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Surprise Medical Billing. Decrease take home income by 40%?
EM threads on SDN are freaking out, some saying this bill would lower take home income by 40%. They have links from their professional society to letters to email reps. Not sure why ACR is being so blase about this.
Also apparently there is now a rival bill.
[link=https://thehill.com/policy/healthcare/474145-ways-and-means-committee-working-on-rival-surprise-medical-billing-fix]Ways and Means Committee announces rival surprise medical billing fix[/link] -
67 Replies
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Personally, I hope it passes. I’m happy that progress is being made on this. It is a scourge of our profession – it is absolutley part of the reason that lay people have a worse opinion of physicians than they did in the past. The fact that we would defend out fellow docs sending out bills for thousands of dollars just because a patient is not on the right insurance plan at the time of a true emergency is just sad.
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Guess it depends on your patient mix.
Not sure how this is all a physician problem. Hospitals are just as bad about this, if not worse. Story out there about UVA doing this to many of its patients. Surprise bill doesn’t impact them as far as I know. Not sure many of our colleagues are abusing this system. Many of us have a percentage of free work we do already.
I’m behind the surprise bill act, just not as written and being pushed through. There is no mechanism to negotiate with insurance companies unless the bill is above $1250? Below that, insurance companies can pay default rate, like 10% above medicare rate?-
Can someone clarify what the default rate in the legislation is? Looking for a number.
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Where does 40% decrease in income come from? Alarmist?
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Quote from Frumious
Where does 40% decrease in income come from? Alarmist?
It was from a post on SDN so possibly an alarmist, they did not go into details about how they reached this figure
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The ACR email from yesterday says that the IDR (independent dispute resolution) process will only be available for commercial, median, in-network payments that exceed $750, and that the vast majority of imaging services will not meet this threshold. Out-of-network radiologists will be forced to accept an arbitrary government set rate for services provided and will not get a chance to use the IDR process. The batching of claims to reach this amount will not be allowed.
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The price of everything will now be listed at $751.
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Fair bargaining power is fine & fair, but whats fine & fair for the patient who got the surprise bill?
And Im still trying to figure out how this law reduces incomes by 40%. Math was one of my best subjects but 40% seems unrealistic.-
A 40% reduction in income seems to be a rather drastic projection.
On another note, some big private equity firms owning physician recruiting companies seem to have lobbied hard against this legislation. PE owned firms hiring Anesthesiologists, Pathologists and Emergency Med physicians for out-of-network services have been implicated a lot for the origin of many surprise bills.
Now this issue seems to have grabbed a lot of public angst and lawmakers have been forced to do something about it. If this legislation becomes law, these PE company bottom lines will be hit very hard.-
The biggest issue for us is that the downstream effects will result in far less leverage when negotiating with insurers. Rather than paying you a higher multiple (relative to Medicare), theyll negotiate for lower reimbursement – or else. They can always just make everyone out of network and give you a much lower reimbursement (as detailed above).
This wont just affect the typical out of network patients youre thinking of – there will be a movement to make as many patients out of network as possible and thereby decrease the amount insurance companies pay physicians.
The better your payer mix, the more this hurts you.
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Quote from Labslave
The better your payer mix, the more this hurts you.
There’s the rub. With some of the % to Medicare rates touted on here a 40% drop is not unreasonable.
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[link=https://www.nytimes.com/2019/09/13/upshot/surprise-billing-laws-ad-spending-doctor-patient-unity.html]https://www.nytimes.com/2…tor-patient-unity.html[/link]
Dont cry about this bill. Youre crying for private equity.
Surprise billing is one of the biggest methods the private equity firms have to rip off innocent patients.
They can go to hell, and I will not shed a single tear for the sellout docs who enabled this scam to explode
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Quote from Loudog
Can someone clarify what the default rate in the legislation is? Looking for a number.
