With the current COVID-19 surge not expected to peak until mid-October, treatments for the deadly virus are set to cost much more for those infected.
Michigan’s large health insurers—including Blue Cross Blue Shield of Michigan and Priority Health—are sunsetting their programs that waived all costs to patients treated for COVID-19.
The waiving of cost-sharing for patients expires on Sept. 30 for the two insurers.
More than 2 million Americans have checked into hospitals to get treated for severe cases of COVID-19 and many, thanks to insurers and government programs, have received no bills in the mail.
The cost for treating COVID-19 varies greatly, depending on severity. But after Oct. 1, Michiganders who contract COVID-19 and seek treatment will face co-pays and treatment bills.
Nationally, COVID-19 treatments performed in an outpatient setting cost an average between $500 and $1,000, according to a February report from the Blue Cross Blue Shield Association.
Insured individuals generally cover 30 percent of medical bills out of pocket, meaning those patients would be charged roughly $150 to $300.
However, costs rise exponentially for COVID-19 patients hospitalized or placed in the intensive care unit.
Total costs on average for treating patients hospitalized with COVID-19 is $22,500 to $45,000, according to the Blue Cross study. That mean patients could see bills as high as $13,500.
For patients requiring treatment in the ICU, total costs average $56,250 to $112,500. Patients could see bills as high $33,750 for COVID-19 ICU treatments.
The move is part returning to regular course of business for the insurers and part pushing the costs on to those the virus preys on—the unvaccinated.
Hospitalizations are doubling every 10 days in the state—there were more than 700 hospitalized with COVID-19 in Michigan on Aug. 8, according to state data—and the majority of those are unvaccinated.
“The vaccines have proven to be extremely effective at preventing the transmission of COVID-19 and severe illness or death,” Grand Rapids-based Priority Health said in a statement to Crain’s. “We will continue to offer the vaccine at $0 to all members, as we believe getting vaccinated is the most effective way for our members to keep themselves, their families, and their community safe.”
U.S. health officials on Wednesday recommended all Americans get COVID-19 booster shots to shore up their protection amid the surging delta variant of the coronavirus and evidence that the vaccines’ effectiveness is falling. The doses could begin the week of Sept. 20.
Charging unvaccinated workers with higher insurance premiums could help employers fully vaccinate their workforces and mitigate the health and financial risks of employees contracting COVID-19.
About 10% of employers have offered cash and prizes to persuade workers to get immunized, but those tactics may have outlived their usefulness. Private and public employers increasingly are imposing mandates instead that require workers to be vaccinated or, in some cases, to submit to regular COVID-19 testing as a substitute.
Early in the nationwide vaccination campaign, employers were comfortable staying on the sidelines but now more understand their crucial role in brining the pandemic to a close, said Wade Symons, a partner and leader of Mercer’s regulatory resources group. “It is important for employers to be sending the right messages about vaccination and getting behind these efforts,” he said.
Around 65% of workers say their employers encouraged them to get vaccinated, and 72% say they trust their companies to provide reliable information about the vaccines, according to a Kaiser Family Foundation COVID-19 Vaccine Monitor report published in June.
Now some companies are weighing the advantages and disadvantages of increasing health plan premiums on employees who refuse the vaccine and don’t qualify for medical or religious exemptions.
“Employers feel like that may be justified, similar to a surcharge for those that use tobacco, because of the potential for unvaccinated employees to cost more from a medical claims perspective,” Symons said.
While most businesses still want vaccination to remain a choice for workers, 20 to 30 large employers are investigating the possibility of premium surcharges for unvaccinated employees, Symons said. Companies want to shield themselves from the medical costs of hospitalizing COVID-19 patients and create safe workplaces for all employees.
Higher health insurance premiums for unvaccinated people could provoke a backlash from employees who don’t want the vaccine, however, said Adam Block, assistant professor of Public Health at New York Medical College and founder of Charm Economics.
Employers that want to avoid surcharges could instead offer wellness credits that reduce health insurance premiums for workers who get inoculated, as some companies do for employees who get annual flu shots, Block said.
Companies considering premium surcharges also must be mindful of federal laws governing health insurance and employee benefits, Block said.
While the Affordable Care Act prohibits insurers from charging higher premiums to unvaccinated people, employers are still able to encourage vaccination through penalties and mandates.
