Debbie Perlman Blog

Using Data Privacy to Empower Health Research The importance of data security and data privacy policies have recently come under scrutiny due to revelations around Google’s Project Nightingale. The initiative with Ascension, the nation’s largest nonprofit health system, granted Google access to medical records of more than 50 million individuals in 21 states and may hinder the trajectory of health discovery by eroding “consumer” trust.  While historically it might have been a safe harbor to stay within the letter of the law, consumer sentiment around health data privacy, control, and opportunity has shifted dramatically in the last year. The biggest challenge affecting the sharing of individual data is the establishment of trust between the individual and the researcher. Mistrust has developed as a result of the unethical and/or unconsented use of data for research purposes – like the cases of HeLa cell line creation, and the Tuskegee and Havasupai studies –...

When a merger or acquisition occurs in healthcare, the conjoining providers often say that patient experience will benefit as a result. But new findings published in the New England Journal of Medicine suggests that may not be the case. In fact, the study found just the opposite: Acquired hospitals actually actually saw a patient experience that was moderately worse, on average. What's more, 30-day mortality and readmission rates stayed largely the same at such facilities. The only real improvement that was found among the majority of acquired entities was in the realm of clinical process, which improved modestly. But the improvement was so incremental that it couldn't be linked to the actual acquisition, and prices for commercially insured patients tended to be higher. WHAT'S THE IMPACT   The research looked at 250 hospitals acquired in deals between 2009 and 2013. In addition to patient satisfaction and 30-day mortality and readmission rates, the...

As we increasingly understand the impact of social factors on people’s health, health insurance providers are seeking – and finding – new ways to have a positive impact on the health of their members from this broader perspective. A lack of access to transportation and stable housing are both tangible barriers to care, making it difficult or impossible for patients to prioritize their health or visit their care providers. If a lift is the problem, perhaps a Lyft is an answer. Transportation challenges prevent 3.6 million people from accessing medical care each year. It is estimated that patients who don’t (or can’t) attend their appointments cost the U.S health care system approximately $150 billion each year. Missed appointments also impact providers, who lose the chance to care for their patients. Rideshare benefits are one way that some health insurance providers are working to help their members overcome a lack of access to reliable transportation. In fact, in O...

Below is a warning issued by the Drug Enforcement Administration (DEA) on counterfeit prescription drugs coming into the States from Mexico that are causing fatalities. Beneficiaries who use pain medication should be especially aware of this warning. Also, we have a new fraud alert on Opioid Fraud and Abuse. Opioids have killed more than 47,000 people to date, and  2.1 million Medicare beneficiaries have an opioid disorder. This alert discusses what opioids are, what opioid fraud and abuse looks like and where to report it. DEA issues warning over counterfeit prescription pills from Mexico The Drug Enforcement Administration is alerting the public of dangerous counterfeit pills killing Americans. Mexican drug cartels are manufacturing mass quantities of counterfeit prescription pills containing fentanyl, a dangerous synthetic opioid that is lethal in minute doses, for distribution throughout North America. Based on a sampling of tablets seized nationwide between January and Mar...

White House chief of staff Mick Mulvaney wants to see if the Medicare chief Seema Verma and the health secretary, Alex M. Azar II, can still work together. The acting White House chief of staff has summoned President Trump’s top two health policy officials to the White House on Thursday to assess whether the president’s health secretary and his Medicare chief can continue to work together, a senior administration official confirmed on Tuesday. White House aides said President Trump is still standing by his embattled administrator of the Centers for Medicare and Medicaid Services, Seema Verma, amid reports that she had requested that taxpayers reimburse her $47,000 for property stolen on a trip, including jewelry priced at more than $40,000.  But her feud with Alex M. Azar II, the health and human services secretary, has reached the president’s desk and the attention of the acting White House chief, Mick Mulvaney. For now, Mr. Trump is not expected to at...

While health care costs take many different shapes, your employees probably associate them most closely with the premiums they pay for their insurance. That said, they may not know everything they should about this piece of the puzzle. Who sets the price? Where does the money go? Are health insurance premiums tax deductible? Here’s a look at some common questions your employees — and you — might have about your premiums. What Are Insurance Premiums? A premium is what you pay to keep an insurance policy active. In exchange for this fee, the insurance company agrees to cover some or all of your medical bills. Monthly premiums are the most common type, but you can also make larger payments less frequently, for instance once a quarter or once a year. The insurance company collects premiums from its customers to cover their future health care bills. Where, exactly, does the money go? The vast majority — roughly 82 cents of each dollar — goes toward medical expenses ...

