Author: jhyman@jeffhyman.net

For cancer patients, the road from diagnosis to survivorship feels like a never-ending parade of medical appointments: surgeries, bloodwork, chemotherapy, radiation treatments, scans. The routine is time-consuming and costly. So, when hospitals charge patients double-digit parking fees, patients often leave the garage demoralized.

Iram Leon vividly remembers the first time he went for a follow-up MRI appointment at Dell Seton Medical Center in Austin, Texas, after he had been treated at another hospital for a brain tumor.

The medical news was good: His stage 2 tumor was stable. The financial news was not. When he sat down at the receptionist’s desk to check out, Leon was confronted by a bold, red-lettered sign on the back of her computer that read: “WE DO NOT VALIDATE PARKING.”

Below that all-caps statement was a list of parking rates, starting with $2 for a 30-minute visit and maxing out at $28 a day. Lose your ticket? Then you could pay $27 for an hour.

“To this day, I remember that sign,” Leon, 40, said of the 2017 appointment, which he posted about on Facebook. “These patients were people who were coming in for various types of cancer treatment. These were people who were keenly aware of their own mortality, and yet the sign was screaming at them, ‘We do not validate parking.’” (Hospital officials did not respond to requests for comment about their parking policy.)

JulieAnn Villa, who was diagnosed in March with her third bout of cancer, estimates she has spent “thousands of dollars” on parking fees during her years of treatment and follow-up care. She faces a transportation dilemma every time she commutes 6 miles to Chicago’s Northwestern Memorial Hospital from her apartment. Should she take public transit? Call a pandemic surge-rate Uber? Ask a friend to drive her? Or pay $12 to $26 (with validation) to park in a garage where each floor is named after singers like Dolly Parton and Frank Sinatra?

She was hospitalized for multiple days in April after spending 23 hours alone in an overburdened ER, because she didn’t want friends to pay to wait with her. “I almost drove myself, and I’m so glad I didn’t,” Villa said. “That would have been expensive.”

Long a source of frustration for patients, the cost of parking while in cancer treatment is finally drawing national scrutiny from oncology researchers and even some hospital administrators.

“If you want to rile up patients or caregivers or family members, just bring up parking costs,” said Dr. Fumiko Chino, a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York who studies the “financial toxicity” of cancer treatment, including costs not covered by insurance, such as parking fees.

Chino, who enrolled in medical school after her husband died of a rare neuroendocrine cancer in 2007, added, “For people who have to pay $15 to $18 every single time, which is what I remember paying, it really feels like the last straw, frankly — like kicking you when you’re down.”

Public transit is possible for some cancer patients in larger cities, but not for those too ill or immunocompromised. Others have accessibility issues. Many must travel to get care, making driving the best option.

Parking fees can have implications for more than just the patient. “Some patients say, ‘This is the reason I didn’t participate in a clinical trial, because I couldn’t afford the parking,’” Chino said.

At a time when hospitals and drug companies are under increasing pressure to diversify clinical trial populations, testing only patients who can afford high parking fees is problematic, Chino said.

There are some pilot programs to improve access to drug trials, and some charities, such as the Leukemia & Lymphoma Society, offer travel grants, but accessibility remains a substantial barrier to cancer care, said Elizabeth Franklin, president of the nonprofit Cancer Support Community, which offers financial aid to patients and advocates in Washington, D.C., for “patient-centered” health policies.

“The true definition of a patient-centered health care system,” Franklin said, is one that allows patients to choose the best means of transportation. “It’s not making them go into debt because they’ve had to pay a ton of money for parking each time they go to the clinic or the hospital.”

Chino and colleagues published a short study in July showing that some cancer patients pay $1,680 over the course of treatment.

According to readership statistics released in late March, the study was the most read and downloaded article in JAMA Oncology last year, and it continues to prompt a lively social media response. A thread on Reddit has logged more than 1,100 comments, including many from patients in other countries voicing surprise at U.S. parking policies.

The researchers calculated the cost to park at 63 National Cancer Institute-designated cancer centers while receiving the standard number of treatments for each of three types of cancers: node-positive breast cancer, head and neck cancers, and acute myeloid leukemia, or AML. They did not calculate costs for follow-up appointments, blood draws, routine scans and immune-boosting injections.

They found that, while 20 of the hospitals provided free parking for all cancer patients, the other 43 had widely varying fees.

“The range was $0 to $800 for breast cancer,” Chino said. “That’s huge, and it’s not like the person who’s paying $800 is necessarily getting any better treatment.” The maximum charges for a standard course of therapy for head and neck cancer were $665 and for AML, $1,680.

Practices should change, Chino said, “to alleviate this strain for our patients.”

Of the 63 hospitals, including those where parking is free for cancer patients, 54% offered free parking for chemotherapy and 68% for radiation treatment.

The top daily parking rate, according to the researchers, is $40 at New York’s Mount Sinai Hospital. (A spokesperson for Mount Sinai declined to comment.) Chino’s own institution, Memorial Sloan Kettering, is not far behind; parking at one of its main garages begins at $12 an hour and maxes out at $36 a day. A spokesperson for the hospital said some locations do offer free parking, and all patients can apply for aid to cover parking costs.

