Sunday, June 16, 2013

Florida’s Win: Feds Grant Medicaid Managed Care Waiver

HEALTH CARE IN THE STATES

By Jim Saunders, The News Service of Florida

JUNE 14TH, 2013, 1:45 PM

This story comes from our partner, The News Service of Florida.

TALLAHASSEE – The federal government gave final approval Friday to Florida’s long-debated proposal to overhaul the Medicaid system by requiring beneficiaries statewide to enroll in HMOs and other types of managed-care plans.

The decision was not a surprise: Federal officials signaled earlier this year that they would grant approval. Also, the Obama administration had already signed off on requiring managed care for tens of thousands of Florida seniors who need Medicaid-funded long-term care.

But Friday’s announcement was a victory for Gov. Rick Scott and Republican lawmakers who approved the proposal to move to statewide Medicaid managed care in 2011, amid controversy about whether the changes would best serve the needs of low-income Floridians.

Scott this year lobbied U.S. Department of Health and Human Services Secretary Kathleen Sebelius for approval and said the managed-care changes will lead to improved coordination of care for beneficiaries. Republicans also have argued that the changes will help control rising Medicaid costs.

The approval of what is known as a Medicaid “waiver” came in a letter from the federal Centers for Medicare & Medicaid Services, which is part of Sebelius’ department.Florida is leading the nation in improving cost, quality and access in the Medicaid program,” Scott said in a prepared statement. “CMS’s final approval of our Medicaid managed care waiver is a huge win for Florida families because it will improve the coordination of care throughout the Medicaid system. Health-care providers can now more effectively manage chronic conditions and work with families to provide preventative treatments.”

Florida CHAIN, a patient-advocacy group that has been among the most-vocal critics of the managed-care requirement, issued a news release that said the federal government had included safeguards that will help protect beneficiaries. Among those safeguards: HMOs will have to spend at least 85 percent of the money they receive on patient care, a concept known in the insurance industry as a “medical loss ratio.”

But Florida CHAIN also said patients and advocates will have to remain “vigilant” and pointed, in part, to controversies about a Medicaid managed-care pilot program that began in 2006 and 2007 in Broward, Duval, Clay, Baker and Nassau counties.

Despite these federal safeguards, the focus now shifts to the state and its efforts to implement this program that will affect access to care for millions of patients in all 67 counties,” Florida CHAIN’s statement said. “The countless reports of disrupted, delayed and denied care streaming in from the original five counties are still very fresh in the minds of all stakeholders.”

The state Agency for Health Care Administration said the plan approved Friday ultimately could affect 2.9 million people, with enrollment in managed-care plans tentatively scheduled to start in April 2014. The related move to enroll seniors in managed-care plans is slated to start this August in central Florida.

In the approval letter, federal officials also signed off on the continuation of a $1-billion-a-year program that helps hospitals and other providers care for uninsured and low-income people. That program, known as the Low Income Pool, is closely watched by the state’s hospital industry.

Along with people in the five pilot counties, hundreds of thousands of Medicaid beneficiaries already get care through HMOs. But others are part of a health-care payment system known as “fee for service” that critics have long derided as fragmented.

Scott and Republican lawmakers in 2011 approved making managed-care enrollment mandatory for almost all beneficiaries statewide and set up a process that involves HMOs and other types of plans, known as provider-service networks, competing for contracts in 11 different regions. The state needed federal approval before it could move forward with the changes, and the process crept slowly as AHCA and Obama administration officials negotiated details.

Even though final approval did not come until Friday, AHCA has already started the process of selecting managed-care plans to serve the 2.9 million people. It is expected to award contracts in September and has received proposals from about 20 managed-care plans, including major industry players such as Coventry Health Care of Florida, Humana Medical Plan, WellCare of Florida, Sunshine State Health Plan and UnitedHealthcare of Florida.

