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To me the more interesting part of the article, and the one apparently ignored by everyone on this thread up until this point, is that even in the TOP hospitals, apparently some are not so good with across the board quality of treatment. And the pricing system is all over the board. Found at the bottom of the article:
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The price differences among hospitals "can be pretty profound," said Joe Mondy, spokesman for Cigna insurance. "When you are doing a cost comparison with doctors, you should look up the quality of the hospital as well. Hospital 'Y' could be great at pediatrics and not great at surgery."
Insurers operating in the exchanges are apparently hesitant to talk about the trade-off between price and quality. Two of the nation's largest insurers – Wellpoint and Aetna – refused to respond to a dozen calls and emails placed over the course of a week.
The options of finding the "quality" of a hospital are still almost nil. Only medicare/medicaid is posting any information at all about quality of care in hospitals. And the percentage of people on these programs still pales in comparison to the overall number of people getting care.
At least one STATE has the idea that hospitals will not pick and choose or make deals with insurance companies (that sometimes include kickbacks to insurance companies)
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A few, like No. 1-rated Johns Hopkins in Maryland, are mandated under state law to accept all insurance companies.
To me the more interesting part of the article, and the one apparently ignored by everyone on this thread up until this point, is that even in the TOP hospitals, apparently some are not so good with across the board quality of treatment. And the pricing system is all over the board. Found at the bottom of the article:
The options of finding the "quality" of a hospital are still almost nil. Only medicare/medicaid is posting any information at all about quality of care in hospitals. And the percentage of people on these programs still pales in comparison to the overall number of people getting care.
At least one STATE has the idea that hospitals will not pick and choose or make deals with insurance companies (that sometimes include kickbacks to insurance companies)
same source
You can find some ratings for hospitals with US News.
With the increasing number of hospital mergers, acquisitions and alliances that are happening all over the country, I'm wondering how these providers on the exchange with narrow networks will provide suitable and reasonable coverage for consumers within their immediate geographic area. The most expensive hospitals will be off limits; each hospital will have to be reviewed on its own merits. Does low cost equal low quality? Maybe, maybe not. But I am betting the big ones (Mayo, MD Anderson, Cleveland) will be off limits for many who are looking for specialized care.
Doesn't mean it is right. Obamacare "replaced" the ACA. I hate that people call it Obamacare.
The Affordable Care Act standardized insurance policies, requiring them to offer at least the 10 basic coverages and it created some standards that companies have to follow. The Exchanges are a clearing house for people to shop for individual or small business plans. You don't HAVE to get an individual or small business plan from the ACA, it's just supposed to be a place where it is EASIER to shop plans from several different companies..and once they get the kinks worked out, it will be. You can buy the SAME plans directly from the insurance company website. By calling the ACA insurance plans you are just spreading the misinformation, sorry. Once people actually understand that there is no such thing as an "ACA" policy..maybe, just maybe, they will open their minds to what is really out there...
Actually all plans will be ACA plans as that is the new standard for every health plan sold as of 1/1/14.
As you point out the difference is whether the policy will be purchase from the Exchanges or apart from the Exchanges.
BTW. Do you have a link that shows you can take the tax credit for purchasing a non Exchange plan if your income is within the limits? I thought it had to be an Exchange plan. Thanks
You can find some ratings for hospitals with US News.
With the increasing number of hospital mergers, acquisitions and alliances that are happening all over the country, I'm wondering how these providers on the exchange with narrow networks will provide suitable and reasonable coverage for consumers within their immediate geographic area. The most expensive hospitals will be off limits; each hospital will have to be reviewed on its own merits. Does low cost equal low quality? Maybe, maybe not. But I am betting the big ones (Mayo, MD Anderson, Cleveland) will be off limits for many who are looking for specialized care.
U.S. News and World Report is somewhere between useless and less than useless for determining quality care. They place high emphasis on patient satisfaction which tends to be mostly in line with "bedside manner" as opposed to quality health care.
I want to know infection rates within the hospital, re-admission rates within 30 days, percentage of negative outcomes for procedures and surgeries such as appendectomies, gastric by-pass (boy, that one sucks in most hospitals), Cabbage procedures (heart stents), thyroid and gall bladder removal, etc. Every single hospital keeps this data but generally refuse to release this information unless required to by law. Whenever they do, they have to spend money to refine their operations, get rid of dangerous physicians (who might be bringing money into the hospital), and suffer negative public impact until their ratings improve.
My favorite example is in New York City, where 20 years ago a cardiologist was appointed as the state's "health czar" or commissioner or something. He got the state legislature to pass a law requiring all hospitals in the state to release information concerning negative outcomes regarding heart stents. The first year the information was released, of the 60 or so hospitals in New York City, the range of negative outcomes was from 1% to 18%. Two years later it had dropped to 0% to 9%. Hospitals actually did something. If you had that information prior to having stents inserted into your heart arteries, would you be more likely to go to a hospital where there was a one in six chance of a negative outcome?