However, Equal Employment Opportunity Commission rules restrict employers promoting vaccinations from instituting incentives or surcharges so large that they is considered coercive, Block said.
Under the Americans with Disability Act, employers are required to provide reasonable accommodations for employees aren’t vaccinated against COVID-19 due to a disability. The Civil Rights Act mandates that accommodations must also be made for employees who do not comply based on a sincerely held religious beliefs.
Typically, employers can modify health insurance premiums to offer tax-free incentives or penalties to employees as part of a workplace wellness program, said Bob Neiman, a principal at Much Shelist’s Healthcare Law Group.
Full FDA approval of the Pfizer-BioNTech, Moderna and Johnson & Johnson vaccines would strengthen the grounds for vaccine mandates and insurance surcharges, Symons said. That’s despite the fact that the U.S. Department of Justice issued an opinion stating that employers are not prohibited from imposing vaccination requirements even though the vaccines are only available under an emergency use authorization.
Because employers are interested in increasing vaccination levels soon, they are likely to begin rolling out surcharges next month, giving employees time to get vaccinated, Symons said.
“Healthcare providers more than employers in other sectors have struggled with the concept of vaccine mandates because they’ve been concerned that if they mandate the vaccines, they might have 20% of their nurses quit and then they couldn’t care for their patients,” Neiman said.
But healthcare workers resistant to the vaccine may prefer getting the shots or paying the penalities if the alternative is finding a new job during a pandemic, Neiman said. Still, employers should consider the risks of implementing incentives and disincentives based on the vaccination rates of their individual workforces and their geographical areas, he said.
Health insurance companies on their own are unlikely to modify premiums or benefits to add vaccination-related surcharges or incentives, said Paul Keckley, managing editor of The Keckley Report. Instead, they will set premiums based on community vaccination rates to anticipate where COVID-19 costs will be higher, he said.
By: MARI DEVEREAUX Modern Healthcare August 13, 2021 04:59 PM
by Robert King | Jul 19, 2021 11:24am FIERCRE HELTHCARE
A new analysis found only 5.6% of hospitals were fully compliant with a major price transparency rule, with most failures centered on not posting payer-negotiated prices.
The analysis released Friday by the group PatientRightsAdvocate.org is the latest evidence of widespread noncompliance with the rule, which went into effect back in January.
“These findings align with previous research indicating that hospitals are undermining the rule with incomplete information, burdensome access restrictions, code to block prices from being displayed on search engines and tools to obfuscate access to mobile app developers and to patients,” the analysis said.
Another problem has been price estimator tools that don’t enable meaningful accessible comparison of discounted cash prices, researchers said.
The group examined a random sample of 500 hospital websites out of the roughly 6,000 facilities subjected to the rule’s requirements.
Only 5.6% of the websites were compliant with all the rule’s requirements. It found that 471 facilities did not post a complete machine-readable file of standard charges.
A large majority (80.6%) of hospitals did not publish payer-specific negotiated charges that were clearly associated with each payer and plan, a controversial requirement of the rule. It found that 258 hospitals (51.6%) didn’t publish any negotiated rates at all and 198 hospitals (39.6%) didn’t publish any discounted cash prices.
The rule required hospitals to also publish 300 shoppable healthcare services in a list or an estimator tool. The group found that 96 hospitals presented them in a “consumer-friendly display for customary charges. However, a significant number of these hospitals presented incomplete data fields and were therefore noncompliant.
There were 378 hospitals that posted a price estimator tool. However, the tools were inconsistent and limited researchers’ ability to determine if the tool was compliant with the rule.
The analysis is the latest finding that many hospitals are not complying with the new rule. A study published last month found that 83 out of 100 randomly sampled hospitals were not compliant with the regulation.
The Centers for Medicare & Medicaid Services has sent out warnings to some hospitals for noncompliance. There is a $300-per-day penalty for hospitals for each day they aren’t fully following the regulation.
But the analysis posits that the penalty is nowhere near enough.
“Scaling the penalty to $300 per hospital per bed per day and robustly enforcing the rule will result in a meaningful financial incentive for hospitals to comply, while providing proportional fairness to smaller and rural hospitals,” the group said.
PatientRightsAdvocate.org also wants CMS to scrap the requirement for a price estimator tool and instead require hospitals to provide “guaranteed price quotes.”