A study finds evidence for how to reduce some of it, but also a large blind spot on how to remove the rest.  Even a divided America can agree on this goal: a health system that is cheaper but doesn’t sacrifice quality. In other words, just get rid of the waste.  A new study, published Monday in JAMA, finds that roughly 20 percent to 25 percent of American health care spending is wasteful. It’s a startling number but not a new finding. What is surprising is how little we know about how to prevent it.  William Shrank, a physician who is chief medical officer of the health insurer Humana and the lead author of the study, said, “One contribution of our study is that we show that we have good evidence on how to eliminate some kinds of waste, but not all of it.”  Following the best available evidence, as reviewed in the study, would eliminate only one-quarter of the waste — reducing health spending by about 5 percent. Teresa Rogs...

  Medicare, Medicaid, and private payers covered 82 percent of prescription drug spending in 2017.   Total prescription drug spending reached $333 million in 2017, but the way that lump sum was divided among Medicare, Medicaid, and employer-sponsored health plans may reveal differences between the populations each payer covers, according to a May analysis from the Kaiser Family Foundation (KFF). The analysis, which looked at claims data from large, employer-sponsored health plans, Medicare Part D plans, and Medicaid, revealed that some payers cover more of that $333 billion figure than others do, likely because of the complexity and size of the populations they cover. Combined, employer plans, Medicare Part D, and Medicaid covered 82 percent of all prescription drug spending in 2017, while out-of-pocket patient costs covered 14 percent. Broken down by payer, the analysis showed that private insurers ate the biggest piece of the prescription s...

No Democrats crossed party lines. Four Republicans did cross party lines. Members of the U.S. House voted 230-183 Thursday to pass H.R. 986, a bill that could keep the administration of President Donald Trump from implementing new Affordable Care Act (ACA) state waiver program guidelines. The Democrats who participated voted 226-0 to support the bill. The Republicans who participated voted 4-183 against H.R. 986. About 2.1% of House Republicans crossed party lines to vote for the bill. H.R. 986 appears to be the first stand-alone health insurance policy bill that has come up for a recorded vote on the House floor since Democrats took control over the House in January. Republicans control the Senate, with 52 of the 100 Senate seats. In theory, if a bill reaches the Senate floor, the Republicans could lose a vote if three members, or 5.7% of their members, cross party lines to vote with the Democrats. SREW Program The Trump administration recently developed ru...

The cutting edge of the insurance industry involves adjusting premiums and policies based on new forms of surveillance. A smartphone app that measures when you brake and accelerate in your car. The algorithm that analyzes your social media accounts for risky behavior. The program that calculates your life expectancy using your Fitbit.  This isn’t speculative fiction — these are real technologies being deployed by insurance companies right now. Last year, the life insurance company John Hancock began to offer its customers the option to wear a fitness tracker — a wearable device that can collect information about how active you are, how many calories you burn, and how much you sleep. The idea is that your Fitbit or Apple Watch can tell whether or not you’re living the good, healthy life — and if you are, your insurance premium will go down. This is the cutting edge of the insurance industry, adjusting premiums and policies based on new forms of surve...

It's peak season for travel insurance claims, a time of year when vacationers are sending their reimbursement requests for their ill-fated year-end holiday getaways. If you're one of the unlucky travelers who are about to file a claim, be careful to not make one of several common travel insurance mistakes,` any of which can potentially lead to a rejection of your claim. Travel insurance claim denial rates are not publicly reported, but they are said to be somewhere between 2% and 5%. Don't worry, you can easily avoid the most common travel insurance claims mistakes. All you need is a cheat sheet of the most common claim mistakes and a few insider strategies for getting around them. If you've purchased a policy through a third party, there's good news: The company will help you and ensure that you've filed all the paperwork correctly. For example, G1G.com, a travel insurance comparison site, can process a claim either through a customer care...

Opponents of the role of consumers and markets in health care have one go-to argument above all others: that you can’t shop for health care when you’re unconscious. The rising problem of gargantuan, surprise medical bills in surgical wards and emergency rooms shows that they have a point. The good news is that constructive, bipartisan reforms may be on the horizon. A close encounter with surprise billing A few years back, my wife and I had an up-close look at how surprise billing works. We were about to have our first child. I had warned my wife, Sarah, about the problem of surprise billing. She meticulously researched everything to make sure that the hospital she chose—part of the St. David’s HealthCare system in Austin—was part of our insurer’s provider network. She then did the same for her obstetrician and her anesthesiologist. When Sarah went into labor, and we got to the hospital, the receptionist asked me to sign a form, agreeing to allow the on-call pe...