“Alexa, Open Symptom Checker” Gets You This Health Startup’s App | Piotr Orzechowski Infermedica

By JESSICA DaMASSA, WTF HEALTH

One of Europe’s top health tech startups, Infermedica out of Poland just closed a $3.65M funding round for its suite of tools that help patients figure out the best place to go to get care. It’s a patient-routing / symptom-checker with “AI under the hood” that is delivered via an app, chatbot, and voice application for Alexa. (In fact, they “own” the symptom checker that opens when you ask Alexa to “open symptom checker.”) Piotr Orzechowski talks about the full range of ways Infermedica is engaging patients and how they are scaling up their provider facing products as a result of this influx of funding.\

Filmed at HIMSS/Health 2.0 Europe in Helsinki, Finland in June 2019.

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Doctors Will Vote With Their Patients

By MIKE MAGEE, MD

As Robert Muller’s testimony before Congress made clear, we
owe President Trump a debt of gratitude on two counts. First, his unlawful and
predatory actions have clearly exposed the fault lines in our still young
Democracy. As the Founders well realized, the road would be rocky on our way to
“a more perfect union”, and checks and balances would, sooner or later, be
counter-checked and thrown out of balance.

On the second count, Trump has most effectively revealed
weaknesses that are neither structural nor easily repaired with the wave of the
wand. Those weaknesses are cultural and deeply embedded in a portion of our
citizenry. The weakness he has so easily exposed is within us. It is reflected
in our stubborn embrace of prejudice, our tolerance of family separations at
the border, our penchant for violence and romanticism of firearms, our
suspicion of “good government”, and –unlike any other developed nation – our
historic desire to withhold access to health services to our fellow Americans.

In the dust-up that followed the New York Times publication
of Ross Douthat’s May 16, 2017 article, “The 25th
Amendment Solution for Removing Trump”, Dahlia Lithwick wrote in SLATE, “Donald Trump isn’t the disease that plagues
modern America, he’s the symptom. Let’s stop calling it a disability and call
it what it is: What we are now.”

Recently a long-time health advocate from California told me
she did not believe that the majority of doctors would support a universal
health care system in some form due to their conservative bend. I disagreed.

It is true that, to become a physician involves significant
investment of time and effort, and deferring a decade worth of earnings to
pursue a training program that, at times, resembles war-zone conditions can
create an ultra-focus on future earnings. But it is also true that these
individuals, increasingly salaried and employed within organizations struggling
to improve their collective performance, deliver (most of the time) three
critical virtues in our society.

First is the patient-physician relationship marked by
compassion, understanding and partnership, committed to individualized care
without prejudice.

Second, in the normal course of care, though inclusion,
involvement and planning, doctors reinforce important bonds between
individuals, families and society.

Finally, doctors allay fear and worry, which, in their
absence would accumulate and eventually undermine safety and security in our
society.

In a short two decades of this new century, technology,
global markets, and climate change have left the American experiment in all
manner of disarray. Justice, tranquility, defense, welfare, and liberty itself
have been undermined. Our prime-age workers in the bottom 60% have seen no real
income growth in four decades. During this span, the income of the top 10% has
doubled, and the income for the top 1% has tripled.

Our nation has not figured out how to get along economically
with our market equal, China. New York Times columnist Thomas Friedman says we have no “rules, norms, or
laws” to protect trust and truth in a world of social networks, cybertools, and
cyberbullies. We have moved from a “work, learn, retire” model to a “learn,
work, learn, work, learn, work” survival mode.

We need to listen to our own Preamble
and our own history. It states:  “We the people of the United States, in
order to form a more perfect union, establish justice, insure domestic
tranquility, provide for the common defense, promote the general welfare, and
secure the blessings of liberty to ourselves and our posterity, do ordain and
establish this Constitution for the United States of America.”

It suggests that, in establishing our Constitution, we
continually must determine how best to promote and maintain a healthy nation
filled with healthy citizens – mind, body and soul.