This is all I know so far:
[b]The measure from Ways and Means, [link=https://waysandmeans.house.gov/sites/democrats.waysandmeans.house.gov/files/documents/WM%20Surprise%20Billing%20Summary.pdf]announced Wednesday[/link], would take a different approach. It would at first let insurers and doctors try to work out payment on their own, and if they cannot come to agreement, an arbitration process would begin. Full text was not yet available. The Energy and Commerce proposal, in contrast, relies in large part on essentially setting a payment rate based on the average price for that service in the geographic area.[/b]-
Based on my personal experience – the surprise bills I have received have always been from ER docs and once in a while Gas. I have gotten a few bills from other Rad groups but usually for some insignificant amount like $15. Speaking to our billing company, our group only out-of-network bills 2 or 3% of the time. I feel the risk of this bill is not to radiology immediately or drastically – but rather the risk of loss of negotiating power with insurance companies in the future. Hate to say but the mega-rad corporate group may have an advantage in negotiation in the future with insurance companies if this passes. However, this will def hurt ER and Gas quite a bit and much sooner.
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“I feel the risk of this bill is not to radiology immediately or drastically – but rather the risk of loss of negotiating power with insurance companies in the future.”
yes this is the main threat, depending on your payor mix this may be a big deal -
I heard someone from RadPartners speak at RSNA. Theyre worried too. If the feds set the rate then no one will have leverage. Not even corporate groups.
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Quote from pgustine
I heard someone from RadPartners speak at RSNA. Theyre worried too. If the feds set the rate then no one will have leverage. Not even corporate groups.
I heard the same message at RSNA. If rates dropped even close to this amount (unlikely), it would be catastrophic on a number of levels; some where docs may not care and are actually happy to see PE fail and others where everyone should be highly concerned regarding our future.
1-PE/corporate groups that are highly levered would tank. Balance sheets and EBITDA would fall apart leaving some of them out of business or selling at fire sale prices. Those high asset valuations of goodwill and intangible assets would plummet as they already are with some of the corporate write downs and even larger portions of cash flow will be required to cover interest expenses rather than salaries.2-Hospital bankruptcies will increase. Many hospitals, particular smaller hospitals and some in underserved populations and with academic training programs, operate at razor thin margins of 1-3%. Many of those facilities employ their physicians so this would put them out of business and add to the massive consolidation into larger systems.
3-Future of medicine? Who would go into medicine given the length of training, loss of free time, and low return on investment. The best and brightest students, seemingly, are already shifting in higher numbers to law, tech, and business (hoping for PE job) rather than medicine. There will always be a need for healthcare providers, just concerned who will be caring for me in 30+ years. These matters will clearly evolve in a few additional unseen ways over those decades.
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I don’t think it’ll be a big deal. We have a something similar in California. As long as proper disclosures are in place, you don’t fall under “surprise” billing. It’s just part of the larger trend of price transparency, which is good for the industry and patients, weeds out the crooks. Ironically they always exempt emergency care, where most of the surprise stuff happens.
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I hope it passes!!
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DRADCAR,
I agree on your first point about PE/Corporate Radiology getting creamed.
As for the hospitals, I think the opposite is true. I think that rads/ER/gas/pathology will have to either become employed or somehow partner with hospitals to survive in that environment. My understanding of the law is that it applies to in-network ER’s/hospitals. If the hospital has a vested interest, then they can negotiate with the insurer for the physician professional fee rate as a part of their overall negotiation. I still think this will be worse than the current setup for rads, but better than working for medicare rates.
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Most hospitals I have ever dealt with required anyone who provides inpatient and ER services to contract with all the insurers the hospital is PAR for. Every couple of months you get an updated list and if you dont show up on the insurers roster, the ‘VP of network somethingtheother’ at the hospital will come knocking. The hospital doesn’t want the locals to show up with torches and pitchforks and doesn’t like bad feeback on customer satisfaction surveys.
The only ones who may see a ‘40% reduction’ are those who specialize on springing suprise bills on their patients. There are ER groups and hospital based specialists who do that.
One reason why this has become a bigger issue in recent years is the decrepit quality of health coverage available to the average consumer since 2014. In the old days, you may have seen a higher cost-share with a non-network provider, now with the narrow networks and high deductibles that have become the norm, you are on the hook for the entire bill.-
Well said.
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FW, I understand your point, and that is our practice too- in network at all of our hospitals with their network providers.
My concern is the cycle that propogates with the regional average benchmark:
1. Insurers set price at 25th percentile- all others are out of network and get the market average
2. year 2: insurers do the same thing, but now the “market average” has dropped to the prior year’s value, which is the now the average of the lowest providers.