THIS ENTRY WAS POSTED ON FRIDAY, JUNE 14TH, 2013 AT 1:45 PM.

http://capsules.kaiserhealthnews.org/index.php/2013/06/floridas-victory-feds-grant-medicaid-managed-care-waiver/#.Ub5qipvYm4Y.email

Digital and mobile startups are fueling health care innovation in Dallas

Entrepreneurs across the country are transforming the health care industry through technology.

Digital and health information tech startups are growing as doctors, hospitals and administrators look for ways to provide better care and reduce costs under federal mandates.

Consumers, too, are embracing mobile tools to be healthy.

Dallas is no exception.

“D-FW has a tremendous amount of health information technology activity, far more than we give ourselves credit for,” said Dr. Hubert Zajicek, co-founder of Health Wildcatters, a new seed accelerator for digital health startups in Dallas.

“An extremely competitive health care delivery market in the most rapidly growing top five American metro areas, combined with our strengths in technology and telecom, provides fertile grounds to grow and support the newest crop of innovative health care startups in Dallas,” he said.

To get a picture of the activity, we talked with executives from three health care startups in D-FW:

Vivify Health, a Plano company that developed a cloud-based platform for remote patient monitoring.

Axxess Technology Solutions, a Dallas company that uses cloud-based software to perform administrative functions for home health care agencies.

DealWell, a Dallas firm that has a website where people can shop for the best deals in health care services.

Vivify Health

For the last several years, Vivify has been developing its platform for remote patient monitoring and testing it with several hospitals and other partners, such as Texas Health Resources and AT&T Inc.

In May, the company announced it raised funds from venture firms Ascension Health Ventures and Heritage Group, whose partners include hundreds of hospitals. The startup, founded as Intuitive Health in 2009, also rebranded itself.

Regulatory filings put the investment at $3.4 million, but founder and CEO Eric Rock said the amount is much larger, though he declined to provide an exact number.

With the funds, Vivify plans to jump-start the marketing of its platform to users, such as hospitals, home health care agencies and physician practices. It also plans to offer a direct-to-consumer product soon.

Rock described Vivify’s software as a tool that seeks to reduce hospital readmissions, improve care and reduce costs — challenges facing the health care industry amid reforms.

“Driven by extreme demands on the crumbling U.S. health care system, care must now be delivered outside the four walls of the hospital,” Rock said.

Vivify’s software, Rock said, is less costly and easier to use for both patients and providers because it uses common consumer devices, such as mobile tablets and computers. The platform also provides video conferencing, educational health videos and customized care plans.

Here’s how it works: Using a tablet, for instance, patients log onto the Vivify platform from their home. Depending on the plan customized by a physician or provider, patients typically answer a daily health survey, keeping track of their weight, blood pressure and other vital signs. Vivify’s platform can be integrated with other devices like a scale or a blood glucose meter.

On the other end, doctors can monitor the patient’s progress remotely.

Preliminary results from a pilot involving AT&T and Texas Health Resources using Vivify’s platform have shown positive patient feedback and reduced readmissions for chronic heart patients, according to the Texas Health Research & Education Institute.

St. Vincent Health, Indiana’s largest health system, is getting ready to launch a large-scale program to monitor patients using Vivify’s software in July, said Dr. Alan D. Snell, St. Vincent’s chief medical informatics officer.

On any given day, health care providers expect to monitor 500 patients who have complex chronic diseases, as well as those discharged with specific diagnoses such as heart failure, heart attack and pneumonia, Snell said.

St. Vincent chose Vivify as its software vendor because of “the flexibility of their platform and software, their analytic capabilities and their progressive view of where remote care management should be going,” Snell said.

Vivify is Rock’s third startup and second in health care.

Two previous ventures had successful exits. His first, ProHost, a table management system for restaurants, was sold to OpenTable. MedHost, focused on emergency room information systems, was also acquired.

Axxess

In six years, Axxess Technology Solutions has grown into an $8 million business.

Dallas-based Axxess provides cloud-based software that serves as the clinical, operational and administrative backbone for home health care agencies.

The home care market represents about $68 billion a year in U.S. health spending, according to McKinsey & Co. The consulting firm said in a study that technology can be the main driver for expanding the market.

