Hospital Sleuths Unearth Surprise: Knee Surgery Bills Are 5 Times Its Cost.
Officials at Gundersen Health System in Wisconsin decided that they needed better numbers for the cost of a knee replacement, The Wall Street Journal reports. They were billing more than $50,000 and, after a study, found that the real cost was closer to $10,550. In other health industry news, Bloomberg profiles consumers who are priced out of health insurance, Maryland gets federal approval for a plan to help spread costs and risks across insurers, and Delaware approves an increase for the insurer that sells on the federal health law's marketplace.
The Wall Street Journal:
What Does Knee Surgery Cost? Few Know, And That’s A Problem
For nearly a decade, Gundersen Health System’s hospital in La Crosse, Wis., boosted the price of knee-replacement surgery an average of 3% a year. By 2016, the average list price was more than $50,000, including the surgeon and anesthesiologist. Yet even as administrators raised the price, they had no real idea what it cost to perform the surgery—the most common for hospitals in the U.S. outside of those related to childbirth. ... Prompted by rumblings from Medicare and private insurers over potential changes to payments, Gundersen decided to nail down the numbers. ... The actual cost? $10,550 at most, including the physicians. The list price was five times that amount. (Evans, 8/21)
Priced Out Of Health Insurance, Americans Rig Their Own Safety Nets
The number of people joining so-called health-care sharing ministries—religion-based cost-sharing plans—rose 74 percent from 2014 to 2016, according to the latest Internal Revenue Service data. An alliance for the groups said that more than 1 million people now participate in such programs. Similarly, primary-care clinics like the one Julie Gunther started in 2014 have grown to almost 900 from just a handful in the early 2000s, according to the Direct Primary Care Coalition, a trade group for the clinics. (Tozzi, 8/22)
The Associated Press:
Maryland Lawmakers Say Health Reinsurance Plan OK’d
Maryland lawmakers say a federal waiver has been approved to hold down consumer costs to Maryland’s individual market for insurance in the state’s health care exchange. Sen. Thomas Middleton and Del. Joseline Pena-Melnyk said Tuesday the federal government has approved Maryland’s plan to create a reinsurance plan. The lawmakers, both Democrats, sponsored legislation for the plan. (Witte, 8/21)
U.S. Approves Waiver Allowing Maryland To Lower Obamacare Premium Costs
State officials plan to announce Wednesday that the Trump administration has approved a federal waiver that is expected to stave off increases in health insurance costs for more than 200,000 Marylanders. ... The plan imposes a one-year state tax on insurance companies and uses that revenue to subsidize the most expensive health insurance claims from policies sold through Maryland’s health exchange. By lowering the risk to insurers selling on the individual market, state leaders hope to lower premiums enough to make them affordable next year. (Dresser, 8/21)
Related KHN coverage: States Leverage Federal Funds To Help Insurers Lower Premiums (Findlay, 8/15)
The Associated Press:
Delaware Officials Approve ACA Rate Request
Delaware regulators have approved a 3 percent rate increase for the lone insurer offering coverage under the Affordable Care Act in Delaware. Highmark Blue Cross Blue Shield of Delaware initially sought an average rate increase of 5.7 percent for individual plan coverage next year. The request was revised to 3.7 percent because the initial filing erroneously contained a risk adjustment factor. (8/22)