3. cycle repeats until the “market average” approaches the medicare rate
There are fair systems that can avoid this, such as the independent arbitrator- without the $750 minimum, which would fix the corrupt out of network practices.
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Looks like at least this temporary budget avoids including the surprise billing act.
[link=https://www.politico.com/news/2019/12/16/congress-repeal-major-health-care-taxes-spending-deal-086138]https://www.politico.com/news/2019/12/16/congress-repeal-major-health-care-taxes-spending-deal-086138[/link] -
Quote from Tony Tony Tony
My concern is the cycle that propogates with the regional average benchmark:
1. Insurers set price at 25th percentile- all others are out of network and get the market average
2. year 2: insurers do the same thing, but now the “market average” has dropped to the prior year’s value, which is the now the average of the lowest providers.
3. cycle repeats until the “market average” approaches the medicare rateThere are fair systems that can avoid this, such as the independent arbitrator- without the $750 minimum, which would fix the corrupt out of network practices.
Yes, that’s the problem with any ‘survey’ data if the data pool you are drawing from is not created by a free market.
Same scam as medical groups using MGMA data to justify cutting the salaries of their employed physicians. Other clinics and health systems use the same garbage data to lower their salaries. Next survey they report lower salaries and downward the spiral goes.
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Another story brought to you by your local chapter of the Physician Cartel:
[link=https://www.npr.org/sections/health-shots/2019/12/23/787403509/for-her-head-cold-insurer-coughed-up-25-865]https://www.npr.org/sections/health-shots/2019/12/23/787403509/for-her-head-cold-insurer-coughed-up-25-865[/link]
“For Her Head Cold, Insurer Coughed Up $25,865”
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There are some abusive outliers. Dont paint the rest of us with that brush.
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The question is how are patients supposed to know who are the abusive outliers? They only find out after everything is done and they get billed – for which they are responsible for paying. All of our insurance rates are higher because of these “outliers” because we all pay.
“She may not be paying anything on this particular claim,” says [link=https://www.forbeslawgroup.com/richelle-marting.html]Richelle Marting[/link], a lawyer who specializes in medical billing at the Forbes Law Group in Overland Park, Kan., who looked into this case for NPR. “But overall, if the group’s claims and costs rise, all the employees and spouses paying into the health plan may eventually be paying for the cost of this.”[size=”0”]
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And patients are still responsible for co-pays, if there is balance billing – as there could have been in the above case if teh lab did not “waive” the balance above the $25K and “out-of-network” actors.
$25K for a swab. And her insurance paid that out of the actual charge – for a swab – of $28k+.
Who would ever expect a bill like that in the rational universe?
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Get on the right side of history folks.
[link=https://www.usnews.com/news/health-news/articles/2019-07-03/california-doctors-oppose-expanding-nurse-practitioner-authorities]https://www.usnews.com/news/health-news/articles/2019-07-03/california-doctors-oppose-expanding-nurse-practitioner-authorities[/link]
Amid Provider Shortage, California Doctors Oppose Expanding Nurse Practitioner Abilities
[link=https://thedo.osteopathic.org/2018/10/dos-help-defeat-bills-that-seek-to-cut-doctors-out-of-health-care/]https://thedo.osteopathic.org/2018/10/dos-help-defeat-bills-that-seek-to-cut-doctors-out-of-health-care/[/link]
As APRNs and nurse-midwives ramp up their efforts to practice independently, DOs are fighting back.
[link=https://www.kcur.org/post/nurse-practitioners-try-shake-free-doctors-kansas-physicians-resist#stream/0]https://www.kcur.org/post/nurse-practitioners-try-shake-free-doctors-kansas-physicians-resist#stream/0[/link]
As Nurse Practitioners Try To Shake Free Of Doctors, Kansas Physicians Resist
[link=https://www.wabe.org/bid-to-loosen-rules-on-mid-level-providers-draws-legislative-debate/]https://www.wabe.org/bid-to-loosen-rules-on-mid-level-providers-draws-legislative-debate/[/link]
But the vote for recommending the imaging change was 3-2 in favor, with two physicians on the panel, Sens. Ben Watson (R-Savannah) and Kay Kirkpatrick (R-Marietta), voting against.
