As of April 1, 2011, CoverColorado will be switching to a new fee schedule for reimbursing providers. In the past, CoverColorado has used the Rocky Mountain Health Plans provider network, and doctors were paid according to the RMHP network-negotiated rates when they treated CoverColorado members. The new CoverColorado-specific fee schedule applies to any provider who treats a CoverColorado member, regardless of whether that provider is part of the RMHP network or not. […]
[…] But the shortage of doctors who will accept new Medicaid patients could definitely be seen as a significant obstacle to receiving care for people who rely on Medicaid to cover their healthcare costs. It’s likely that there is a long list of reasons why people on Medicaid have poorer health outcomes (and we have to be careful to not mistake correlation with causation). But it’s reasonable to assume that the difficulty Medicaid patients experience in finding a doctor isn’t doing anything to improve their health outcomes.
[…] We seem to be caught up in a wave of screening test excitement lately, with new advanced testing available for every disease under the sun. Rather than focusing on things that can truly prevent health problems (the old, and decidedly low-tech diet and exercise ideas…), we are fixated on developing newer and better screening tests. This exacerbates the problem of over-consumption of health care and rising health care costs.
I doubt that regulators will simply throw out the existing rules and allow ACOs to operate without consumer protections to place to guard against fraud and abuse. Instead, I see them coming up with new regulations that take into account the changing landscape of health care delivery, including ACOs. But either way, the creation of new consumer protections while suspending others does make for an interesting discussion. […]
Accountable Care Organizations (ACOs) have received a lot of buzz lately as the nation grapples with ways to reign in health care costs. But I think that there’s still a lot of confusion about how they would work. A couple of very informative posts on the topic were included in this week’s Grand Rounds, and I wanted to share them with our readers. […]
Health care costs are rising at a dizzying pace. For most Americans, this translates into increasing health insurance premiums, which are driven mostly by the cost of health care. Getting health care costs under control is a necessary step, and one that politicians generally say is important. But what is said and what is done are not always in line with each other. This outstanding article on Emergency Physicians Monthly is a perfect example of health care costs run amok. […]
[…] While these changes might not have been warmly welcomed, they will ultimately help to make the system sustainable in the long term. The same could be said for the rest of the health care industry if similar cuts are implemented in other areas. Although the physician reimbursement cuts are unpopular with most doctors, they may be the only way to keep Medicare as a viable payer for seniors’ health care needs. And ultimately, it’s in the best interest of both doctors and seniors to keep Medicare around.
[…] Time will tell, but it seems that as long as doctors, hospitals, medical device makers, and pharmaceutical companies are exempt from any rules concerning profits and administrative costs, the MLR rules might not have much long term impact on the actual cost of health insurance. Premiums will keep rising (at a pace similar to what we’ve seen over the last several years) as long as the cost of healthcare continues to climb at the same rate it has for the last decade or so.
IMG Europe just won Best International PMI Provider at the Health Insurance Awards 2010. IMG Europe is a subsidiary of International Medical Group Inc. – one of the most popular travel insurance benefits providers […]
David mentioned that “…ideologues would call this rationing.” I couldn’t agree more, and I think that research like this is the best defense against those who criticize any sort of evidence-based medicine that results in less treatment – but better or equally good outcomes. The word rationing has a bit of a negative connotation in our culture. It conjures up images of people standing in line for hours to get a loaf of bread, or only being allowed to buy five gallons of gasoline at the pump. It makes us think of hardship and having to do without things that we need. I believe that people who are opposed to scientific, evidence-based medicine are capitalizing on the public’s general dislike of the concept of rationing […]
[…] Personally, I would be open to the idea of seeing a family practice doctor who doesn’t contract with health insurance carriers, and paying for routine care out of pocket, if there were some way to combine that with a discount on our health insurance premiums… If the DocTalker Family Medicine idea were to become more widespread and if insurers could account for this type of care when setting premiums, I can see it making a lot of sense for healthy families who want to use health insurance for large medical bills and budget for smaller bills themselves.
[…] Regardless of the practicalities involved, there’s no doubt that the headlines about insurers ceasing to issue child-only policies is generating some ill will and bad PR for insurance carriers. Either lawmakers knew that would happen, or else they put very little thought into considering the details of how insurers would go about making children’s coverage guaranteed issue a mere six months after the bill was signed into law, and just added the provision as a feel-good part of the bill.
[…] A lot has been said about over-utilization of health care lately, and the need to reduce both cost and utilization in order to make our health care system sustainable. But I have to wonder how many urgent care clinic front desk people would be willing to give out free advice like that, and how many would have just taken our insurance info and sent us in to see the doctor?
