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Recent editorials published in Indiana newspapers

May 21, 2019

The (Fort Wayne) Journal Gazette. May 15, 2019

The cost of care

Why is American health care so expensive? A study by the Rand Corp. offers some possible insights into this increasingly urgent question. It also offers new evidence of the particularly acute health care challenges in Indiana.

Rand’s analysis compared what private insurers paid 1,598 hospitals for health care services to what Medicare might have paid those hospitals for the same services. That private insurers paid more than Medicare should not surprise anyone. But the size of the disparity is startling.

Overall, Rand found that private insurance plans were paying hospitals an average of 241% of what Medicare reimburses. Of $13 billion in payments in the study, Rand estimates, $7.7 billion of those charges would have been saved if those private insurers had paid at Medicare rates.

While the rate disparity has gone down in Michigan and several other states studied, the gap in Indiana has gone up over the past two years, according to Rand. Indiana hospitals included in the study were reimbursed by private insurers for outpatient service at more than 400% of Medicare rates, the highest of any state in the survey.

Indiana’s inpatient rates were under less than twice Medicare rates but also higher than many states.

Parkview Health billed private insurers included in the study at nearly four times Medicare rates, the report found - one of the highest listed in the nationwide survey. Indiana University Health and Lutheran Health Network were also listed as among the hospital systems with the highest reimbursement rates - IU at 2.8 times Medicare rates, and Lutheran at 2.5 times Medicare.

The study is an attempt to break open a payment system hidden from public view. As Parkview CEO Mike Packnett noted last week, the dealings between hospital systems and insurance companies traditionally have been confidential. “We had no idea where we stood versus others,” he told The Journal Gazette’s Sherry Slater. Sharing data with other hospitals, he added, could even be an antitrust violation.

Thus, there are lots of caveats in interpreting these numbers:

. Rand acknowledged that this sampling - which covered just 2% of the privately insured population - may not be statistically representative. In some states, some of the data Rand was able to access was from officially maintained all-payer-claims databases. Otherwise, the study relied on data from insurance companies and self-insured employers that were willing to participate.

. Data from Indiana, which does not have an all-payer-claims database, may have been particularly sketchy. Packnett noted only two insurance contracts of more than 400 statewide and just three regional employers were part of the study.

. Medicare rates, determined under a formula set by law, provide a steady baseline for comparison. But Medicare reimburses hospitals 87 cents for every dollar of the cost of care, according to the American Hospital Association. Hospitals that billed all customers at Medicare rates “would not have the resources to keep our doors open,” Melinda Hatton, the association’s general counsel, said in a statement last week. The study also does not evaluate the quality of care at systems such as Parkview, which has been ranked among the nation’s best.

If rates at Parkview and other Indiana hospitals are farther above the Medicare baseline than other states, the problem may not be one those institutions can solve by themselves. Indeed, some of the disparity in Indiana is likely a result of the costs of dealing with some of the nation’s most serious health problems. One response to the disturbing numbers in the Rand report would be for Hoosiers to demand adequate public health spending and to get serious about fighting the state’s outsized tobacco, alcohol, obesity, drug and mental health problems.

Hospital-by-hospital, the exact dimensions of the problem may be debated. But the Rand study - the first time such data about individual health care systems has been revealed on a large scale - illuminates what must certainly be a significant cause of cost increases.

The report suggests ways to ensure transparency and consistency in the way health care reimbursements are determined. Hospital leaders here and elsewhere should take the lead in demanding such reforms.

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South Bend Tribune. May 19, 2019

St. Joseph County’s method of assessing rental properties flawed and unfair

A recent Tribune story on St. Joseph County’s method of assessing rental properties in Portage Township could leave you with a simple question.

Why?

Why is County Assessor Rosemary Mandrici’s office using a method that has caused rentals near the University of Notre Dame and in other areas to have low gross assessed values? Her method is based on income reported by landlords and sale prices of rentals across four broad, economically diverse areas in Portage Township.