[link=https://www.aei.org/carpe-diem/whod-a-thunk-it-a-medical-cartel-doesnt-like-competition/]https://www.aei.org/carpe-diem/whod-a-thunk-it-a-medical-cartel-doesnt-like-competition/[/link]
the American Academy of Pediatrics declared that retail health clinics are an inappropriate source of primary care for pediatric patients, as they fragment medical care and are detrimental to the medical home concept of longitudinal and coordinated care.
[link=https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557]https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557[/link]
[link=https://fee.org/articles/the-medical-cartel-is-keeping-health-care-costs-high/]https://fee.org/articles/the-medical-cartel-is-keeping-health-care-costs-high/[/link]
[link=https://www.modernhealthcare.com/patients/surprise-medical-bills-becoming-more-frequent-and-costly]https://www.modernhealthcare.com/patients/surprise-medical-bills-becoming-more-frequent-and-costly[/link]
Stanford University researchers found that from 2010 through 2016, 39% of 13.6 million trips to the ED at an in-network hospital by privately insured patients resulted in an out-of-network bill. That figure increased during the study period from about a third of ED visits nationwide in 2010 to 42.8% in 2016.
[link=https://www.npr.org/sections/health-shots/2019/12/23/787403509/for-her-head-cold-insurer-coughed-up-25-865]https://www.npr.org/sections/health-shots/2019/12/23/787403509/for-her-head-cold-insurer-coughed-up-25-865[/link]
[link=https://www.medscape.com/viewarticle/922816]https://www.medscape.com/viewarticle/922816[/link]
More Than Half of Doctors Get Industry Payments/Meals: Poll
[link=https://revcycleintelligence.com/news/aha-others-to-sue-hhs-over-new-hospital-price-transparency-rule]https://revcycleintelligence.com/news/aha-others-to-sue-hhs-over-new-hospital-price-transparency-rule[/link]
AHA, Others to Sue HHS Over New Hospital Price Transparency Rule
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Medical cartel ? Please.
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> More Than Half of Doctors
> Get Industry Payments/Meals:I got a dinner out of a rep when I went on a date with someone. $56 in the database and now I am in genentechs pocket 🙂
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Quote from avocado
Another story brought to you by your local chapter of the Physician Cartel:
[link=https://www.npr.org/sections/health-shots/2019/12/23/787403509/for-her-head-cold-insurer-coughed-up-25-865]https://www.npr.org/sections/health-shots/2019/12/23/787403509/for-her-head-cold-insurer-coughed-up-25-865[/link]“For Her Head Cold, Insurer Coughed Up $25,865”
That sounds about normal for NYC.
‘You won’t find a more wretched hive of scum and villany!’
Otoh, pretty difficult to find a lab that’s non-par with the blues. But then, that’s NYC where you have providers who specialize on waylaying travelers with out of state indemnity plans. It’s the environment that gave us the $56000 echos and $30,000 OB ultrasounds. Outliers bred in an specific environment with little relevance for medicine at large.
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As if NYC were the only place where healthcare profiteering takes place.
You’ve not been paying attention and reading about all the other states where excessive predatory profiteering takes place. -
Quote from Frumious
As if NYC were the only place where healthcare profiteering takes place.
You’ve not been paying attention and reading about all the other states where excessive predatory profiteering takes place.
Those moon charges are the result of a quirk in NY and NJ insurance law. The scam doesn’t seem to work anywhere else. The victim are the out of state insurers.
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On a separate note, here’s another dark side of the Physician Cartel rampaging through America unchecked: [link=https://www.nytimes.com/2019/10/02/us/opioids-doctor-sentenced-joel-smithers.html]https://www.nytimes.com/2019/10/02/us/opioids-doctor-sentenced-joel-smithers.html[/link]
Seems like something is wrong with the incentives.
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Quote from fw
Quote from Frumious
As if NYC were the only place where healthcare profiteering takes place.
You’ve not been paying attention and reading about all the other states where excessive predatory profiteering takes place.
Those moon charges are the result of a quirk in NY and NJ insurance law. The scam doesn’t seem to work anywhere else. The victim are the out of state insurers.
