Category: Uncategorized

Doctors Who Don’t Take Insurance: What Does It Mean for Patients?

Jul 9, 2008• 54

By MAGGIE MAHAR

More and more doctors are fed up with private insurers. It’s not just a question of how stingy they are, but how difficult it is to get reimbursed. Paperwork, phone calls, insurers who play games by deliberately making reimbursement forms difficult to interpret…

Some physicians have just said “no” to insurers.

What does this mean for patients? Business models vary. Some doctors charge by the minute. I recently read about a physician who punches a time-clock when the appointment begins. She has calculated that her time is worth $2 per minute. Fifty-nine minutes = $118. Will you be paying cash, or by charge today?

Somehow, I think the meter would make me nervous. I suspect I might begin talking very quickly. But this is only one model.

Rather than charging by the minute, some doctors charge fee-for-service. In those cases, many physicians mark up their fees well beyond what an insurer would pay. But, they point out, they also spend more time with their patients. No one feels rushed.Continue reading…

Health care financing confuses consumers

Jul 9, 2008• 3

By Jane Sarasohn-Kahn

Consumers are interested in a variety of financial instruments to help them purchase health care. However, even when given a choice to shop for and eventual purchase insurance, millions of people don’t.

Consumers are confused about health plan choices and need help in financial decision making. Data from McKinsey presented in an essay, "What consumers want in health care," analyzes results from a survey of about 3,000 retail health consumers. According to McKinsey, "many consumers aren’t accustomed to shopping for health insurance, so they are not prepared for this additional responsibility."

One of the most surprising, sobering findings is that people were more concerned about the cost of illness than about the illness itself.

Overcoming the challenges facing rural health care

Jul 8, 2008• 18

By Sarah Arnquist

Kensington, Minn. is barely a dot on the map. This small grid of concrete, where fewer than 300 people live, is a brief interruption amid the sprawling acres of green corn, soybean and wheat fields that cover Minnesota’s western plains.

Similar tiny villages exist every seven or so miles along the Soo Railroad route. These once busy agricultural hubs are now skeletons of commerce with rapidly aging populations.

About one-fifth of Americans live in rural areas, and providing health care to them is a challenge financially and logistically. Only 10 percent of the nation’s doctors practice in rural areas, and rural residents tend to be poorer and less likely to have employer-based insurance than urban dwellers. The list of challenges is long.

HELP WANTED: Zimmerman seeks revenue consultant

Jul 8, 2008

Zimmerman research and consulting firm seeks a self-motivated and goal-oriented revenue cycle consultant to join its team in providing best practice installation/consulting services to hospitals nationally.

Qualified individuals should have a 3 to 5 years experience working in the hospital and healthy system setting as well as a bachelor’s or master’s degree in health care administration or finance. The position requires extensive travel and includes a lucrative compensation package.

View the full job description here. Please send your resume and cover letter including salary requirements to ts***@**********cm.com

If California can’t protect consumers, who can?

Jul 7, 2008• 1

By Robert Laszewski

Crazy as it sounds an Associated Press story from Thursday reported that the California Department of Managed Care "didn’t even try to enforce a million-dollar fine against health insurer Anthem Blue Cross because they feared they would be outgunned in court."

Last year, the department announced that it would fine the insurer for improperly rescinding individual heath insurance policies in the midst of the California rescission controversy. Since then, most insurers have announced policy changes in the way they rescind coverage.

A message you hope to never send

Jul 7, 2008• 7

By Paul Levy

First, an email sent out on Thursday morning. My commentary follows.

Dear BIDMC Community,

This week at BIDMC, a patient was harmed when something happened that never should happen: A procedure was performed on the wrong body part. With the support of all our chiefs of service, we are sharing this information with the whole organization because there are lessons here for all of us.

While respecting the confidentiality of both the patient and caregivers, here are the key facts: It was an elective procedure, involving an excellent team of providers. It was a hectic day, as many are. Just beforehand, the physician was distracted by thoughts of how best to approach the case, and the team was busily addressing last-minute details. In the midst of all this, two things happened: First, no one noticed that the wrong side was being prepared for the procedure. Second, the procedure began without performing a "time out," that last-minute check when the whole team confirms "right patient, right procedure, right side." The procedure went ahead. The error was not detected until after the procedure was completed. When it was, our patient safety division was notified immediately, and they in turn took all appropriate steps including investigation, reporting and corrective action. The physician discussed the error with the patient at the first opportunity, and made a full apology. The patient is now recovering at home from the injury, which is not life-threatening.