Axxess CEO Niyi “John” Olajide saw the underserved technology market in the sector when he started his business as a one-person consultant a decade ago.

At that time, he was a telecommunications engineering student at University of Texas at Dallas. While visiting an aunt who was an administrator at a home care agency, Olajide noticed the computers were not set up under one network.

After inquiring about the issue, he was hired as an IT consultant. That job led to others, and Axxess was officially created in 2007.

After realizing that Olajide was solving similar problems for his clients, Axxess decided to develop Web-based software that would help home care agencies automate their business. The product launched in 2011.

“We saw a need for that and set out for the home health care software market and haven’t looked back since,” Olajide said.

Administrators and health care providers can schedule patient visits, bill insurance providers and document patient care plans using Axxess’ software. Since it is cloud-based, nurses can update patient files or access medication guides on any mobile device during a home visit.

For MedPro Health Providers, a home care agency outside of Chicago, using Axxess’ software has reduced time on paperwork, cut the hassle of billing and made patient care coordination among the various providers easier, said chief executive Riz Villasenor.

“As we work with hospitals and other institutions, the ability to share information swiftly and the right information is also a big plus when you’re working in an environment like health care,” Villasenor said.

Today the startup has 800 customers in almost 40 states, serving about 150,000 patients.

Olajide bootstrapped the business and has not taken any outside investment. The startup has been profitable since 2011.

Now the firm, which has 53 employees, faces a different challenge.

“We’re always looking for talented people, and we can’t find them fast enough to maintain our pace of growth and innovation,” he said.

DealWell

The Internet has changed the way we shop for most everything.

One exception has been health care. Now, an increasing number of startups are trying to create marketplaces where consumers can shop around for the best deals for medical services.

Dallas-based DealWell is one such company.

The website officially launched in August to offer services in nine categories in the Dallas-Fort Worth region. They are chiropractic services, cosmetic surgery, dental, eye exams/Lasik, hormone therapy, massage, medical imaging, medical/day spa, and weight loss and management.

“We’re bringing price transparency and comparison shopping,” said Geoffrey Fischer, DealWell’s chief executive, whose experience includes working at Microsoft’s MSN division. “We’re making the market more efficient and helping customers get good deals.”

The startup is backed by Plano-based Preferred Medical Holdings, a provider of MRI services in the region.

Every offer on the site is at least 20 percent off retail and as much as 85 percent in some cases. DealWell vets providers that sign up, checking their credentials.

Consumers can buy a deal or bid for a better one. Think of DealWell as being like Priceline for health and wellness services.

And unlike popular deal sites, offers do not expire and consumers can choose from a variety of providers for a single service, Fischer said.

Fischer declined to provide revenue but noted that sales have been increasing 25 percent monthly. Several thousand customers have bought a deal on the site.

DealWell takes a cut of each sale. Fischer declined to give an exact figure but noted that it was far less than the 50 percent split that deal sites like Groupon reportedly take.

DealWell providers also pay a small monthly fee to participate.

William A. Moore, clinical director of Dallas-based Advanced Skin Fitness and Advanced Men’s Clinic, has been using DealWell since last fall.

Moore said the clinics have seen a “great return” from DealWell. In several cases, DealWell customers have bought additional services.

“They’re not deal hopping,” he said. “They seem to be a more loyal clientele.”

Follow Hanah Cho on Twitter at @hanahcho.

By the numbers: Digital health care

73: Percent of doctors who believe health information technology will improve the quality of health care in the long term

43: Percent of physicians who use mobile health technology for clinical purposes

35: Percent of U.S. hospitals that have converted to electronic health records

44 million: Number of mobile health care and health apps downloaded in 2012

$1.4 billion: Amount of venture funding raised for digital health startups in 2012

SOURCES: Deloitte; U.S. Department of Health and Human Services; Juniper; Rock Health

http://www.dallasnews.com/business/health-care/20130615-digital-and-mobile-startups-are-fueling-health-care-innovation-in-dallas.ece

Centers of Innovation strive to help Georgia companies be more successful | jacksonville.com

4,000 lives a year lost by poor hospital care at weekends

Poor care in hospitals at weekends is claiming more than 4,000 lives a year, NHS officials have warned.