A few colleagues scoffed when Chino said she was researching parking charges, she said, but a growing number of mostly younger oncologists are concerned about indirect costs that contribute to the financial toxicity of cancer.

“It seems ethically incorrect to nickel-and-dime patients for parking charges,” a trio of doctors wrote last year in an editorial published by the American Society of Clinical Oncologists. They acknowledge that most top cancer hospitals are in urban centers, where parking costs are often high and third-party agencies may operate the garages. “Nevertheless, in 2020, with our multibillion-dollar cancer center budgets, we as health care systems should do everything we can to help patients and caregivers,” the editorial said.

City of Hope National Medical Center in Los Angeles is one of the 20 NCI-designated hospitals that do not charge patients for parking. Dr. Vijay Trisal, a surgical oncologist who serves as City of Hope’s chief medical officer, takes pride in that distinction.

“Charging cancer patients for parking is like a knife in the back,” he said. “We can’t control copays, but we can control what patients pay for parking.”

While Trisal would never want a patient to choose City of Hope for the free parking alone, he acknowledges the policy gives his hospital a competitive advantage.

“You would not believe how many patients have said to me, ‘Thank you for not charging for parking,’” he said.

Click on the link below to watch my discussion with CFO Steve Watson as I discuss why most employees are paying too much for worksite benefits and how I can help change that trend.

https://www.linkedin.com/embed/feed/update/urn:li:share:6788197828247220224

In my conversations with CEOs and CFOs, I often hear why our employees did not purchase the voluntary benefits that they offered at open enrollment through XYZ company. My response is, let me review your summary plan documents on your most recent open enrollment to understand your offering better.

As we all know, the pricing of insurance products may vary depending on different factors. What are some of the critical factors that make up the rate?

Total expenses are developed based on the internal expectations of commission, premium taxes, administrative costs, and overhead. The expense assumptions outlined below represent an example of a  new case:

Claims Adjudication 1.75%

Commissions 15%-20%

Premium Tax 2%

Overhead 10%

Profit Margin of 8%

Loss Ratio 55-60%

Also, at the case level, expense assumptions may vary.

Click on the link below to listen to my recent conversation with @stevewatson, CFO as we discuss heaped, level, or net commissions.

http://trendbreakers.buzzsprout.com/1122509/5507068-54-building-worksite-employee-benefits-net-of-commissions-jeff-hyman-principal-consultant-jlh-consulting

The Accident and Health segment is +2.01% YTD, but the Life segment is down 28.91% YTD.

Aflac, the leading provider of supplemental insurance in the U.S., closed Friday at $36.75, down 30.48% YTD.

Prudential, closed at $63.34, down 30.76%.

Unum stock closed at $18.15, down 37.83%.

Lincoln National Corp closed at $37.30, down 36.94%.

Met Life closed at $38.10, down 25.01%.

Hartford Financial closed at $41.48, down 31.74%

Allstate closed at $94.00, down 16.09%.

Voya Financial closed at $49.19, down 19.33%.

Sun Life (U.S.) closed at $39.63, down 13.03%.

Principal Financial closed at $44.40, down 18.61%.

Manulife Life closed at $13.96, down 31.10%.

Aegon (owns Transamerica) closed at $3.04, down 32.89%.

Health Insurance Companies (Stock)

United HealthCare Group closed at $298.30, up 2.32%

Cigna closed at $180.25, down 11.48%

CVS (owns Aetna) closed at $74.16, down $14.74%.

Anthem closed at $270.49, down 10.44%.

Humana closed at $392.14, up 6.99%.

Global Brokers

Marsh & McLennan, the world’s largest broker, closed at $114.62, up 2.88%.

Aon closed at $207.17, down 0.54%.

Willis Towers Watson closed at $211.52, up 4.74%.

Arthur J. Gallagher closed at $103.93, up 9.14%

Brown & Brown closed at $40.45, up 14.99%

Aflac market cap has fallen $13 billion since February 3, 2020. Aflac stock was trading at $52.01 at the close on February 3. Today, March 12, 2020, Aflac stock closed at $32.39 per share, with a market cap of $26.69 billion. YTD, Aflac stock is down 41.11%.

Prudential, known as a piece of the rock, has seen its stock drop 51.17% YTD. Their stock closed at $91.50 on February 3, 2020, and closed today at $47.64 with a market cap of $23.01 billion.

Unum has seen its stock drop 54.22% YTD. Unum stock closed on February 3, 2020, at $27.03 and closed today at $14.55 and a market cap of $3.55 billion.

Lincoln National Corp has seen its stock drop 60.89% YTD. On February 3, 2020, LNC stock closed at $54.32 and closed today at $24.14 and a market cap of $6.23 billion.

Met Life has seen its stock drop from $49.69 at the close of trading on February 3, 2020, to closing today at $29.02 and a market cap of $30.50 billion. Met Life stock is down 45.18% YTD.

