015 after a string of financial losses and now owns or leases 77 hospitals in 15 states, with more than 1,000 care venues.
"Tampa General Hospital is a well-respected healthcare system with a demonstrated commitment to delivering quality care to the patients they serve across the communities they serve," Bravera Health Seven Rivers CEO Linda Stockton says. "Our tradition of delivering medical services close to home will continue thanks to the dedication and skill of our medical staff and employees."
HIDA and scores business organizations are raising concerns about the disruptions that would occur in a walk-out.
The Aug. 1 strike threatened by 340,000 United Parcel Services workers would quickly and adversely affect medical supply chains, the Health Industry Distributors Association is warning.
HIDA was one of scores business organizations from across the nation that signed a letter sent Friday to President Joe Biden, raising concerns about the disruptions to the economy that would occur if the rank-and-file workers leave the job.
"UPS is a vital lifeline for America, moving between 5% and 6% of U.S. GDP, or $3.8 billion in goods, per day," the letter states. "America also relies on critical medical deliveries enabled by the predictability and reliability of the UPS network, such as vaccines, medical devices, and life-saving medication."
"A strike would lead to months-long backlogs in the supply chain and the interruption of deliveries of critical medical supplies and other essential items."
The letter cites a study estimating that a 15-day UPS strike would harm the health and safety of U.S. consumers by $55.5 billion; even a 5-day strike at UPS, by this account, would harm the country by $15.8 billion – or $3.7 billion per day.
HIDA President / CEO Matthew J. Rowan says in a media release that "the potential impact on healthcare is very real,"
"The supply chain relies on small parcel delivery to get supplies to patients in their homes, doctors' offices, first responders, and clinics," he says. "We strongly urge the parties and the Biden administration to avoid a work stoppage at all costs."
UPS and the International Brotherhood of Teamsters severed negotiations on July 5, at loggerheads over issues that include wage hikes for experienced part-time workers who make up about half of UPS' unionized workforce.
The two sides said this week that they would resume talks on July 25 after UPS announced that it was "prepared to increase our industry-leading pay and benefits, but need to work quickly to finalize a fair deal that provides certainty for our customers, our employees and businesses across the country."
Bloomberg cites estimates that a strike would cost UPS about $170 million a day. Reuters reports that 28 U.S. senators and 178 U.S. representatives have said they will not to intervene if a strike takes place.
Letters to providers highlight concerns stemming from use of technologies that may share a user's sensitive health data.
Federal regulators are warning hospitals and telehealth providers about the risks that patients' health data could be "impermissibly disclosed" by online tracking technology wired into providers' websites and mobile apps.
The Federal Trade Commission and the Department of Health and Human Services' Office for Civil Rights cited potential violations of the Health Insurance Portability and Accountability Act (HIPAA) in a joint letter sent this week to 130 hospital systems and telehealth providers.
The watchdogs raised concerns about the privacy risks linked to online tracking platforms such as the Meta/Facebook pixel and Google Analytics that gather user personal data, often without their knowledge and in ways that are hard to avoid when users visit a website or mobile app.
"If you are a covered entity or business associate ("regulated entities") under HIPAA, you must comply with the HIPAA Privacy, Security, and Breach Notification Rules (HIPAA Rules), with regard to protected health information (PHI) that is transmitted or maintained in electronic or any other form or medium," the letter says.
"Even if you are not covered by HIPAA, you still have an obligation to protect against impermissible disclosures of personal health information under the FTC Act and the FTC Health Breach Notification Rule," the letter continues. "This is true even if you relied upon a third party to develop your website or mobile app and even if you do not use the information obtained through use of a tracking technology for any marketing purposes."
HHS highlighted these concerns in a bulletin late last year that reminded HIPAA entities of their responsibilities to protect health data from unauthorized disclosures.
The commission has backed up its warnings to third-party players with recent multimillion-dollar fines and legal actions against BetterHelp, GoodRx and Premom.
Samuel Levine, director of the FTC's Bureau of Consumer Protection, says "the FTC is again serving notice that companies need to exercise extreme caution when using online tracking technologies and that we will continue doing everything in our powers to protect consumers' health information from potential misuse and exploitation."
