Most on Medicaid will have co-payments starting Jan. 1; foes say it's a barrier to care, proponents say it improves engagement

By Melissa Patrick
Kentucky Health News

Starting Jan. 1, most adult Medicaid beneficiaries in Kentucky will be required to make co-payments for many of their health-care services, a rule change that prompted 26 organizations to sign a letter asking state officials to reconsider this decision because they say it will create a barrier to care.

"Requiring co-payments from Medicaid beneficiaries is a choice each state must make. Any budgetary benefits are limited at best, as the unintended consequences of creating barriers to care are often offset by increased costs down the road," says the Dec. 11 letter to the state's new Medicaid commissioner, Carol Steckel.

Co-payments have long been required from Medicaid members who are aged, blind or disabled. They are not part of the "managed care" system in which insurance-company subsidiaries or other organizations oversee care funded by Medicaid. The managed-care organizations, or MCOs, have been able to waive co-pays, "and all of them have waived some or all of those," said Doug Hogan, spokesman for the state Cabinet for Health and Family Services. "The new regulation will remove that ability to waive the co-pays and create more uniform application across all populations."

These new co-pay rules are separate from the state's new Medicaid plan, which is set to roll out on April 1. And as soon as that plan is implemented, monthly premiums ranging from $1 to $15 per month will replace the co-pays for most beneficiaries. Implementation could be delayed by courts.

The rule that takes effect Jan. 1 requires MCOs to charge co-pays that range from $1 for some prescriptions to $50 for any type of inpatient service, including mental-health and substance-abuse admissions.

The rule exempts children, pregnant women, hospice patients and beneficiaries who have reached their "cost sharing limit" for the quarter, which amounts to 5 percent of a person's household income during three-month quarters of the year.

The  rule also exempts a few services, including emergency care, some family planning and preventive care, such as screenings, check-ups and patient counseling to prevent illnesses, like diabetes or heart disease.

Providers cannot refuse to see Medicaid beneficiaries who are below the federal poverty level if they cannot afford their co-payment, but can refuse services to those above the level -- though this has to be their current business practice for all patients, not just those on Medicaid.

The cabinet has provided a PowerPoint presentation to help providers navigate the changes.

The 26 organizations that signed the letter included links to two bodies of research that support their concerns that even small co-pays will cause many to go without care. One, published by the National Institutes of Health, cites several examples of state co-pay requirements that reduced faithfulness to prescriptions, and another that reviewed 65 studies from the Kaiser Family Foundation, which found that even modest co-payments create barriers to care for low-income populations.

"Having worked hand-in-hand with state agencies, providers, application assisters, legal aid programs, and others across the commonwealth to get Kentucky covered, we have found that even modest financial barriers can mean the difference between having access to healthcare or going without," says the letter.

Hogan said state health officials hope that mandatory co-payments and the new Medicaid plan will "empower individuals to improve their health and their lives," as well as help them to transition from Medicaid into commercial health insurance.

"We see from other states that premiums have an even more profound effect at increasing engagement and improving utilization," he said. "For example, in Indiana, people who chose the premium plan over the co-pay plan had nearly double the rate of primary-care utilization.  We think that may be because premiums are easier to plan and budget for, and serve as a monthly reminder that they have health coverage that they associate value with—which makes them more likely to use it in a preventable manner."

House conservatives oppose McConnell-endorsed efforts to resume Obamacare subsidies to moderate-income people

https://www.politico.com/story/2017/12/08/susan-collins-obamacare-deal-213254

State health plan provides free or low- cost diabetic meds and supplies; study finds program improves employees' health

Kentucky.gov photo

An analysis of Kentucky's state-employee health insurance plan, which provides free or reduced-cost diabetic medications and supplies, found this service was helping its members better manage their condition and make better health decisions.

“Many times the cost of medical and pharmacy treatment prohibits members from receiving care,"Jenny Goins, commissioner of the Department of Employee Insurance, said in a news release.

The study found that participants in the Diabetes Value Benefit program showed better adherence to their medications and a 3.5 percent decrease in other prescription drug use. Emergency-room visits were down 10.3 percent, doctor-office visits decreased 3.1 percent and hospital admissions dropped 6.5 percent since 2015.

The DVB program allows members with a diabetes diagnosis to receive maintenance prescriptions and supplies, such as diabetic strips, free or at a reduced copay or coinsurance, with no deductible. KEHP also provides coverage for the Diabetes Self-Management Education program and pays 100 percent of the cost of the Diabetes Prevention Program for those with pre-diabetes.