Seems high prices are NOT limited to NY & NJ but is nationwide. But then everyone already knows that.
[link=https://www.nytimes.com/2019/12/27/upshot/expensive-health-care-world-comparison.html]https://www.nytimes.com/2…-world-comparison.html[/link]
Why does health care cost so much more in the United States than in other countries? As health economists love to say: [link=https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.3.89]Its the prices, stupid[/link].
As politicians continue to lament the systems expense, and more Americans struggle to pay the high and often unpredictable bills that can accompany their health problems, its worth looking at just how weird our prices really are relative to the rest of the world.
The International Federation of Health Plans, a group representing the C.E.O.s of health insurers worldwide, publishes a guide every few years on the international cost for common medical services.
Its [link=http://www.ifhp.com/insights/ifhp-comparative-price-report-issued/]newest repor[/link]t ([link=http://www.ifhp.com/insights/ifhp-comparative-price-report-issued),]http://www.ifhp.com/insig…-price-report-issued),[/link] on 2017 prices, came out this month. Every time, the upshot is vivid and similar: For almost everything on the list, there is a large divergence between the United States and everyone else.
Patients and insurance companies in the United States pay higher prices for medications, imaging tests, basic health visits and common operations. Those high prices make health care in the U.S. extremely expensive, and they also finance a robust and politically powerful health care industry, which means lowering prices [link=https://www.nytimes.com/2019/12/17/upshot/surprise-billing-democrats-2020.html]will always be hard[/link].
For a typical angioplasty, a procedure that opens a blocked blood vessel to the heart, the average U.S. price is $32,200, compared with $6,400 in the Netherlands, or $7,400 in Switzerland, the survey finds. A typical M.R.I. scan costs $1,420 in the United States, but around $450 in Britain. An injection of Herceptin, an important breast cancer treatment, costs $211 in the United States, compared with $44 in South Africa. These examples arent outliers.
There are so few cases where the United States price isnt the highest that they jump out. Cataract surgery costs more in New Zealand; Kalydeco, a new drug for cystic fibrosis, costs more in the United Arab Emirates. But for most of the studied cases, prices for services and drugs in other developed countries are less than half of those in the United States.
It is staggering how much the United States is more expensive, said John Hargraves, the director of data strategy at the [link=https://www.healthcostinstitute.org/]Health Care Cost Institute[/link], a group that aggregates claims data from several large American insurance companies and provided the U.S. data to the study.
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Couple more anecdotes from Jeff Bezos Washington Post attacking physicians:
[link=https://www.washingtonpost.com/opinions/the-health-care-industry-is-letting-surgeons-behave-like-muggers/2020/01/13/f2089094-3636-11ea-bb7b-265f4554af6d_story.html]https://www.washingtonpos…65f4554af6d_story.html[/link]
[link=https://www.washingtonpost.com/business/2020/01/07/every-american-family-basically-pays-an-poll-tax-under-us-health-system-top-economists-say/]https://www.washingtonpos…em-top-economists-say/[/link]
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If hospitals are truly “not for profit” … then they wouldn’t miss the revenues going to the “hospital,” right? So let’s end the hospitals and replace them with public utilities which aren’t bloated marketing machines diverting most of the money to their pyramids and not physicians.
Ohhh, I forgot. These NFP organizations have big lobbies. OH yeah, small detail I forgot there. They are driven so little by profit, they employ expensive lobbyists to maintain … their integrity. I forgot that detail too, I guess.
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That won’t matter now. I’m already telling my kids not to go into medicine and be an engineer instead. PAs and NPs have already dumbed down the health system.
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Daily reminder: US MD salaries need to drop 50% or more in order to reach sustainable global equilibrium, normalized by country’s wealth. All the forces including midlevels are pushing towards that goal.
[link=https://www.medscape.com/slideshow/2019-international-compensation-report-6011814]https://www.medscape.com/slideshow/2019-international-compensation-report-6011814[/link]
Be sure to keep that in mind and think ahead. Best to learn how to code, invest, or hit the gym to become an instagram model.-
Gee, you hate doctors AND you’re a Socialist. Who knew?
