June 10, 2005
i t e m s o f i n t e r e s t f r o m t h e m e d i a
Modern Healthcare – June 6, 2005
Hatch hunts for hospitals
By Melanie Evans
Three times in as many months, Whether other states follow suit insurance. The hospitals and clinics
Minnesota's Attorney General Mike remains to be seen. also agreed to adopt a zero-
Hatch and state hospital executives tolerance policy for abusive debt-
have heralded deals to end one of "The rest of the country is going to collection practices and not to sue
the most divisive practices in follow," Hatch said. "It has to." for payment before first making
healthcare: billing uninsured sure patients owe money and their
patients more for care than those Hatch has long been an aggressive insurers have been billed, if
with medical benefits. watchdog of Minnesota's healthcare appropriate. An estimated 400,000
The latest agreements, announced industry. His audits of Minnesota residents are uninsured.
last week, included 35 hospitals that Bloomington, Minn.-based
voluntarily signed two-year deals HealthPartners; Allina, A single standard for all U.S.
with Hatch to give uninsured Minneapolis, and its former health hospitals may be difficult to draft,
patients at least the same discount plan, Medica, criticized Minnesota said Richard Scruggs, the Oxford,
as had been negotiated with each not-for-profits for excessive Miss., lawyer leading a consortium
hospital's largest insurer. In May, 16 spending on travel and of lawyers suing not-for-profit
hospitals with four Twin Cities entertainment. hospitals over how and how much
health systems voluntarily signed they bill the uninsured. But no
identical agreements. Hospitals face mounting pressure hospital should bill uninsured
nationally to address aid for the patients more than those with
A fifth health system, Fairview uninsured. Congress and state coverage, he said. Not-for-profits
Health Services, reached a separate legislatures have launched inquiries. receive a tax exemption to provide
deal announced April 1 that covers Lawyers have sued not-for-profits, care to the underserved.
six hospitals, after being the subject alleging that unfair billing and
of a 15-month inquiry by Hatch aggressive collection practices "There's no justification for a
(For a complete list of participating violate their tax-exempt status. penalty for being poor and
hospitals, click here. To date, Minnesota hospitals have addressed uninsured," Scruggs said, nor will it
roughly 75% of Minnesota hospital the problem head- on, Hatch said, hurt them financially to change.
admissions are covered by such and others can, too. "That's not where any hospital, big
agreements, which also lay out or small, rich or poor, makes any
standards for debt-collection "It's the right thing to do," he said. money."
policies. "If it's the right thing to do that the
uninsured should pay the market Terence Pladson, president and
Expect more hospitals in the state to rate, then do it. If it's the right thing chief executive officer of
follow, said Hatch and Minnesota to do to set standards for CentraCare Health System, is also a
Hospital Association President collections, then do it." member of the St. Paul-based
Bruce Rueben. "We believe other Minnesota Hospital Association's
hospitals will sign on because it's Under the agreements, patients with board of directors, which worked
become an industrywide standard in annual household incomes of with Hatch to draft the billing and
Minnesota," Hatch said. In many $125,000 or less will be charged no collection agreements. CentraCare,
cases, hospital executives must wait more than the amount paid by each St. Cloud, which owns three central
for trustees or directors to meet and hospital's largest insurer according Minnesota hospitals, promised to
approve the deal before signing on, to revenue. The terms apply to adopt the standards, which modified
Rueben said. patients without insurance and to similar discount and collection
medical care not covered by
policies adopted by its board within to hospitals, which seek to make up Unlike other agreements, Fairview's
the last year. lost revenue by spreading costs to deal requires that a third-party
other patients. Insurers negotiate reviewer must agree the health
"We saw this as a positive response discounts for enrollees, leaving the system has complied with all
to a major public challenge," uninsured bearing the brunt of a necessary safeguards before suing a
Pladson said. Hospitals sought a broken system, he said. patient for payment.
voluntary agreement to avert more
stringent state legislation or costly, Mark Rukavina, director of the David Page, Fairview's president
time-consuming investigations by Access Project, Boston, praised the and CEO, said Hatch's inquiries into
Hatch. deal and said it appears more Fairview highlighted unrecognized
comprehensive than legislative problems faced by Minnesota's
"Hospitals elsewhere face a similar efforts elsewhere, such as in uninsured. "We have an activist
choice," he said. "I would urge Connecticut and California, where attorney general who is interested in
other states to look to proactively laws address patients' access to and understands the healthcare
enact similar measures or discuss information or what fees and industry," Page said.