The 2020 election is an opportunity to reclaim
self-governance, to plan, to work, to build together. Universal health coverage
is not the only platform from which to launch a recommitment to our common
future, but I would argue, it is a logical starting point to pursue “a more
perfect union” during these turbulent times.

Excluding moments of self-doubt and discouragement, I
believe most doctors know they are appreciated, and even loved by most of their
patients. They also know that the current system is highly variable,
inefficient, and wasteful.  They have
spent enough time idled on insurance pre-approval lines, seen enough Pharma ads
imploring their patients to “Ask your doctor”, and witnessed enough lives
shortened by human error to know we can do better than this.

When push comes to shove, doctors will vote with their patients.

Mike Magee is a Medical Historian and author of “Code Blue: Inside the Medical Industrial Complex” (Grove Atlantic/June, 2019).

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Security Crisis of Cardiac Pacemakers Paves the Way for IoT Security Evolution in Cardiology

By INGA SHUGALO

While the healthcare IoT demand forecasts are more than generous, anticipating the market to hit $158.07B by 2022, there is still a certain delay in IoT adoption across the industry. Connected medical devices, especially those that are directly involved in patient care, are adopted cautiously due to potential security vulnerabilities and risks to patient safety.

One of the reasons behind the hesitant adoption of healthcare IoT in
cardiology is preexisting concerns about the security of implantable medical
devices, such as pacemakers.

The recent pacemaker crisis revealed the vulnerabilities in pacemaker
software across several major vendors. If exploited, software vulnerabilities would
allow hackers to take over the device and control it fully. The crisis led to device
recalls, certain features disabled, and even remote updates cut off completely to
avoid unacceptable health risks.

This series of events led to a cautious attitude toward the emerging cardiology IoT. Since we can’t be sure that all exploits and vulnerabilities are eliminated in less advanced systems, are we really ready to take a step forward to more elaborate healthcare software solutions at this point?

The fact of the matter
is, cardiology is already taking these steps. The new generation of pacemakers has
embedded sensors to monitor a patient’s blood temperature, sinus node rate,
breathing, and other vitals. This data is used to flexibly alter the heart
rate, slowing or speeding it depending on a patient’s current activity level. They
also inherited remote control from their predecessors. Practically, next-gen
pacemakers are IoT devices.

Accordingly, the
industry can either stigmatize the security concerns or choose to adopt a new perspective,
seeing the pacemaker crisis as an opportunity to create a solid platform for
unbiased adoption of upcoming connected cardiac devices.

The Pacemaker Crisis: Fast Facts

In 2017, FDA recalled approximately 465K pacemakers made by Abbott due to their potential security issues. In particular, the devices were identified as vulnerable to hacking, which could increase their activity or reduce battery life. Tampering with such insecure pacemakers would quicken the battery drainage and pose an indirect risk for the patients’ health and safety.

That same year, security researchers Billy Rios of Whitescope and Jonathan Butts of QED Secure Solutions uncovered vulnerabilities in one of Medtronic’s cardiac device programmers. They found vulnerabilities which would allow unauthorized users to get access to the programmer’s settings and tweak the functionality, taking control over the pacemakers. If any hackers were to exploit these vulnerabilities, they could disrupt the patient’s heart rhythms, hurting or even killing people.

The researchers
notified Medtronic about their findings, warning them about potential patient
safety threats. However, the vendor didn’t address the issue fully until 2018,
when Billy Rios and Jonathan Butts demonstrated their discovery during the
Black Hat security conference speech. The demonstration resonated with the
audience and also drew the attention of DHS, FDA, and NCCIC. The regulators
started collaborating with Medtronic to assist them in mitigating data security
and patient safety threats in their devices.

However, security assurance seems to be still far from completion, as the attention of manufacturers and government agencies spreads to other cardiac devices. The 2019 FDA safety communication lists a wide range of Medtronic’s products that are still considered vulnerable.