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[link=https://www.medscape.com/viewarticle/921909]https://www.medscape.com/viewarticle/921909[/link]
15 Docs Fired From Illinois Health System to Be Replaced With NPs -
Quote from DoctorDalai
Gee, you hate doctors AND you’re a Socialist. Who knew?
Anytime you hear “right side of history” it is coming from the …. wrong side of history. -
[link=https://www.washingtonpost.com/health/surprise-medical-bill-stimulus-package/2020/12/21/51cffdae-43a2-11eb-a277-49a6d1f9dff1_story.html]https://www.washingtonpos…9a6d1f9dff1_story.html[/link]
[b]Congress shields patients from unexpected medical bills[/b][/h1]
A ban on what is known as surprise billing is woven into a pandemic relief package, which lawmakers approved late Monday. The ban is based mainly, but not entirely, on a bipartisan accord this month among three House committees and one in the Senate that had [link=https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2019/05/24/the-health-202-momentum-is-building-in-congress-to-take-on-surprise-medical-bills/5ce6d0b11ad2e52231e8e79b/?itid=lk_inline_manual_2]each tried [/link]to outlaw the practice before.
The ban, to take effect at the start of 2022, will be the biggest victory for consumers since the Affordable Care Act, said Rep. Frank Pallone Jr. (D-N.J.), chairman of the House Energy and Commerce Committee, which approved the first unsuccessful federal legislation in mid-2019. Its now up to the provider and the insurance to figure this out. Its not the consumers problem, Pallone said in an interview Monday.
Buffering patients from such unexpected bills is a rare health policy issue that Democrats and Republicans have both endorsed in theory. In May 2019, President Trump urged Congress to help protect consumers from surprise bills when polls showed that health-care costs would be a dominant issue in this years presidential election. President-elect Joe Biden also has called for an end to the practice.
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Sounds like a relatively favorable outcome. Thank radpartners I guess.
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The Energy and Commerce committee model (which is a benchmark rate model-preferred by the public and lawmakers because of its simplicity and lower costs) is the California state model which became law there in 2017. The Ways and Means committee model (which is the arbitration process model-preferred by most hospitals and providers because there is a chance to get higher reimbursements) is the New York state model which became law there in 2015.
Lawmakers have been debating these two models for quite a few months now it seems. It looks like we may have to wait till Jan or Feb next year to get a final decision.-
Surprise billing is a racket and fraud. Out of network ER docs can cry me a river.
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Unless you specialize on the ‘take no insurance’ market, this isn’t gonna affect you much. Most of our work is already government or contracted.
What this does is give the insurers a stronger hand in cramming poor contracts down the throats of ER and radiology groups because they have the cudgel of enforced rates. I would of course prefer a mechanism that forced the insurer to pay U&C on any emergent out of network services.
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That being said, there is some abusive shit going on in NY and NJ. The $56,000 echocardiogram and the $20,000 neurosurgeon consults. I have met some of those crooks and those are the abuses that spawn that kind of legislation.
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[link=https://www.modernhealthcare.com/patients/surprise-medical-bills-becoming-more-frequent-and-costly]https://www.modernhealthcare.com/patients/surprise-medical-bills-becoming-more-frequent-and-costly[/link]
From 2010 through 2016, 39% of 13.6 million trips to the ED at an in-network hospital by privately insured patients resulted in an out-of-network bill. That figure increased during the study period from about a third of ED visits nationwide in 2010 to 42.8% in 2016.-
Here’s a simple pro-consumer framework:
1. All non-emergency bills are null. You can send a random bill after the fact if you want, but patient has no legal obligation to pay for it. Similarly to how if a homeless cleans my window at the traffic light I have no obligation to pay him after the fact. Providers collect payment for the service upfront if they want any payment (cash or insurance or ass – whatever idc), with an obviously explicit patient consent and price-point decision making. No limit on how much provider can charge upfront. Free market capitalism for non-EM services.
2. For emergency visits, patient is not legally responsible for a bill over a federally set amount. Say $500 max in San Francisco, $250 in Kansas. If you came with a legit problem you get charged less, and get priority treatment. If you came to abuse the system you get charged up to max, and will sit in the lobby for 4 hours. Heavily socialized, private ERs are legal but don’t get government $ (or 120% of Medicare at best).