them with their hospital associations interest hospitals can charge. "This
before Congress takes action." is a new development," he said. For Fairview, Hatch's audit
provided uncomfortable but
"It's a great example," said Nancy Alicia Mitchell, spokeswoman for important lessons. "We had to get
Kane, a professor of health policy the American Hospital Association, past the criticism and look at
and management at Harvard said the trade group applauds the ourselves in the mirror," he said,
University's School of Public Minnesota agreements. The AHA “and ask, `Are we proud of all the
Health. Kane testified at a U.S. encourages hospitals to develop things we're doing?' "
House Ways and Means Committee local solutions to billing and
hearing on not-for-profit hospitals collection issues, she said. The answer was no. Now, as
that too few of them provide enough Fairview adopts changes, the health
financial aid for needy patients to One agreement -- the one between system must do more than follow
justify their tax-exempt benefits. Hatch and Minneapolis-based the letter of the law and be fully
Before Congress, Kane called for Fairview -- differs from the rest, responsible for its policies. When an
stronger standards to be required for which were voluntary. Hatch error occurs, "we've got to err on the
hospitals that are granted tax- concluded a 15-month inquiry into side of the uninsured," Page said.
exempt status, including discounted Fairview by releasing a damning
rates for the uninsured and less five-volume report on the health Jim Abelsen, senior vice president
aggressive collection practices. system's collection and billing and general counsel for St. Mary's
"That's where Minnesota is headed," practices. Duluth (Minn.) Clinic Health
she said. System, said Fairview's experience
No other Minnesota health systems raised awareness among Minnesota
Minnesota's history as a progressive were subject to an inquiry. hospitals that uninsured patients
state, with a commitment to public However, four systems that paid an unfair price for medical
health and no investor-owned announced deals with Hatch in early care.
hospitals, made it easier for such an May -- Allina Hospitals & Clinics,
agreement to flourish, Kane said. Minneapolis; HealthEast Care "I think you need to give credit to
"Hopefully, more states will see it System, St. Paul; North Memorial the attorney general for recognizing
as something to emulate," she said. Health Care, Robbinsdale; and Park a problem, and you need to give
Nicollet Health Services, St. Louis credit to Fairview for
"Of course, that's for other states to Park -- received requests for acknowledging it," Abelsen said. As
answer," said the MHA's Rueben. "I information about billing and more Minnesota hospitals adopt the
think what we're doing is the right collection practices from Hatch. standards, it sends a message to the
thing for Minnesota." state's residents that the healthcare
Fairview's low-income patients system is responsive to their needs.
The deal won't solve the wider faced harassing collectors, even "There is a value in acknowledging
problem of access to affordable after agreeing to payment plans. a problem and agreeing to live by
healthcare, he said. "What led us to Fairview garnished wages that standards and then letting the public
this point is a flawed financing should have been exempt from such know they'll be accountable," he
system," Rueben said. Government action and pursued payment from said.
insurers deeply discount payments those who did not owe money.
Des Moines Register – June 4, 2005
Don't mix two issues of income,
hospitals' tax status
By Jack Dusenbery
A May 30 Register editorial took issue with the publicly the cost of supplies, staff, overhead and the allocation of
reported earnings of several physicians based at Covenant the cost of caring for the uninsured among the insured.
Medical Center in Waterloo. The issue at hand has been
inappropriately intertwined with the tax-exempt status of Tax-exempt status allows hospitals like Covenant Medical
hospitals. Center to ensure that a full array of high-quality services is
available to all who seek them. While "for-profit"
First, on physician compensation: Certainly the numbers competitors cry foul, they open surgery centers and add
are attention-grabbing. Underreported and certainly imaging facilities to siphon out business they carefully
underappreciated are the underlying numbers from which select, leaving to hospitals the care for the uninsured and
that compensation was calculated - statistics that speak to the responsibility for unprofitable business lines, like many
how hard each of these physicians works. emergency rooms and obstetric programs.
The Register was provided with data on these physicians' Tax-exempt status helps institutions run patient-care
so-called relative value unit, which showed, related to services that, if left to profit-and-loss decisions, might not
national data, that the amount of care delivered is in the be made available locally. The status allows systems like
top 1 percent nationally. Their work generated payment, Covenant to reinvest in the community and our charitable
primarily from insurers, that, minus business expenses, mission by providing clinics in rural Iowa - Jessup and
became income to the physician. They are not paid a Oelwein, Gladbrook and Hudson. Tax-exempt status
salary; they were paid what they earn by seeing patients. creates modern facilities and high-quality care in places
where it is needed - our hometowns.