Hartford Financial has seen its stock drop from $60.14 at the close of trading on February 3, 2020, and closed today at $41.15 and a market cap of $16.17 billion. Hartford stock is down 34.08% YTD.

Allstate has seen its stock drop from $119.05 at the close of trading on February 3, 2020, to $86.08 at the end of trading today. Allstate stock is down YTD 25.72%.

Voya Financial has seen its stock drop from $60.40 at the close of trading on February 3, 2020, to $40.56 at the end of trading today with a market cap of $5.37 billion.

Global Brokers stock has also struggled year-to-date.

Marsh & McLennan, the world’s largest broker, is down 16.99% YTD after closing today at $95.27. Marsh & McLennan has a market cap of $49.86 billion at the end of trading today.

Aon, who announced it was acquiring Willis Tower Watson, closed at the end of trading today at $174.67, down 16.90% YTD. Aon has a market cap of $42.84 billion.

Willis Towers Watson closed at $175.00 today, down almost 15% YTD. WTW has a market cap of $24.23 billion at the close of trading today.

Arthur J. Gallagher closed today at $87.20, down 8.70% YTD. Gallagher has a market cap of $17.88 billion.

Brown & Brown closed today at $37.99, down 4.1% YTD. Brown & Brown has a market cap of 11.71%.

Aflac market cap has fallen $13 billion since February 3, 2020. Aflac stock was trading at $52.01 at the close on February 3. Today, March 12, 2020, Aflac stock closed at $32.39 per share, with a market cap of $26.69 billion. YTD, Aflac stock is down 41.11%.

Prudential, known as a piece of the rock, has seen its stock drop 51.17% YTD. Their stock closed at $91.50 on February 3, 2020, and closed today at $47.64 with a market cap of $23.01 billion.

Unum has seen its stock drop 54.22% YTD. Unum stock closed on February 3, 2020, at $27.03 and closed today at $14.55 and a market cap of $3.55 billion.

Lincoln National Corp has seen its stock drop 60.89% YTD. On February 3, 2020, LNC stock closed at $54.32 and closed today at $24.14 and a market cap of $6.23 billion.

Met Life has seen its stock drop from $49.69 at the close of trading on February 3, 2020, to closing today at $29.02 and a market cap of $30.50 billion. Met Life stock is down 45.18% YTD.

Hartford Financial has seen its stock drop from $60.14 at the close of trading on February 3, 2020, and closed today at $41.15 and a market cap of $16.17 billion. Hartford stock is down 34.08% YTD.

Allstate has seen its stock drop from $119.05 at the close of trading on February 3, 2020, to $86.08 at the end of trading today. Allstate stock is down YTD 25.72%.

Voya Financial has seen its stock drop from $60.40 at the close of trading on February 3, 2020, to $40.56 at the end of trading today with a market cap of $5.37 billion.

Global Brokers stock has also struggled year-to-date. Marsh & McLennan, the world’s largest broker, is down 16.99% YTD after closing today at $95.27. Marsh & McLennan has a market cap of $49.86 billion at the end of trading today.

Aon, who announced it was acquiring Willis Tower Watson, closed at the end of trading today at $174.67, down 16.90% YTD. Aon has a market cap of $42.84 billion.

Willis Towers Watson closed at $175.00 today, down almost 15% YTD. WTW has a market cap of $24.23 billion at the close of trading today.

Arthur J. Gallagher closed today at $87.20, down 8.70% YTD. Gallagher has a market cap of $17.88 billion.

Brown & Brown closed today at $37.99, down 4.1% YTD. Brown & Brown has a market cap of $11.71 billion.

What If Aflac Group was reported separately?

If, is such a big word to be two letters. But what if Aflac reported Aflac Group separately from Aflac as Unum Group does with Unum and Colonial?

The top five carriers would have a different standing with MetLife leading with a 12.84% market share followed closely by Aflac, Aflac Group third, Colonial Life forth, and Unum fifth. But only “If.”

I wish all of my LinkedIn friends a great 4^th quarter.

This amazing story started in 2005 by Greg Williams, a former banking and telecommunications executive and his partner, Ricky Norris, who had an insurance background. This incredible story began with a business plan, vision, and a hope that they could execute their dream. And boy have they accomplished that.

In 2010, I started following Acrisure, and they had about 27 million in revenue. In 2012, Acrisure made its debut in the Top 100 Brokers in the U.S. at #85 according to the annual Business Insurance Top 100 brokers rankings. But this story doesn’t stop here.

Every year Acrisure climbed the Business Insurance Top 100 rankings. Today, after more than 375 acquisitions, including more than 100 in 2018, Acrisure had almost $1.4 billion in revenue. While there has been hundreds of acquisitions, organic growth has been over 4% the last eight years with a EBITDA of over 35%.

So what will we see in 2019, more acquisitions for sure? In 2018, Acrisure increased revenue more than $350 million over 2017. With that type of growth in 2019, Acrisure will continue to close the gap on #9, USI Insurance Services, who reported $1.66 billion of revenue in 2018.

I expect this amazing broker firm to continue to grow in the plus 25% – 30% range.

Congratulations to Greg Williams and the Acrisure team.