Miscellaneous And Off Topic Subjects

[hack]

yup, they got 2 inches in DC. Schools shut down.

Well, to be fair, it's probably closer to 4. Still equally perilous.

[WingsFan]

I always get high snow drifts, what has it been 8 weeks (?) and I used the snowblower I bought once. Got about 6 inches here, but can't complain what's going on in the NE. No problem clearing it away used it on the deck also, but the drifts cover it up quickly.

[AlabamAlum]

...or increased profits.

Once a facility can charge $10.00 for an aspirin, its never going to take less. The way to cut costs is to reduce the amount of aspirin charged for. JMO.

The $10 aspirin is not a real thing. It never has been, really - except with the most unfortunate of self-pays, and a self-pay who pays his bill in full is nearly a unicorn.

[SeattleLionsFan]

Lets look at it this way ....... you either think the government is responsible for those 14 million who will loose coverage under Medicaid reductions or you don't.

Right now, the Medicaid program is a proven and well documented disincentive to work. The reason for that is as soon as a Medicaid beneficiary gets a job and starts earning money, they lose Medicaid coverage and have to buy it on the open market.

If you start from the premise that each person, not the Feds, has to be responsible for purchasing HC insurance then you put your legislative efforts into lessening the cost of care which translates into lower insurance costs.

There are two targets: (1) Incentivize the formation of aggregated care entities in the health care delivery market place. (2) Regulate Insurance Exchanges, subsidize or provide tax incentives for insurance coverage for specific groups.

I have not heard that about Medicaid. I was always under the impression that it was income based and not employer based. Do you have a cite I can read?

As far as inefficiencies go, nothing is more inefficient that insurance. It inserts a needless third party onto the equation, creates a ton of paperwork and other costs, and separates the consumer from pricing. It's a terrible model and should be abandoned post haste.

[Wild Hoss]

Replace with "overpaid admin staff"?

hi!

[SeattleLionsFan]

One other thing, I have very little patience for exactly who is to blame for millions of people losing health coverage. I am more concerned about how we are going to prevent them from dying on the street or just passing their bills onto others.

[Wild Hoss]

One other thing, I have very little patience for exactly who is to blame for millions of people losing health coverage. I am more concerned about how we are going to prevent them from dying on the street or just passing their bills onto others.

To the first question...John Stamos!

[AlabamAlum]

Replace with "overpaid admin staff"?

hi!

lol.

But seriously, the $10 aspirin or whatever is an accounting write-off. We charge that, BCBS says it's not UCR and pays us $2. We write off a few dollars as a loss.

Why write-off anything?

Well, aspirin (or whatever) at a medical center isn't like you going to Wal-Mart and buying it yourself. You have a MD, NP, or PA who writes for it, a pharm tech who carries it up, a pharmacist who checks for interactions, and an RN who double checks interactions, appropriateness, gives it, and documents, a coder who bills for it and a QA/UR person who reviews it after the fact. Throw in a piece of any lawsuit, insurance, a piece of medical records, and the electronic health record - with all of this apportioned out with all meds and you can see how costs are added. Could this be streamlined? Yeah, some. But remember, hospitals are not the ones who wanted the red tape and bureaucracy to begin with.

And most of the reimbursement hospitals get nowadays is not line-item, anyway. The old "cost plus 10%" days are long gone.

[entropy]

bundles... lots and lots of bundles...

[entropy]

AA.. I agree. Get rid of the lawyers and things would be cheaper.


:::walks to the snack bar:::

[Jeff Buchanan]

...or increased profits.

Once a facility can charge $10.00 for an aspirin, its never going to take less. The way to cut costs is to reduce the amount of aspirin charged for. JMO.

I thought about this as I constructed the post you quoted from - how do you insure that as efficiencies of aggregated HC entities increase and costs decrease that the accrued benefit doesn't wind up as pocketed increased profit?

Some of it should end up as increased profit. I'm fine with that.

What we're leaving out of the profit equation though is the bargaining power of Insurance companies offering HC coverage who represent their policy holders. For example, this is how Medicare (over 65s) and Tricare (Military) control costs. These two insurers represent large groups of HC consumers and they negotiate pricing with HC entities to provide HC services at agreed upon prices.

If, as a provider, you want to serve these groups of HC consumers, you have to agree to accept what reimbursement the insurer is willing to pay. We know these as networks. i.e., if you are a Medicare or Tricare beneficiary, you can only see providers, go to hospitals or pharmacies that are "in network."

As an Insurance company offering HC insurance, you either don't do business with Medicare or Tricare beneficiaries or, you do and to do so, you optimize your margins by lowering your costs. This model is working exceedingly well to drive down HC costs for these beneficiaries. Also noteworthy is that the CMS model is becoming the standard for most insurers who are providing benefit services to employers. It's going to take time for the commercial insurance world to adapt but it will.

