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10-02-2013 | Article

The week in review, February 4–10, 2013

medwireNews: This week's stories include: out-of-network billing that surpasses Medicare price tags by orders of magnitude; religious challenge to Obama's recent proposal modification to birth control coverage; Sunshine Act finally becomes a reality and it is time to act; patient's reluctance to consider healthcare costs in the grand scheme of things; the occasional need for decision aids to "nudge" a patient in a certain direction.

Maximum overcharge

Making healthcare coverage more affordable means controlling the skyrocketing medical costs that are becoming more unsustainable with each passing year. While a large majority of all claims paid in 2011 were on an in-network basis, a significant 12% were paid for out-of-network services - which often is a much pricier alternative.

According to a snapshot of state level out-of-network billing taken by America's Health Insurance Plan, providers have billed for services to an extent that surpasses several hundred to several thousand percent of what Medicare would reimburse for the same service in the same area.

The report emphasized the dire need to protect consumers from these "runaway" charges, describing it as a policy issue that is made all the more urgent at a time of economic challenges.

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Not appeased

The Obama administration proposed another policy adjustment regarding women's rights to contraception, healthcare, and religious freedom that will likely become a Supreme Court decision.

The proposal would expand the number of groups exempt from having to pay directly for contraceptive coverage to include non-profit religious organizations, such as hospitals and institutions of higher learning.

In the meantime, lawsuits continue to pour in to challenge birth control coverage while the nation's Roman Catholic bishops rejected the proposal on the grounds that it still bound religious hospitals, colleges, and charities in a manner that still infringed on religious rights.

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Breaking through the clouds

The Centers for Medicare and Medicaid at long last released a final version of the Sunshine Act, which will guide various entities in arranging for the provision and collection of data about financial or other forms of gain that physicians have acquired from the medical industry.

The rule addresses speaking engagements as well as continuing education certification so that consumers can better understand the nature of a recipient's vested interest.

With the rule now made official, it is hoped that clinical decision-making in the long run will be bolstered by a healthcare system that prioritizes integrity by empowering patients to anonymously check on their doctor's potential conflict of interest.

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The big picture

It is becoming increasingly apparent that all players in the health system will need to be involved in curbing health costs. Such involvement will likely entail nothing less than a cultural shift in our understanding of health resources and their limits.

Inherent in that awareness is gaining information about how our healthcare choices affect those resources; a perspective that patients are rather resistant to, according to a Health Affairs study.

As the ultimate deciders of what health options they will go with, consumers will need to put their decisions in the context of surging health insurance premiums and society's healthcare costs as a whole if manageability is ever to be achieved.

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Sage bias

Ideally, patient decision aids are void of bias and information that is slanted toward special interests so that they can rely on material that appropriately guides them in their health choices.

But a Health Affairs analysis warned that being purist about neutrality is not always to the benefit of the patient since in some cases patients need a "nudge" in the right direction.

The study authors list various scenarios that exemplify when developers of these aids should not necessarily default to presenting options in a nondirective manner.

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By Peter Sergo, medwireNews Reporter