What Does It Cost Physician Practices to Interact with Health Insurance Plans?
Synopsis
A national study of nearly 900 U.S. physicians and medical group administrators found that physicians spent on average 142 hours annually interacting with health plans, at an estimated annual cost to physician practices of $31 billion, or $68,274 on average per physician, per year.
The Issue
Administrative costs are high in health care. While those incurred by physician offices are a contributor to overall administrative costs, very little information has been available regarding the costs physician practices incur when they interact with health insurance plans. The authors surveyed a national sample of physicians and medical group administrators to ascertain how much time physician practices spent interacting with health plans on prior-authorization requirements, pharmaceutical formularies, claims, credentialing, contracting, and quality data. The study examines in depth the extent of such interactions, generating both time and dollar value estimates for such administration.
Friday, July 10, 2009
Wednesday, July 8, 2009
Big Questions About Deals Whitehouse is Making with the Big Players in Healthcare
White House, health industry deals raise questions about quid pro quos for private sector.
In a front page story, the New York Times (7/8, A1, Herszenhorn, Stolberg) reports, "The deals, trumpeted loudly by the White House, would each help pay for a sweeping overhaul of the healthcare system." But the promises by health industry groups, drugmakers and hospitals to save the government billions in healthcare costs, hailed as "historic" by the White House, have come with almost no discussion of "what the industry groups will be getting in return for their cooperation, whether or not the promised savings ever materialize." But in spite of the White House's deal making, "some lawmakers said the deals, while seemingly helpful, could raise false expectations by obscuring how much the industry is demanding for its concessions." A rumored deal in the works with doctors "could come at a steep price: a $250 billion fix to a 12-year-old provision in federal law intended to limit the growth of Medicare reimbursements."
In a front page story, the New York Times (7/8, A1, Herszenhorn, Stolberg) reports, "The deals, trumpeted loudly by the White House, would each help pay for a sweeping overhaul of the healthcare system." But the promises by health industry groups, drugmakers and hospitals to save the government billions in healthcare costs, hailed as "historic" by the White House, have come with almost no discussion of "what the industry groups will be getting in return for their cooperation, whether or not the promised savings ever materialize." But in spite of the White House's deal making, "some lawmakers said the deals, while seemingly helpful, could raise false expectations by obscuring how much the industry is demanding for its concessions." A rumored deal in the works with doctors "could come at a steep price: a $250 billion fix to a 12-year-old provision in federal law intended to limit the growth of Medicare reimbursements."
Tuesday, July 7, 2009
Lobbyists Descend on Congress to Do the Bidding for Corporations
Washington Post
Familiar Players in Health Bill Lobbying
Firms Are Enlisting Ex-Lawmakers, Aides
The nation's largest insurers, hospitals and medical groups have hired more than 350 former government staff members and retired members of Congress in hopes of influencing their old bosses and colleagues, according to an analysis of lobbying disclosures and other records.
The tactic is so widespread that three of every four major health-care firms have at least one former insider on their lobbying payrolls, according to The Washington Post's analysis.
Nearly half of the insiders previously worked for the key committees and lawmakers, including Sens. Max Baucus (D-Mont.) and Charles E. Grassley (R-Iowa), debating whether to adopt a public insurance option opposed by major industry groups. At least 10 others have been members of Congress, such as former House majority leaders Richard K. Armey (R-Tex.) and Richard A. Gephardt (D-Mo.), both of whom represent a New Jersey pharmaceutical firm.
The hirings are part of a record-breaking influence campaign by the health-care industry, which is spending more than $1.4 million a day on lobbying in the current fight, according to disclosure records. And even in a city where lobbying is a part of life, the scale of the effort has drawn attention. For example, the Pharmaceutical Research and Manufacturers of America (PhRMA) doubled its spending to nearly $7 million in the first quarter of 2009, followed by Pfizer, with more than $6 million.
The push has reunited many who worked together in government on health-care reform, but are now employed as advocates for pharmaceutical and insurance companies.
... public interest groups and reform advocates complain that the concentration of former government aides on K Street has distorted the health-care debate, and that it further illustrates the problem posed by the "revolving door" between government and private firms.
"The revolving door offers a short cut to a member of Congress to the highest bidder," said Sheila Krumholz, executive director of the Center for Responsive Politics, which compiled some of the data used in The Post's analysis. "It's a small cost of doing business relative to the profits they can garner."