3. This will make it hard to meet demand with current supply, so reform supply side by increasing midlevel supply by 1200%, MD supply by 400% in 5 years thru immigration and un-licensing / deregulation of AI and other technologies / deregulation of drug/devices imports from OECD countries / deregulation of clinical trials.
4. Once the framework is in place add some extra social protections where needed thru HSAs, basic universal coverage for immunizations / prevention of unwanted low-income babies / incentives for loosing weight, etc.-
More trolling
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Comparing patients to “homeless” squeegee men is a definite problem.
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Quote from Frumious
Comparing patients to “homeless” squeegee men is a definite problem.
s/patients/doctors
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Quote from avocado
Here’s a simple pro-consumer framework:
1. All non-emergency bills are null. You can send a random bill after the fact if you want, but patient has no legal obligation to pay for it. Similarly to how if a homeless cleans my window at the traffic light I have no obligation to pay him after the fact. Providers collect payment for the service upfront if they want any payment (cash or insurance or ass – whatever idc), with an obviously explicit patient consent and price-point decision making. No limit on how much provider can charge upfront. Free market capitalism for non-EM services.
2. For emergency visits, patient is not legally responsible for a bill over a federally set amount. Say $500 max in San Francisco, $250 in Kansas. If you came with a legit problem you get charged less, and get priority treatment. If you came to abuse the system you get charged up to max, and will sit in the lobby for 4 hours. Heavily socialized, private ERs are legal but don’t get government $ (or 120% of Medicare at best).
3. This will make it hard to meet demand with current supply, so reform supply side by increasing midlevel supply by 1200%, MD supply by 400% in 5 years thru immigration and un-licensing / deregulation of AI and other technologies / deregulation of drug/devices imports from OECD countries / deregulation of clinical trials.
4. Once the framework is in place add some extra social protections where needed thru HSAs, basic universal coverage for immunizations / prevention of unwanted low-income babies / incentives for loosing weight, etc.
Interesting ideas but may not always work. Many elective procedures can have additional charges that were not foreseen- endoscopy for example- biopsies, snare procedures, banding, cauterization, not to mention complications.
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The reality is the consumer framework doesn’t work well in medicine.
Why don’t we apply it to defense spending as well since we are going down the wingnut path? -
Quote from drad123
The reality is the consumer framework doesn’t work well in medicine.
Why don’t we apply it to defense spending as well since we are going down the wingnut path?The consumer framework works well when it comes to elective procedures and patients have full price transparency. United Healthcare for all it’s warts provides that transparency to their subscribers.
The consumer framework doesn’t work well when it comes to unplanned ER care and all the consults an involuntary hospitalization can spawn.
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If United is transparent it is a very recent 180 degree change from former practice.
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Quote from fw
Quote from drad123
The reality is the consumer framework doesn’t work well in medicine.
Why don’t we apply it to defense spending as well since we are going down the wingnut path?The consumer framework works well when it comes to elective procedures and patients have full price transparency. United Healthcare for all it’s warts provides that transparency to their subscribers.
The consumer framework doesn’t work well when it comes to unplanned ER care and all the consults an involuntary hospitalization can spawn.
What kind of elective procedures are you referring to? liposuction or facial cosmetic surgery?
What can we point to in the world to verify your hypothesis? -
Quote from drad123
What kind of elective procedures are you referring to? liposuction or facial cosmetic surgery?
What can we point to in the world to verify your hypothesis?
LASIK, tatoo removal, nose jobs etc. Customers are quite capable to decide whether they want to go to the $250 place in the mall or the $2000 alternative. But that is because the price is transparent and the customer can make a value decision.
Try to find out how much you are going to pay out of pocket to get a knee or spine MRI done locally while using your health plan. It can be done, but its a pain. You should be able to just go to your insurers website, plug in a CPT and get guaranteed prices for the local hospitals and imaging centers. If you go to the hospital to have an elective procedure and have lets say BCBS, it should be possible to just click on ‘no out of network providers’ and it would restrict who can do your anesthesia, where your bloodwork has to go etc.
There are always going to be limits to this for emergency hospitalizations, but for elective procedures there is no excuse for ‘suprise bills’, its just lazyness by the hospitals to not set it up in a customer friendly way.