NHS England is beginning a public consultation on a review which could lead to a major restructuring of the NHS. Photo: CHRISTOPHER FURLONG/GETTY IMAGES

By Laura Donnelly, Health Correspondent

10:00PM BST 16 Jun 2013

10 Comments

The disclosure comes in an official review of Britain’s emergency and urgent healthcare which says the current system is unsustainable, unaffordable and soaking up more than half of the health service budget.

Health officials will on Monday launch plans which attempt to tackle a deepening crisis in Accident & Emergency (A&E) units, hospital wards and out-of-hours GP services.

They have collected evidence of system buckling under the strain and placing patients at increased risk - especially if they fall sick at weekends.

The dossier is published as NHS England begins a public consultation on a review which could lead to a major restructuring of the NHS, with specialist services concentrated in larger units and changes to put hospitals on a “seven-day” footing, with more consultants and diagnostic tests available at weekends.

The damning official report warns of:

* More than 4,400 lives a year lost in England because hospital mortality rates are worse at weekends, largely because of shortages of senior doctors;

* Spiralling numbers of patients readmitted to hospital because they were discharged too quickly, because of cuts to bed numbers;

* Evidence of a 30 per cent rise in death rates when casualty units are crowded;

* Widespread shortages of A&E doctors, with half of training posts unfilled for the past two years;

* Confusion among the public about how to access urgent care and lack of confidence in the care provided by GPs;

Despite widespread concerns about failings of the non-emergency 111 telephone line, which was introduced in most parts of England this year, the official leading the review said the future model of urgent and emergency care will rely heavily on phone-led services.

The report comes amid increasing fears about the pressures on A&E departments, which senior doctors have likened to “warzones,” while the head of the NHS regulator has said emergency care is “out of control”.

Ministers have indicated that they want GPs to take more responsibility for the care given to their patients when surgeries are not open, but it remains unclear how this will work.

NHS England is now undertaking a review of “urgent and emergency care,” which on Monday publishes a case for significant changes in the way health services are provided.

Specific proposals will be published in September, but ideas under consideration include increasing specialisation of some services, such as stroke and trauma, a drive to train more A&E doctors, investment in telemedicine, and changes to the disastrous 111 non-emergency phoneline, so that more clinically-trained staff are involved in decisions.

Professor Keith Willett, the director of NHS England in charge of urgent and emergency care, told The Daily Telegraph: “We need to redesign the system because it is not sustainable as it is. We need a lot more care closer to home and we also have to have high-quality specialist services.”

He said changes which have already occurred in some parts of the country - such as the reorganisation of specialist stroke services in London, into a smaller number of units - had saved lives and reduced disability levels of stroke sufferers because patients received expert care more quickly.

Pressures on A&E units in recent months have come amid the national roll-out of the 111 phone line, which was supposed to reduce the number of people arriving at hospitals, by diverting those with minor complaints to out-of-hours GP services.

Instead, there have been widespread concerns about areas in which the service has collapsed under the pressure of calls, while in others, call handlers without clinical training dispatched paramedics to the most trivial cases, heaping pressure on A&E units.

There have been investigations into at least 22 potential “serious untoward incidents” since April, including three deaths.

A separate review by NHS England will recommend changes to the way the phonelines are run.

However, Prof Willett, a consultant trauma and orthopaedic surgeon at the John Radcliffe Hospital, in Oxford, indicated that the future model is likely to rely heavily on phone access to services.

He said those in need of urgent NHS care needed to be directed to the right place, so they did not just turn up at hospitals without a full range of services.

He said: “The concept behind 111 is really good - where the delivery falls down may be to do with the need for senior clinical input.”

Prof Willett said it was “a really important principle” of any future model of services that the public would be expected to phone first to ensure they got the right help. He said: “If you don’t phone first, the risk is you are essentially joining the wrong queue.”

