Hospitals are collecting consumer purchases…beware drinkers, over eaters, and the lazy…you have been warned!

 

 

You are on notice...BIG BROTHER IS WATCHING...and you will pay! But ah....if you are over using the system because of self destructive behavior (i.e. drug, drink, too much food...)  you should have to pay more! Just saying!

 

Hospitals Spy on Your Purchases to Spot Bad Habits

By Shannon Pettypiece and Jordan Robertson Jun 26, 2014 12:01 AM ET

You may soon get a call from your doctor if you’ve let your gym membership lapse, made a habit of picking up candy bars at the check-out counter or begin shopping at plus-sized stores.

That’s because some hospitals are starting to use detailed consumer data to create profiles on current and potential patients to identify those most likely to get sick, so the hospitals can intervene before they do.

Information compiled by data brokers from public records and credit card transactions can reveal where a person shops, the food they buy, and whether they smoke. The largest hospital chain in the Carolinas is plugging data for 2 million people into algorithms designed to identify high-risk patients, while Pennsylvania’s biggest system uses household and demographic data. Patients and their advocates, meanwhile, say they’re concerned that big data’s expansion into medical care will hurt the doctor-patient relationship and threaten privacy.

“It is one thing to have a number I can call if I have a problem or question, it is another thing to get unsolicited phone calls. I don’t like that,” said Jorjanne Murry, an accountant in Charlotte, North Carolina, who has Type 1 diabetes. “I think it is intrusive.”

Acxiom Corp. (ACXM) and LexisNexis are two of the largest data brokers who collect such information on individuals. They say their data are supposed to be used only for marketing, not for medical purposes or to be included in medical records.

While both sell to health insurers, they said it’s to help those companies offer better services to members.

Bigger Picture

Much of the information on consumer spending may seem irrelevant for a hospital or doctor, but it can provide a bigger picture beyond the brief glimpse that doctors get during an office visit or through lab results, said Michael Dulin, director of research and evidence-based medicine at Carolinas HealthCare System.

Carolinas HealthCare System operates the largest group of medical centers in North Carolina and South Carolina, with more than 900 care centers, including hospitals, nursing homes, doctors’ offices and surgical centers. The health system is placing its data, which include purchases a patient has made using a credit card or store loyalty card, into predictive models that give a risk score to patients.

Within the next two years, Dulin plans for that score to be regularly passed to doctors and nurses who can reach out to high-risk patients to suggest interventions before patients fall ill.

Buying Cigarettes

For a patient with asthma, the hospital would be able to score how likely they are to arrive at the emergency room by looking at whether they’ve refilled their asthma medication at the pharmacy, been buying cigarettes at the grocery store and live in an area with a high pollen count, Dulin said.

The system may also score the probability of someone having a heart attack by considering factors such as the type of foods they buy and if they have a gym membership, he said.

“What we are looking to find are people before they end up in trouble,” said Dulin, who is also a practicing physician. “The idea is to use big data and predictive models to think about population health and drill down to the individual levels to find someone running into trouble that we can reach out to and try to help out.”

While the hospital can share a patient’s risk assessment with their doctor, they aren’t allowed to disclose details of the data, such as specific transactions by an individual, under the hospital’s contract with its data provider. Dulin declined to name the data provider.

Greater Detail

If the early steps are successful, though, Dulin said he would like to renegotiate to get the data provider to share more specific details on patient spending with doctors.

“The data is already used to market to people to get them to do things that might not always be in the best interest of the consumer, we are looking to apply this for something good,” Dulin said.

While all information would be bound by doctor-patient confidentiality, he said he’s aware some people may be uncomfortable with data going to doctors and hospitals. For these people, the system is considering an opt-out mechanism that will keep their data private, Dulin said.

‘Feels Creepy’

“You have to have a relationship, it just can’t be a phone call from someone saying ‘do this’ or it just feels creepy,” he said. “The data itself doesn’t tell you the story of the person, you have to use it to find a way to connect with that person.”