Chris Biddle, a KEHP member who's been diagnosed with diabetes and participates in the DVB program, said, ""My numbers have improved so much that I ceased taking some of my other cardiac medications and my diabetes medications have been cut in half -- a big savings out of my pocket! I'm now going to the doctor about half as much as I did before."

The Kentucky Employees' Health Plan covers more than 260,000 state employees, retirees and others, and spends more than one million dollars in diabetes claims each year, says the release. More than 23,000 KEHP members were diagnosed with diabetes in 2016, down from 25,000 members in 2015, according to the release.

Kentucky ranks 12th in the nation for diabetes. It’s the seventh leading cause of death by disease in the state.

Kentuckians who are not covered by the KEHP can get information about diabetes resources by visiting the Kentucky Diabetes Resources Directory .

Beshear joins lawsuit to defend Obamacare cost-sharing subsidies; D.C. appeals court to consider request Monday

By Melissa Patrick
Kentucky Health News

Kentucky Attorney General Andy Beshear and 15 of his counterparts have filed a motion aimed at maintaining cost-sharing subsidies for health insurance for low-income people under the Patient Protection and Affordable Care Act. The attorneys general want a federal court to let them directly defend the subsidies, about which the Trump administration has been ambivalent.

In 2014, House Republicans sued the Obama administration over the legality of these cost-sharing subsidies being paid to insurance companies because Congress never appropriated the funding for them. A district court ruled in favor of the House, but the Obama administration appealed the ruling. The subsidies were allowed to continue pending the appeal.

When Obama left office, the Trump administration became the defendant in the lawsuit. The administration is scheduled to inform the U.S. Court of Appeals for the District of Columbia Circuit on Monday, May 22, how it wants to proceed with the appeal.

Harris Meyer of Modern Healthcare reports, "The state attorneys general claim their states' interests would be gravely harmed if the payments stop because many insurers would exit the individual insurance market, premiums would spike, many of their residents would be left uninsured, and state and local governments would face heavy costs in paying for medical care for the newly uninsured people."

Beshear said in a news release, “Thousands of Kentuckians who purchase health insurance from the federal exchange are at risk of losing access to affordable health care coverage. The loss of federal funds and the financial uncertainty threatened by the case would lead to higher health insurance costs for Kentuckians and to insurers abandoning the individual health insurance market.”

The Kaiser Family Foundation projects that without the cost-sharing subsidies, premiums would increase by an average of 19 percent on ACA "silver" plans, the most popular, and higher in states that have not expanded Medicaid. The subsidies are available to people with incomes between 100 and 250 percent of the federal poverty level -- between $24,300 and $60,750 for a family of four.

Kentucky has extended its deadline for filing 2018 Obamacare plans to June 7, from the original May 17, "to allow insurers more time to obtain relevant data, including enrollment and claims data for the beginning of 2017, for use in developing assumptions utilized by actuaries to determine necessary plan pricing," Ronda Sloan, spokeswoman for the state Department of Insurance, told Kentucky Health News in April.

During the 2017 open enrollment period, 81,155 Kentuckians enrolled for coverage through the exchange and four out of five of them received a subsidy to help pay for their premiums, according to the Kentucky Center for Economic Policy. 

Both the ACA and the House-passed health bill, called the American Health Care Act, include subsidies, but use different formulas. The ACA takes family income, local cost of insurance and age into account, while the AHCA bases its tax credit only on age, with a phase-out for individuals with incomes above $75,000. It would continue the cost-sharing subsidies until 2020, "but would not appropriate those funds, leaving insurers uncertain whether they would receive the payments," Modern Healthcare reports.

Subsidies to low-income consumers who sign up for insurance on the exchange are estimated at $7 billion this year, according to the Congressional Budget Office.

Politico reports that Trump has told his advisers that he wants to end the Obamacare subsidies to force Democrats to the table to negotiate an Obamacare replacement.

The states seeking to intervene in the case are California, Connecticut, Delaware, Hawaii, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Minnesota, New Mexico, New York, Pennsylvania, Vermont and Washington, as well as the District of Columbia.

Millions of Americans miss out on tax credits for health insurance because they don't buy policies on government exchanges

Commonwealth Fund graphic:
People who visited marketplaces, but didn't enroll

About 2.5 million Americans are overpaying for health insurance because they don't use the government exchanges or marketplaces that provide tax credits to reduce premiums, says a study by the Department of Health and Human Services. Kentuckians will use the federal exchange to enroll, starting Nov. 1.