The report does not single out any one factor for the current pressure on hospitals, but says public confidence in 999 services is far higher than that in family doctors, while one in ten patients who fail to get a suitable GP appointment turn up at A&E.

In less than a decade, the number of calls for ambulances has risen from 4.7 million to over 8 million.

The report says many such calls relate to non life-threatening conditions, and are made because the public does not know where else to turn, with a “perceived or actual lack of alternative options” in parts of the country when GP surgeries are closed.

It also describes ageing and increasingly frail population, and says that the increasing number of emergency admissions to hospital, combined with cuts to bed numbers, have meant patients have been discharged too quickly, without being properly assessed or given help at home.

As a result, the number of patients readmitted to hospital within one month has increased by more than 50 per cent between 2003/2004 and 2010/11, the report says. Over the same period, the number of hospital beds has been cut by more than 80,000, down to 104,000, separate figures show.

Dr Cliff Mann, from the College of Emergency Medicine, which represents A&E doctors, urged the Government to take quick action, and said the most pressing problem was the crisis in staffing.

“From this August we will be short of between 200 and 300 registrars [trainee doctors] in A&E, and just as many consultants,”he said. “That means the pressures we are seeing now are going to be exacerbated. We need a clear signal that there will be some quick action to tackle this - I am worried that despite all this analysis, what we will see instead is an exercise in prevarication.”

http://www.telegraph.co.uk/health/healthnews/10122625/4000-lives-a-year-lost-by-poor-hospital-care-at-weekends.html

The Future of Medicare Advantage: Are We on the Right Path?

Video:

Speakers discussed how Medicare Advantage plans are expected to respond to payment changes; if quality bonus payments created significant changes in patient care or plan choices; and what implications could these decisions have on beneficiaries with...

http://bcove.me/6yn7j2vo
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Panel Tells Congress Medicare Is Unfairly Penalizing Hospitals Serving The Poor - Kaiser Health News

Panel Tells Congress Medicare Is Unfairly Penalizing Hospitals Serving The Poor

TOPICS: MEDICARE, AGING, HOSPITALS, HEALTH REFORM, HEALTH DISPARITIES

By Jordan Rau

KHN Staff Writer

JUN 14, 2013

This KHN story was produced in collaboration with

The financial penalties that Medicare imposes on hospitals with high rates of patient readmissions are too harsh for hospitals serving the poor and should be changed, according to a congressional advisory agency.

Since last fall, Medicare has been reducing its payments to 2,213 hospitals under a provision in the health care law that aims to improve quality at the nation's hospitals. The penalties kick in when patients with heart failure, heart attack or pneumonia are readmitted at higher than expected rates within 30 days.

While the Medicare policy seems to be having an effect - facilities are scurrying to keep better tabs on their high-risk patients after discharge - some hospital officials and other experts say the penalties are unfair because hospitals that treat the poorest patients are getting hit harder than others.

"The idea is right, but the implementation has been greatly flawed by penalizing hospitals that take care of the most vulnerable patients," said Dr. Atul Grover, chief public policy officer at the Association of American Medical Colleges.

Low-income patients, doctors and researchers say, are more likely to have trouble following hospital instructions for taking care of themselves after discharge. They don't always have easy access to doctors to monitor their recuperations and sometimes can't afford needed medications.

The maximum penalties, now set at 1 percent of Medicare payments, are scheduled to double to 2 percent starting in October and 3 percent in the fall of 2014.

In the District of Columbia, Howard University Hospital, which treats the largest share of low-income patients, is being penalized the most of any area hospital; since last October, its Medicare payments have been reduced by 0.95 percent. Sibley Memorial Hospital, which treats the smallest share of poor patients, was the only District hospital to avoid a penalty, data show.

In Virginia, Mary Washington Hospital in Fredericksburg and Culpeper Regional Hospital were penalized 1 percent. Maryland hospitals are exempted from the federal program because the state has a unique reimbursement system.

Medicare has disagreed that the readmissions penalty program needs revisions. But thereport to Congress from the Medicare Payment Advisory Commission, or MedPAC, agreed with critics that there are "shortcomings" that "can work at cross purposes to the policy's intent." The criticisms carry extra weight because MedPAC helped devise the readmission penalties, calling for them back in 2008.