The list features implantable
cardioverter defibrillators (ICDs), cardiac resynchronization therapy
defibrillators (CRT-Ds), device programmers, and monitors. Due to the lack of
encryption, authentication, and authorization in the Conexus wireless telemetry
protocol used in these devices, unauthorized users may be able to access and
control them. The FDA also states that Medtronic is on the way to implementing additional
security updates to ensure both PHI and patient health safety.

Turning Gaps into Gains: The Action Plan

Following the
pacemaker crisis, cardiac IoT security assurance activities must be
prioritized.

First, the regulators,
providers and manufacturers must reach a consensus. All parties should make an
effort to come up with standardized practices for securing IoT development and
maintenance. In particular, they should define the obligatory protocols for
remote configuration, data transfer, and updates to ensure the following
security measures:

Authentication

Identity validation
and role-based access allow securing cardiac devices against unauthorized
access. Only verified users, messages and services will be able to interact
with protected device.

Integrity

To ensure integrity,
security testing should be held throughout the stages of development, upon
implementation, and after each major update. Moreover, the manufacturers can
issue specific certificates to validate data transactions, making sure they can’t
be intercepted or altered.

Encryption

Encrypted data transfer
is also an essential measure for assuring the safety of cardiac devices. All
inbound and outbound data flows, such as monitored vitals and patients’ current
health status information, will be transmitted privately, making it much more
difficult for hackers to access and modify data.

While the older cardiac
devices may be too low-power, low-memory or low-capability to support all the basic
security measures, vendors and regulators can work together to get rid of the
vulnerabilities and exploits with certain workarounds.

For example, Medtronic
significantly limited the range for the remote control and configuration of
their pacemakers, programmers, and monitors. So while the vulnerabilities may
still be in place, unauthorized users can only access them while physically
near the active devices.

Conclusion

Fortunately, there
have been no malicious activities or attacks in which hackers tampered with
pacemakers, programmers, or other cardiac devices so far. However, the
possibility itself is critical enough to prioritize the security assurance of
connected cardiology devices.

The security crisis associated with cardiac devices might have hindered their adoption, yet it also pointed to a critical gap in policy-making and technology testing on the whole. While some measures are underway, fully bridging this gap will require a more coordinated effort from both regulators and manufacturers.

Inga Shugalo is a Healthcare Industry Analyst at Itransition, a custom software development company headquartered in Denver, Colorado. She focuses on Healthcare IT, highlighting the industry challenges and technology solutions that tackle them.

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Health in 2 Point 00 Episode 89 | IPOs, Oscar and Fitbit

Today on Health in 2 Point 00, it’s IPO day! On Episode 89, Jess asks me about the recent IPOs, Oscar Health getting into Medicare Advantage, and Fitbit accuracy in people of color. Jess asks me to weigh in on whether Livongo’s IPO was better than we expected and it’s safe to say that they are growing fast. On the flip side, the “silent” IPO that no one seems to be talking about is Health Catalyst, which is also doing quite well with a $1.6 billion valuation although they are not growing as fast as Livongo is. Next, Oscar Health decided to enter into Medicare Advantage, which is not surprising because that’s where the real money is in the insurance side. Finally, Fitbits and other wearables may not be tracking heart rates accurately in people of color, so what does this mean for the wearables industry—and their potential use for medical purposes? —Matthew Holt

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Health Reform Job One: Stop the Gouging! | Part 3

By BOB HERTZ

We Need Legal Assaults On The Greediest Providers!

When a patient is hospitalized, or diagnosed with a deadly disease, they often have no choice about the cost of their treatment.

They are legally helpless, and vulnerable to price gouging.

We need more legal protection of patients. In some cases we need price controls.

In the final part of this series, I discuss how we need to empower patients by allowing them to challenge their medical bills in courts.

Assault Phase Four – Binding
Arbitration of Medical Bills

 We must allow patients to challenge their medical bills in expanded
‘Health courts.’