A new analysis found only 5.6% of hospitals were fully compliant with a major price transparency rule, with most failures centered on not posting payer-negotiated prices.
The analysis released Friday by the group PatientRightsAdvocate.org is the latest evidence of widespread noncompliance with the rule, which went into effect back in January.
“These findings align with previous research indicating that hospitals are undermining the rule with incomplete information, burdensome access restrictions, code to block prices from being displayed on search engines and tools to obfuscate access to mobile app developers and to patients,” the analysis said.
Another problem has been price estimator tools that don’t enable meaningful accessible comparison of discounted cash prices, researchers said.
The group examined a random sample of 500 hospital websites out of the roughly 6,000 facilities subjected to the rule’s requirements.
Only 5.6% of the websites were compliant with all the rule’s requirements. It found that 471 facilities did not post a complete machine-readable file of standard charges.
A large majority (80.6%) of hospitals did not publish payer-specific negotiated charges that were clearly associated with each payer and plan, a controversial requirement of the rule. It found that 258 hospitals (51.6%) didn’t publish any negotiated rates at all and 198 hospitals (39.6%) didn’t publish any discounted cash prices.
The rule required hospitals to also publish 300 shoppable healthcare services in a list or an estimator tool. The group found that 96 hospitals presented them in a “consumer-friendly display for customary charges. However, a significant number of these hospitals presented incomplete data fields and were therefore noncompliant.
There were 378 hospitals that posted a price estimator tool. However, the tools were inconsistent and limited researchers’ ability to determine if the tool was compliant with the rule.
The analysis is the latest finding that many hospitals are not complying with the new rule. A study published last month found that 83 out of 100 randomly sampled hospitals were not compliant with the regulation.
The Centers for Medicare & Medicaid Services has sent out warnings to some hospitals for noncompliance. There is a $300-per-day penalty for hospitals for each day they aren’t fully following the regulation.
But the analysis posits that the penalty is nowhere near enough.
“Scaling the penalty to $300 per hospital per bed per day and robustly enforcing the rule will result in a meaningful financial incentive for hospitals to comply, while providing proportional fairness to smaller and rural hospitals,” the group said.
PatientRightsAdvocate.org also wants CMS to scrap the requirement for a price estimator tool and instead require hospitals to provide “guaranteed price quotes.”
Karen Jo Young wrote a letter to her local newspaper criticizing executives at the hospital where she worked as an activities coordinator, arguing that their actions led to staffing shortages and other patient safety problems.
Hours after her letter was published in September 2017, officials at Maine Coast Memorial Hospital in Ellsworth, Maine, fired her, citing a policy that no employee may give information to the news media without the direct involvement of the media office.
But a federal appellate court recently said Young’s firing violated the law and ordered that she be reinstated. The court’s decision could mean that hospitals and other employers will need to revise their policies barring workers from talking to the news media and posting on social media.
Those media policies have been a bitter source of conflict at hospitals over the past year, as physicians, nurses and other health care workers around the country have been fired or disciplined for publicly speaking or posting about what they saw as dangerously inadequate covid-19 safety precautions. These fights also reflect growing tension between health care workers, including physicians, and the increasingly large, profit-oriented companies that employ them.
On May 26, the 1st U.S. Circuit Court of Appeals unanimously upheld a National Labor Relations Board decision issued last year that the hospital, now known as Northern Light Maine Coast Hospital, violated federal labor law by firing Young for engaging in protected “concerted activity.” The NLRB defines it as guaranteeing the right to act with co-workers to address work-related issues, such as circulating petitions for better hours or speaking up about safety issues. It also affirmed the board’s finding that the hospital’s media policy barring contact between employees and the media was illegal.
“It’s great news because I know all hospitals prefer we don’t speak with the media,” said Cokie Giles, president of the Maine State Nurses Association, a union. “We are careful about what we say and how we say it because we don’t want to bring the hammer down on us.”
The 1st Circuit opinion is noteworthy because it’s one of only a few such employee speech rulings under the National Labor Relations Act ever issued by a federal appellate court, and the first in nearly 20 years, said Frank LoMonte, a University of Florida law professor who heads the Brechner Center for Freedom of Information.
The 1st Circuit and NLRB rulings should force hospitals to “pull out their handbook and make sure it doesn’t gag employees from speaking,” he said. “If you are fired for violating a ‘don’t talk to the media’ policy, you should be able to get your job back.”
