A recent thought-provoking article in the Fort Collins Coloradoan delves into the future of independent medical practices and the pros and cons of hospital mergers and “closed” healthcare systems like Kaiser Permanente (Kaiser opened for business in northern Colorado last fall) moving into the area. The article notes that the split between employed physicians and… Read more about Doctors Moving Away From Independent Practice – What That Means For Patients
Archives for May 2013
Over-Screening And Over-Treating Prostate Cancer
Brad Wright did a great job hosting the most recent Health Wonk Review at Wright on Health, so if you’re looking for a little weekend reading, don’t miss it. Brad’s got some good twists on classic vocabulary lessons, and tons of links for all your healthcare policy news. Have any of the rest of you… Read more about Over-Screening And Over-Treating Prostate Cancer
No Colorado Health Insurance Rate Information Yet
May 15th was the deadline for health insurance carriers in Colorado to submit rates for new plans that will be sold in the individual and small group markets in Colorado, both in and outside of the exchange/marketplace (Connect for Health Colorado). Much has been said about today – May 22nd – being the date when those rates are available to the public, and there has been a lot of anticipation about getting to find out what health insurance premiums are going to look like next year in Colorado. We know that in the Pacific Northwest, rates have come in lower than expected, attributed partially to the “heavy competition” in the WA and OR marketplaces (9 and 12 insurers, respectively). Colorado has even more competition than that, with 19 different carriers submitting rates for plans to be sold through Connect for Health Colorado and on the open market (I’ve seen other reports that say 17 carriers, but either way, it will be a robustly competitive market – just as we’ve always had in Colorado).
There has been much speculation about what the new rates will look like. 9News did a piece last week that highlighted the concerns that rates – particularly in the individual market – could be much higher next year. Over the last year or so, in talking with knowledgeable representatives from the various health insurance carriers (who are themselves talking with knowledgeable actuaries), we’ve heard predictions that range from rate decreases for older policy-holders to rates more than doubling for younger insureds… and just about everything in between. So we are very curious to see how things look once the DOI releases rates.
Today’s the day that those rates are scheduled to be made public, but I doubt that things will be particularly clear anytime soon […]
ACA – We Need Solutions Instead Of Repeal Votes
By now it’s probably not surprising to anyone to hear that the House voted – yet again – to repeal the ACA yesterday. This is the 37th time in the last three years that they’ve voted to repeal and/or defund all or part of the law. They are fully aware of the fact that their vote will – as usual – end with them, as it’s highly unlikely to get through the Senate. But they continue to focus a rather significant portion of their (taxpayer funded) time on this issue.
It’s understandable that there are objections to the ACA. To say otherwise is to be blind to some of the obvious problems that are inherent in the law. We’ve written numerous posts in support of the ACA over the past few years, but we’ve also noted several concerns that we have, and I think they’re valid ones. Premiums in the individual market might end up being higher after full ACA implementation for a lot of people who receive little or no subsidies (we’re expecting to see rates published by the end of this month for policies that will be sold in the Colorado health insurance exchange. The deadline for carriers to file them was Wednesday). New restrictions on age-banded rate ratios might end up making younger, healthier people (the ones who are most needed in the health insurance pool in order to stabilize premiums for older, sicker insureds) less likely to obtain coverage. This problem might be exacerbated by a less-than-robust individual mandate, at least for the next year or two. We’ve also wondered whether the exchanges will be capable of providing a high level of customer service, given the complexity of the enrollment process (assuming an applicant qualifies for subsidies) and the fact that many of the applicants will be applying for health insurance for the first time. Will the exchanges have enough staff to rise to the customer service level provided by private industry, or will contacting a knowledgeable representative during the open enrollment period be on a par with getting a hold of a knowledgeable representative at the IRS between January and April?
The concerns that we have about the ACA are outweighed by the positives though: More people with health insurance, guaranteed issue individual plans, better preventive care, and numerous[…]
Freedom Of Religion And Workers’ Comp In The Cav
I’m sure a lot of people would have an opinion on this based on religious and/or business beliefs. Jon’s take on this situation is probably far more informed than the average person’s would be, given his knowledge of the workers’ comp system. I cannot imagine going without health insurance, or employees going without workers’ comp, but I recognize that my viewpoint is based on my own experiences in the secular business world – where money (and expensive healthcare) is very much a necessity. It will be interesting to see how this plays out in a Supreme Court appeal. Jon mentioned that there’s a lot of legal precedent in favor of religious exemptions from workers’ comp coverage, so maybe the court will side with the Hutterites. In terms of the unfair competitive advantage that the Hutterite workers have over secular contractors who are paying workers’ comp premiums, I would say that the small number of Hutterite laborers (when compared with the number of non-Hutterite laborers) could possibly be a reason for ruling in favor of the Hutterites: can they really present that much of an unfair business advantage with such a relatively small number of workers?
