From Health Care

Number Of Cases Of Mysterious Polio-Like Illness In Children Climbs To Record High, Well Above Previous Years

What’s more, CDC officials say many children have lasting paralysis, and close to half the kids diagnosed with it this year were admitted to hospital intensive care units. In other public health news: CRISPR and gene editing ethics; screen time for kids; telemedicine; suicide; and more.

Sandy Hook Shooter’s Documents Offer No Revelations, But Experts Say They Could Offer Insights About Disturbed Minds

Under a court order, Connecticut State Police released hundreds of pages of documents that shed light on gunman Adam Lanza’s anger and fascination with mass shootings. While some in the criminology field say it could spur copy cat killer or glorify mass shooters, others see it as helpful insights about his isolation and odd behaviors.

Sen. Markey Wants To Know Why Nurses, Other Good Samaritans Are Denied Life Insurance For Carrying Naloxone

Sen. Ed Markey (D-Mass.) wants to know how insurers determine if an applicant is prescribed naloxone because they are at risk for an overdose, or to save others; how often have applicants been denied life insurance for carrying naloxone; and whether there are guidelines to prevent wrongful denials. Other news on the national drug epidemic comes from Oregon and Texas.

Proposed ‘Public Charge’ Policy Would Have ‘Deleterious Impact’ On Dallas’ Economy And Public Health, Mayor Says

The city is the latest to take a stand against the Trump administration’s proposed policy that would penalize legal immigrants who are seeking green cards for accepting government aid such as Medicaid. Meanwhile, Democratic lawmakers at the national level are coming out against the proposal.

Obama Strikes Serious Tone As He Implores People To Sign Up For Health Law Coverage Before Deadline

“No jump shots. No ferns. No memes. Not this time. I’m going to give it to you straight: If you need health insurance for 2019, the deadline to get covered is December 15,” tweeted former President Barack Obama, who in the past has taken more light-hearted approaches. “Pass this on — you just might save a life.” Enrollment news comes out of Maryland and Georgia, as well.

Health Industry Groups: Congress Must Act To Protect Patients From Surprise Medical Billing

“When doctors, hospitals or care specialists choose not to participate in networks, or if they do not meet the standards for inclusion in a network, they charge whatever rates they like,” wrote the groups, which include powerful lobbyists like the Blue Cross and Blue Shield Association, America’s Health Insurance Plans, the National Business Group on Health, and the Consumers Union. “The consequence is millions of consumers receiving surprise, unexpected medical bills that can often break the bank.”

One Implant, Two Prices. It Depends On Who’s Paying.

Kim Daniels didn’t have to pay a penny for her double mastectomy or the reconstructive surgery she had after treatment for breast cancer in June 2018. Her health insurance, PennCare, administered through Independence Blue Cross in Pennsylvania, fully covered both procedures.

Knowing that, cost wasn’t an issue for Daniels when selecting the type of breast implants. She asked her plastic surgeon at the Hospital of the University of Pennsylvania, “If I were your wife, what would you [choose]?” He went with Mentor MemoryGel implants.

According to Daniels’ hospital bill, those implants came with a price tag of $3,500 apiece, or $7,000 total.

Such a high charge for the exact same item would have been unthinkable if the procedure was cosmetic breast augmentation, which is generally not covered by health insurance. When patients pick up the tab, cosmetic surgery packages for breast augmentation cost about the same — $7,000 — but that includes the doctor’s fee, implants, operating room time and anesthesia.

The radical difference in price demonstrates in stark numerical terms how costs often depend on who is paying the bill.

Dr. Anupam Jena, a health economist at Harvard Medical School, said it’s precisely because cosmetic patients pay out-of-pocket that their costs for implants are far lower than what hospitals charge reconstructive patients.

“Cosmetic surgery providers have to compete with each other,” he said, and “one of the big ways they’re going to compete is to compete on price.”

“Whatever the cost is for the implant, they can’t up-charge too much, or a patient will just go somewhere else.”

Dr. Alex Sobel, a cosmetic surgeon and president of the American Board of Cosmetic Surgery, said the price he charges cosmetic patients for breast implants is pretty close to the price he pays for the implants from the manufacturer. High-end implants like Daniels’ would be priced at a maximum of $3,000 for a set, he added, if Daniels had been undergoing cosmetic breast augmentation surgery.