HHS estimates that of the 6.9 million people who have health insurance in the off-exchange individual market, "1.9 million either have incomes that would qualify them for Medicaid or place them in the Medicaid coverage gap, or are ineligible to purchase marketplace coverage due to immigration status, while the remainder could enroll in marketplace-qualified health plans."

Amother problem is that only 46 percent of uninsured adults (as of spring 2015) were aware that the Patient Protection and Affordable Care Act offers financial assistance, according to a 2015 study by The Commonwealth Fund, report the fund's Sophie Beutel, Sara R. Collins and Munira Z. Gunja. Researchers also found that in 2014 more than half of people who visited the marketplace but did not enroll said they weren’t able to find an affordable plan, even though "most of these people had incomes that made them eligible for premium subsidies."

Huge infographic offers facts about Kentucky's oral health

The Kentucky Oral Health Coalition, a project of Kentucky Youth Advocates, recently released an infographic "Word of Mouth: The Importance of Oral Health in Kentucky" to offer some general awareness about dental health. It displays fun facts about oral health as well as details about the consequences of poor oral hygiene and barriers Kentuckians face related to oral health, such as cost and lack of access. View it here (sorry, this is as large as we can reproduce it), or download the full-size PDF version to share.

Doctors don't tell most patients or caregivers about a diagnosis of Alzheimer's until the disease advances, advocacy group says

Every 67 seconds someone in the U.S. develops Alzheimer’s disease and most don't find out they have it until their disease becomes more advanced, according to a report by the Alzheimer's Association.

The organization's 2015 Alzheimer's Disease Facts and Figures report says only 45 percent of people with the disease, or their caregivers, were told their diagnosis by their doctor.

One reason, the report says, is that they don't want to cause the patient emotional distress, but the report says studies have found that "few patients become depressed or have other long-term emotional problems" when they learn of their diagnosis.

The Alzheimer's Association says early disclosure of the diagnosis "should be standard practice" because it allows the patient to participate in early decision making about their care plans, deal with legal and financial issues, decide if they would like to participate in research, and gives them time to fulfill lifelong plans. The association said in the release that not enough resources and education are in place to help medical providers with "best practices for telling patients and their families."

"Telling patients the truth about their diagnosis allows them to seek treatment early, when it’s likely to be more effective, and gives them a voice in planning how they want to live the rest of their lives," DeeAnna Esslinger, executive director of the Greater Kentucky and Southern Indiana Chapter of the Alzheimer’s Association, said in a press release.

The report says an estimated 5.3 million Americans have Alzheimer’s disease, including 68,000 Kentuckians. And barring the development of medical breakthroughs, the report says the number of Americans with the disease will rise to 13.8 million by 2050. Other items from the report:

• Almost half a million people age 65 or older will develop Alzheimer’s in the U.S. this year.
• By 2050, an American will develop the disease an average of every 33 seconds.
• Two-thirds of Americans over age 65 with Alzheimer’s (3.2 million) are women.
• Alzheimer’sis the sixth-leading cause of death in the U.S.
• In Kentucky, 1,462 people died with Alzheimer’s in 2012, a 74 percent increase since 2000.
• Nationwide from 2000-2013, the number of Alzheimer’s deaths increased 71 percent, while deaths from other major diseases decreased.

The cost to care for Americans with Alzheimer's and other dementias in 2015 are estimated at $226 billion, of which $153 billion is the cost to Medicare and Medicaid alone, making Alzheimer's the costliest disease to society, the release says. The report projected this cost will increase to more than $1 trillion in 2050.

“Alzheimer’s is a triple threat unlike any other disease — with soaring prevalence, lack of effective treatment and enormous costs. Promising research is ready for the pipeline, but there’s an urgent need to accelerate federal funding to find treatment options that effectively prevent and treat Alzheimer’s," Beth Kallmyer, vice president of constituent services for the Alzheimer’s Association, said in a release.

Most Kentuckians don't communicate with doctors electronically; most are confident about access to pricing information for care

Most Kentuckians don't communicate with their doctor electronically, according to the latest Kentucky Health Issues Poll.

The poll, taken Oct.8-Nov.6, found that 73 percent of Kentuckians have not communicated with their doctor using text, email or a website during the last year. A national poll found similar results.

This finding was consistent in all age groups, but there was a difference among socioeconomic groups.

