View
213
Download
0
Category
Preview:
Citation preview
Introduction to Healthcare and Public Health in the US
Financing Healthcare (Part 2)
Lecture bThis material (Comp1_Unit5b) was developed by Oregon Health and Science University, funded by the Department of Health
and Human Services, Office of the National Coordinator for Health Information Technology under Award Number [IU24OC000015)].
Financing Healthcare (Part 2)Learning Objectives
• Describe the revenue cycle and the billing process undertaken by different healthcare enterprises. (Lecture a)
• Understand the billing and coding processes, and standard code sets used in the claims process. (Lecture a)
• Identify different fee-for-service and episode-of-care reimbursement methodologies used by insurers and healthcare organizations in the claims process. (Lecture a)
• Review factors responsible for escalating healthcare expenditures in the United States. (Lecture b)
• Discuss methods of controlling rising medical costs. (Lecture c)
Health IT Workforce Curriculum Version 3.0/Spring 2012
2Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Financing Healthcare (Part 2) Lecture b - Goals
• Review US healthcare expenditures and medical inflation
• Examine the factors contributing to the increase in health care expenditures in the United States
• Describe the Emergency Medical Treatment and Active Labor Act (EMTALA)
• Discuss the cost of care to the uninsured
Health IT Workforce Curriculum Version 3.0/Spring 2012
3Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
National Health Expenditures and Gross Domestic Product, select years 1960-2009
5.1 Chart: Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; NHE summary including share of GDP, CY 1960-2009; file nhegdp09.zip). (CMS, 2011, PD-US, CC BY-NC-SA 3.0)
Dollars in Billions:
5.2% 7.2% 9.2% 12.5% 13.8% 14.5% 15.4% 15.9% 16.0% 16.0% 16.1% 16.2% 16.6% 17.6%
Health IT Workforce Curriculum Version 3.0/Spring 2012
4Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
US National Health Expenditures per Capita, Select Years 1960-2009
5.2 Chart: The Kaiser Family Foundation, Kaiser Fast Facts. Data Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; NHE summary including share of GDP, CY 1960-2009; file nhegdp09.zip). Available at http://facts.kff.org/chart.aspx?ch=854. (KFF, CMS, 2011, PD-US, CC BY-NC-SA 3.0).
Health IT Workforce Curriculum Version 3.0/Spring 2012
5Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Per Capita Health Care Expenditures, U.S. and Select Countries, 2008
5.3 Chart: Chart: The Kaiser Family Foundation, Kaiser Fast Facts. Data Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011). Available at http://facts.kff.org/chart.aspx?ch=1952. (KFF, CMS, 2011, PD-US, CC BY-NC-SA 3.0).Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted.
Health IT Workforce Curriculum Version 3.0/Spring 2012
6Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Concentration of Health Spending in the Total U.S. Population 2007
5.4 Chart: Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), 2008. (HHS, MEPS, KFF, 2008, PD-US, CC BY-NC-SA 3.0).
Perc
ent
of T
otal
Hea
lth
Care
Spe
ndin
g
Health IT Workforce Curriculum Version 3.0/Spring 2012
7Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Factors Contributing to High Healthcare Expenditures
• Technology • Increased demand and utilization
– Chronic disease– Aging population
• Administrative costs
Health IT Workforce Curriculum Version 3.0/Spring 2012
8Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Technology and National Healthcare Expenditures
• Congressional Budget Office Estimates– 40-50% of total expenditures
• Technology in healthcare – procedures, equipment, and processes by
which medical care is delivered
Health IT Workforce Curriculum Version 3.0/Spring 2012
9Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Technology
• Previously untreatable conditions– Repair of torn ligament of the knee
• New medical and surgical procedures – Angioplasty– Joint repairs/replacements
Health IT Workforce Curriculum Version 3.0/Spring 2012
10Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Technology
• Medical devices– CT scanners– MRI imaging– Implantable defibrillators
• Health Information Technology(HIT) – Electronic medical records – Telemedicine
Health IT Workforce Curriculum Version 3.0/Spring 2012
11Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Pharmaceutical Costs
• Estimated 10% of total expenditures– $234 billion 2008/$40.3 billion 1990– Average ~12% increase over the last 10 years– Drug costs inflated above CPI/other healthcare
sectors• Increased availability
– Medications for chronic disease• e.g. cholesterol, diabetes
• Increased demand– Cancer chemotherapy
Health IT Workforce Curriculum Version 3.0/Spring 2012
12Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Administrative Costs
• Administrative costs– Approximately 7% of annual US healthcare
expenditures– Administrative costs more than twice average
of other western industrialized nations– Estimated excess expense = $91 billion
Health IT Workforce Curriculum Version 3.0/Spring 2012
13Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Physician/Hospital Costs
• Increased demand– Utilization
• Positron emission tomography • Magnetic resonance imaging
– Techniques• Minimally invasive surgery
– daVinci robotic surgery
• Imaging techniques
Health IT Workforce Curriculum Version 3.0/Spring 2012
14Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Chronic Disease
• Chronic disease – Affects 1 of 2 adults in the US– Accounts for 7 of 10 deaths– Daily activity limitations for 1 in 4 with chronic
disease– Obesity major concern and contributor
• 1 in 3 adults• 1 in 5 children between ages 6 and 19
Health IT Workforce Curriculum Version 3.0/Spring 2012
15Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Chronic Disease and Health Risk Behaviors
• CDC - four health risk behaviors– Lack of physical activity– Poor nutrition - obesity– Tobacco use– Excessive alcohol consumption
Health IT Workforce Curriculum Version 3.0/Spring 2012
16Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Chronic Diseases• Chronic Disease
– Asthma– Chronic obstructive pulmonary disease– Chronic renal failure– Congestive heart failure – Coronary artery disease– Diabetes– Mood disorders/senility– Cancer – Hypertension
Health IT Workforce Curriculum Version 3.0/Spring 2012
17Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Chronic Disease and Increased Demand for Services
• Increased utilization of services– Management/treatment to decrease risk of
complications• e.g. aggressive treatment of diabetes to avoid such
complications as heart disease, kidney failure or blindness
– Early intervention at risk groups• e.g. weight loss, smoking cessation
Health IT Workforce Curriculum Version 3.0/Spring 2012
18Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Early Detection and Prevention
• Increased preventive services– Detection
• Screening mammograms• Colonoscopy
– Prevention • Immunizations
Health IT Workforce Curriculum Version 3.0/Spring 2012
19Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Spending by Age Group
5.5 Table: Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), 2008. HHS, MEPS,, KFF, 2008, PD-US, CC BY-NC-SA 3.0).
Health IT Workforce Curriculum Version 3.0/Spring 2012
20Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Increased Demand: Aging
• Increased utilization of services for chronic illness above age 64
• 1946-1964 – 66 million children• Medicare eligibility beginning in 2011
– Additional 10 million enrollees by 2018– Projected costs > $13,000 per capita with
comparable increase in Medicare costs
Health IT Workforce Curriculum Version 3.0/Spring 2012
21Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
The Uninsured
• Uninsured receive– Less preventive care– Diagnosed at more advanced disease states– Once diagnosed, received less therapeutic
care– Have higher mortality rates
• Cost of care for insured twice as much as uninsured
Health IT Workforce Curriculum Version 3.0/Spring 2012
22Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
The Uninsured 2009
• 17% of the population = ~50 million people• The Kaiser Commission on Medicaid and the
Uninsured 2010– In 2004 - $125 billion
• $40.7 billion uncompensated– In 2008 - $87 billion
• $57 billion uncompensated– Government pays the majority of
uncompensated care
Health IT Workforce Curriculum Version 3.0/Spring 2012
23Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Number of Nonelderly Uninsured Americans, 2000 – 2009
39.6 40.943.3 44.7 45.5
43.0 44.4 46.5 45.0 45.750.0
0
25
50
2000 2001 2002 2003 2004 2004 2005 2006 2007 2008 2009
2000-2004 Method 2004 Revised Method
5.6 Chart: Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2001-2010 ASEC Supplements to the CPS. (KFF, PD-US, CC BY-NC-SA 3.0).
Health IT Workforce Curriculum Version 3.0/Spring 2012
24Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
The Recession and Uninsured, 2008-2009
Decrease in Employer Sponsored Insurance
(million)2.8%
National Unemployment Rate Increase
since 2008(from 7.2% in
Dec-08 to 10.0% in Nov-09)
=2.8 3.0
Medicaid / CHIP
Enrollment Increase(million)
Uninsured Increase(million)
&
6.9
Figure 5.7: The Recession and Uninsured, 2008-2009
Impact of the Rise in Unemployment on Health Coverage, 2008 to 2009
5.7 Chart: Source: Based on John Holahan and Bowen Garrett, Rising Unemployment, Medicaid, and the Uninsured, prepared for the Kaiser Commission on Medicaid and the Uninsured, January 2009. (KFF, 2009, PD-US).