Sobel operates a cosmetic surgery practice in Bellevue, Wash., which is in the region of the U.S. with the highest cost range for cosmetic breast surgeries. He said he usually pays around $250 to $700 per implant for saline and $700 to $1,000 per implant for silicone. The most expensive form — stable silicone or “gummy bear” implants — are usually priced around $1,350 each.

Similarly, Dr. Brent Rosen, a cosmetic surgeon with a practice in a northern suburb of Philadelphia, said the silicone implants he buys range from $1,500 to $2,000 per individual implant.

For the entire cosmetic breast augmentation procedure with silicone implants Rosen charges $6,500. That’s $500 less than the charge for just Daniels’ silicone implants at the nearby Hospital of the University of Pennsylvania.

Jena, the Harvard health economist, said the reason behind many of these price markups is that hospitals are like any other business trying to make a profit. They can ask more from a company like an insurer than they can from an individual.

“Why does Apple charge $1,000 for an iPhone? It doesn’t cost that much to make an iPhone. It’s so they can extract surplus money. Same goes for hospitals,” said Jena.

Breast implants are just one example of how medical devices are significantly marked up by hospitals.

A 2017 study published in JAMA found that for knee and hip implants, insurance companies were paying double what the hospitals paid when they purchased the implants from manufacturers.

It is hard to define a reasonable manufacturing cost or wholesale price for a medical-grade bag of silicone. Mentor Worldwide and Allergan, the two biggest manufacturers of breast implants in the U.S., declined to share their products’ wholesale costs or their price negotiation practices with providers. Manufacturers regard their pricing as a trade secret.

Hospitals typically obtain medical devices through health care group purchasing organizations, which are supposed to negotiate with manufacturers to get lower costs for items. Bigger hospitals or providers that offer to use more of a certain product often get steep discounts over wholesale.

In 2016, Medicare, which has huge leverage in negotiations, paid $516.59 for a “silicone or equivalent breast prosthesis.”

So, the hospital markup for patients who pay for the procedure or are commercially insured is even more extraordinary.

A Penn Medicine spokesperson told KHN in an email that they were unable to comment on specific patient cases, but that the hospital receives a single “case rate” or bundled payment for all breast reconstruction surgeries and that reimbursement is not related to the type of breast implant chosen.

Of course, when dealing with powerful insurance companies, hospitals don’t get paid the full asking price conveyed on their bills. The price is often merely the starting point for negotiations with insurers.

“Hospitals are absolutely marking up the prices for medical devices,” said Jeffrey McCullough, a health policy professor at the University of Michigan. But, he added, “you can almost guarantee the list price you see on a hospital bill is not what the hospital is getting paid by insurance companies,” which bargain for discounts.

Even so, not all patients have health insurance coverage as comprehensive as Kim Daniels’. In such cases, all or part of the hospital’s high charge for breast implants could be billed directly to patients.

“If you don’t have an insurance company bargaining on your behalf, the default is to charge the patient,” McCullough said.


KHN’s coverage of women’s health care issues is supported in part by The David and Lucile Packard Foundation.

Planned Parenthood’s State Funding Protected With Supreme Court’s Decision Not To Hear Case

Five Supreme Court justices rejected an appeals case from Kansas and Louisiana in their effort to withhold Medicaid money from Planned Parenthood. As a result, two lower court rulings stay in place that block the states from stripping funds from the women’s reproductive health organization. Justice Clarence Thomas, one of the three dissenting judges, accused his colleagues of avoiding the case for political reasons.

Weeklong Strike Set To Start For 4,000 Kaiser Mental Health Professionals In California

“This strike is a clear message to Kaiser that its mental health clinicians won’t stand by silently while their patients can’t get the care they need,” union leader Sal Rosselli said in a statement. Kaiser claims the union is most interested in raising wages that are already among the best in the nation.

Weeklong Strike Set To Start For 4,000 Kaiser Permanente Mental Health Professionals In California

“This strike is a clear message to Kaiser that its mental health clinicians won’t stand by silently while their patients can’t get the care they need,” union leader Sal Rosselli said in a statement. Kaiser Permanente claims the union is most interested in raising wages that are already among the best in the nation.

Doctors Who Treat Gunshot Victims Tell NRA Why Gun Safety Is Their ‘Highway’

After the NRA said “anti-gun” physicians should stay in their lane, a growing number of doctors join the social media campaign with the hashtag “#ThisIsOurLane,” gaining support from the U.S. Surgeon General Jerome Adams. Other gun violence news looks at a lack of CDC gun studies, a faulty high school active shooter drill and disturbing writings from the Sandy Hook shooter.