Familiar Players in Health Bill Lobbying
Firms Are Enlisting Ex-Lawmakers, Aides
The nation's largest insurers, hospitals and medical groups have hired more than 350 former government staff members and retired members of Congress in hopes of influencing their old bosses and colleagues, according to an analysis of lobbying disclosures and other records.
The tactic is so widespread that three of every four major health-care firms have at least one former insider on their lobbying payrolls, according to The Washington Post's analysis.
Nearly half of the insiders previously worked for the key committees and lawmakers, including Sens. Max Baucus (D-Mont.) and Charles E. Grassley (R-Iowa), debating whether to adopt a public insurance option opposed by major industry groups. At least 10 others have been members of Congress, such as former House majority leaders Richard K. Armey (R-Tex.) and Richard A. Gephardt (D-Mo.), both of whom represent a New Jersey pharmaceutical firm.
The hirings are part of a record-breaking influence campaign by the health-care industry, which is spending more than $1.4 million a day on lobbying in the current fight, according to disclosure records. And even in a city where lobbying is a part of life, the scale of the effort has drawn attention. For example, the Pharmaceutical Research and Manufacturers of America (PhRMA) doubled its spending to nearly $7 million in the first quarter of 2009, followed by Pfizer, with more than $6 million.
The push has reunited many who worked together in government on health-care reform, but are now employed as advocates for pharmaceutical and insurance companies.
... public interest groups and reform advocates complain that the concentration of former government aides on K Street has distorted the health-care debate, and that it further illustrates the problem posed by the "revolving door" between government and private firms.
"The revolving door offers a short cut to a member of Congress to the highest bidder," said Sheila Krumholz, executive director of the Center for Responsive Politics, which compiled some of the data used in The Post's analysis. "It's a small cost of doing business relative to the profits they can garner."
Monday, July 6, 2009
Senator Ask's Aetna Why Texas Man With Insurance Owes $200,000
New York Times July 2nd.
Late last week Senator Charles Grassley sent a letter to Aetna insurance to ask why a policy they sold a Texas man didn't cover his hospital expenses.
"The man, Lawrence Yurdin, age 64, was included in a front-page article in The New York Times on Tuesday about the many people whose insurance coverage does not protect them from financial ruin in the case of a medical crisis.
Although Mr. Yurdin and the hospital where he received heart treatments say they both understood that the Aetna policy covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the medical care he received. He and his wife, Claire, filed for personal bankruptcy in December.
Senator Grassley, the ranking Republican on the Senate Finance Committee, has also investigated some of the health plans that another insurer, the UnitedHealth Group, sold through AARP, the advocacy group for older people. Those plans, which also had sharp limits on coverage, are no longer being sold.
“I remain concerned about health insurance plans that may appear to offer more coverage than they do and the effect subsequent underinsurance may have on the health care system as a whole,” Mr. Grassley wrote to Aetna’s chief executive, Ronald A. Williams."
In an article in the NYT last Tuesday entitled "Insured, but Bankrupted by Health Crises" Reed Abelson describes the specifics of Mr.Yurdin's case:
"...One of them is Lawrence Yurdin, a 64-year-old computer security specialist. Although the brochure on his Aetna policy seemed to indicate it covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the treatment he received at an Austin, Tex., hospital...
"..“Underinsurance is the great hidden risk of the American health care system,” said Elizabeth Warren, a Harvard law professor who has analyzed medical bankruptcies. “People do not realize they are one diagnosis away from financial collapse.”
"...Last week, a former Cigna executive warned at a Senate hearing on health insurance that lawmakers should be careful about the role they gave private insurers in any new system, saying the companies were too prone to “confuse their customers and dump the sick.”
“The number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance,” Wendell Potter, the former Cigna executive, testified.
Mr. Yurdin learned the hard way.
At St. David’s Medical Center in Austin, where he went for two separate heart procedures last year, the hospital’s admitting office looked at Mr. Yurdin’s coverage and talked to Aetna. St. David’s estimated that his share of the payments would be only a few thousand dollars per procedure.
He and the hospital say they were surprised to eventually learn that the $150,000 hospital coverage in the Aetna policy was mainly for room and board. Coverage was capped at $10,000 for “other hospital services,” which turned out to include nearly all routine hospital care — the expenses incurred in the operating room, for example, and the cost of any medication he received.
In other words, Aetna would have paid for Mr. Yurdin to stay in the hospital for more than five months — as long as he did not need an operation or any lab tests or drugs while he was there."