Seventy-nine percent of those whose incomes are 200 percent of the federal poverty level or below said they had no electronic communication with their doctor in the past year, but only 66 percent of those above this level said they had had no electronic contact. In 2013, 200 percent of poverty level was $47,100 for a family of four.

Electronic communication with doctors was most common in Northern Kentucky and least common in Eastrern and Western Kentucky.

The Kentucky Health Information Exchange, the hub that connects participating providers with each other to share health information via certified electronic health records, is now working to connect patients to their electronic health records via a pilot program.

Research has found that patients who are better informed about their health and health care cost are more engaged with their health, according to the release.

Patients at UKHealthCare who have access to their "patient portals" seven days after discharge are an example of how few Kentuckians are engaging with their health care provider via electronics.

“About 8 to 10 percent of hospitalized patients look at their patient portals, of our inpatients,”Dr. Carol Steltenkamp, chief medical information officer at UKHealthCare, said in a phone interview “We would love for that to increase.”

Steltenkamp said that patients often don't understand how to use their portals and that the hospital is working diligently to educate them.

The poll also found that most Kentuckians think they can find out what doctors charge for treatments and procedures if they need this information, finding 36 percent extremely or very confident that they could find out how much treatments and procedures cost; 34 percent moderately confident and 28 percent not too confident or not confident at all. These answers did not vary by income, age or region.

The poll is conducted by the Institute for Policy Research at the University of Cincinnati and was funded by the Foundation for a Healthy Kentucky and Interact for Health, formerly the Health Foundation of Greater Cincinnati. It surveyed a random sample of 1,597 adults via landline and cell phone, and has a margin of error of plus or minus 2.5 percentage points.

Report links smoking with rheumatoid arthritis, other diseases

By Melissa Landon
Kentucky Health News

Smoking is even more harmful than previously thought. It not only can cause lung cancer but also rheumatoid arthritis and a long list of other diseases, according to The Health Consequences of Smoking—50 Years of Progress, a report of the surgeon general. Kentucky leads the nation in the habit, with 28.3 percent of adults smoking.

Since 1964, more than 20 million Americans have perished from smoking-related illnesses. Although most of the deaths were deliberate smokers, 2.5 million were nonsmokers who are believed to have died from exposure to secondhand smoke. "The burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other combusted tobacco products; rapid elimination of their use will dramatically reduce this burden," the report says.

The report provides supporting evidence that smoking often causes people to die early. Besides respiratory disease, cardiovascular diseases, and diabetes, new information gathered for this study reveals that smoking can also cause reproductive effects, such as ectopic pregnancy; eye disease, such as age-related macular degeneration; and immune and autoimmune disorders such a rheumatoid arthritis.

Because smoking weakens the immune system and causes systemic inflammation, it can not only cause RA but also impede treatment of it. RA is a chronic disease that involves inflammation of the joints and sometimes other parts of the body, according to WebMD. The report also found that women who smoke are just as likely as men to die from smoking-related illnesses—including lung cancer.

Though smoking has become less common since 1964, the costs associated with it are still high. The cost every year for direct medical care needed to treat smoking-related issues is $130 billion annually, and the cost for loss of productivity resulting from premature deaths are greater than $150 billion.

Regardless of constant warnings about the harmfulness of smoking, almost 42 million adults and over 3.5 million middle- and high-school children still smoke. "Each year for every adult who dies prematurely from a smoking-related cause, more than two youth or young adults become replacement smokers," the report says. Advertisements and marketing influence young people to begin smoking at a young age—88 percent begin before age 18—then the addiction to nicotine makes them continue.

The report suggests the following five measures for fighting the smoking battle in our society: raising the price of cigarettes and tobacco products, forming media campaigns, providing access to cessation treatments and funding statewide tobacco control programs.

Watch out for specious claims about health-reform law in highly politicized debate; Sen. Paul among those found off base

The biggest story in the state and nation is about to be Tuesday's opening of online health-insurance marketplaces, or exchanges, under the federal health reform law. "Obamacare" has been politicized from the start, and the current debate has featured several specious claims that journalists should be on the lookout for as they report, edit, present and choose commentary (including letters to the editor and person-on-the-street interviews) on the subject.

"There’s plenty of fodder for fact-checkers in Sen. Ted Cruz’s looong attack on Obamacare, and in President Obama’s defense of it," says FactCheck.org, the oldest of the nonpartisan political fact-checking services. It says the Texas Republican falsely claimed that spouses of United Parcel Service employees will be “left without health insurance” and forced into “an exchange with no employer subsidy.” UPS is dropping coverage only for who can get insurance with their own employer.