Another thing to keep in mind is that CMS (Medicare HQ) has been shifting reimbursement for HC from the basis of fee for service to the basis of the value of the outcome to the patient. How value is determined is controversial but this basis of reimbursement is going to become common place as how the value is determined is sorted out.

[Wild Hoss]

lol.

But seriously, the $10 aspirin or whatever is an accounting write-off. We charge that, BCBS says it's not UCR and pays us $2. We write off a few dollars as a loss.

Why write-off anything?

Well, aspirin (or whatever) at a medical center isn't like you going to Wal-Mart and buying it yourself. You have a MD, NP, or PA who writes for it, a pharm tech who carries it up, a pharmacist who checks for interactions, and an RN who double checks interactions, appropriateness, gives it, and documents, a coder who bills for it and a QA/UR person who reviews it after the fact. Throw in a piece of any lawsuit, insurance, a piece of medical records, and the electronic health record - with all of this apportioned out with all meds and you can see how costs are added. Could this be streamlined? Yeah, some. But remember, hospitals are not the ones who wanted the red tape and bureaucracy to begin with.

And most of the reimbursement hospitals get nowadays is not line-item, anyway. The old "cost plus 10%" days are long gone.

This describes most every service process anymore, thus my contention that reducing demand is the best way to reduce cost.

Any entity charges what its customers will pay. Getting from here to there though....

[Wild Hoss]

I thought about this as I constructed the post you quoted from - how do you insure that as efficiencies of aggregated HC entities increase and costs decrease that the accrued benefit doesn't wind up as pocketed increased profit?

Some of it should end up as increased profit. I'm fine with that.

What we're leaving out of the profit equation though is the bargaining power of Insurance companies offering HC coverage who represent their policy holders. For example, this is how Medicare (over 65s) and Tricare (Military) control costs. These two insurers represent large groups of HC consumers and they negotiate pricing with HC entities to provide HC services at agreed upon prices.

If, as a provider, you want to serve these groups of HC consumers, you have to agree to accept what reimbursement the insurer is willing to pay. We know these as networks. i.e., if you are a Medicare or Tricare beneficiary, you can only see providers, go to hospitals or pharmacies that are "in network."

As an Insurance company offering HC insurance, you either don't do business with Medicare or Tricare beneficiaries or, you do and to do so, you optimize your margins by lowering your costs. This model is working exceedingly well to drive down HC costs for these beneficiaries. Also noteworthy is that the CMS model is becoming the standard for most insurers who are providing benefit services to employers. It's going to take time for the commercial insurance world to adapt but it will.

Another thing to keep in mind is that CMS (Medicare HQ) has been shifting reimbursement for HC from the basis of fee for service to the basis of the value of the outcome to the patient. How value is determined is controversial but this basis of reimbursement is going to become common place as how the value is determined is sorted out.

Expansion of HC providers is one answer that comes to mind. You once posted about the network of clinics that existed in this country, and filled the needs for much of what now ends up in doctor's offices....supply and demand for HC services are out of whack. Wildly so in my novice estimation.

[Jeff Buchanan]

I have not heard that about Medicaid. I was always under the impression that it was income based and not employer based. Do you have a cite I can read?

It is, among other things, income based: the formula for determining Medicaid eligibility is diverse but fundamentally you are income level eligible at 133% of published (gets revised every year) Federal Poverty Level (FPL). That is based on number of persons in the household. For a family of 4, the FPL is $32.3K.

Here's the problem. I'm uneducated and unmarried. The FPL for a one person household to gain eligibility for Medicaid is around $11k. If I earn less than about $8/h I can remain eligible for Medicare. Or, I can find 4 dependents or have 4 babies and boost my FPL to $32.3K or about $16/h ...... I think everyone gets the picture here and the validity of what I posted.

As far as inefficiencies go, nothing is more inefficient that insurance. It inserts a needless third party onto the equation, creates a ton of paperwork and other costs, and separates the consumer from pricing. It's a terrible model and should be abandoned post haste.

On what basis do you make this claim? Aside from my question about that, if you get rid of Insurance companies who represent large groups of policy holders (e.g., AARP and there are a bunch of others like this) or large employers providing HC benefits to thousands of employees, you lose a powerful free market force to put downward pressure on HC costs. What you then have is individuals out there searching for insurance. That's not going to turn out well for the consumer.

When you start to delve into questions and issues like this, you begin to see how complex the problem of delivering HC equitably actually is.

[froot loops]

Yeah I'm sure the are numerous people having babies and turning down more than 8 bucks an hour to stay on Medicaid. The Welfare queens.