The level of work, not the corresponding compensation,
points more to the real problem - a shortage of specialty Current movements to review the rules and status of tax-
physicians in rural health-care markets. It is not executive exempt health-care providers are important and
compensation; it was earned by responding to patient worthwhile. We support efforts to ensure that health-care
needs every day of the week, regardless of the hour. dollars are spent taking care of people in need, not paying
salaries to those who in their daily work might never see a
It demonstrates what is still right about health care - patient.
dedication to serving those in need. We believe their hard
work and dedication is commendable, not condemnable. We fear that recent stories have confused the issues of how
much physicians can earn seeing patients and the
Second, on the issue of tax exemption: These physicians worthiness of the tax exemption their home-base hospital
did not benefit from this hospital's status. They were paid receives. It would be bad public policy to continue the
the same for the work performed as their colleagues in confusion and send a message that taking care of patients
other local health systems or in stand-alone practice for when and where needed is wrong.
similar activity during the same time period.
We all need to be part of the debate to make sure that,
Paying people not providing patient care an excessive from access, to privacy, to care for the uninsured, to the
salary is far different from paying a physician what his or high cost of care, we make decisions that put patients first.
her personal patient-care activity, minus business
expenses, generated. JACK DUSENBERY is president and chief executive
officer of Covenant Health System.
Doctors seeing patients is not what drives up the cost of
care, as your editorial suggests. The true accelerants are
Washington Post – June 8, 2005
Doesn't Always Work for Health Care
By Steven Pearlstein
As the head of Medicare and Medicaid, Mark McClellan profit they need to operate unprofitable departments such
may be the most powerful man anywhere, in control of as burn units and emergency rooms 24/7.
about 7 percent of the U.S. economy. And today was to be
the deadline for him to rule on one of the most heavily In truth, the arguments tend to jumble different issues that
lobbied issues of the past year: whether to lift an 18-month need to be pulled apart.
moratorium on creating new physician-owned specialty
hospitals. While specialized, high-volume units are probably a better
way to provide some health services, they don't need to be
It's all very technical and bureaucratic, to be sure. But in owned by physicians. There are plenty of other sources of
deciding the issue, McClellan is being asked to choose investment capital. And the experience with doctor-owned
between two competing and fundamentally irreconcilable labs and MRI machines suggests that physician ownership
models for the U.S. health care system. of surgical hospitals will inflate total health care spending
by increasing the number of unnecessary operations.
One model would rely even more on competition among
self-interested providers for the business of increasingly At the same time, community hospitals are probably right
empowered consumers to restrain prices, assure quality that specialty hospitals cream-skim the most profitable
and spur innovation. That, after all, is how it works in business. But the larger question is why the system doesn't
nearly every other industry. allow hospitals to price their services so that "hard" cases
are just as profitable as "easy" ones and emergency rooms
The other model is based on the premise that competition enjoy the same operating margins as cardiac units.
in health care will always be highly imperfect, and that too Eliminating cross-subsidization within hospitals would
much competition will have socially unacceptable significantly reduce the amount of "cream" available for
consequences. This model envisions even more "skimming."
government regulation and stronger management by public
and private health plans. McClellan hopes that by adjusting and refining Medicare
reimbursement rates for different categories of services,
In a decision that seems only fitting for a Harvard-trained and allowing general hospitals to offer "gains-sharing"
physician and MIT-trained economist, McClellan has payments to doctors that could substitute for ownership of
decided to kick the can down the road, extending the their departments, he can level the playing field enough to
moratorium until year-end. diffuse the specialty hospital issue. Like many
conservatives, he looks to specialty hospitals, consumer-
There are about 130 physician-owned specialty hospitals, driven health savings accounts and new reimbursement
most of them focused on heart, orthopedic or other types of schemes that pay doctors and hospitals for the quality
surgery. There is some evidence that by doing large rather than the quantity of care they provide to push the
numbers of the same kinds of operations, the tightly U.S. health care system toward the market model.
focused hospitals lower costs, improve medical outcomes
and deliver more patient satisfaction. And, in theory, McClellan's crusade is likely to fail, however, if he doesn't
giving doctors a stake in the enterprise not only gives them resolve a fundamental question about the proper role of
greater control over their professional lives, but also offers doctors in the health care system.
extra incentive to innovate and improve service.