Quote:
The U.S. News & World Report rankings depend in part on how other doctors feel about a hospital. But this reputation measure is determined by U.S. News asking doctors to write down the hospitals that they think are best for each specialty.
It’s very important for reporters to read the methodology of each scoring system. You have to understand the source of each type of data that makes up a measure, how it’s gathered, processed and presented. That’s the only way to really understand each quality measure.
Again....SLOPPY reporting. Here is the deal, at least with the Mayo system. The Mayo system does NOT participate in ANY HMO---NONE--doesn't matter where you get your policy from..this is NOT ACA related, they just DON'T and haven't for YEARS and YEARS...so, many of the policies under the ACA are HMO's, thus, you can't use that policy at the Mayo clinic. I'll bet the same goes for these other top hospitals. They don't NEED to be in an HMO network because they don't need to take those crap payments from an HMO. So, I guess if you are trying to write a sensationalist news report, yes, top hospitals are "opting out" of "Obamacare"--
If you have a clue what you are talking about--they CAN'T opt out of Obamacare....I'll let you figure that one out....
But they could refuse to participate in any insurance plans and become a "concierge" type of healthcare system, or take only patients who can pay their bills out of pocket.
But they could refuse to participate in any insurance plans and become a "concierge" type of healthcare system, or take only patients who can pay their bills out of pocket.
In some states they do not accept any insurance as payment (they are glad to do your insurance paperwork for reimbushment to you, but you pay the bills directly) because they have their own state insurance plan. They want consumers to purchase their health insurance plan so they don't take others. It would be like a retailer not taking any credit cards because they have their own in-house credit plan. If they bill their products and services up enough that some think they are the kings, consumers will fall for this.
Actually all plans will be ACA plans as that is the new standard for every health plan sold as of 1/1/14.
As you point out the difference is whether the policy will be purchase from the Exchanges or apart from the Exchanges.
BTW. Do you have a link that shows you can take the tax credit for purchasing a non Exchange plan if your income is within the limits? I thought it had to be an Exchange plan. Thanks
In some states they do not accept any insurance as payment (they are glad to do your insurance paperwork for reimbushment to you, but you pay the bills directly) because they have their own state insurance plan. They want consumers to purchase their health insurance plan so they don't take others. It would be like a retailer not taking any credit cards because they have their own in-house credit plan. If they bill their products and services up enough that some think they are the kings, consumers will fall for this.
None of this is entirely accurate. For example - Mayo JAX accepts Medicare patients - but not "Medicare assignment" (the last is kind of "vintage" for most health care providers - used to be common maybe 20 years ago - but is almost extinct today). You are personally responsible for bills you incur there and pay them directly. Mayo will bill Medicare and your Medigap carrier - who then send whatever they owe for your care directly to you. In some cases - you're asked to sign papers acknowledging that you will personally be responsible for X dollars if Medicare/Medigap don't pay. This happens most commonly to us when it comes to lab work and tests where Medicare/Medigap reimbursement isn't a sure thing.
This system has worked out fine for us - because neither we nor our doctors are into a lot of unnecessary/questionable lab work or tests. Also - we get a lot of FF miles/points when we pay our bills through a credit card .
To the best of my knowledge - Mayo isn't in the insurance business. Robyn
U.S. News and World Report is somewhere between useless and less than useless for determining quality care. They place high emphasis on patient satisfaction which tends to be mostly in line with "bedside manner" as opposed to quality health care.
Don't know anything about USNWR but agree with your general point.
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I want to know infection rates within the hospital, re-admission rates within 30 days, percentage of negative outcomes for procedures and surgeries such as appendectomies, gastric by-pass (boy, that one sucks in most hospitals), Cabbage procedures (heart stents), thyroid and gall bladder removal, etc. Every single hospital keeps this data but generally refuse to release this information unless required to by law. Whenever they do, they have to spend money to refine their operations, get rid of dangerous physicians (who might be bringing money into the hospital), and suffer negative public impact until their ratings improve.
The raw data is worthless without adjusting for the types of patients hospitals are treating. Some are dealing primarily with low risk patients - some with high risk patients - and others are in the middle. Your local community hospital may have great stats because it's referring its higher risk patients elsewhere. And then there are cases like my late MIL. Where her local community hospital screwed her up royally - and she wound up in a major metro teaching hospital that probably got all the dings for her bad outcome.
Also - hospital stats can vary a lot depending on the type of patients they're treating in terms of socio-economics. How compliant and/or knowledgeable patients are in terms of dealing with pre- and post-op stuff. All other things being equal - I wouldn't expect an inner city hospital that deals mostly with poorer and more ignorant people to have stats as good as those in hospitals who are treating people with more money and more knowledge (unless they're dealing with higher risk patients to start with - see above).
As is often said - there are lies - da** lies - and statistics.
FWIW - a cabbage (cardiac bypass surgery) isn't the same as stenting. And there are lots of controversies about which is better in various kinds of patients. Robyn
I haven't found a plan I can afford so I suppose the subject is moot to me
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