American health care is exceptional

By - Last modified: March 28, 2013 at 8:59 AM

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Heather Stauffer
Heather Stauffer

If there is an eternal verity of health care reporting, it is this: Every time a new study comes out saying health care costs more in America than in the rest of the world, someone will email it to me.

I'm never quite sure what to do with them.

For one thing, it's old news. That is, it has been true so long that it really doesn't fit into any "here's what's breaking" criteria.

For another, it's a deep concept. If you're really going to properly assess the findings, you need to address a lot of issues. Aaron Carroll of the The Incidental Economist took a stab at this a while ago — and it ran to 10 posts and two additional ones responding to comments. I don't have that kind of space or that kind of expertise.

But despite those factors, I agree with the people who email me in that I think how America stacks up against the world in both cost and quality is important. When you read stories about changes in our health care system, it should be in the context of the knowledge that American health care is exceptionally expensive.

That is all.

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Oh, and if you want a one-installment read on a similar subject, you might find this interesting: "Seven Factors Driving Up Your Health Care Costs."

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Last week I wrote about local insurer Highmark Blue Shield's new plan that will give subscribers a financial break for choosing services from an "enhanced" provider — one that offers less-expensive care. The plan will roll out only in Northcentral Pennsylvania, and Highmark says Geisinger Health System will be classed as a standard provider.

Time prevented me from including Geisinger's response in the story, so here it is now.

"Although we prefer not to comment specifically on other providers and their products, we do believe that customers benefit when there are more choices made available," Geisinger spokesman Mike Ferlazzo said in an emailed statement. "Competition breeds better service, more individualized options and viable rates. It's unfortunate that this new plan restricts people from receiving care from Geisinger physicians and the quality they bring to the community."

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Remember the observation status lawsuit that Lancaster General Health, the American Hospital Association and several other organizations filed against the U.S. Department of Health and Human Services? At issue is the fact that if HHS decides after the fact that inpatient status (Part A in Medicare code) wasn't warranted, it doesn't just retroactively reduce the payment to the lower observation status (Part B) level — it pulls it altogether.

Earlier this month HHS moved, issuing a ruling that changes the policy and allows for payment of Part B in the case of denial of Part A. The ruling is a temporary measure, and HHS also issued a proposed rule that would make the change permanent.

Sounds good, right? But there's a catch.

The package also includes this: "We propose to continue applying the timely filing restriction to the billing of all Part B inpatient services, under which claims for Part B services must be filed within 1 year from the date of service."

That stipulation would apply even if a Part A payment were denied more than a year after the date of service, and consequently hospitals aren't mollified. In fact, they say these proposed changes would make their situation worse.

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Last week, the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute released their most recent County Health Rankings.

Leaders from Aligning Forces for Quality–South Central PA said in a news release that they remain encouraged by the progress on key initiatives and the community's dedication to solving trouble areas together.

"Since our start in 2007, we've continued to see great progress around treating costly, chronic conditions, as well as improving the number of preventable hospitalizations," said Chris Amy, project director for AF4Q-SCPA.

AF4Q-SCPA noted the following:

• 90 percent of diabetic Medicare patients received HbA1c screenings in York County, which is higher than the percentage for all of Pennsylvania and equal to the national benchmark. The screenings help assess how well a patient has managed his or her diabetes over a course of time.

• York County had a lower rate of preventable hospital stays among Medicare patients in comparison to the statewide average and its 2012 rankings.

• On quality of care, York County ranked third in the state. This category measured preventable hospital stays, or the hospitalization rate for ambulatory-care sensitive conditions; diabetic Medicare patients that received HbA1c screenings; and female Medicare patients age 67-69 that had at least one mammogram over a two-year period.

AF4Q-SCPA plans to remain focused on addressing problem areas such as obesity, physical inactivity and overall health education. It currently offers the I Can! Challenge, a 12-week program focused on improving the health of residents with chronic diseases through healthy eating, exercise and more. Additionally, its Community Checkup allows residents to compare doctors' offices and hospitals' results relating to blood pressure, blood sugar levels, LDL cholesterol levels and more online.

Heather Stauffer covers Lancaster County, nonprofits and health care. Have a tip or question for her? Email her at heathers@centralpennbusiness.com. You can also follow her on Twitter, @StaufferCPBJ.

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