When they are vilifying insurers and managed-care
General hospitals, by contrast, see the move toward companies, physicians like to present themselves as Dr.
specialty hospitals as nothing more than cream-skimming Welby -- selfless professionals whose medical judgments
by self-dealing doctors that will put community hospitals would never, ever be colored by their financial interests.
into an economic death spiral. They argue that doctors But in lining up behind physician ownership of specialty
referring patients to hospitals they own is an unacceptable hospitals, the doctors essentially acknowledge that they are
conflict of interest. And by siphoning off the most just like the rest of us, their behavior swayed by even
profitable patients in the most profitable parts of medicine, modest financial incentives.
the specialists rob general hospitals of the scale, scope and
You can't have it both ways. And the way the people For most Americans, providing health care ought to be
would have it is to pay their doctors well, put them in the different from selling soap; they won't tolerate doctors
central decision-making role in the health care system -- acting like commissioned salesmen and investment
and then demand that they give up the right to invest in bankers. And if that means having less market competition
MRI machines or specialty hospitals or get incentive and more regulation in the health care system, it seems to
payments from drug companies. be a trade-off they're willing to make.
Wall Street Journal – June 7, 2005
Cases, Fines Soar In Fraud Probes Of Drug Pricing
By John R. Wilke
Months before a new law kicks in The recent surge in cases reflects criminal investigations under way
that will dramatically escalate increasing scrutiny of drug makers' stands at 150 and involves nearly
government spending on drugs, pricing practices and a sharp rise in 500 drugs. "We've been focusing on
state and federal prosecutors are federal and state prosecutions of pharmaceuticals intensively over the
investigating 150 cases that involve health-care fraud. Prescription drugs past year, to coordinate the massive
alleged pricing fraud by some of the represent an ever-larger share of the number of cases with others in law
world's largest drug makers and nation's health bill, and the federal enforcement, the states and federal
could produce more than $1 billion government is preparing for a huge agencies," he said.
in criminal fines and civil penalties increase in spending when the new
this year. Medicare drug benefit goes into The scope of the investigation and
effect in January. the cooperation involved suggests
The cases are part of an expanding that what had appeared to be
industrywide investigation of drug It will cover prescription drugs for scattered moves in the past few
pricing that has produced scores of the first time for more than 40 years has coalesced into a broad
lawsuits currently under seal in million Americans and will cost an concerted effort. State and federal
courts around the country. They are estimated $720 billion in its first 10 fraud cases have already netted $2.4
focused on allegations that drug years. With these huge increases on billion from drug firms -- including
companies cheat state and federal the way, Senate Finance Committee Bayer Corp., Pfizer Inc. and
health-care programs by inflating Chairman Charles Grassley, an Schering-Plough Corp. -- that were
prices, offering undisclosed rebates Iowa Republican, has pressed the alleged to have overcharged state or
to distributors or marketing drugs Justice Department to step up fraud federally backed health-care
for unapproved uses, according to enforcement. programs, according to an estimate
lawyers and officials involved in by Taxpayers Against Fraud, a
these cases. While the criminal and civil nonprofit advocacy group. James
penalties and settlements represent a Moorman, the group's director, said
A half-dozen major drug makers small fraction of drug-company the cases publicly acknowledged to
have already paid fines and profits, they are rising fast. Fines date are "just the tip of the iceberg."
penalties to settle charges in the past and penalties this year could amount
two years. At least three more -- to almost twice the totals paid in "It's safe to say that we're
Serono Inc., Abbott Laboratories each of the past three years, officials investigating many more companies
Inc. and King Pharmaceuticals Inc. - said. than have been publicly identified,"
- are expected to face similar said Patrick O'Connell, a prosecutor
allegations and possible criminal Peter Keisler, who oversees the in the Texas attorney general's
fines or civil penalties this year. Justice Department's civil-fraud office. He wouldn't name
unit, said that "the most frequent companies under scrutiny. Nicholas
Prosecutors also could force these defendant in fraud cases today is in Messuri, an assistant attorney
companies to accept "corporate health care" and that the industry general in Massachusetts, said this
integrity agreements" that include now accounts for "the lion's share of year "already looks like a record-
tough federal oversight of the way fraud, both in number of cases and breaking year" for health-care fraud
the companies price and market dollar amounts -- and those numbers cases.
drugs under government-paid are going up."
health-care programs, including Serono, the U.S. unit of Swiss-
Medicaid and Medicare. Mr. Keisler wouldn't discuss based Serono SA, one of Europe's
individual cases. But he said the largest drug makers, has set aside
number of separate civil and $725 million to cover possible
criminal fines and civil penalties. taxpayers by falsely setting a high defend ourselves against these
Serono says it is cooperating with reimbursement rate, the suit said. claims."