[…] that could become the standard payment for all births, regardless of whether a c-section were performed or not. There would be no financial incentive for doctors to opt for c-sections, as they would no longer receive higher compensation for doing so. The tough medical malpractice environment that OBs practice in would likely provide more than enough motivation for them to continue to do c-sections when there was a true medical emergency, despite the fact that they would know there would be no additional compensation for the birth. […]
A year ago I wrote an article about how health insurance companies were generally doing a better job in 2008 of paying claims faster and denying fewer claims than they did in 2007. The annual Athena Health study results are now out for 2009, and overall there was another significant increase in the speed with which health insurance companies paid claims (7 days faster than in 2008) and a decline among most payers in terms of the percentage of claims denied. […]
I just read a rather alarming article about the dramatic increase in radiation exposure from medical tests over the last couple decades. We get more medical radiation than people in any other country – in fact, half of the world’s advanced imaging procedures that use radiation are done in the US. And the average American’s radiation exposure from medical testing has grown sixfold in the last twenty years. […]
[…] The PCP shortage is likely to become even more of a problem once the health care reform provisions kick in and millions of currently uninsured Americans become insured and presumably start to seek out more health care. Unless we can make primary care more attractive to people in medical school, all of those newly insured people are going to end up seeing expensive specialists instead of PCPs, and the burden of paying for health care will only become harder to bear.
[…] The problem with concierge-style medical practices now is the relatively large retainer fee that patients have to pay in order to join. It’s really only available to those at the top end of the income scale, and generally not covered by health insurance. But maybe the idea should get another look. Maybe we should be looking at the idea of health insurance companies reimbursing doctors for keeping patients healthy, rather than just caring for us after we become sick.
A new state law that imposes fees on hospitals went into effect this week. Over the next few years, it’s expected to allow Colorado to expand access to health insurance to about 150,000 of the state’s 800,000 uninsured residents. The funds generated from the hospital fees will allow Colorado to expand access to Medicaid for adults, increase the income limit to qualify for Medicaid, and expand access to Child Health Plan Plus (CHP+) for children and pregnant women. […]
[…] Ultimately, I’d like to see us reach a point where medication waste is virtually eliminated. Medication bottles that allow pills to be removed but not re-inserted, or a switch to only using blister packs for pills, could allow even partially used prescriptions to be returned to pharmacies for redistribution. And with the cost of prescriptions becoming more of a barrier between patients and needed treatment, the destruction of perfectly good unused medication seems like a travesty.
Amnesty International has released a shocking and sobering report about maternal mortality in the US. In 1987, there were 6.6 maternal deaths per 100,000 live births. Two decades later, that number had risen to 13.3 deaths per 100,000 live births. Part of the increase is due to better reporting, but there are also more women dying from pregnancy complications than there were in the 80s. […]
[…] What if we implemented a system whereby doctors could not be compensated for ordering medical imaging for their patients? The imaging equipment could be strategically located throughout each city and state, but not in doctors’ offices, and not run by doctors who order the tests. If a doctor were to have no financial incentive one way or the other, we could probably assume that imaging would only be ordered when it was deemed medically necessary, and we would expect to see roughly the same rate of imaging use from one doctor to the next.
[…] What if our health insurance ID cards came with barcodes that could be scanned in the doctor’s office or hospital, immediately allowing the office staff to see our benefits, how much of our deductible still needs to be met, and any exclusions on our policy? Then admission and treatment data could be transmitted directly to the health insurance carrier, without the need for phone calls or extra staff. […]
[…] It’s hard to have an effective dialog about costs and cost-control when the average person has no idea what the costs actually are, and no realistic way of finding out. EOBs are great, but they only come after a person has received treatment, and thus aren’t particularly useful in terms of comparison shopping. Kefalas’ bill would be a good step towards transparency in health care costs, and I hope it is well received.
The Healthcare Economist’s Jason Shafrin has written an interesting article about how the French healthcare system utilizes hyperbolic discounting in order to avoid moral hazard. Basically, their system requires the patient to pay up front for a visit to the doctor, but then health insurance reimburses the patient 70% of the cost. This has two advantages over a system like ours which only requires the patient to pay their copay at the time of service. First, it conveys the value of the visit. Here in the US, people who have health insurance with copays for office visit are often unaware of the actual cost of the visit. They pay their copay and the rest is billed to the health insurance company. People who read their EOBs will see the actual billed amount and the amount that the insurance company paid, but I doubt that everyone reads their EOBs […]