Late last week Senator Charles Grassley sent a letter to Aetna insurance to ask why a policy they sold a Texas man didn't cover his hospital expenses.
"The man, Lawrence Yurdin, age 64, was included in a front-page article in The New York Times on Tuesday about the many people whose insurance coverage does not protect them from financial ruin in the case of a medical crisis.
Although Mr. Yurdin and the hospital where he received heart treatments say they both understood that the Aetna policy covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the medical care he received. He and his wife, Claire, filed for personal bankruptcy in December.
Senator Grassley, the ranking Republican on the Senate Finance Committee, has also investigated some of the health plans that another insurer, the UnitedHealth Group, sold through AARP, the advocacy group for older people. Those plans, which also had sharp limits on coverage, are no longer being sold.
“I remain concerned about health insurance plans that may appear to offer more coverage than they do and the effect subsequent underinsurance may have on the health care system as a whole,” Mr. Grassley wrote to Aetna’s chief executive, Ronald A. Williams."
In an article in the NYT last Tuesday entitled "Insured, but Bankrupted by Health Crises" Reed Abelson describes the specifics of Mr.Yurdin's case:
"...One of them is Lawrence Yurdin, a 64-year-old computer security specialist. Although the brochure on his Aetna policy seemed to indicate it covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the treatment he received at an Austin, Tex., hospital...
"..“Underinsurance is the great hidden risk of the American health care system,” said Elizabeth Warren, a Harvard law professor who has analyzed medical bankruptcies. “People do not realize they are one diagnosis away from financial collapse.”
"...Last week, a former Cigna executive warned at a Senate hearing on health insurance that lawmakers should be careful about the role they gave private insurers in any new system, saying the companies were too prone to “confuse their customers and dump the sick.”
“The number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance,” Wendell Potter, the former Cigna executive, testified.
Mr. Yurdin learned the hard way.
At St. David’s Medical Center in Austin, where he went for two separate heart procedures last year, the hospital’s admitting office looked at Mr. Yurdin’s coverage and talked to Aetna. St. David’s estimated that his share of the payments would be only a few thousand dollars per procedure.
He and the hospital say they were surprised to eventually learn that the $150,000 hospital coverage in the Aetna policy was mainly for room and board. Coverage was capped at $10,000 for “other hospital services,” which turned out to include nearly all routine hospital care — the expenses incurred in the operating room, for example, and the cost of any medication he received.
In other words, Aetna would have paid for Mr. Yurdin to stay in the hospital for more than five months — as long as he did not need an operation or any lab tests or drugs while he was there."
Wednesday, July 1, 2009
Wednesday, June 24, 2009
Health Insurers Have Cheated Consumers Out of Billions of Dollars
On Tuesday the Senate Commerce Committee released a report showing that health insurers have cheated consumer's out of billions of dollars. Though that amount seems astounding, most of us have experienced the methods used by these giant corporate criminals to extort that money from us. If you have ever had a claim denied on the basis of a clause in your policy that you didn't even know about then you have been a victim of these cold hearted bastards. Have you ever read the fine print in your health insurance policy? Most people who aren't lawyers haven't. According to testimony in the hearing the policies are written to confuse consumers on purpose.
According to the Washington Post article:
"At a committee hearing yesterday, three health-care specialists testified that insurers go to great lengths to avoid responsibility for sick people, use deliberately incomprehensible documents to mislead consumers about their benefits, and sell "junk" policies that do not cover needed care. Rockefeller said he was exploring "why consumers get such a raw deal from their insurance companies."
"...Insurers make paperwork confusing because "they realize that people will just simply give up and not pursue it" if they think they have been shortchanged..."
In New York State Attorney General Andrew Cuomo has discovered that health insurers bilked consumer's out of millions of dollars by underpaying for out-of-network physicians and hospitals. The accomplished this by using rates determined by a database OWNED by United Health Care called Ingenix. The AG asserted in court that this database was routinely "scrubbed" of justifiably higher rates and "low-balled usual and customary rates and shifted costs from insurers to their customers.."
"Cuomo found that insurers under-reimbursed New York consumers by up to 28 percent, the report said. A dozen insurers have reached settlements agreeing to change their practices; UnitedHealth agreed to the largest payment, $50 million, to help a nonprofit organization set up a new database to replace Ingenix."