MedPAC found that hospitals where fewer than 3 percent of Medicare patients were low income received an average penalty of 0.21 percent. Hospitals where more than 18 percent of Medicare patients were low income had an average penalty more than twice that, 0.45 percent.

"Income is still an important … variable in explaining variation in readmissions," the commission said. It recommended that in future years, when determining penalties, Medicare compare a hospital's readmission rates to those of hospitals with comparable numbers of poor patients. Penalties can be a drain on safety net hospitals, many of which operate on slim profits or at a loss.

The Centers for Medicare & Medicaid Services did not comment on the MedPAC recommendations. In the past, officials have noted that after years of holding steady, the national hospital readmission rate last year dipped below 18 percent.

But MedPAC warned that if the penalty formula remains unchanged many hospitals will continue to get penalized in future years even if they reduce readmissions because they will be judged on how they compare to the entire industry. MedPAC proposed that Medicare set target readmission rates for hospitals each year and exempt from penalties those that succeed.

"These are all steps in the right direction," said Dr. Ashish Jha, a Harvard School of Public Health researcher who first documented the unevenness of the penalties. “MedPAC is thinking smartly about this and they're looking at the evidence coming and making changes to the metrics."

Changing the program, however, might not be easy. Medicare officials have said that many details were spelled out in the 2010 law, making them difficult to change in light of deep partisan divisions in Congress.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

http://www.kaiserhealthnews.org/Stories/2013/June/14/medpac-hospital-readmissions-poor-congress.aspx

Doctors Lag Far Behind On ICD-10 Readiness

6/15/2013 @ 12:30PM |8,513 views

Less than 5 percent of physician practice have made “significant progress” when rating their overall readiness for tens of thousands of new government-mandated “ICD-10” codes used to describe diseases and hospital procedures in the insurance billing process, a new study shows.

Though the conversion to 140,000 new codes that medical-care providers will use in order to bill government and private insurers doesn’t occur until Oct. 1, 2014, it doesn’t look like doctor practices will be ready.

“It is proving to be one of the most complex and expensive changes our healthcare system has faced in decades,” said Dr. Susan Turney, president and chief executive officer of the Medical Group Management Association.New research out this week by the Medical Group Management Association shows “only 4.8 percent of practices reported that they have made significant progress when rating their overall readiness for ICD-10 implementation.” More than 1,200 medical groups representing more than 55,000 doctors were part of the research.

The conversion is being required by the Centers for Medicare & Medicaid Services to provide more specificity to the existing coding system. The current ICD-9 codes have limited information about medical conditions and hospital procedures while the new ICD-10 code “sets provide flexibility to accommodate future health care needs, facilitating timely electronic processing of claims by reducing requests for additional information to providers,” Marilyn Tavenner, Acting Administrator of the Centers for Medicare & Medicaid Services wrote earlier this year to the American Medical Association, which has urged a delay in implementing the new codes.

At the American Medical Association House of Delegates meeting in Chicago, which runs through Wednesday of next week in Chicago, doctors are endorsing legislation in Congress to try to prevent the Obama administration from implementing ICD-10. The AMA is also calling for alternatives.

MGMA’s Turney said the transition will impact documentation of clinical care, physician productivity in how they care for patients and reimbursement to doctors from insurance companies and government payers at a time doctors are also trying to get their practices ready for electronic health records, or EHR.

“Adding to the implementation challenge and clearly taxing all stakeholders, ICD-10 will arrive at the same time that a number of other transformative federal policies go into effect, such as health insurance exchanges and Stage 2 of the (Centers for Medicare & Medicaid Services) Meaningful Use EHR Incentive Program,” Turney said.

The ICD-10 conversion is also adding costs to health insurance companies and will impact the likes ofAetna AET -1.72% (AET), Cigna CI -1.83% (CI), Humana HUM -0.65% (HUM), Wellpoint (WLP) andUnitedHealth Group UNH -0.55% (UNH)as they use the codes in their claims processing and paying of physicians and other providers.