Comparing CEO Compensation in Various Healthcare Industries
Joe Paduda of Managed Care Matters did an excellent job with the most recent Health Wonk Review – be sure to stop by his blog and check it out. I thought this article from Dr. Roy Poses was especially interesting. Writing at Health Care Renewal, Dr. Poses shines the spotlight on UnitedHealth Group’s CEO Stephen Hemsley’s oversized compensation. Roy notes that while the increase in CEO compensation does mirror the company’s overall financial success of late, it must also be considered in light of the fact that the company has made some missteps in terms of fulfilling its stated mission to provide health care “at an affordable price” and “expand access to quality health care.” Roy’s article cites several examples of allegedly unethical behavior, and concludes by noting that “Real health care reform needs to make health care leaders accountable, and especially accountable for the bad behavior that helped make them rich.”
I definitely do not disagree with Dr. Poses, and we’ve noted in the past that UnitedHealth Group has had issues with large executive compensation and backdating stock options (that was with a previous CEO, however). But I do want to use this as an opportunity to remind our readers and clients that most health insurance companies have CEO compensation packages that are far lower. Forbes compiled a list of the 498 highest-paid CEOs in 2012, and I scrolled through the first 150 on the list. UnitedHealth Group is there on the first page, ranked number 8 (they’re also ranked number 31 in Fortune 500 total profits, so as Roy said, the CEO salary is at least in the same ballpark with the company’s financial performance).
But you have to click through several pages of the CEO compensation list to get to the next health insurance carrier. Humana was the next one I found, ranked at […]
Balance Billing From Non-Network Providers Who Work At In-Network Facilities
We recently heard from one of our clients who is dealing with a balance billing issue resulting from a NICU stay. For her baby’s birth, she chose a large hospital in Denver that was on her Humana health insurance network. Her OB/GYN was also on the Humana plan, and she figured she had all of her ducks in a row. But complications necessitated an emergency transfer to the NICU, where her new baby was cared for by doctors who are contracted with the hospital, but are not part of the Humana network.
When patients are treated by out-of network providers, there’s no contractual obligation between the doctors and the health insurance carrier. The patient will usually be responsible for a higher deductible when using a non-network provider (although this is not typically enforced for emergency care), but even after the deductible is met, the provider is not obligated to accept the “reasonable and customary” payment from the health insurance carrier. The provider can choose to bill the patient the shortfall between what was originally billed and what was paid by insurance.
Our client has been balance billed over $5,000 by the NICU doctors. Humana paid the doctors their in-network amounts for the NICU stay and counted it as an in-network expense (ie, no additional out-of-network deductible was charged) because it was an emergency situation. But the doctors refused to accept the insurance reimbursement as payment in full, and billed the family for an additional $5,000+. I suppose it could be worse – this family ended up with a $50,000 balance bill from their baby’s NICU stay.
But it could also be better. People who are recovering from an illness or injury don’t need to also be finding out that an in-network facility where they were treated also has providers who are not […]
Colorado Health Insurance Exchange Won’t Be A Train Wreck
When Max Baucus predicted that the implementation of key aspects of the ACA could be a “huge train wreck coming down“, his comments were met with a lot of “see, I told you so!” comments from the right, and some surprise from the left, given how instrumental Baucus was in drafting the legislation. Now Harry Reid has stated that he agrees with Baucus. Reid noted that there is still much work to be done, and that significant additional funding is needed in order to make the remaining implementation of the ACA successful. HHS Secretary Kathleen Sebelius pointed out that her requests for additional funding were rejected in a recent short-term funding plan, but she’s optimistic about the ACA implementation, saying “…we are on track to fully implement marketplaces in January 2014 and to be open for open enrollment.”
I would say that the job Sebelius has in front of her is a monumental one, no doubt made harder by the propagation of misinformation and outright lies (there are no death panels!). In addition, a majority of the states opted to either have the federal government run their exchanges (26 states) or partner with the state on a joint exchange (7 states). Only 17 states plus the District of Columbia have taken sole responsibility for running their own health insurance exchanges (Colorado is in this category). So although HHS will likely be able to implement very similar exchanges in the 26 states where they will be fully responsible for running the exchange, making economies of scale work in their favor, the fact remains that they face a significant task: getting exchanges going in more than half the states, often in places where resistance to the ACA […]