the inquiry, which it describes as Under Medicaid rules, companies
"an ongoing, industrywide are generally required to give the Much of the new wave of cases is
investigation by the states and government the best price that they being pursued under the False
federal government" into the setting give to any purchaser of a drug. Claims Act, signed into law by
of wholesale prices and other Abraham Lincoln to damp
commercial practices, and that Since the California case was filed profiteering in the war effort and
many other drug companies are also in 2003, investigators have found an during reconstruction. Under the
under scrutiny. alleged pattern of similar fraud act, which was widened in 1986, the
involving other drugs and other government gets triple damages
King Pharmaceuticals, of Bristol, companies, lawyers briefed on the when companies are found to have
Tenn., and Abbott, of Abbott Park, case said. As a result of this new bilked taxpayers.
Ill., also have said they are information, a wider complaint
cooperating with investigators. King against Abbott and other drug Last year, Pfizer paid $430 million
has set aside $130 million for companies is expected to be filed to settle False Claims Act lawsuits
possible civil penalties and fines. A within weeks, including new involving marketing of its anti-
spokesman says the company hopes charges covering other drugs and seizure medication, Neurontin, for
to strike a "comprehensive new defendants, and possibly new unapproved uses after a sales
settlement" soon with the Justice federal charges, lawyers briefed on executive blew the whistle on the
Department and other regulators to the case said. Justice Department practice. Schering-Plough settled
resolve all pricing claims. officials declined to comment. two False Claims Act cases for a
combined $372 million, for
Abbott faces pricing-fraud claims In a statement, Abbott said the allegedly reporting inflated prices
brought two years ago by California case "is "similar to others for its Claritin antihistamine and
California's attorney general, based filed against our industry." The albuterol asthma inhalant. In 2003,
on alleged overcharges to company said it has "consistently Bayer paid $257 million for
government-paid drug programs for complied with all laws and concealing pricing data; Bayer also
vancomycin, a powerful antibiotic. regulations" and "properly and paid $14 million for alleged
Abbott is alleged to have reported to lawfully provided information as overcharges in 2001, in one of the
the state Medi-Cal program an required by the government and first big cases that led investigators
average wholesale price of $55 a requested by the independent drug- to begin examining similar alleged
dose while charging pharmacies price reporting services." The pricing frauds by other major drug
only $6.29 a dose. The alleged statement added, "We have a strong makers, state and federal officials
scheme, apparently intended to help defense and intend to vigorously said.
the drug gain market share, cheated
Wall Street Journal – June 3, 2005
Health Effort Tackles Patients' Data
By Vanessa Fuhrmans
More than 50 major health insurers, patient from any participating health and what it covers. In many cases,
medical associations, hospitals and plan, possibly by early next year, staffers spend hours on the phone
technology companies have joined group participants say. with managed-care companies or
in an effort to resolve a daily hassle logging on to dozens of differently
that contributes to health-care costs: Once information-exchange formatted health-plan Web sites.
the cumbersome process of standards are established, the group The time and money spent on this
obtaining patients' health-insurance expects technology companies that administrative chore have grown
information. specialize in administrative software with the multiplying variations on
for doctors will create systems to co-payments and deductibles. Soon,
The effort could lead to an initial set extract patient eligibility from the the growth of consumer-driven
of information-exchange rules this various health plans. health plans will bring even more
fall. These would allow medical complexity to the task.
providers, using an electronic Today, medical practices have no
system of their choice, to obtain single, easy way of checking Physician practices containing 10
coverage information for any whether a patient has a health plan physicians spend about $39,000
annually, on average, to verify information-exchange rules allow The Waltham, Mass., company
coverage eligibility, according to a easy use of direct deposit or athenahealth Inc., which sells such
survey conducted for the Medical automated tellers regardless of online systems to providers, says
Group Management Association, where a person's home bank is about 23% of claims denied by
while larger medical centers often located. insurers are because of incomplete
spend more than $1 million. Further or incorrect eligibility information.
contributing to health-care costs are "For that information transfer to And according to CAQH, some
claims errors or denials due to happen they have to talk in the same medical groups estimate that up to
incorrect or sketchy information. language and work under the same 50% of the bad debt they incur
operating rules," Ms. Thomashauer comes from inaccurate eligibility
To address that, a health-plan said. information.