“A successful transition to ICD-10 requires coordination between providers and their vendor, clearinghouse and health plan trading partners,” Turney said. “Our data suggest that many practices are in the dark in terms of moving forward with ICD-10 as this coordination has not yet occurred.”

MGMA, the American Medical Association and various other medical-care provider groups worry the health care industry will not be ready, saying they still have to train their office staffs, buy the right computer systems and grapple with the mountain of administrative and related changes necessary that increases the number of diagnostic codes to about 69,000 from nearly 14,000 while the number of inpatient procedure codes rises to about 87,000 from about 3,000.

“Without the necessary software changes and testing, practices will have no confidence that they will be paid for the care they deliver to their patients after Oct. 1, 2014,” Turney said.

Medicare administrator Tavenner has said there are no plans to delay or cease implementation, saying the conversion to ICD-10 was already delayed a full year from October of this year when it was originally scheduled to be implemented.

http://www.forbes.com/sites/brucejapsen/2013/06/15/doctors-lag-far-behind-on-new-medicare-diagnosis-codes/

7 Countries With the Highest Health Care Costs

by Keith Speights, The Motley Fool Jun 15th 2013 2:30PM

Updated Jun 16th 2013

"Price is what you pay. Value is what you get."
These words spoken by Warren Buffett come to mind when looking at how much people across the world pay for health care.

Are the nations that pay much more for health care than others also getting commensurately more value? Let's look at the seven countries with the highest health care costs among the 34 member nations of the Organisation for Economic Co-operation and Development, or OECD.

7. Denmark Danes pay greatly for health care when compared to other countries. Denmark spends 11.1% of the country's GDP on health care, or around $4,464 per person. However, the country's life expectancy is 79.3 years, below the OECD average of 79.8.

6. Switzerland The Alps aren't the only things reaching lofty heights in Switzerland. The nation spends 11.4% of its GDP on health care, high enough to claim the No. 6 spot on our list. Switzerland's per capita spending of $5,270 ranks third-highest among all OECD countries. The Swiss might be getting a good return on this spending, though. The nation's life expectancy of 82.6 ranks as the second-highest of all OECD nations after Japan.

5. Canada Canada stands as the second-largest country in the world in terms of geographical area, but it also has relatively large health care costs. Canadians spend 11.4% of GDP on health care. The country's $4,445 per capita in medical spending ranks seventh-highest among OECD nations. Canadians have a life expectancy of 80.8 years, one year more than the OECD average.

4. Germany Germany is Europe's greatest economic powerhouse, with a sizable portion of that economic power directed toward health care. German spending on health care comprises 11.6% of its GDP and totals $4,338 per person. The German life expectancy of 80.5 years exceeds the OECD average but only ranks 20th among the 34 OECD member nations.

3. France France also spends 11.6% of its GDP on health care, but edges Germany in our ranking. French medical-related spending amounts to $3,974 per person. On the positive side, though, France boasts the ninth-highest life expectancy in the OECD at 81.3 years.

2. Netherlands Healthcare isn't exactly a Dutch treat. The Netherlands spends 12% of its GDP -- $5,056 per capita -- on medical costs. The country ties Canada for 13th place among OECD members with a life expectancy of 80.8 years.

1. United States As you probably expected, Americans are No. 1 -- unfortunately, in an area where we'd prefer to rank lower. The U.S. spends a staggering 17.9% of its GDP on health care. That's $8,680 per person -- 61% higher than the next-highest nation. However, Americans' life expectancy of 78.7 years places 27th among OECD members and is over a year less than the OECD average.

Observations

Digging into some of the details behind these numbers yields some interesting information. There are some areas where the U.S. fares much better than most other countries. Americans' cancer survival rates rank among the best in the world. The U.S. also has significantly lower waiting times than other nations for receiving certain types of care, including elective surgeries.

The U.S. has the sixth-lowest average hospital stay length and the seventh-lowest number of hospital beds per 1,000 people. This either means that American hospitals are more efficient than most of the world -- or they push patients out the door more quickly one way or the other.

