Author Archives: Joseph Burns

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at

Legal reporters’ coverage of medical funders prompts calls for regulatory action



It’s no secret that even insured patients sometimes are unable to cover the full cost of their care. When that happens, some people turn to medical funding companies for help. Physicians and other providers sometimes will even refer patients to these entities, which are set up to pay the provider and then collect from the patient.

There can be problems with this option, as journalists Alison Frankel and Jessica Dye learned last year in an investigation of unscrupulous medical funding companies. Continue reading

Clinton’s ambitious mental health reform plan faces severe shortage of specialists

Photo: Matt A.J. via Flickr

Photo: Matt A.J. via Flickr

Hillary Clinton this week unveiled a comprehensive plan to reform how mental health care is delivered in this country. While it calls for addressing many of the most serious problems in the behavioral health care system, it could be hampered – at least initially – by a severe shortage of mental health professionals at all levels (map as of 2014).

To address that problem, the plan calls for increasing reimbursement for collaborative care (where mental health professionals work with medical providers) in Medicare and Medicaid Continue reading

FOIA lawsuit uncovers audits showing 35 health plans overbilled Medicare Advantage

Fred Schulte

A federal review of health insurers operating Medicare Advantage plans shows that 35 health plans overbilled the federal Centers for Medicare & Medicaid Services, the Center for Public Integrity reported on August 29.

Fred Schulte, a CPI senior reporter, said the center obtained 37 MA plan audits through a Freedom of Information Act lawsuit. The documents indicated that 35 of those health plans were overpaid in 2007. The typical overpayment was several hundred thousand dollars.

“Among the insurers charging the government too much: five Humana, Inc. health plans, three UnitedHealth Care Group plans and four Wellpoint, Inc. plans,” Schulte wrote. None of the plans would comment for Schulte’s article. Continue reading

Reference pricing for ‘shoppable’ health care services steers consumers to low-cost providers

Source: Robinson JC, Whaley C, Brown TT. Association of Reference Pricing for Diagnostic Laboratory Testing with Changes in Patient Choices, Prices, and Total Spending for Diagnostic Tests. JAMA Intern Med. Published online July 25, 2016. doi:10.1001/jamainternmed.2016.2492.

When Safeway, a grocery store chain, introduced reference pricing for the most commonly used clinical laboratory tests, spending on those tests dropped by 32 percent over three years, according to a recent study.

Using reference pricing, Safeway saved $2.57 million over the three years of the study (2011 to 2013). Of that amount, $1.05 million (41 percent) went back into consumers’ pockets, and the remaining $1.70 million accrued to Safeway, the study showed. Also, reference pricing led to a 32 percent drop in the average price that consumers paid for 285 different lab tests.

The researchers concluded that reference pricing can lead to savings for employers, workers and family members. JAMA Internal Medicine published the study online on July 25. Continue reading

Watch for potential pitfalls as CMS tests a new bundled payment program for cardiac care

Photo: Penn State via Flickr

The Centers for Medicare & Medicaid Services just announced a five-year test, to begin next summer, of a new way to pay for the care of patients who have had a heart attack or need coronary artery bypass graft surgery.

As with any new payment model, unintended consequences are possible. The experimental bundled-payment program, which was announced July 25 and will begin July 1, 2017, potential could lead some physicians to sell their practices to hospitals, be financially risky and potentially harmful to the hospitals forced to participate, and could lead to an increase in heart attacks, warned Francois de Brantes, executive director of the consulting firm Health Care Incentives Improvement Institute and an expert on bundled payment models. Continue reading