The American Hospital Association and the Federation of American Hospitals declined to comment for this article.
While the 1st Circuit’s opinion is binding only in four Northeastern states plus Puerto Rico, the NLRB decision carries the force of law nationwide. The case applies to both unionized and non-unionized employees, legal experts say.
Hospitals and health care organizations often have policies requiring employees to clear any public comments about the workplace with the organization’s media office. Many also have policies restricting what employees can say on Facebook and other social media.
Hospitals say requiring employees to go through their media office prevents the spread of inaccurate information that could damage the public’s confidence. In Young’s case, the hospital argued that her letter contained false and disparaging statements. But the 1st Circuit panel agreed with the NLRB that her letter was “not abusive” and that its only false statement was not her fault.
Health care organizations have undisputed legal authority to prohibit employees from disclosing confidential patient information or proprietary business information, legal experts say.
But the 1st Circuit panel made clear that an employer cannot bar an employee from engaging in “concerted actions” — such as outreach to the news media — “in furtherance of a group concern.” That’s true even if the employee acted on her own, as Young did in writing her letter. The key in her case was that she “acted in support of what had already been established as a group concern,” the court said.
“I think employers with a blanket ban on talking to the media need to relook at their policies,” said Eric Meyer, a partner at FisherBroyles in Philadelphia who often represents companies on employment law matters. “If you go to the media and say, ‘There are unsafe working conditions impacting me and my colleagues,’ that’s protected concerted activity.”
Chad Hansen, Young’s attorney in a separate federal lawsuit alleging discrimination based on a disability against the hospital, said she has not yet been reinstated to her job. Young would not comment.
The hospital’s parent company, Northern Light Health, said only that its news media policy — which was amended after Young’s firing — meets the NLRB and 1st Circuit requirements and will not be further changed. The new policy created an exception allowing employees to speak to the news media related to concerted activities protected by federal law.
Speech rights under the National Labor Relations Act are particularly important for employees of private companies. Although the Constitution protects people who work for public hospitals and other government employers with its guarantee of unrestricted speech, employees at private companies do not have a First Amendment right to speak publicly about workplace issues.
“I hope this case keeps alive the right of health care workers to speak out about something that’s dangerous,” said Dr. Ming Lin, an emergency physician who lost his job last year at PeaceHealth St. Joseph Medical Center in Bellingham, Washington, after publicly criticizing the hospital’s pandemic preparedness.
Lin, who was employed by TeamHealth, which provides emergency physician services at the hospital, lost his assignment at PeaceHealth in March 2020 soon after saying on social media and in interviews with news reporters that PeaceHealth was not taking urgent enough steps to protect staff members from covid. He had worked at the hospital for 17 years.
In an April 2020 YouTube interview, PeaceHealth’s chief operating officer, Richard DeCarlo, said Lin was removed from the hospital’s ER schedule because he “continued to post misinformation, which was resulting in people being afraid and being scared to come to the hospital.” DeCarlo also alleged that Lin, who was out of town for part of the time he was posting, refused to communicate with his supervisors in Bellingham about the situation. PeaceHealth declined to comment for this article.
PeaceHealth’s social media policy at that time stated that the company does not prohibit employees from engaging in federally protected concerted activity and that they “are free to communicate their opinions.” TeamHealth’s social media policy, dated July 15, 2020, states the company reserves the right to take disciplinary action in response to behavior that adversely affects the company.
Lin, who’s now working for the Indian Health Service in South Dakota, has sued PeaceHealth, TeamHealth and DeCarlo in state court in Washington claiming wrongful termination in violation of public policy, breach of contract and defamation.
Dr. Jennifer Bryan, board chair of the Mississippi State Medical Association, who publicly defended two Mississippi physicians fired for posting about the inadequacy of their hospitals’ covid safety policies, said she faced pressure from her hospital for speaking to the news media without approval.
The medical association pushed its members to talk to the media about the science of covid, while employers insisted doctors’ messages had to be approved by the media office. That reflected a conflict, she said, between medical professionals primarily concerned about public health and executives of for-profit systems who were seeking to shield their corporate image.
Bryan predicted the court ruling and NLRB decision will be helpful. “Physicians have to be able to stand up and speak out for what they believe affects the safety and well-being of patients,” she said. “Otherwise, there are no checks and balances.”