Murry, the diabetes patient from Charlotte, said she already gets calls from her health insurer to try to discuss her daily habits. She usually ignores them, she said. She doesn’t see what her doctors can learn from her spending practices that they can’t find out from her quarterly visits.

“Most of these things you can find out just by looking at the patient and seeing if they are overweight or asking them if they exercise and discussing that with them,” Murry said. “I think it is a waste of time.”

While the patients may gain from the strategy, hospitals also have a growing financial stake in knowing more about the people they care for.

Under the Patient Protection and Affordable Care Act, known as Obamacare, hospital pay is becoming increasingly linked to quality metrics rather than the traditional fee-for-service model where hospitals were paid based on their numbers of tests or procedures.

Hospital Fines

As a result, the U.S. has begun levying fines against hospitals that have too many patients readmitted within a month, and rewarding hospitals that do well on a benchmark of clinical outcomes and patient surveys.

University of Pittsburgh Medical Center, which operates more than 20 hospitals in Pennsylvania and a health insurance plan, is using demographic and household information to try to improve patients’ health. It says it doesn’t have spending details or information from credit card transactions on individuals.

The UPMC Insurance Services Division, the health system’s insurance provider, has acquired demographic and household data, such as whether someone owns a car and how many people live in their home, on more than 2 million of its members to make predictions about which individuals are most likely to use the emergency room or an urgent care center, said Pamela Peele, the system’s chief analytics officer.

Emergency Rooms

Studies show that people with no children in the home who make less than $50,000 a year are more likely to use the emergency room, rather than a private doctor, Peele said.

UPMC wants to make sure those patients have access to a primary care physician or nurse practitioner they can contact before heading to the ER, Peele said. UPMC may also be interested in patients who don’t own a car, which could indicate they’ll have trouble getting routine, preventable care, she said.

Being able to predict which patients are likely to get sick or end up at the emergency room has become particularly valuable for hospitals that also insure their patients, a new phenomenon that’s growing in popularity. UPMC, which offers this option, would be able to save money by keeping patients out of the emergency room.

Obamacare prevents insurers from denying coverage because of pre-existing conditions or charging patients more based on their health status, meaning the data can’t be used to raise rates or drop policies.

New Model

“The traditional rating and underwriting has gone away with health-care reform,” said Robert Booz, an analyst at the technology research and consulting firm Gartner Inc. (IT) “What they are trying to do is proactive care management where we know you are a patient at risk for diabetes so even before the symptoms show up we are going to try to intervene.”

Hospitals and insurers need to be mindful about crossing the “creepiness line” on how much to pry into their patients’ lives with big data, he said. It could also interfere with the doctor-patient relationship.

The strategy “is very paternalistic toward individuals, inclined to see human beings as simply the sum of data points about them,” Irina Raicu, director of the Internet ethics program at the Markkula Center for Applied Ethics at Santa Clara University, said in a telephone interview.

Hospital's lose Hospital’s cutting work force…How much, and will effect me? Get admitted into the hospital, and find out!

So Obamacare is lowering reimbursements from Medicare. Americans are not signing up for Obamacare. Obamacare is reimbursing on the same scale as Medicaid (in some instances ½ of what Medicare pays). Private insurances are lowering reimbursements because Medicare is. Americans are losing their health insurance from work. Private insurances are not writing policies to individuals. On and on and on and on…..So what could go wrong? Read on and find out!

In Obamacare Buildup, Hospitals Face a Self-Inflicted Wound

By John Tozzi July 18, 2013

From BloombergBusinessweek

Liberty Hospital near Kansas City, Mo., has eliminated 120 jobs this year, closed its wound-care clinic, and stopped offering free rides to poor and elderly patients. The Cleveland Clinic is searching for ways to cut $250 million from its $6 billion budget in the next 16 months. It’s already closed expensive maternity wards in half the hospitals it operates. In northern New York, Adirondack Health may shutter its emergency room in Lake Placid and a dialysis center in Tupper Lake. All of these hospitals and scores of others nationwide are squeezing services to make up for unexpected budget shortfalls—the result of a deal they made with the federal government that they’re now having second thoughts about.

