THE SOURCE BLOG

By: Danika Rothwell, Student Fellow Paul DeWolfe needed back surgery.  He knew the operation would be covered by his insurance and was careful to make sure the hospital he chose was in his insurer’s network.  DeWolfe sat down and did the math. He figured his portion of the bill would cost roughly $3,000.  When DeWolfe recovered from his procedure, he was shocked to receive a bill for $18,590.83.[1]  Despite all his attentive preparation, some of the physicians who treated him at his in-network hospital were, in fact, out-of-network.  This story …

By: Megan Pham, Student Fellow   COVID-19 has upended the way individuals across the country access medical care and has made doctors’ offices and hospitals high-risk grounds for transmission. This leaves the elderly and immunocompromised who seek care especially vulnerable. In response, the U.S. Department of Human and Health Services (HHS) and Centers for Medicare and Medicaid Services (CMS) have adopted a series of waivers to allow increased access to and coverage of healthcare services through telehealth.   PRE-PANDEMIC TELEHEALTH Telehealth is “the use of telecommunications and information technology to …

By: Swaja Khanna, Student Fellow With the coronavirus pandemic causing shelter-in-place restrictions around the world, we here at The Source hope you are staying safe and healthy as we catch you up on some of the articles and reports in health policy this month. In this edition of the Source Roundup, we cover articles and reports that discuss: (1) the cost of hospital care for COVID-19 for the uninsured, (2) how health costs may change in the pandemic, (3) surprise out-of-network billing from ambulance transportation, (4) in-network ASC episodes that …

By: Swaja Khanna, Student Fellow In this edition of the Source Roundup, we highlight articles and reports from February that discuss: (1) the prevalence of out-of-network billing during elective procedures with in-network services, (2) affordable care organizations’ potential to limit out-of-network spending, (3) findings from the new Health Care Cost and Utilization Report, (4) private health care spending growth  varies by hospital referral regions, (5) U.S. has highest healthcare spending despite worst health outcome, and (6) how states policies encourage provider market competition and lower healthcare spending.   The Prevalence …

By: Swaja Khanna, Student Fellow Happy New Year! We hope you had an exciting start to the new decade! In this edition of the Source Roundup, we cover articles and reports from December that discuss: (1) increase in US health care spending in 2018, (2) health system affiliation and how it affects patient access, (3) out-of-network provider charges between 2012 and 2017, and (4) how billing in-network could save millions.   U.S. Health Care Spending Increased 4.6 Percent to Reach $3.6 Trillion in 2018 In the Health Affairs article National …

See UFCW & Employers Benefit Trust v. Sutter Health case page.   Updated 10/11/19: Start of Trial further delayed to Monday, October 21 per 10/11 hearing regarding jury selection. By: Alex Montague, Graduate Research Fellow Opening arguments for the antitrust case against Sutter Health, set to begin Oct 10 at 10:15am in the Superior Court of San Francisco, were postponed today after the court expressed concern that there was an insufficient number of jurors available to move forward for the trial. Several jurors were absent for today’s trial due to medical conditions …

By: Mary Breffle, Student Fellow The autumnal season is upon us!  This month, we pull no tricks, and treat you to a review of articles and reports about 1) the impact of healthcare market concentration, 2) the potential use for price transparency, and 3) government efforts to influence pharmaceutical pricing.   Conflicting Views on How Market Concentration Impacts Healthcare Prices Two recent reports point to an increase in healthcare market concentration and discuss the effects on price and competition.  The American Medical Association (AMA) just published the 2019 edition of the …

By: Hayden Soria, Student Fellow Hello September! As we see cooler days slowly roll in, there are still many sizzling topics in this month’s health policy literature. In this Roundup, we take a dive into article and reports that discuss 1) the prevalence of surprise billing, 2) the effects of California’s AB 72 on provider networks, 3) increasing hospital prices, 4) hospital quality ratings, 4) increasing insurance premiums and out-of-pocket costs, and 5) health plan profitability.   Surprise Billing and Provider Networks Eric C. Sun, Michelle Mello, and Jasmin Moshfegh explore …

By: Hayden Soria, Student Fellow Happy August! Even as the summer winds down, there is no waning of health policy literature. In this month’s Source Roundup, we take a look at academic articles and studies that analyze 1) potential prescription drug savings from generics and biosimilars, 2) the need for price transparency, and 4) a multitude of efforts in health system reform.   Potential Prescription Drug Savings from Generics and Biosimilars As prescription drug pricing continue to capture the nation’s attention, Stacie B. Dusetzina et al. take a dive into cost …

By: Hayden Soria, Student Fellow Happy July! Hope everyone is staying cool in the summer heat. In this month’s Source Roundup, we take a dive into academic articles and studies that look at 1) healthcare system reform on a national and state level 2) health care markets concentration and competition, and 3) developing trends in prescription drug pricing.   Healthcare System Reform Ever since the Affordable Care Act (ACA) implementation nine years ago, it has become one of the most polarizing topics in American political culture, spawning debates both in support …