Medical pricing system seen as “inscrutable.” September 10, 2008
Posted by Obi Jo in Insurance Profits, health reform.Tags: hospital billing, hospital profits, Hospitals, insurance benefits, Insurance Profits, patients, physician behavior, physician billing, physician payments
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Medical pricing makes the head spin – well let’s unspin it just a bit . . . No question, political courage is lacking at all levels to deal with these issues.
First, hospital billing has been out of sync for decades. This began, when as pointed out, all overhead charges were rolled into the bill. Thus the famous $10 aspirin and the like became lead flags waived by reform advocates. However, the flaw is in not forcing hospitals to bill like contractors and other service providers do. Bill for the cost of products, drugs, devices, disposables and the like, then bill for labor separately (just as a mechanic or plumber would do), then bill for general overhead and finally there should be an allowance for profit in the billing. At present that amount is hidden as are the other real costs under the foolish billing system that exists and which private carriers have perpetuated. As for physicians, the fees charged bear no basis to reality, in that almost all patients being treated by the vast majority of doctors are covered under one health plan or another which DICTATES TO THE MARKET what the pricing structure will be. Thus in the end, for almost all the services provided by physicians and surgeons, the amount billed to the patient is not relevant, it the amount ALLOWED or CONTRACTED that matters. And that is often always much less than the billed amount.
* David Lazarus wrote about “the inscrutable way that healthcare providers and insurers put a dollar value on medical services.” According to Jim Lott, executive vice president of the Hospital Association of Southern California, “patients are wrong to think that the charge on their bill reflects the actual cost of treatment.” Lott explained the “cost-plus system” allows hospitals to include “both the cost of a service and a portion of general overhead, including treatment of uninsured people,” to calculate charges. Meanwhile, insurance companies and “state and federal authorities…negotiate lower rates, in return for delivering thousands of patients to a particular clinic or hospital.” Lott described the system as one “that both condones and perpetuates inflation, while all but eliminating transparency in the marketplace.” Insured patients are overcharged by providers, and insurers pay “significantly less than the billed amount because they know they’re being hit up for unrelated costs.” Lazarus concluded that “a massive infusion of political courage” is needed “to tackle genuine healthcare reform.”
link to full article in the LA Times by David Lazarus @ http://www.latimes.com/business/la-fi-lazarus7-2008sep07,1,1072727.column
Physician discusses flaws in P4P program September 10, 2008
Posted by Obi Jo in health insurance, health reform, patient care.Tags: Congress, health care reform, health reform, Medicare, P4P, pay for performance, personal health mandates, physician payments
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Once again, our “esteemed” bureaucrats in Washington, this time at CMS and Medicare, have come up with a great idea, while sitting behind a desk – not the place to find out what changes in care for patients need to be made. This is a GREAT example of the potential massive failures that would be exhibited in a fully government run health system. Making rules about disease in general, when disease effects human beings specifically, is both dangerous and foolish. Doctors MUST be allowed to practice medicine. Oversight is fine. Review is great. Hold folks accountable. Make sure everyone is learning and keeping up to date. But paying physicians to meet an artificial bar is NOT where we should be focusing our attention. This encourages attempts at gaming the system when the focus should be on providing the best care possible to all patients . . . jomaxx
The Pitfalls of Linking Doctors’ Pay to Performance
Sandeep Jauhar, M.D., writes in a NY Times piece that these days, patients often receive “antibiotics without solid evidence of an infection. And, part of the blame lies with a program meant to improve patient care.” This “program is called pay for performance, P4P for short,” and “employers and insurers, including Medicare, have started about 100 such initiatives across the country.” It is intended “to reward doctors for providing better care.” For instance, physicians “receive bonuses if they prescribe ACE inhibitor drugs to patients with congestive heart failure.” Dr. Jauhar argues that this may seem like a sound idea, but “in a survey [conducted] in New York State, 63 percent of cardiac surgeons acknowledged that because of report cards, they were accepting only relatively healthy patients for heart bypass surgery.” In addition, while Medicare requires that “antibiotics be administered to a pneumonia patient within six hours of arriving at the hospital,” physicians “often cannot diagnose pneumonia that quickly.” Dr. Jauhar concludes that the program’s “deep flaws must be addressed before patient care is compromised in unexpected ways.”
Link to the full article by Dr. Jauhar in the NY Times @ . . . http://www.nytimes.com/2008/09/09/health/09essa.html?_r=1&scp=1&sq=%2bmedicare&st=nyt&oref=slogin
Congress likely to delay health care overhaul – and just why is that?! September 10, 2008
Posted by Obi Jo in Insurance Profits, health insurance, health reform.Tags: Congress, health care reform, health insurance, health plans, health reform, pre existing conditions, previous illnesses, previous injuries
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Now the general election is in full swing, and after an August hiatus, it is time to get back to it.
All of this info below is just great news . . . HOWEVER, WHY WILL CONGRESS AND THE PRESIDENT NOT TACKLE THE REAL ISSUES.
Pass legislation that OUTLAWS private insurance carriers from excluding potential policy purchasers due to pre-existing conditions, illnesses or surgery.
Pass legislation that OUTLAWS the ability of private insurance companies to drop paying policy holders that THEY deem to be too “high risk” (translation, they have been or may be likely to be sick in the foreseeable future).
Pass legislation that OUTLAWS the ability of private carriers to impose complex, bizarre and artificial rules on who can be covered (translation, forcing children off of policies when they reach a certain age, defining groups as strangers as opposed to a family).
Pass legislation that OUTLAWS the ability of private carriers to impose arbitrary rate increases independent of their truly necessary reserve levels (and those need to be reviewed) as well as their profits. CEO’s of health plans making millions is obscene when the front line providers, doctors and nurses, NEVER make that amount of compensation, and when those bonuses are really made in the long run by denying payment for needed services.
Congress, Mr. President, Candidates McCain and Obama, wake up and smell the coffee . . . the current private system, which is essentially unregulated from the market perspective, needs serious overhaul . . . jomaxx
As Congress returns from summer recess, lawmakers are expected to continue needling…health insurers with investigations, while holding off on major healthcare reform until next year.” So far this year, Congress has approved legislation that bans “insurance sales representatives from cold-calling, door-to-door solicitations.” And, analysts are predicting “continued scrutiny on how health insurers market their Medicare Advantage offerings to seniors.” The AP noted, however, that because Democrats are “expected to pick up additional seats in Congress, and possibly the White House in November,” lawmakers will not immediately “tackle campaign promises like expanding government health coverage.” Analysts also say that the “slowing economy, rising food and gas prices, and new tensions with Russia will take precedence over health reform” next year.
See link to full article on CNN Money.com @ . . .