When the Obama administration was selling the benefits of the Affordable Care Act in 2010, the hospital industry agreed to accept a $155 billion decrease in Medicare payments over a decade. The administration assured hospital executives that patients newly covered under the health-care law would make up for much of the loss. Because of the ongoing squabbles between President Obama and Republicans in Congress over the U.S. budget, that hasn’t happened.

The automatic federal spending cuts known as sequestration have sliced an additional 2 percent from Medicare reimbursement payments to hospitals this year. Beginning next year, many hospitals will also collect less money from Medicaid, the federal program that provides coverage for the poor, than they’d been promised when they signed on to the Affordable Care Act. The law required all states to expand their Medicaid programs to cover uninsured citizens who make too little to buy plans under Obamacare. But the Supreme Court ruled last year that states could opt out. Nearly half have chosen to do so, as Republican governors or GOP-led state legislatures have opposed the increased Medicaid spending. That means 6 million poor Americans who would’ve been eligible for health coverage won’t get it; many of them will continue to walk into emergency rooms unable to pay for services that hospitals by law have to provide. “We are hugely affected by what’s happening in Washington,” Adirondack Chief Executive Officer Chandler Ralph says. “It’s a hiccup there, and it’s a tsunami here.”

For-profit health systems whose patients are largely covered by private insurance may be equipped to absorb the losses. Rural and inner-city hospitals that run on thin margins and treat large populations of patients on Medicare, Medicaid, or without any insurance are suffering. “The trade-off that the hospital industry made was, we’ll take lower payments going forward in exchange for more people being insured,” says Patrick McGuire, chief financial officer of St. John Providence Health System in the Detroit area, which eliminated 160 positions in May. “It’s not quite working out the way we thought it was going to.”

Missouri’s decision not to expand Medicaid is bad news for Ozarks Medical Center, which serves a largely poor, rural part of the state near the Arkansas border. Beginning on Oct. 1, the 114-bed nonprofit hospital will lose $630,000 a year in federal payments it now gets for treating low-income patients. Expanded coverage under Medicaid was supposed to make up for that, but Missouri’s Republican legislature blocked it. The federal sequester is taking another $660,000 from Ozarks’ budget, says CEO David Zechman. He and 64 other managers took a 5 percent pay cut at the end of June, and the hospital laid off 32 workers. A dozen open positions won’t be filled. “We haven’t cut any services yet. That’s not to say we won’t in the future,” Zechman says.

The industry is lobbying to get some government money back. A bill by Georgia Democratic Representative John Lewis would delay Obamacare cuts to the extra Medicare and Medicaid payments that Ozarks and other hospitals receive for treating the poor. Another measure, introduced in June by Democratic Representative Bruce Braley of Iowa, would reinstate some funds for rural hospitals, such as Adirondack Health, that were allowed to expire in the fiscal cliff standoff in December.

U.S. hospitals have lost jobs in two of the last six months, according to the Bureau of Labor Statistics, a point hospital lobbyist’s stress in their rounds on Capitol Hill. They aren’t hopeful of persuading lawmakers to put money back into the federal budget when all of Washington is arguing over how to take more out. Rick Pollack, executive vice president of the American Hospital Association, says hospitals that treat the poor and elderly are instead focused on preventing deeper cuts in the deficit showdown coming this fall. The goal for now, he says, is “making sure that there is no more harm done.”

Obamacare lowers reimbursements to Hospital! Hospital close because of ObamaCare Reimbursements

Hospitals were promised reimbursements for uninsured patients. Well…The uninsured are still uninsured. 75% of ObamaCare enrollments are Americans that had lost their health insurance because of ObamaCare. Here is the thing….Obamacare reimburses for SHIT! Hospitals cannot stay open with these low, low, low reimbursements. There you go…!