Patients should be able to contest any bill over $250,  especially if they have not given ‘informed
financial consent’ to the provider.

Such ‘consent’ would require that if a procedure can be
scheduled in advance, it can also be quoted in advance. If the patient requests
an estimate, they must be notified in writing at least seven days in advance.
This would allow the patient to request a different provider, or to investigate
other alternatives. If an estimate is requested but never produced, the patient
has no liability. (That will shake up the providers rather quickly.)

 The  Health Courts will be staffed by
ex-physicians and active judges. All court costs will be paid by the
government, and the patient will not always need an attorney. There will be a
free ‘ombudsman’ service (as Medicare already has) to provide guidance to
patients.

A padded bill of $1500 may be financially significant to a patient, but too small for an attorney to take on the patient’s case, and perhaps too insignificant for the state’s attorney general to pursue. 

The courts can rely on the following principles:

  • If a patient is insured and their care is
    in-network, no balance billing is allowed without informed consent.
  • If the care is out-of-network, they can only be
    charged a ‘reasonable and fair fee.’ Generally this will be equal to the
    provider’s average reimbursement from insurance companies.
  • If an insurance claim is denied, the patient is
    not necessarily liable. Under Medicare, if an insurance claim is denied and the
    patient could not have been expected to know this in advance, then the health
    care provider suffers the economic loss.

The case law is ready and waiting to
apply.  Arbitrators can cite numerous
rulings that have required providers to accept ‘reasonable charges.’

Right now, small claims courts are used
mainly by providers to collect their own billiings. We would open them to
patients, to challenge their bills.

Here is a sample of 
potential Health Court cases :

  • Extra billing for ‘facility fees’ (i.e higher
    charges for outpatient care done in hospitals)
  • Outlandish charges for simple diagnostic tests
    (i.e. $5000 for an echocardiogram)  
  • $50,000 in charges for an air ambulance trip
  • $35,000 for an artificial knee that costs about
    $700 to produce 
  • $20,000 for a pacemaker that costs about $6,000
    in the US, and $1,000 in India
  • $4,000 for a drug infusion that costs $500 in
    Britain, France, or Germany
  • $12,000 for an “operating room” to conduct a 20
    minute surgery
  • $15,000 for a ‘Trauma Activation Team” to help
    with an ER admission
  • $20,000 for an anti-venom inoculation that costs
    the hospital about $200.
  • Extra charges because a doctor inadvertently
    referred you to a non-network provider
  • Extra charges because the provider used a higher
    “severity” code when coding the claim.

(You can still go to Health Court even if you are insured. For example, if
your high-deductible insurer approved $4000 for a simple echocardiogram and
left you with a bill for $2000, you still have a grievance. For that matter,
insurance companies can even use Health Courts when they are being gouged by
providers.)

  All bill collections
will be suspended while a patient is waiting for a hearing in health courts. We
do not care if thousands of medical bills wind up sidetracked in health courts.
Hospitals will claim that their insurance reimbursements are ‘confidential’,
but this must be overturned. Sometimes it takes a few bad results to wake up a
complacent and powerful industry.

This is not really “a terrible expansion of state
power.”  Remember that doctors and
hospitals are fiduciaries, because patients are medically at their mercy.
Charging patients more if they are 
unprotected  flagrantly exploits
the patient’s  vulnerability.

 Price gouging will
not go away overnight — there are always loopholes, and some providers will
always persist in financial exploitation. They figure they have nothing to
lose.

The goal of health courts is that greedy providers should
lose money, due to fines and attorney costs.

 (In a competitive market, they would also lose
reputation for gross overcharges. But people may only use a hospital or
specialist once in their lives, so predatory billing goes almost wholly
unpunished.)

It is ridiculous that 
some hospital stays require virtually a fresh negotiation every time —
starting with the hospital bill, and then the patient going to the media and
hiring a lawyer and/or going to Health Courts. 
All states would benefit from a binding fee schedule for all hospitals,
versus the current free-for-all.  One
virtue of a single-payer system would be that hospitals would get one check a
month from the government, and not need to recover all their expenses from
patients.

