State regulations spike health care costs, experts say

(The Center Square) — Pennsylvania’s above-average health care costs and per-capita spending have risen almost 30% since a decade ago.

Figuring out how to drive down those costs while improving access weighs heavy on policy makers and researchers.

The Commonwealth Foundation, in an online event on Wednesday, argued that creating a personal option, where people can customize health care plans and reduce bureaucracy, could improve the state’s health care system.

“There’s a misunderstanding that health care is all federal now, but there’s a lot that Pennsylvania can do,” said Elizabeth Stelle, director of policy analysis at the Commonwealth Foundation.

Change may be an inevitability; state spending on Medicaid has grown dramatically from about $11 billion in 2000 to almost $47 billion now.

Dr. Kimberly Legg-Corba, who runs a direct primary care office in the Lehigh Valley, argued the current approach of insurance companies covering all health care services isn’t working.

“When patients seek out an alternative form of primary care, like direct primary care, I hear all of their complaints,” she said. “Cost is No. 1, access is No. 2, and attention is No. 3 …  They’re paying a lot of money for services that they’re not happy with.”

With direct care as Legg-Corba operates, her office doesn’t accept insurance, which helps her avoid bureaucracy and higher administrative costs.

“It’s not just about how the provider gets paid, but all the layers in between the patient and provider, and all that money that’s going to entities that are smack in the middle,” Legg-Corba said. “We got rid of the third party in the room … there are so many places where the money is flowing and it’s not flowing back to lower premiums for patients.”

Stelle warned that a focus on making sure that Pennsylvanians have insurance coverage does not mean they have access to health care.

“When you have more government intrusion and involvement, you have more of the focus shift away from the patient and to the payment systems,” she said.  “I would reframe the conversation: It’s not about, ‘Are you insured?’ It’s about, ‘Can you access care in a timely way?’”

Pennsylvania recently took steps to expand telemedicine coverage, but it has lagged on another way that other states have expanded health care access in rural and underserved areas: expanding the scope of practice for nurse practitioners to work independently of physicians.

Those restrictions limit what sorts of health care they can provide and limit the economic viability of working independently.

“When we opened our practice, the first thing was the hardest because a lot of insurances don’t recognize nurse practitioners as primary care,” Dallas Riley, a certified registered nurse practitioner and partner of Hall & Riley Comprehensive Healthcare outside Wilkes-Barre. “Reimbursement: NPs only get reimbursed 85% of the max Medicaid-allowable reimbursement.”

She also argued current regulations can have “kind of silly” outcomes, like allowing her to prescribe insulin but prevent her from approving diabetic shoes for a patient without a doctor signing off on it.

“There are a lot of really ridiculous limitations for nurse practitioners in primary care,” Riley said.

The Senate has taken some action that could remove some restrictions on NPs: in July, a Senate committee approved a bill to grant them more independent authority, but it still must pass the full Senate and then receive House approval.

Until then, the commonwealth has its hands full with Medicaid.

“We’ve seen this program explode in cost, also explode in terms of the population we’re serving, but we’re not really seeing any improvement in health outcomes,” Stelle said.