We desperately need to have a reasoned debate about the reform of health care and I know that everyone involved in delivering health care has contributed to the burden it places financially on everyday Americans. Cuomo's findings just proved what most of us have known for a long time. This hearing was a shot fired across the bow of the ship of the insurer's who have been playing hard ball to undermine real reform of the system they profit by. Many more salvos are to come and the debate seems to swing back and forth. It isn't easy to figure out what will work better than the crazy quilt of a system we now have. Don't be mislead by easy answers because they are the ones that will leave us stuck with a dysfunctional result.
According to the Washington Post article:
"At a committee hearing yesterday, three health-care specialists testified that insurers go to great lengths to avoid responsibility for sick people, use deliberately incomprehensible documents to mislead consumers about their benefits, and sell "junk" policies that do not cover needed care. Rockefeller said he was exploring "why consumers get such a raw deal from their insurance companies."
"...Insurers make paperwork confusing because "they realize that people will just simply give up and not pursue it" if they think they have been shortchanged..."
In New York State Attorney General Andrew Cuomo has discovered that health insurers bilked consumer's out of millions of dollars by underpaying for out-of-network physicians and hospitals. The accomplished this by using rates determined by a database OWNED by United Health Care called Ingenix. The AG asserted in court that this database was routinely "scrubbed" of justifiably higher rates and "low-balled usual and customary rates and shifted costs from insurers to their customers.."
"Cuomo found that insurers under-reimbursed New York consumers by up to 28 percent, the report said. A dozen insurers have reached settlements agreeing to change their practices; UnitedHealth agreed to the largest payment, $50 million, to help a nonprofit organization set up a new database to replace Ingenix."
We desperately need to have a reasoned debate about the reform of health care and I know that everyone involved in delivering health care has contributed to the burden it places financially on everyday Americans. Cuomo's findings just proved what most of us have known for a long time. This hearing was a shot fired across the bow of the ship of the insurer's who have been playing hard ball to undermine real reform of the system they profit by. Many more salvos are to come and the debate seems to swing back and forth. It isn't easy to figure out what will work better than the crazy quilt of a system we now have. Don't be mislead by easy answers because they are the ones that will leave us stuck with a dysfunctional result.
Saturday, June 20, 2009
New Poll: Majority of Americans Support Public Health Insurance Option
This past week the republican lie machine has aimed it's magic words against any true reform of our broken health care system. All they have had to do to delay reform is to invoke the word's "government run" "socialized" "bureaucrats" "expensive" and "between you and your doctor" and the MSM (mainstream media) have panicked. Practically all you heard about the, still being debated, proposals was that the "public option" was dead. The public option was the plan to give Americans the option to enroll in a government sponsored non-profit making health insurance plan.
Of course when the republicans heard non-profit they knew instantly that it was a communist plot and a covert plan to turn our democracy into a socialist dictatorship, and I am not exaggerating!
Never doubt the power of a lie told often enough to become the "truth". The fact is that there is nothing a public plan would do but provide an option of a lower cost plan to poor Americans. Of course it would also pressure insurance companies to lower their prices and compete for customers. As it is the only customers the giant health insurance companies have competed for are the young and healthy. If you were sick, old or cost them a lot in claims they dumped you. If you ONCE had an illness they dumped you. For years now these greedy money mongers have had all of the power and few competitors. Because of that dynamic they have dictated the terms of coverage, co-pays, deductibles, which doctors we could see, which hospital we could go to and which procedures were medically necessary. In other words, if you want to see what it would actually be like for someone to stand between you and your doctor, just think about your health insurance company's rules.
Of course when the republicans heard non-profit they knew instantly that it was a communist plot and a covert plan to turn our democracy into a socialist dictatorship, and I am not exaggerating!
Never doubt the power of a lie told often enough to become the "truth". The fact is that there is nothing a public plan would do but provide an option of a lower cost plan to poor Americans. Of course it would also pressure insurance companies to lower their prices and compete for customers. As it is the only customers the giant health insurance companies have competed for are the young and healthy. If you were sick, old or cost them a lot in claims they dumped you. If you ONCE had an illness they dumped you. For years now these greedy money mongers have had all of the power and few competitors. Because of that dynamic they have dictated the terms of coverage, co-pays, deductibles, which doctors we could see, which hospital we could go to and which procedures were medically necessary. In other words, if you want to see what it would actually be like for someone to stand between you and your doctor, just think about your health insurance company's rules.
Subscribe to:
Posts (Atom)