In fact, in the words of Adam Gaffney:

“Hospitals shouldn’t have prices at all, any more than public schools, parks, or libraries. For one thing, the very meaning of per-user “prices” in social institutions is murky. We could attempt to attribute the costs of maintaining Central Park to distinct visitors, I suppose, based on how long they spent lounging on the Great Lawn, whether they circle the reservoir once or twice, whether or not they ask for directions from park staff, and so forth. But it would be a very crude, and perhaps intrinsically fraudulent, effort. Regardless, it would necessitate a major diversion of park resources into a bookkeeping apparatus with zero social value.”

Final Note

Medicare patients have been protected against balance
billing, surprise billing, claims-denial liability and ER overcharges for over
50 years. This level of decency should
not be restricted by age.

The reforms described here will require relatively little in
new taxes — at most about $40 billion for ER subsidies and ambulance funding.
This is less than one percent of payroll, if funded by an increase in Medicare
taxes.

What these reforms 
require is public officials who not beholden to the medical industry. We
must build on what Elizabeth Rosenthal called “Nine Rights Every Patient Should
Demand” in the New York Times (4-27-2018)

All economic systems ultimately run on fear and greed.
Some  health care providers now need a
good dose of fear to bring them under control. ‘Charging what the market will
bear’ is no longer acceptable.

Bob Hertz is a retired insurance broker. He learned about health care from Uwe Reinhardt, Joseph White, Dr. Robert Evans, and George Halvorson a fellow Minnesotan.

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Health Reform Job One: Stop the Gouging! | Part 2

By BOB HERTZ

We Need Legal Assaults On The Greediest Providers!

When a patient is hospitalized, or diagnosed with a deadly disease, they often have no choice about the cost of their treatment.

They are legally helpless, and vulnerable to price gouging.

We need more legal protection of patients. In some cases we need price controls.

Next in this three-part series, I discuss how we could challenge Big Pharma by lessening regulation of generic drugs, having the government take over production and establishing price review boards.

Assault Phase Three – Challenge Big Pharma

Step OneLess Regulation of Generic Drugs

If an off-patent drug has been approved by other first-world nations, this would
constitute automatic approval by the FDA.

The price gouging around Epipen would have ended quickly,
if new versions of genetic drugs did not require an FDA approval process. We
should let reputable drug companies produce whatever generic drugs they want.

If an office products company like Staples tried to charge
$50 for a box of paper clips, a competitor would have a price of $1 on the
street in a week.

But not in the drug industry!  Thanks to the FDA,
Staples paper clips would in effect be protected for years even though no
patent is involved. Competitors would be bogged down for years in litigation,
or in waiting for the FDA to prove that no one could cut their finger on a
non-Staples clip.

It is wasteful for the FDA to take over two years to review competitive generic drugs, when the original version has been on the market for years and poses zero danger to anyone. Companies must be prevented from ‘stealing’ popular and effective drugs that have been in the public domain for years, and then claiming them as private property until their competitors can slog through FDA approval. By the time the FDA gives anyone else permission to compete, the price gougers will have made their fortune and can move on to their next scheme.

 Step Two – The Government Could Take Over
Production

For drugs with no 
competitors,   the Government can
still stand up to the drug companies….and here’s how…………

Under 28 U.S.C. § 1498 (“Section 1498”), the federal government has the power to
use or manufacture any patented product, and must provide only “reasonable”
compensation to the patent holder. The government could therefore elect to
contract with another manufacturer to produce a cheap generic version of
expensive patented drugs;

 Section 1498 was used routinely by federal
agencies in the 1960s and early 1970s to obtain cheaper  drugs. In one notable case, the Defense
Department purchased an antibiotic from a generic manufacturer in Italy at a 72
percent discount on the price charged by Pfizer, the drug’s patent owner.