alliance called the Council for
Affordable Quality Healthcare has With the parameters set, software The physician practices owned by
brought together the disparate group companies would know what is the University of Kansas Hospital in
to hammer out a set of interoperable needed. "They've already said, if we Kansas City see about 800 patients
rules for exchanging such health can come up with the rules, the a day. Often patients forget their
benefit and eligibility information. marketplace will build this," said insurance cards, or present cards
The group includes insurers such as Carl Volpe, vice president of that are out of date or don't detail
Aetna Inc. and Humana Inc., some strategic initiatives for health- what is actually covered. Patient
of the biggest Blue Cross and Blue insurance titan WellPoint Inc., eligibility for government programs
Shield plans, Montefiore Medical another participant in the initiative. such as Medicaid can change
Center of New York, and the federal monthly.
Centers for Medicare and Medicaid Already, many larger practices and
Services. And the group continues hospitals use automated software "There's no way we can call every
to add participants. that verifies patients' eligibility with health plan or look at every Web
health-plan Web sites ahead of an site," said Tammy Shepherd, chief
The idea isn't to create a central appointment. But the information financial officer of the Medical
database of information, said Robin isn't consistent among the Web Administrative Services of KU,
Thomashauer, CAQH's executive sites, and usually doesn't explain owned by the hospital.
director. Rather, the model is the what co-payments or deductibles
banking industry, where are involved.
Los Angeles Times – June 6, 2005
A mini price, a mini policy
By Daniel Costello
Connie Terwilliger, a 53-year-old perhaps some prescription drugs but get coverage or to help struggling
voice-over artist, has found a way to that don't cover catastrophic employees keep it.
cut her insurance premiums by more illnesses or most hospital care.
than half. California-based Jack in the Box
For some healthy consumers, they Inc. and Marie Callender's recently
By switching health plans, her may be a good idea. But as the plans started offering limited-benefit
monthly cost will drop from $300 to become more popular, consumer health plans to their employees,
$123. For that, she will get five advocates warn that they may joining companies such as Exxon
doctor visits a year, some lab tests provide a false sense of security. Mobil Corp., Home Depot Inc. and
— and strict limits on hospital care. Without that ultimate protection, Denny's Corp. Later this year, more
they say, the plans might not always than 20 national companies,
"I'm pretty healthy and in many be worth the cost. including Intel Corp., IBM and
ways this plan is better for me at Sears, Roebuck & Co., are expected
half the price," the San Diego The bare-bones policies, known as to include limited health insurance
woman said. "limited-benefit" or "mini-medical" in their coverage options as well.
plans, have been popular for several
Like Terwilliger, more Americans years with some small employers. Critics of mini-medical insurance
are turning to low-cost health plans, Now more companies are point out that most employers don't
some as cheap as $50 a month, that embracing the leaner policies as a contribute to the plans, as opposed
pay for routine doctor visits and way to cajole uninsured workers to to traditional plans in which
employers often pay 80% to 100% that typical comprehensive plans do. for doctor visits and prescription
of employee premiums. Most pay for routine medical care drugs run about $20 to $50.
such as doctor visits and offer some
And, they say, these policies won't prescription drug coverage but Because they have yearly coverage
much help workers who most need typically cover only a tiny portion ceilings, nearly anyone can qualify
it — those who end up in the of major costs incurred by hospital for them, even with preexisting
hospital facing huge unpaid medical visits, operations or mental health medical conditions. The plans are
bills. Research shows that up to half services. often the same price no matter the
of all bankruptcies today are related policyholder's age, gender or area of
to medical costs. For instance, the plans may pay for residence.
several doctor visits a year,
Another concern, say benefit immunizations for children and Those buying the skimpiest
experts, is that if employees try to $500 worth of yearly prescription coverage will still qualify for
reapply for comprehensive coverage drugs. But employees could be "group" prices at hospitals rather
down the road, limited plans may eligible for as little as $300 a year in than the sticker price that uninsured
not be considered "credible emergency room care — or enough patients are often charged. That
coverage," and applicants could be to last no more than a few minutes means those who exceed a $1,000
denied for preexisting conditions in most hospitals. yearly coverage limit could walk
just as if they had no insurance at away with a hospital bill that is half
all. The plans have strict coverage caps, or even a third the size of the bill
which may be as low as $1,000 a they would have gotten if
"Let's say exactly what this is year and are rarely higher than uninsured.