How do we disrupt the cycle of rising health costs?

Jul 7, 2008• 5

By Jane Sarasohn-Kahn

Last week two new excellent new reports on health spending asked, do
we get what we pay for?

The answer is, well, sometimes — particularly when you follow the perverse incentives that lead you on the money trail of waste, ineffectiveness and, worst of all, poor health outcomes.PricewaterhouseCoopers’ Health Research Institute and the Center for Studying Health System Change offer their views on this topic with slightly different lenses.

In You Get What You Pay For, PwC examines 20 health systems and finds that managing costs is the top ranked factor for re-engineering payment systems throughout. Costs are put ahead of quality, efficiency, or meeting demand. While prospective payment (a la DRGs) has been adopted in 20 countries belonging to the OECD, and two-thirds of those countries believe their payment methods will change as they’re not stemming cost increases.

"Better informed patients" are seen as an optimal way to manage demand — not increasing out-of-pocket payments, at least not as a strategy on its own.

Health 2.0 Accelerator — The waiting is over….

Jul 4, 2008• 5

By Matthew Holt & Indu Subaiya

For several months there has been discussion amongst Health 2.0 companies about the concept of a Health 2.0 Accelerator. It started with Marty Tenenbaum’s introduction of the concept in September 2007. It continued with the discussion at the San Diego meeting in March 2008. Since then conversations and meetings among a small group have continued to define a first cut at what the Health 2.0 Accelerator should be.

The basic idea is for organizations to collaborate to create “public goods” —frameworks and strategies that will help all concerned to advance the industry. The way to do this is via projects that tackle particular problems, and leave behind frameworks and utilities that all can use.

The reality is of course going to be more complex, but we’re delighted to announce that the first project concerning moving pharmaceutical data has been announced, and the first principles and statements about the future of the Accelerator are now up at its own wiki at Health2Accelerator.org.

We are now asking for everyone in the Health 2.0 Community to become members, suggest projects, and contribute to the wiki. This is very much a work in progress, but we believe that the potential is huge. Please go to the new site, and contribute by giving us your comments.

What the candidates’ searches say about them

Jul 4, 2008• 4

By Craig Stoltz

One of the fun parlor games of Election ’08 is to look at Internet data and figure out what they mean.

The answer may be "nothing," of course.

But let’s play along and look at the latest Hitwise data on popular search terms. HitWise, a company that tracks Internet traffic, counted the search words that sent people to John McCain or Barack Obama’s websites. [Here’s a press release about the findings on the candidates’ top Internet search terms.]

"Health care" didn’t make Obama’s top 5 search terms in the first quarter of 2008. In the second quarter, health care took the number 4 slot. [Q1’s top term was "gay marriage," Q2’s "abortion."]

Meantime, "health care" took the tops spots for John McCain in both Q1 and Q2.

So: Does this mean people think they already know Obama’s healthcare plan and don’t need to search about it on the Internet? Or, don’t they have much interest in the issue?

As for McCain, do the searches mean his plan is little-known and people want information on it? Or do those interested in McCain care more about healthcare than Obama’s voters?

Retreat to the parlor and discuss, please.

UnitedHealth trying to regroup for an uncertain future

Jul 3, 2008

By Matthew Holt

In an attempt to put that messy options back-dating business behind it, yesterday
UnitedHealth Group settled with CalPERS (the ever vigilant pension fund of California state employees) and other class action suit members. And they settled for a bunch — $985 million. That’s even more than ex-CEO Bill McGuire gave back in his long running attempt to apologize without admitting criminal liability. Although, of course, United’s stock is down so much from the halcyon days of 2006 that it would require me to take my socks of both feet to work out if McGuire’s remaining options are worth anything these days!

Meanwhile, the CEO of Brocade is in jail (or may be out on appeal, I’m not sure) for back-dating options that helped his employees — and hurt his shareholders. Yet, McGuire (and for that matter Steve Jobs) seem to my untrained eye to have done the same thing without severe consequences. I’m still baffled.

United’s business seems to be heading into more trouble. Profits are down, lay-offs are up, and overall membership is down. More people and employers can’t afford health insurance in a weakening economy. And don’t forget total enrollment in commercial employment-based insurance plans fell during the most recent economic expansion!

The only logical rescue comes from an expansion of government plans. But there’s of course the little issue of how much they get paid for those government plans! The long-term question is whether they will lose more on the Medicare Advantage roundabout under the next Administration than they make up on any universal health care swings.

UPDATE: Wall Street didn’t like it too much. UNH is down 9% today