[…] As David pointed out, there’s also likely to be frustration for patients as providers move in and out of networks. This can happen regardless of the size of a network, but if networks are purposely kept small, it’s more likely to happen. Patients tend to be wary of having to find new doctors, and having to do so simply because of network changes isn’t likely to make people happy. Hopefully the idea of narrow provider networks won’t become a widespread trend with employers, medical providers, or health insurance carriers.
[…] 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.
Welcome to the Health Wonk Review. Health care costs, politics, and the economics of health care seemed to be the prevailing themes in the submissions this time, and there are some great ideas floating around here. Enjoy! […]
[…] We need to make sure everyone has health insurance (first step in expanding access). We need to make sure there are enough primary care physicians (and other care providers) to go around. And then we need a systematic, coordinated effort between health care providers, hospitals, and health insurance carriers to make sure that everyone is on the same page. Expanding access to primary care is part of the solution, but it will only work in tandem with the other parts.
Jaan Sidorov of the Disease Management Care Blog has started deciphering the specifics of the Medical Loss Ratio requirements, and it looks like the National Association of Insurance Commissioners (NAIC) is taking a rather inclusive view of medicine in their interpretation of the law. Ever since the MLR minimums were laid out in the PPACA, there has been much debate over what would be considered administrative costs. It’s heartening to see the NAIC giving so much leeway in terms of what will be considered medical expenses. […]
[…] In general, I’m a fan of as much transparency as possible in health care. I think that patients, doctors, and payers (both public and private health insurance) should have access to information related to treatment, diagnoses, and cost – as quickly as possible and as clearly as possible. Open source medical records is one step towards transparency, and I like that. […]
[…] 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?
[…] some doctors are nervous about such a system because they fear that they would earn less money overall. But he goes on to point out that earning a little less money might be well worth it if your job is easier and you get to spend far less time repeating tasks that someone else has already done. In addition, there would be less paperwork (electronic or otherwise) for health insurance companies to process, which should result in lower administrative expenses.
[…] 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. […]
[…] Private health insurance companies tend to take some of their cues from Medicare in terms of what they cover, so if Medicare eventually makes home visits more available, it stands to reason that people with private health insurance might also have access to house calls from doctors, even if they can’t afford to pay full price to a non-network provider.
[…] In addition, we have a malpractice system that provides a strong incentive for doctors to perform c-sections at the first hint of a problem. With a system like that, it’s hard to fault OBs for taking the c-section route, and intervening in general. We can wring our hands all we want about how we need to reduce the rate of c-sections and medical interventions during childbirth, but as long as our malpractice system penalizes doctors for avoiding c-sections, we won’t make much progress.
I have often thought that an instant billing/payment system for medical offices (sort of a Visa/Mastercard type of setup between providers and health insurance carriers) was long-overdue. This New York Times article details exactly how such a system could work, but also addresses some of the problems it would face. The main issue is the complicated nature of health insurance billing, with thousands of medical codes that the doctor’s office has to sort through in order to correctly submit a bill. […]
[…] And that means that Medicaid claims submitted over the last couple weeks won’t be paid until July 9th – providers will miss out on payments that were scheduled for last week and later this week. The 2011 fiscal year begins in July, and the state is planning to push Medicaid reimbursements out in order to contain the budget for this year. The money will eventually be paid to the providers, but for book-keeping purposes it will be in a different fiscal year, and it also amounts to an interest-free short term loan from the providers to the state. […]
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.
[…] Finding a doctor who takes Medicaid is significantly more difficult than finding a doctor who takes private health insurance, and I wonder if that might be a contributing factor in the crowding of our emergency rooms. If a person with Medicaid is sick and unable to find a nearby doctor who accepts Medicaid, he might end up not seeing a doctor at all and his condition might worsen to the point of needing emergency room care. Maybe efforts to make Medicaid more attractive to doctors might help to alleviate some of the over-crowding in emergency rooms.
[…] MD Whistleblower had a couple good observations:
– Dentists prescribe prophylactic antibiotics (ATBs) with routine recklessness… Many dentists irrationally prescribe ATBs before teeth cleanings and other procedures.
– Not a syllable in the ~2000 page health care reform law that affects dentists.
[…] The problem is that health insurance companies are paying for care with premium dollars collected from insureds, and as costs go up, so do premiums. Until we shift our attitude to a “less is more” mentality, we’re going to continue to see an increase in the cost of care, and subsequently in the cost of health insurance. But it’s not just about money. Articles like Maggie’s should give us a reason to question excessive screening and testing, simply from a standpoint of having a better quality of life. The fact that it could drive down health care costs is a bonus.
[…] There’s a pretty obvious need for a dramatic increase in the number of medical students entering the field of geriatrics, and it is a bit perplexing as to why the health care reform legislation didn’t put more emphasis on loan repayments and other financial incentives to encourage doctors to pursue a career in geriatrics. My guess is that as the shortage of geriatricians becomes more pressing over the next few years, we might see some additional funding aimed at solving the problem.
[…] So unless rationing (explained in a positive light) becomes the industry standard for doctors, I doubt that any one doctor could make much of a difference, since people who are used to getting what they want from their doctors might just seek out another doctor. Hopefully as time goes by and more people understand the lack of sustainability with regards to health care costs, more people will be willing to consider the possibility that some forms of rationing in health care might be a good thing after all.
David Williams has written an excellent article about the overuse of mammography screening in older women with cognitive impairment. When you read his article, especially the part about how women with a higher net worth are more likely to be screened, it’s obvious that money is playing a large role when it comes to determining who should get mammograms. […]
[…] 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. […]
van Falchuk has written a very thoughtful article about a recent graph created by National Geographic. At first glance, the implications of the graph are startlingly obvious: the US spends way too much on health care, a view that has been widely repeated throughout the health care reform debate. But Evan’s detailed analysis of the graph does make one pause to consider whether the graph might be over-simplifying things. […]