Health IT Workforce Curriculum Version 3.0/Spring 2012
25Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
The Uninsured: Spending (2008)• Annual Spending per person
– Uninsured: $1686 • One third out of pocket
– Insured (non-elderly): $4463• Total spending (uninsured)
– $87 billion• $57 billion uncompensated
– 75% uncompensated paid by government
Health IT Workforce Curriculum Version 3.0/Spring 2012
26Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
EMTALA• Emergency Medical Treatment and Active Labor Act
of 1986– Legal mandate to offer medical care to all
patients regardless of ability to pay– Anyone presenting to an emergency department
(ED) • Must be examined to determine if there is an
emergency• Treated until stabilized, discharged to self care or
continuing care• Transfer to a facility capable of providing care if the
facility is unable to provide the required care
Health IT Workforce Curriculum Version 3.0/Spring 2012
27Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
ED Utilization and Uninsured• Is uninsured care cause for overcrowding of the
ED?– Uninsured poor use the ED as a safety net for
care • 2008 – Weber et al examined ED use
– Percent of uninsured using the ED did not change over 10 years
– Non-poor insured with PCP accounted for most increase in ED visits
Health IT Workforce Curriculum Version 3.0/Spring 2012
28Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Emergency Department Overcrowding
• Lack of key clinical staff also has been cited as a driver of ED overcrowding
• Care provided to the uninsured and patients with non-urgent conditions is not a driver of ED overcrowding
• Evidence links ED overcrowding to reduced health care quality and patient safety
Health IT Workforce Curriculum Version 3.0/Spring 2012
29Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Financing Healthcare (Part 2)Summary – Lecture b
• US healthcare expenditures highest worldwide – Both per capita and % GDP
• Factors– Increase demand and utilization
• Aging and chronic disease– Technology – Pharmaceutical costs– Administration costs
Health IT Workforce Curriculum Version 3.0/Spring 2012
30Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Financing Healthcare (Part 2)Summary – Lecture 5b
• EMTALA– Not resulted in increased utilization by the
uninsured– Not a major cause of increased utilization of
the ED• Uninsured costs
– 7% of total healthcare expenditures in 2004– Receive less care and treatment, sicker,
higher mortality rates
Health IT Workforce Curriculum Version 3.0/Spring 2012
31Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Financing Healthcare (Part 2)References – Lecture b
References
• Adapted from: DeLia, D., Cantor, J., Emergency department utilization and capacity; The Synthesis Project, Robert Wood Johnson Foundation. Research Synthesis Report 17, July 2009.
• Centers for Disease Control and Prevention>Chronic Disease Prevention and Health Promotion>Tools and Resources. Recommendations, Best Practices, and Guidelines. Available from: http://www.cdc.gov/chronicdisease/resources/guidelines.htm. Last accessed December 12,, 2011.
• Fisher E, Bynum J, Skinner J. The Policy Implications of Variations in Medicare Spending Growth. The Dartmouth Atlas: The Dartmouth Institute for Health Policy and Clinical Practice Center for Health Policy Research, February 27, 2009. [cited 2010 July 31]. Available at: http://www.dartmouthatlas.org/downloads/reports/Policy_Implications_Brief_022709.pdf. Last accessed March 22, 2011.
• Fisher E, Goodman D, Skinner J, Bronner K. Health Care Spending, Quality, and Outcomes More Isn’t Always Better. The Dartmouth Atlas: The Dartmouth Institute for Health Policy and Clinical Practice Center for Health Policy Research, February 27, 2009. [cited 2010 July 31]. Available at: http://www.dartmouthatlas.org/downloads/reports/Spending_Brief_022709.pdf Last accessed March 22, 2011.
• McKinsey Global Institute, Accounting for the cost of US health care: A new look at why Americans spend more, November 2008 available at:
• http://www.mckinsey.com/mgi/publications/US_healthcare/pdf/US_healthcare_Chapter1.pdf. Last accessed Aug 1, 2010.
• Nelson AR, Costs of Health Care: New Solutions for an Old Problem. The Commonwealth Fund. May 13, 2005 [cited August 3, 2010]. Available from: http://www.commonwealthfund.org/Content/Publications/Commentaries/2005/May/Costs-of-Health-Care--New-Solutions-for-an-Old-Problem.aspx. Last accessed March 22, 2011
Health IT Workforce Curriculum Version 3.0/Spring 2012
32Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Financing Healthcare (Part 2)References – Lecture b
References (continued)
• Robert Wood Johnson Foundation. Available at: http://www.rwjf.org/. Source for health issue research and health policy. Last accessed January 2012.