about," said Lisa McGiffert, senior $20,000. That means that no matter
policy analyst for Consumers how high a medical bill is, the Edelheit of United Group Programs
Union, a Washington, D.C.-based insurer won't pay more than the says a client who bought a mini-
consumer advocacy group. yearly cap. medical plan last year and later had
"Medical coverage is getting more surgery saved thousands of dollars.
limited every day, and people are Still, the growing popularity of the Because she had bought a limited-
paying higher health premiums for plans shows that they are filling a benefit plan, the hospital charged
little in return." need. her just $2,900 for the operation,
and her insurance carrier paid all
Others worry that broader adoption "No one is going to say these are but $900 of the bill.
of limited plans could skew the better than full coverage, but it's a
notion of just what it means to have step up for people who otherwise Other than employers, some
health insurance or encourage more wouldn't have insurance," said associations, including AARP, are
employers already offering better Jonathan S. Edelheit, president of also marketing the limited health
benefits to move to the skimpier United Group Programs, a national plans as supplemental medical
plans. insurance broker based in Florida. insurance. In buying a second health
plan, some people could save
"People could say these folks are Although a broad mix of employers having to pay huge out-of-pocket
technically insured, but that doesn't is starting to offer mini-medical costs on their own.
mean much [with these plans]. plans, they are still primarily aimed
People would still be crippled if at low-income and hourly workers "These are an option for anyone
they get sick," said Jonathan Parker, in industries that have high rates of who can't afford to pay for group
national campaign director for uninsured workers or employees insurance," said Joann Parrino, vice
Americans for Health Care, a who are spending large percentages president of employee benefits at
national grass-roots organization of their income to remain insured. Bolton & Co., an employee benefits
that advocates for universal consulting company in Pasadena.
healthcare. The plans cost $50 to $100 a month "That's a lot of people nowadays."
for an individual and around $200 a
The limited plans keep costs down month for families. Co-payments
by not offering the same benefits
Washington Post – June 5, 2005
A Movement to Bring Grief Back Home
By Rachel S. Cox
After Richard Saul died of Lou the standard American practice of funerals to the aging of the baby-
Gehrig's disease just before handing the body over to a boom generation, a phenomenon
Christmas last year at age 77, mortician for embalming and expected to keep the death rate
neighbors and friends gathered at display before cremation or burial. rising for decades.
his Cleveland Park home to extend
sympathies to his widow, Judy, and Knox said that in her seven years as "It's the other end of the spectrum
their sons and grandson. Many were director of Crossings, a Silver from natural childbirth," she said.
surprised to learn that they could Spring nonprofit she founded to "The baby-boom generation took
also pay their respects to Richard. help others carry out home funerals, control of critical life events, wrote
she has assisted about 150 families. their own wedding vows, had home
His body, washed and dressed in his Others active in the movement births. . . . They're fueling the
favorite clothes, lay in the master report an increased interest in the interest in taking control."
bedroom, cooled by dry ice and practice, but the number of home
open windows, and surrounded by funerals is minuscule considering The funeral industry acknowledges
fresh flowers, burning candles, the roughly 2.4 million annual a growing public interest in more-
family photographs and mementos deaths in the United States. individualized funeral rites. "I think
of his many years as a lawyer, civil a home funeral is a wonderful way
servant and father of four. Like a Like the hospice movement, which to go," said Robert J. Biggins,
small number of other bereaved in since the 1960s has helped the president-elect of the National
the Washington area and nationally, terminally ill die peacefully at Funeral Directors Association.
Judy Saul chose to care for her home, the home funeral movement "What could be more personal? It
husband's body for several days at aims to protect what it calls signifies a family's desire to be
home. individuals' "right" to care for their actively involved in celebrating the
own at death. At its most abstract, life of the family member. Anything
Once the hospice nurse who came promoters say, it hopes to dispel the that we can do to help them do that
to certify the death had convinced fear and denial that accompany an is our mission."
the D.C. coroner's office that institutionalized approach to death,
keeping the deceased at home was and return life's final act to its Yet home funeral advocates said
legal -- as it is in the District and all historical position as a natural, that at the state level, where laws
but five states (Connecticut, profound and private event. governing funerals are made, the
Delaware, Indiana, Nebraska and industry often has opposed the right
New York) -- Saul and a friend, Despite the violent deaths that of individuals to care for their dead.