Why are county assessors near Indiana and Purdue universities using a much different approach, one that relies on tightly defined neighborhoods so that only properties with similar sale prices and rents are grouped for comparison? Those assessors say that Mandrici’s method is comparing apples to oranges, and raises the question of whether all landlords are paying their fair share of taxes.

Judy Sharp, the assessor for Monroe County and board president of the Indiana County Assessors Association, says Mandrici’s method is flawed because rentals near Notre Dame are being improperly compared with hundreds of others. “If you’re skewing it down lower for income-producing properties, the residential homeowner is paying a higher tax because the tax rate is higher.”

For her part, Mandrici says she is following state guidelines and that, “so far, the system has worked.” She also said that everything is “open to review and improvement.”

It’s clear that the system needs such a review. Consider The Tribune’s examination of a sample of 120 single-family rental homes across Portage Township. Among the sample of rental properties in Portage, 51 of them — a total of 43 percent — had assessments changed using the income method from 2013 through 2017. The annual tax bills for those properties dropped anywhere from $60 to $1,830, with an average decrease of $430.

Given the hundreds of rental homes in Portage Township, the annual tax payment decreases could reach into hundreds of thousands of dollars.

It certainly doesn’t help that Mandrici’s brother and sister own a house whose assessed value is roughly half the amount they paid for it in 2013, thanks to its reclassification as a rental.

But the bigger issue is one of fairness. Mandrici’s methodology is flawed, is costing the county and could be leaving residential homeowners paying more than their fair share.

Mandrici has full authority over assessments as a publicly elected official, but she also needs to be accountable to those she serves. It’s time that she act in the best interests of St. Joseph County residents and change her method of assessing rental properties.

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The (Anderson) Herald Bulletin. May 17, 2019

Ask any teen: 8 a.m. isn’t learning time

Remember when you were a teenager?

If you’re like most, you wanted to stay up later than your parents would let you. And in the morning, you dreaded that call from the hallway — “Get up! You’re going to be late for school!”

Used to be, adults would say droopy morning teens were just lazy.

Now, experts say that teens have different biological rhythms than the rest of us. Simply put — their biological clocks say stay up late and get up late. And they need a lot of sleep — 8 to 10 hours a night, according to the American Academy of Sleep Medicine.

But most schools still function on a traditional daily clock, with classes starting before 8 a.m. Bleary-eyed teens stumble into their classrooms and snooze through first period — and maybe second, too.

So, the solution seems simple: Move the start of the school day back to at least 8:30 a.m., the time recommended by the American Academy of Pediatrics.

But it’s not that easy. Other factors merit consideration.

While most teens would thrive on a later school day, it might not fit the rest of the family’s schedule. After all, parents have to work jobs that generally start by 9 a.m., sometimes earlier, and they like to see their kids off to school before they leave for work.

South Madison Community Schools Superintendent Joe Buck said as much when asked recently about the possibility of kicking the school day back an hour or so.

First period at Pendleton Heights Middle School and High School starts at 7:25 a.m., while SMS elementary schools don’t start class until an hour later.

Given the natural sleep habits of teens, why wouldn’t SMS just flip the two schedules?

Well, because many parents object to the idea. They want their older kids home from school first to look after the little ones when they get off the bus.

Extracurricular activities are another consideration. If you push the start of the school day back, practice schedules and some game schedules would be affected. Specifically, it could be cause for concern for outdoor sports, many of which take place on unlighted fields.

In the end, though, tradition — the way things have always been done — is the primary driving force behind the traditional school schedule. That and the continuing notion that teens are just lazy and need the discipline to get up early and go to bed early.

But that’s not working too well.

A Centers for Disease Control and Prevention 2015 study showed that 70% of high schoolers are sleep deprived and 57% of middle schoolers don’t get enough shuteye on school nights.

As school officials and parents consider the question of school start times, they must ask themselves: What is school all about?

Learning, of course. And it just makes sense to set a daily school schedule that best positions teens for that objective.

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