During the Anthrax scare in 2001, the Bush administration
threatened to use Section 1498 to purchase generic versions of Bayer’s
antibiotic ciprofloxacin, which proved enough to coax Bayer to cut its price in
half.

Recently, Louisiana health secretary Rebekah Gee has been urging federal officials to employ this  law to cut the price of hepatitis C drugs.
The state’s 35,000 uninsured or Medicaid-enrolled residents with hepatitis C
are projected to cost Louisiana $764 million per year at the drugs’ retail
rate.

 Section 1498 is a big
stick, and if the administration bothered to pick it up, the threat of this
power alone could compel drugmakers to slash prices.

Sen. Elizabeth Warren and Rep. Jan Schakowsky (D, Il)  have introduced a bill to allow the federal government to
start manufacturing prescription
drugs
, when:

  • no company is producing a generic
    version of the drug
  • only one or two companies are
    producing a drug and there is either a price hike or a drug shortage
  • only one or two companies are
    producing a drug, the price makes it difficult for some patients to afford, and
    the World Health Organization classifies it as an “essential medicine”

Step Three– Establish
Pharmacy Price Review Boards

Unfortunately, not all drugs can easily be produced at a
government-run company.  The
‘bio-similars’ and genetically-engineered drugs today are aimed at relatively
tiny numbers of patients ,and are virtually impossible to copy. A new drug to
prevent infant paralysis has been priced by Novartis at $725,000 a year, and
will help only 2,000 patients.

Why are we allowing Novartis to set the price in the first place?
I would argue that we should not spend that much on any one patient; and if we
do so, it ramps up insurance rates relentlessly.

For these drugs, we will 
need to impose ‘price ceilings.’ We should have a full=fledged ‘Pharmacy
Price Review Board’ as exists in numerous other nations.

The Board would review all new drugs, plus all existing drugs that
have prices over $30,000 a year.

Drug companies will have the opportunity to present their case for
current prices; however, as their usual motive is just ‘greed’ I suspect they
will not have much success. These drugs might never be able to be copied as
generics for $100, but they certainly do not really cost $100,000  or more per patient.

This process will take some time. Whereas surprise billing in hospitals tends to be  caused by a few bad actors, the entire American drug industry is currently based on price-gouging. We will have to try a series of reforms.

Bob Hertz is a retired insurance broker. He learned about health care from Uwe Reinhardt, Joseph White, Dr. Robert Evans, and George Halvorson a fellow Minnesotan.

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Health Reform Job One: Stop the Gouging! | Part 1

We Need Legal Assaults On The Greediest Providers!

By BOB HERTZ

When a patient is hospitalized, or diagnosed with a deadly disease, they often have no choice about the cost of their treatment.

They are legally helpless, and vulnerable to price gouging.

Medicare offers decent protection — i.e. limits on balance billing, and no patient liability if a claim is denied.

But under age 65, it is a Wild West — especially for emergency care, and drugs and devices. The more they charge, the more they make. Even good health insurance does not offer complete financial insulation.

We need more legal protection of patients. In some cases we need price controls.

‘Charging what the market will bear’ is inadequate, even childish, when ‘the market’ consists of desperate patients. Where contracts are impossible and there is no chance for informed financial consent, government can and should step in.

This series describes the new laws that we need. Very little is required in tax dollars….but we do require a strong will to protect.

Assault Phase One: Outlaw surprise
billing

This rule must become universal:

If a hospital is
‘in-network’, then any doctor who practices in that hospital is ‘in-network.’

To enforce this, we should adopt Connecticut’s law on
surprise billing and balance billing for the entire nation.

Connecticut’s
law No.15-146, which took effect July 1, 2016. states
the following:

“If a patient receives a “surprise bill” from a health
insurer for Out-of-Network services provided at an In-Network facility – the
patient will only be responsible to pay the co-insurance, co-payment,
deductible, or other out of pocket expense that would apply – if the services
had been provided by an In-Network provider. 
The physician is reimbursed at the in-network rate,
unless the patient and provider agree upon something else in advance.”