Sally Craig, had prepared her crowd movie and TV screens and "Right after my first book came out,
husband's body with the assistance newspapers, in our culture "we the state of Rhode Island changed
of Beth Knox, a "funeral rites" never see actual death," said Joshua the statutory language to make it
educator whom Saul had met two Slocum, the director of the Funeral more difficult," Carlson said. Her
months before. Consumers Alliance, a national book came out in 1987. Recently,
group that advocates for consumer the Texas legislature debated an
"I got to know people on a really protection in funeral affairs. "The amendment supported by the Texas
personal basis because we had time institutionalization of illness and Funeral Directors Association that
and we were home," Saul said. death has made us inordinately would have made it illegal for
After three days of grieving, she felt terrified." families to contract directly with
ready to part with her husband's crematories, meaning they would
body. "To have him home, you Supporters of home funerals say have to go through funeral homes.
really know the person isn't there they pose no health risk under The amendment was withdrawn last
anymore. That is the whole point, so normal circumstances. month.
that you get used to the idea. By the
third night, I'm ready to see him Lisa Carlson, executive director of One benefit of a home funeral,
go." the nonprofit Funeral Ethics advocates say, is price: A home
Organization, which works with the funeral can cost only a fraction of a
This kind of after-death care, its funeral industry to protect and mortuary funeral, which typically
advocates say, offers a more expand consumer options, attributes runs about $5,000, according to the
humane and healing alternative to the growth of interest in home
Funeral Consumers Alliance. The she said, "a lot of comfort in being It was regret over not seeing her
prices can go much higher. able to perform acts of love in these mother's body at all that led
unbearable situations." American University Park resident
But the most important benefits, Leah Johnson to plan a home
advocates agree, are psychological. In contrast, Washington funeral for her father, James
"There's a tremendous increase in psychotherapist Riki Alexander, a Anastos, who died in January at 91.
healing and acceptance of death for board member of Crossings said:
the family to touch and see and be "I've had so many clients who When her mother was fatally
with the departed," Knox said. "It's grieved for so many years and are injured in an auto accident in 1985,
very empowering at a time when so not over it. I wonder if it's Johnson rushed to the hospital, only
you feel like everything's out of because they didn't get to have the to be told that it would be too
control." time and see that the person wasn't traumatic to see her. Because her
there. It becomes this unresolved mother's cremation was handled by
Knox speaks from hard experience. thing." a funeral home, as her mother had
In 1995 her 7-year-old daughter, wished, Johnson never saw her
Alison Sanders, died from the But American norms and again.
impact of an airbag that deployed expectations about death, other
during a low-speed auto accident. observers say, practically ensure She said having her mother die
Knox found herself unwilling to home funerals a limited following. alone was "too traumatic for the rest
leave after-death care to funeral of my life." She determined that her
home staff, despite the hospital's "For families that have difficulty father's death would be different. "I
insistence that it would release the addressing the topic of death, [a would do the absolute best for him
body to no one else -- still an all- home funeral] is much more at the end."
too-common occurrence, Knox said. difficult," said Stephanie Handel, a
grief therapist at the Wendt Center Although her husband and children
"We're required by law to care for for Loss and Healing in the District. initially voiced reservations about
our children," she said. "But at the Facing not only the many reminders the idea of a home funeral, Johnson
last hour, we're told that their body of a loved one but also the body recalled, when she explained how
doesn't belong to us anymore. That itself "might be too much to cope much it mattered to her, "they rose
makes no sense." with," said Handel, who also directs to the occasion." They had cared at
a program at the Washington home for Anastos, who suffered
Knox found a funeral director morgue that helps next-of-kin cope from Alzheimer's disease, and one
willing to bring Alison's body with the legalities of an unexpected Friday night he died in his sleep.
home, where family members, death, which include identifying a
friends and neighbors joined in a Polaroid photograph of the body. Washing and dressing her father's
three-day vigil. By the time the body with Knox and a close female
funeral director returned to take Knox agreed, and said she can think cousin "felt very biblical," Johnson
Alison's body to her funeral and of many reasons why people might said. As he lay in their guest room,
then to the crematory, Knox was, not want a home funeral, such as if "friends started coming."
she said, ready to let her go. they're exhausted or have no
supportive community. But, she "Some didn't want to go up, which
Having imagined, as most parents added, with an expected death was fine. Some friends came and
do, that she could never endure the "there is no law that states that the just sat there with him. We kept a
catastrophe of a child's death, Knox body needs to be removed in the candle burning. It was so good. It
found that "when it actually first 24 hours. There is much was just quiet. We were kind of
happened, my senses were so highly healing and acceptance to be gained seeing him out. It felt like we were
attuned to the sense of love, I had a by being with the death at this really caring for him."
very precise presence of mind, very time."
clear sense of direction." There is,