In Obamacare Buildup, Hospitals Face a Self-Inflicted Wound

By John Tozzi July 18, 2013 in BloombergBusinessweek

Liberty Hospital near Kansas City, Mo., has eliminated 120 jobs this year, closed its wound-care clinic, and stopped offering free rides to poor and elderly patients. The Cleveland Clinic is searching for ways to cut $250 million from its $6 billion budget in the next 16 months. It’s already closed expensive maternity wards in half the hospitals it operates. In northern New York, Adirondack Health may shutter its emergency room in Lake Placid and a dialysis center in Tupper Lake. All of these hospitals and scores of others nationwide are squeezing services to make up for unexpected budget shortfalls—the result of a deal they made with the federal government that they’re now having second thoughts about.

When the Obama administration was selling the benefits of the Affordable Care Act in 2010, the hospital industry agreed to accept a $155 billion decrease in Medicare payments over a decade. The administration assured hospital executives that patients newly covered under the health-care law would make up for much of the loss. Because of the ongoing squabbles between President Obama and Republicans in Congress over the U.S. budget, that hasn’t happened.

The automatic federal spending cuts known as sequestration have sliced an additional 2 percent from Medicare reimbursement payments to hospitals this year. Beginning next year, many hospitals will also collect less money from Medicaid, the federal program that provides coverage for the poor, than they’d been promised when they signed on to the Affordable Care Act. The law required all states to expand their Medicaid programs to cover uninsured citizens who make too little to buy plans under Obamacare. But the Supreme Court ruled last year that states could opt out. Nearly half have chosen to do so, as Republican governors or GOP-led state legislatures have opposed the increased Medicaid spending. That means 6 million poor Americans who would’ve been eligible for health coverage won’t get it; many of them will continue to walk into emergency rooms unable to pay for services that hospitals by law have to provide. “We are hugely affected by what’s happening in Washington,” Adirondack Chief Executive Officer Chandler Ralph says. “It’s a hiccup there, and it’s a tsunami here.”

For-profit health systems whose patients are largely covered by private insurance may be equipped to absorb the losses. Rural and inner-city hospitals that run on thin margins and treat large populations of patients on Medicare, Medicaid, or without any insurance are suffering. “The trade-off that the hospital industry made was, we’ll take lower payments going forward in exchange for more people being insured,” says Patrick McGuire, chief financial officer of St. John Providence Health System in the Detroit area, which eliminated 160 positions in May. “It’s not quite working out the way we thought it was going to.”

Missouri’s decision not to expand Medicaid is bad news for Ozarks Medical Center, which serves a largely poor, rural part of the state near the Arkansas border. Beginning on Oct. 1, the 114-bed nonprofit hospital will lose $630,000 a year in federal payments it now gets for treating low-income patients. Expanded coverage under Medicaid was supposed to make up for that, but Missouri’s Republican legislature blocked it. The federal sequester is taking another $660,000 from Ozarks’ budget, says CEO David Zechman. He and 64 other managers took a 5 percent pay cut at the end of June, and the hospital laid off 32 workers. A dozen open positions won’t be filled. “We haven’t cut any services yet. That’s not to say we won’t in the future,” Zechman says.

The industry is lobbying to get some government money back. A bill by Georgia Democratic Representative John Lewis would delay Obamacare cuts to the extra Medicare and Medicaid payments that Ozarks and other hospitals receive for treating the poor. Another measure, introduced in June by Democratic Representative Bruce Braley of Iowa, would reinstate some funds for rural hospitals, such as Adirondack Health, that were allowed to expire in the fiscal cliff standoff in December.

U.S. hospitals have lost jobs in two of the last six months, according to the Bureau of Labor Statistics, a point hospital lobbyists stress in their rounds on Capitol Hill. They aren’t hopeful of persuading lawmakers to put money back into the federal budget when all of Washington is arguing over how to take more out. Rick Pollack, executive vice president of the American Hospital Association, says hospitals that treat the poor and elderly are instead focused on preventing deeper cuts in the deficit showdown coming this fall. The goal for now, he says, is “making sure that there is no more harm done.”