Hospital chains across the country are asking to raise prices by as much as 15% to help offset the increase in nurses' salaries. Health insurers and businesses are railing against this proposed increase. HCA Healthcare Inc. and Universal Health Services are two of the hospital chains asking for health plans to pay more—from 7% to 15% more.
Typically hospitals will ask for a 4-6% increase and usually receive about 3%. If hospitals win and get higher prices it will make premiums higher for both employers and their workforce. However, the highest-priced hospitals are already charging more than five times the rates paid by Medicare, and groups such as the Alliance, a group of employers that provide insurance to people in the midwest have rejected the notion they should pay more.
As the pandemic continued hospitals were forced to increase salaries, overtime, and bonuses for nurses. Those in areas hard-hit by Covid also increased costs by paying travel nurses, while losing nurses to retirement and career changes. HCA contends that wage inflation is the highest its been in five years and that the price increases are necessary to stay competitive. Hospitals may reconsider contracts with insurers unwilling to absorb some of the costs.
This article is a summary of an article in the Wall Street Journal, which requires a paid subscription.
Source: Wall Street Journal
Today’s cancer treatments often require biomarker tests to determine the best types of treatment for the patient. As much as 60% of oncology drugs require biomarker testing prior to use. However, insurance often doesn’t cover the cost of this testing.
Lawmakers in Arizona recently passed a law that would require insurers to pay for biomarker testing. While the American Cancer Society, major hospitals, and pharmaceutical companies supported the bill, insurers and the Phoenix Chamber of Commerce did not.
Source: Modern Healthcare
In 2008 a federal law called the Mental Health Parity and Addiction Parity Act was created to require insurance plans to provide comparable access to mental health and substance abuse services. However, some plans are too restrictive in what they cover for mental health services.
For instance, Anthem's pre-pandemic mental health claim denials were at a rate of over 90%. And yet, the need for mental health and substance abuse disorders has grown significantly since 2019. Enforcement of the Mental Health Parity Act has been non-existent therefore health plans are not complying. This hits young people especially hard as the need for inpatient services increases, and yet are denied by health plans. This issue is starting to generate class-action lawsuits and additional regulations. As patients have better access to these services early on, their overall outcomes improve. Source: BenefitNews.com
Tooth decay ranks as the ninth-largest healthcare expense for healthcare payers, right behind smoking. The reason is that filling cavities is the top procedure and is performed much more regularly on the same number of people. In contrast, fewer people will be admitted to the hospital for an illness such as diabetes. However, illnesses such as diabetes make issues like tooth decay even worse, requiring more trips to the dentist for crowns, root canals, etc.
This issue may be helped by reducing the amount of coverage for preventative visits, from 100% to 80% which could provide more coverage for those who need more preventative visits per year. Additionally, methods of treating tooth decay have changed. It’s no longer necessary to drill a cavity when many can be treated with Silver Diamine Fluoride (SDF) which takes two painless visits and costs less than $40. Educating your employees on new treatments such as SDF will help them make better decisions for their families as well as reduce the cost for them.
A recent study of California health plans determined a correlation between higher spending on primary care and fewer hospital visits and emergency care. Greater investment in primary care is linked to better quality care and fewer trips to the hospital or emergency room. Researchers looked at 14 health care products and their primary care spending (adjusted for age, gender, and clinical risk score) and found that those who spent more on primary care saw significant savings overall. Primary care physicians can help patients with preventative care and guide them through health challenges, saving health plans money.
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