There are far fewer physicians per 1,000 people in the U.S. than most other countries. The U.S. ties for seventh-lowest among OECD member nations, with 2.4 physicians per 1,000 persons. However, even with fewer physicians, more CT and MRI exams are performed in the U.S. than nearly any other country. This likely results from multiple factors, including fear of lawsuits and financial incentives within the U.S. health care system.

The U.S. is by far the most obese nation among OECD nations. More than 28% of American reported being obese compared with the OECD average of 15%. The next most obese country was Australia with an obesity rate of 21.3%.

Two findings struck me as most intriguing. First, Americans ranked first among all OECD countries in how healthy they think they are with 89.8% reporting perceived good health. Our life expectancy isn't high relatively speaking, but wethink we're in good shape health-wise.

Second, although our health care costs are by far the highest, the growth rate doesn't look nearly as bad comparatively. U.S. health care costs grew by 4.2% annually between 2000 and 2010, while the average growth rate for all OECD nations was 4.3%.

Investing takeaway
The Motley Fool always looks for an investing angle, so what's the takeaway from all this health care cost information? I think it makes sense for investors to look at the big picture. The U.S. spends way too much on health care. Companies that help control those costs should have significant growth opportunities over the long run.

Pharmacy benefit managers, or PBMs, fit the bill nicely. Average spending on prescription drugs in the U.S. last year was $898 per person. Prescription drugs rank as the third-highest cost of health care, trailing only hospital care and physician/clinical services.

Several PBMs look attractive, but I particularly like Express Scripts . The company ranks as the largest PBM in the nation. Its scale and analytical capabilities give it a competitive edge, in my view, for helping organizations control prescription drug spending.

The stock trades currently at a forward price-to-earnings multiple of 12.5. That's not bad at all considering the company's solid growth prospects. After all, price is only what you pay. Value is what you actually get.

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A&E attendance: by age, waiting time and deprivation

Latest NHS figures show that the number of patients going to accident and emergency departments has hit an all-time high. See how the data breaks down by age, waiting time and deprivation

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Attendances to accident and emergency have hit a record high according to latest figures out today. Photograph: Graeme Robertson/Getty Images

Attendances to accident and emergency (A&E) have hit a record high with 21.739m patients in the first 11 months of 2012-13, according to the latest NHS statistics.

The release today from the Health and Social Care Information Centre (HSCIC) shows that the number of patients going to A&E has been increasing over the past eight years, from 17.837m in 2004-05 to 21.739m in the first 11 months of 2012-13. Health correspondent Denis Campbell writes:

Figures released by the NHS's Health and Social Care Information Centre (HSCIC) depict a relentless rise in A&E attendances, but with a notably large jump occurring between 2011-12 (21.481m) and 2012-13 (21.739m after 11 months). The figures cast serious doubt on health secretary Jeremy Hunt's recent claims that the rise in A&E attendances was due to Labour's "historic mistake" in 2004 of letting GPs no longer be responsible for providing out-of-hours care.

The ageing population, and the fact that growing numbers of older people are suffering from one or more long-term illnesses, such as diabetes and breathing problems, are key factors in the ongoing surge.

If you've ever wondered when the busiest time is in A&E or what age group accounts for the highest number of patients, then this release is filled with just the details you were looking for. Below are some of the figures we've picked out of the report. You can access the full data by using the downloadable spreadsheet below.

Most patients arrive at 11am

There's been a rise in the number of people number of people aged 60-79 and 80+ attending A&E

96.7% of recent attendances were concluded in 4 hours or less - the NHS target is 95% - according to latest weekly data

The most deprived make up the biggest percentage of A&E attendances

The number of doctors working in emergency departments in England has increased by 71% over the past decade

You can find the full data behind this release in the downloadable spreadsheet.

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• DATA: download the full spreadsheet

http://www.guardian.co.uk/news/datablog/2013/jun/14/accident-and-emergency-attendence-age-waiting-time-deprivation