As long as you use an in-network facility, all costs associated with a screening colonoscopy should be paid by the health plan, including the bowel preparation drink, the facility fee, the doctor’s fee, and the anesthesiologist’s fee.
hospitals
Grand Rounds – Colorado Fall Colors Edition
Henry Stern of InsureBlog brings us an interview with the whistleblower who has brought a lawsuit against LabCorp for allegedly charging a lower price to United HealthCare than to Medicare. The post is particularly interesting because Hank adds his own thoughts after the interview, and he sees things a little differently than Andrew Baker (the whistleblower). Hank agrees that it does look like LabCorp lowered their fees for UHC […]
Transferring Costs From Medicaid To Emergency Departments
[…] Denying arbitrary “non-emergent” ED claims for Medicaid patients doesn’t seem like a way to actually reduce ED overutilization. Instead, it seems like a way to cut Medicaid costs by increasing the number of unpaid claims that EDs have to write off each year. In order to cover their costs, hospitals will have to further increase prices for privately insured patients. That in turn causes health insurance premium hikes, which leads to calls for negotiations to artificially lower premiums. Where does it end?
PVHS and UCH Begin Process Of Creating A Joint Hospital System
[…] The merger is expected to provide numerous benefits for both hospital systems, and will presumably make for lower total operating/administrative costs than they would have if they weren’t working together. As health care costs continue to climb, this should help both hospitals continue to provide quality care to their patients. It’s also reasonable to assume that the merger will be beneficial for UCH and PVHS patients, since access to both hospital system’s strengths will likely be available to patients in both Denver and Northern Colorado. […]
Never Events – The Healthcare Version Of A Zero Tolerance Policy
[…] If the goal of CMS is to reduce the number of “never events” – but not to discourage doctors from treating high-risk patients who may be more likely to suffer complications – it would seem to make more sense to evaluate reimbursement for “never events” on a case-by-case basis. Zero-tolerance policies rarely make sense when you consider all of the possible scenarios, and the “never events” list basically amounts to a zero-tolerance policy.
Interesting Data Regarding Pay For Performance Studies
[…] There has been much debate recently about what is the most efficient and cost-effective method of reimbursing doctors and hospitals. While most providers now are paid on a fee-for-service model, there’s concern that such a model tends to encourage over-utilization. ACOs might pose a possible solution, although their designers would be wise to ponder the data regarding pay-for-performance, since much of the success of ACOs could hinge on providers’ ability to “perform” in terms of keeping their patients healthy and avoiding costly hospitalizations.
When The Media Recommends Over-Consumption Of Healthcare
[…] 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.
EHR Transition Process Not A Simple One
[…] But like any big project, nobody said this will be an easy transition. The government has created an incentive program to help providers with the financial aspect of transitioning from paper records to EHR, but of course there are hoops to jump through. It’s not as simple as just setting up the first EHR system you come across and then getting money from the government to help pay for it. In order to qualify for the incentive program, EHR systems must meet meaningful use criteria as laid out by the Centers for Medicare and Medicaid Services last year. […]
Comparing US Healthcare Costs With Other Countries
[…] But is having to wait to see a specialist for a non-emergency situation really that much of a drawback, when we consider that this sort of “rationing” might be what we need to bring our healthcare costs down to a reasonable level (and thus make healthcare more available to more Americans)? Maybe we don’t need MRI machines to be as conveniently-located as ATMs… Our current costs (and the rate at which they are increasing) aren’t really sustainable long-term, and the Healthcare Technology News article is a good reminder of how we stack up against the rest of the world.
Colorado House Bill 1025 Would Repeal Health Care Affordability Act
[…] HB 1025, introduced by Colorado Springs Republican Rep Janak Joshi, would repeal the Health Care Affordability Act of 2009 (HB 1293). That Act introduced the Hospital Provider Fee system to generate about $600 million annually in funds for the expansion of Medicaid, the Colorado Indigent Care Program (CICP) and Child Health Plan Plus (CHP+). Those funds are supplemented with federal matching of an additional $600 million for the expansion of those programs in Colorado. The Health Care Affordability Act was widely supported by hospital and medical groups in the state. […]
ACOs 101
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. […]
Capping Profits And Admin Costs Across The Healthcare Industry
[…] 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.
Diabetes Accounts For Nearly A Quarter Of US Hospital Costs
Diabetes now accounts for nearly a quarter of all hospital spending in the US – about $83 billion a year in hospital fees. The report from the Agency for Healthcare Research and Quality was released in August, but I just came across it today, and the details are staggering. The vast majority – 95% – of all diabetes cases are Type 2 diabetes, which is nearly always caused by poor diet and/or a sedentary lifestyle. In addition, 70% of hospital stays for diabetics are paid for by government health insurance: 60% by Medicare and 10% by Medicaid. […]
The Perils Of Not Having An Individual Mandate
[…] Are we comfortable with allowing emergency services providers to turn away patients who are uninsured and cannot pay upfront for their care? If we are not, then the rest of us are paying for their care (indirectly, through higher health insurance premiums). And if we are, we find ourselves right back in the debate about whether it’s ok for firefighters to watch a house burn to the ground because the homeowner didn’t pay his fire protection fee. It seems that we all like having choices until we make the wrong choice one day.
Narrow Provider Networks Not Likely To Please Patients
[…] 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.
Healthcare.gov A Good Resource For Brokers
I spent some time on the Healthcare.gov website this morning, and found some great resources that could be particularly helpful for people with pre-existing conditions who are unable to obtain coverage in the individual market. The website was set up in conjunction with the PPACA and was designed to help people navigate the myriad of health insurance options available, along with the changes that will happen over the next few years as the provisions of the PPACA go into effect. […]
Health Wonk Review – Politics, Money and Health
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! […]
Colorado Hospitals Expanding
[…] I understand that each hospital needs to bring in enough money to pay staff, maintain the facilities, and – in the case of for-profit hospitals – make a profit for shareholders. But overall healthcare costs aren’t helped by duplication of facilities and high-tech medical gadgets. There has to be a balance between providing the excellent medical care, keeping things at least somewhat convenient for patients, and keeping medical costs under control. […]
Deciphering Medical Loss Ratio Rules
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. […]
Why Medicare For All Might Not Be So Great
[…] most non-elderly Americans still get their health insurance through their employers. And in general, as long as people are somewhat satisfied with the status quo, most of us tend to be a bit resistant to change. Obviously, people who are currently uninsured are likely to support sweeping changes in the health care system. But most Americans do have health insurance, and those who have generous policies – that are at least partially funded by their employers – might find themselves with less coverage if we moved to a single payer plan.
Open Source Medical Records
[…] 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. […]
Sharing Instead Of Duplicating
[…] 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.
Standardizing Payments For Childbirth
[…] 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. […]
Resurrecting House Calls
[…] 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.
An Economist’s View Of Midwifery
[…] 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.