Conversely, "Obama greatly exaggerated when he credited the health care law for bending the cost curve on health care spending," FactCheck says. "Experts say the down economy is the overwhelming reason that national health care spending has been growing at historically slow rates in recent years."

FactCheck also took on Cruz ally Sen. Rand Paul (R-Ky.) for saying “everybody is going to pay more” for health insurance under the Patient Protection and Affordable Care Act. "The fact is, some will pay more and some will pay less," the service says. "Some currently uninsured Americans will pay little or nothing because of the law’s expansion of Medicaid."

As usual, FactCheck has a detailed accounting for its analyses, with plenty of references, here.

U.S. adult smoking rate dips to 18 percent; when state rates come out, will Kentucky still have the country's highest?

CDC chart; confidence interval (or error margin) means that
 95 percent of the time, the result for the entire U.S. population
would be within the range indicated at the tops of the bars.

The smoking rate for U.S. adults dropped to 18 percent last year, continuing a steady decline since 2009, when it was 20.6 percent, says an early release report of the 2012 National Health Interview Survey by the federal Centers for Disease Control and Prevention.

While state numbers will be released later, Kentucky's 2011 smoking rate was 29 percent, higher than any other state, says the CDC's Tobacco Control State Highlights 2012 report. (For county-by-county figures, click here.) State leaders and other observers have cited the high rate as the largest single reason for the state's health problems.

A recent editorial in the Kentucky New Era of Hopkinsville, a tobacco town that recently enacted a smoking ban, says this about the state's smoking statistics: "Medical expenses related to smoking are $1.5 billion annually and smoking is the cause of approximately 7,800 deaths each year."

The editorial says the state's tobacco use hurts its economy and quality of life. In addition to health-care costs, smoking-caused productivity losses in Kentucky total $2.3 billion a year. These amounts do not include health costs caused by exposure to secondhand smoke or other tobacco use, and does not include the money spent to purchase cigarettes.

"At the very least, Kentucky’s political, health and business leaders should know the rates of smoking and what it costs the state in medical care and diminished earning potential," says the editorial.

Dr. Stephanie Mayfield, commissioner for Kentucky's Department of Public Health, recently told a legislative committee that a typical smoker in the state spent $2,237 last year on cigarettes, says the editorial. And, despite Kentucky’s continuous efforts to discourage youth smoking, about 6,100 minors begin smoking each year, reports The Associated Press.

Overall, the U.S. survey found smoking rates were lower among adults ages 65 and over (8.9 percent) than among those ages 45 to 64 (19.5 percent) and those ages 18 to 44 (20.3 percent). Additionally, the percentage of current smokers was higher for men (20.4 percent) than for women (15.8 percent). The report doesn't include smoking rates for children. Click here to read about all CDC early-release measures.

Senate advances bill to allow Christian heath coverage cooperative back into Kentucky

Without dissent, the state Senate approved a bill Wednesday, Feb. 13, that would grant Christian health cost-sharing organization Medi-Share an exemption from the state's insurance laws and enable it to resume operation in Kentucky.

The Florida-based health care ministry was forced out of Kentucky last year by Franklin Circuit Judge Thomas Wingate, who ordered Medi-Share to stop operating in Kentucky. He acted at the request of the state Department of Insurance, which said the organization didn't comply with insurance regulations.

Sen. Tom Buford, R-Nicholasville, chairman of the Banking and Insurance Committee and sponsor of the bill, said the legislation would allow about 800 Kentuckians to rejoin Medi-Share. It would remove Medi-Share and two similar ministries operating in Kentucky out from oversight of the insurance department.

"The Department of Insurance regulates insurance companies. This is not an insurance company," Buford told the committee. Medi-Share does not include any contractual agreement to pay medical bills, but users are matched with each other to help pay for medical expenses through community giving, according to its website.

Medi-Share's plans resembles secular insurance in some ways but only allows participation by people who pledge to live Christian lives with no smoking, drinking, using drugs or engaging in sex outside of marriage, reports Beth Musgrave of the Lexington Herald-Leader.

The bill would require Medi-Share to tell members it's not an insurance company and does not guarantee that all medical bills would be paid, notes Roger Alford of The Associated Press.

The Rev. Dewayne Walker, pastor of Mount Olivet Baptist Church in Lexington, told the committee Medi-Share paid about $250,000 in medical bills for his wife, who had cancer. Medi-Share President Tony Meggs testified in court last year that the group has helped arrange to pay for some $25 million in medical bills for Kentuckians over the past 10 years, Alford reports.