In addition:

  • Patients who see Out-of-Network providers for
    emergency services can only be required to pay the equivalent of In-Network
    costs. This includes Out-of-Network hospitals, transportation services, and
    providers who are Out-of-Network practicing within In-Network facilities.

In addition:

  • It is illegal in Connecticut for
    any provider to request extra payment from a patient who is covered by
    insurance — as the entire purpose of insurance is to negotiate prices for you.
  • It is also an unfair trade practice for a health
    care provider to report a patient’s unpaid surprise medical bill to a credit
    reporting agency.

Other Connecticut rules include:

  • A patient who still receives a surprise bill
    from an out of network provider in excess of what the patient would owe under
    the plan’s in-network rate can seek actual damages, punitive damages, and
    injunctive relief based on the Connecticut Unfair Trade practices Act.
  • Connecticut also prohibits health plans from
    imposing a facility fee for outpatient visits at an off-campus site of a
    hospital. In fact,  billing statements to
    patients must include a notice that the costs might have been less if they had
    had the procedure performed at a facility not owned or operated by the hospital
    or hospital system, and that the patient has the right to request a reduction in
    the fee.
  • For uninsured patients, Connecticut providers
    may not charge more than the applicable Medicare rate.

Only six states have laws that are even close to this level of patient
protection. Let’s establish the Connecticut standard nationwide.

Assault Phase Two:  Regulate the fees of emergency rooms and
ambulances.

 Any 
hospital   ‘contract’ that is
signed upon an emergency admission is legally flawed. Such contracts are in
fact procedurally unconscionable — because the only way for the weaker party
to acquire the services is to agree to the terms dictated by the stronger
party. Signed admission forms, which include a promise to pay, absolutely do not
constitute mutual assent.

Here is the solution:

  • If an ER patient is insured, then the hospital
    must accept ‘mandatory assignment ‘ of benefits –

i.e. if the insurer pays $500, then that
closes the account. (as long as the insurer pays at least as much as Medicare.)
No balance billing would be allowed for emergencies. As described in
Connecticut law, a patient who received a balance bill could sue for damages.

  • ER doctors would be
    barred from billing separately for emergency, ancillary, and hospitalist
    services. The hospital would once again be responsible for paying them, and for
    collecting reimbursement from insurance networks.

Of course hospitals will
complain. Many of them have been ambushing emergency patients with huge
out-of-network bills, basically to put pressure on insurers to raise their
payment rates. Patients are caught in the middle of the power struggle, and
this must cease.

Hospitals are supposed to fight emergencies, not cause them.
They must be forced  to stop abusing
their monopoly position toward emergency patients.

Important note:

 Hospitals
do deserve lump-sum federal subsidies for uncompensated emergency care. The
EMTALA act (which mandates that all patients must be stabilized, whether or not
they can pay) was totally unfunded. That was a mistake that can be corrected
now.

For the insured  population:

Emergency care must be exempt from the deductible in all
health insurance plans. (ER Co-pays up to $250 are acceptable.)

The ridiculous HSA plans 
(where absolutely nothing is covered until a high deductible is met)
must be legally amended.

In addition:

Ambulances should be fully funded by the federal government,
including air ambulances. The cost would be from $14 to $18 billion a year,
which is about ten days worth of Medicare spending.

 It is far better for
us all to pay a few dollars a year in extra taxes, versus a tiny number of us
to be stuck with a huge ambulance bill. Medical transport should be a public
service, instead of another industry on the take.

Note: We could allow a $100 user fee, in order to discourage the  use of ambulances for non-urgent transport to drugstores or to doctors’ appointments. There could be a $500 user fee for air ambulances.

Stay tuned for the next article in the series in which I discuss Big Pharma.

Bob Hertz is a retired insurance broker. He learned about health care from Uwe Reinhardt, Joseph White, Dr. Robert Evans, and George Halvorson a fellow Minnesotan.

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