Aug 19, 2019

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning. Today's Vitals is a short 811 words, or about a 3-minute read. Happy Monday to you.

1 big thing: The looming crisis in long-term care

Illustration: Aïda Amer/Axios

Taking care of the aging population is a crisis in the making, and no one — not families, not government programs and not the health care workforce — is prepared for it, Axios' Sam Baker reports.

The big picture: Providing health care to aging baby boomers will strain Medicare's finances, but the problem is even bigger than that.

Long-term care — the kind of services typically performed in a nursing home or by a home health aide — largely falls through the cracks of both public and private health insurance, saddling seniors and their families with financial and emotional burdens they often didn't anticipate or plan for.

  • "It's a problem nobody's talking about," said David Grabowski, a health policy professor at Harvard who studies long-term care.

By the numbers: Estimates differ on the specifics, but they generally agree that somewhere between half and two-thirds of seniors will need at least some long-term care.

  • Today's seniors will incur an average of $138,000 in long-term care bills, according to one federal study.

How it works: Medicare doesn't cover most long-term care services. The market for private long-term care insurance is tiny and fraught with failure.

  • That leaves three real options: Be rich enough to pay out of pocket, be poor enough to quality for Medicaid, or lean on family and volunteer caregivers.
  • In many cases, seniors must do all three: They begin paying out of pocket, then quickly spend everything they have, making them Medicaid-eligible, but still rely on family members for at least some additional help.

Medicaid is already the biggest line item in most states' budgets — so as the need for long-term care grows, it will cost seniors, families, states and the federal government all at the same time.

Go deeper.

2. The rural hospital problem goes to court

Poplar Bluff Regional Medical Center — a hospital in rural Southeast Missouri — has filed more than 1,100 lawsuits so far this year to collect unpaid medical bills, the Washington Post reports.

Between the lines: The patients being sued — including many who have insurance — often can't afford to pay their bills.

  • At the same time, rural hospitals' financial plight has been well-documented, meaning that this is a fight "which neither side appears to be winning," as WashPost's Eli Saslow writes.
  • Heading to court over hospital bills has become so routine in Poplar Bluff that people refer to it as the "follow-up appointment." It can result in their wages being garnished or liens against their homes.
  • More than 35% of people in Butler County have unpaid medical debt on their credit report, double the national rate.

The other side: Three nearby hospitals have closed in the recent past, leaving Poplar Bluff — which is owned by Community Health Systems — as the last full-service hospital serving 5 rural counties.

  • In the past few years, its uncompensated care cost has risen from $60 million to $84 million.

My thought bubble: This story is a collision of some of health care's most vexing problems: The steady rise in costs, patients' increasing exposure to these costs via their deductibles, America's lingering uninsured population and rural hospitals' financial predicament.

  • None of these problems have easy solutions.
3. Healthy people can pay for gene sequencing

Illustration: Rebecca Zisser/Axios

Two of Boston's top hospitals are rolling out clinics that claim to predict potential diseases through elective gene sequencing, Stat's Rebecca Robbins reports.

The intrigue: Healthy people can pay thousands in cash to visit similar gene clinics at academic centers or hospitals, Axios' Orion Rummler writes.

  • There is no strong evidence that healthy patients are benefiting from these clinics, and insurers generally won't cover the sequencing.

What they're saying: "The idea that genomic sequencing is only going to be accessible by wealthy, well-educated patrons who can pay out of pocket is anathema to the goals of the publicly funded Human Genome Project, and creates new disparities in our health care system," Jonathan Berg, a genetics professor at the University of North Carolina, told Stat.

By the numbers: Patients at Brigham and Women's Preventive Genomics Clinic pay out of pocket for sequencing that ranges from $250 to $2,950. Patients at HudsonAlpha pay up to $7,000 for "whole genome sequencing and interpretation."

  • "It's clearly not been demonstrated to be cost-effective to promote this on a societal basis," said Robert Green, a medical geneticist leading Brigham's new clinic.
4. Colorado ED rates are all over the place

Colorado emergency department visits cost wildly varying amounts, according to a new analysis by the Center for Improving Value in Health Care that used the state's all-payer claims database.

  • It looked only at what hospitals were paid by commercial insurers for the facility component of the visit, meaning that other charges were likely tacked on too.

There's no standard charge for an emergency room visit. And there are insane outliers.

  • Emergency departments were paid an average of $3,115 for the most severe cases; the largest charge was $47,779.

Why it matters: This analysis includes data from one state for one kind of care. This is essentially the kind of transparency that the Trump administration wants to bring to all hospital care.

  • If I was the hospital that was successfully charging 15 times the average rate for a service, I wouldn't want the world to know about it.
5. While you were weekending...
  • The CDC is investigating lung illnesses related to vaping and e-cigarette use, Reuters reports.
  • A Novartis manager sold almost $1 million of shares weeks before the company's Zolgensma scandal became public, Bloomberg reports.
  • The New York Times dives into the centuries-old belief that there are racial differences in physiology, and how it contributes to racial disparities in health care today.
Caitlin Owens