Study: Raising cigarette taxes does curb even heavy smoking

The more you raise cigarette taxes, the less people smoke. That presumption was confirmed this week in a study by the Washington University School of Medicine in St. Louis. This has some resonance in Kentucky, where just last week the state’s Blue Ribbon Commission on Tax Reform told Gov. Beshear the state should raise taxes on tobacco, to $1 per pack from 60 cents. Other forms of tobacco would get a corresponding tax hike, reports Beth Musgrave of the Lexington Herald-Leader. The changes would raise an estimated $120 million in revenue and, if the research is right, cut down on long-term health care costs.

The researchers are the most adamant about the last point. “Most clinicians and researchers thought these very heavy smokers would be the most resistant to price increases,” says study author Patricia A. Cavazos-Rehg, PhD. “But our study points out that, in fact, change can occur. And that’s very good news.” In fact, in states where taxes on tobacco products rose by at least 35 percent, heavy smokers -- who averaged 40 cigarettes a day or more -- lowered their daily smoking by 14 cigarettes, on average.  In real numbers, the price for a pack of cigarettes increased from an average of $3.96 in 2001 to $4.41 in 2004. (Read more)

In Kentucky last year, almost 30 percent of residents said they were smokers, the highest in the nation. The state also has the highest rates of diabetes and lung cancer, reports Jim Malewitz of Stateline News. Kentucky’s cigarette tax is also among the country's lowest.

After several groups say Pap smears aren't needed every year, ob/gyns recommend an annual 'well-woman' visit

Though several groups have said women don't need a Pap smear every year, obstetricians and gynecologists still recommend an annual "well-woman" visit and annual pelvic exams for all females over 21.

These new recommendations by the American College of Obstetricians and Gynecologists were published Monday. They come a few months after the American Cancer Society, the U.S. Preventive Services Task Force and other groups said most women only need a Pap smear every three years starting at age 21. After the age of 30, they can get them less often if they also get tests for the human papillomavirus, known to cause cervical and other cancers.

The visit "can be used to check blood pressure and weight, update immunizations, counsel patients on healthy lifestyles, screen for sexually transmitted infections and other health problems, perform breast exams and build relationships between doctors and patients," reports Kim Painter for USA Today.

But some critics question if these visits are just a way to make money. "We estimate that about $8 billion a year is spent on preventive yearly physicals of all kinds," said Ateev Mehrotra, a professor at the University of Pittsburgh School of Medicine. "The question is whether we could spend those $8 billion more wisely." (Read more)

Tonsillectomies not necessary much of the time; among $158 billion spent each year on unnecessary health care

Photo by Matthew Staver, Bloomberg

Tonsillectomies are the most common procedure for children requiring anesthesia. "The only problem is there's no evidence they work for most" kids, reports Sarah Cliff of The Washington Post.

"The procedure does show some benefits for those with really serious symptoms — very sore throats, fevers and other symptoms at least seven times in the past year — but no improvement for those whose indications are milder," Cliff reports.

Yet, more and more of the procedures are being performed. Between 1996 and 2006, the number of tonsillectomies increased by 74 percent.

"It's a silent epidemic of unnecessary care," said David Goodman of the Dartmouth Atlas of Health Care. "In most instances, it's done for patients with much less recurrent symptoms than should be indicated. I think a lot of this is unbeknownst to providers."

Unnecessary health care costs about $158 billion every year, Cliff reports, and the sum is partly to blame on demanding patients, to whom doctors acquiesce. Because doctors are paid based on volume, there is also an incentive to provide more care, even if it's not necessary.

Goodman said the medical education system is one main culprit. "Medical schools and graduate schools are failing us deeply," he said. "We need to move some of these ideas about the evidence being uncertain into the beginning of education. There's been such little work on that." (Read more)

1 percent of population accounts for 22 percent of health-care spending, study finds

Just 1 percent of Americans were responsible for 22 percent of the nation's $1.26 trillion in health-care costs in 2009, and 5 percent accounted for 50 percent of costs, a federal report has found.

The numbers may seem shocking, but the concentration has dropped in recent years; in 1996, the top 1 percent of the population accounted for 28 percent of health-care spending.

"The report's findings can be used to predict which consumers are most likely to drive up health care costs and determine the best ways to save money," reports Kelly Kennedy of USA Today. (Read more)