• The Congress of the United States Congressional Budget Office. Washington DC: 2008 [cited July 31, 2010]. Technological Change And The Growth Of Health Care Spending. Available at: http://www.cbo.gov/ftpdocs/89xx/doc8947/01-31-TechHealth.pdf. Last accessed December 12, 2011.
• The Hastings Center (nd.). Health Care Costs and Medical Technology From Birth to Death and Bench to Clinic: The Hastings Center Bioethics Briefing Book for Journalists, Policymakers, and Campaigns, available at: http://www.thehastingscenter.org/uploadedFiles/Publications/Briefing_Book/health%20care%20costs%20chapter.pdf. Accessed December 12, 2011.
• The Henry J Kaiser Family Foundation. Menlo Park, CA (2009) [cited 2010 August 1]. Healthcare Costs: A Primer; available from: http://www.kff.org/insurance/ 7670.cfm. Key information on health care costs. Last accessed March 22, 2011.
• The Henry J Kaiser Family Foundation. Menlo Park, CA (2010) [cited 2010 August 1]. Kaiseredu.org > Cost and Spending > US Healthcare Costs; Available from: http://www.kaiseredu.org/index.asp. Provides background information, links to key data and policy information on US healthcare costs. Last accessed March 22, 2011.
• The Henry J Kaiser Family Foundation. Menlo Park, CA (2010). [cited 2010 August 1]. Prescription Drug Trends. Available at: http://www.kff.org/rxdrugs/index.cfm. Last accessed March 22, 2011.
• The Henry J Kaiser Family Foundation. Menlo Park, CA (2010). [cited 2010 August 1]. The Kaiser Commission on Medicaid and the Uninsured; Uninsured and Untreated: A Look at Uninsured Adults Who Received No Medical Care for Two Years; Available at: http://www.kff.org/uninsured/8083.cfm. Last accessed March 22, 2011.
• Weber EJ, Showstack JA, Hunt KA, et al. “Are the Uninsured Responsible for the Increase in Emergency Department Visits in the United States?” Annals of Emergency Medicine 52(2): 108–115, 2008.
Health IT Workforce Curriculum Version 3.0/Spring 2012
33Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Financing Healthcare (Part 2)References – Lecture b
Charts, Tables and Figures
• 5.1 Chart: Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; NHE summary including share of GDP, CY 1960-2009; file nhegdp09.zip). (CMS, 2011, PD-US, CC BY-NC-SA 3.0).
• 5.2 Chart: The Kaiser Family Foundation, Kaiser Fast Facts. Data Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical; NHE summary including share of GDP, CY 1960-2009; file nhegdp09.zip). Accessed 11 Dec 2011. Available at http://facts.kff.org/chart.aspx?ch=854. (KFF, CMS, 2011, PD-US, CC BY-NC-SA 3.0).
• 5.3 Chart: Chart: The Kaiser Family Foundation, Kaiser Fast Facts. Data Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011). Available at http://facts.kff.org/chart.aspx?ch=1952. (KFF, CMS, 2011, PD-US, CC BY-NC-SA 3.0).
• 5.4 Chart: Concentration of Health Spending in the Total U.S. Population 2007. Adapted from: Healthcare Costs – A Primer 2009. Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), 2008. Available at: http://facts.kff.org/chart.aspx?ch=1344. (HHS, MEPS,, KFF, 2008, PD-US, CC BY-NC-SA 3.0).
• 5.5 Table: Distribution of Average Spending Per Person, 2008. Source: Kaiser Family Foundation calculations using data from U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS), 2008. Adapted from: Healthcare Costs – A Primer, 2009. Available at: http://facts.kff.org/chart.aspx?ch=1390. Last accessed December 12, 2011. (HHS, MEPS, KFF, 2008, PD-US, CC BY-NC-SA 3.0)
Health IT Workforce Curriculum Version 3.0/Spring 2012
34Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Financing Healthcare (Part 2)References – Lecture b
Charts, Tables and Figures (cotinued)
• 5.6 Chart: Number of Nonelderly Uninsured Americans, 2000 – 2009. Source: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of 2001-2010 ASEC Supplements to the CPS. (KFF, PD-US, CC BY-NC-SA 3.0).
• 5.7 Chart: The Recession and Uninsured, 2008-2009. Source: Based on John Holahan and Bowen Garrett, Rising Unemployment, Medicaid, and the Uninsured, prepared for the Kaiser Commission on Medicaid and the Uninsured, January 2009. (KFF, 2009, PD-US).
Health IT Workforce Curriculum Version 3.0/Spring 2012
35Introduction to Healthcare and Public Health in the US Financing Healthcare (Part 2)
Lecture b
Recommended