The ‘market’ in healthcare isn’t working because as it is designed right now, its not a market. -
Quote from drad123
Interesting ideas but may not always work. Many elective procedures can have additional charges that were not foreseen- endoscopy for example- biopsies, snare procedures, banding, cauterization, not to mention complications.
At Kaiser I’d pay $300 for EGD with my plan in advance. Any “unexpected” biopsies are still included. They have some incentive to make the most out of those $300. I’m not sure what I’ll pay if they mess up and I have to follow up to fix some internal bleeding, I’m hoping I wouldn’t have to pay for it. I had an unexpected skin biopsy once for a routine specialist visit but I never had to pay anything besides the upfront specialist $80 fee. Also the PCP sent a pic to a dermatologist on the phone during the visit and I didn’t have to pay extra for that besides PCP visit fee.
My plan is still too expensive (and so are the services on the price list, and the drugs), but I think they are trying to implement the part 1 from my post in some capacity. We just need part 3 nation-wide to get the market where it should be, and prices will go down. And basically mandating whatever Kaiser is trying to do with upfront payments for everyone else (no after-the-fact bills unless emergency care). There’s still a lot of BS coinsurance payments in my Kaiser contract (no upper limit essentially).
Also for part 4 I have another idea – free bariatric surgery for every BMI>30 fat person (required if you want state subsidies in any sort). Performed by an imported cuban doctor with waived US residency requirement. $600 value but huge savings down the road.
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Quote from avocado
[link=https://www.modernhealthcare.com/patients/surprise-medical-bills-becoming-more-frequent-and-costly]https://www.modernhealthcare.com/patients/surprise-medical-bills-becoming-more-frequent-and-costly[/link]
From 2010 through 2016, 39% of 13.6 million trips to the ED at an in-network hospital by privately insured patients resulted in an out-of-network bill. That figure increased during the study period from about a third of ED visits nationwide in 2010 to 42.8% in 2016.
Two possible explanations :
– greedy doctors
Or
– insurers who don’t feel they have to negotiate in good faith and come to the hospital based specialists with a ‘this is the deal, take it or leave it’ attitude when it comes to network contracts.As someone who deals with this as both hospital based provider and patient, I know the answer.
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Quote from jd4540
EM threads on SDN are freaking out, some saying this bill would lower take home income by 40%. They have links from their professional society to letters to email reps. Not sure why ACR is being so blase about this.
Also apparently there is now a rival bill.
[link=https://thehill.com/policy/healthcare/474145-ways-and-means-committee-working-on-rival-surprise-medical-billing-fix]Ways and Means Committee announces rival surprise medical billing fix[/link]
ACR sent an email out a few days ago regarding this and had a link at the bottom that sent me to a form letter that i signed. Letter automatically sent to my state senators and reps.
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Ok but who is at risk of a 40% cut in income & exactly why?
Explain someone, especially those of you who sign petition. What are you entitled to that the petition adddesses?
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some of you on here would like to work for free or at reduced rates. I am not one of those people. i am “entitled” to fair bargaining power with insurers, hospitals and and being paid as well for my labor next decade as in the past, not at 75% or 50% of it.
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Quote from delawarerad
Quote from jd4540
EM threads on SDN are freaking out, some saying this bill would lower take home income by 40%. They have links from their professional society to letters to email reps. Not sure why ACR is being so blase about this.
Also apparently there is now a rival bill.
[link=https://thehill.com/policy/healthcare/474145-ways-and-means-committee-working-on-rival-surprise-medical-billing-fix]Ways and Means Committee announces rival surprise medical billing fix[/link]
ACR sent an email out a few days ago regarding this and had a link at the bottom that sent me to a form letter that i signed. Letter automatically sent to my state senators and reps.
Can you post a link?
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[link=https://www.bakersfield.com/ap/news/nevada-jury-finds-unitedhealthcare-and-affiliates-guilty-of-oppression-fraud-and-malice-in-its/article_6ede6657-822b-563b-a4f2-3aeea6ca5497.html]https://www.bakersfield.c…a4f2-3aeea6ca5497.html[/link]
Nevada Jury Finds UnitedHealthcare and Affiliates Guilty of Oppression, Fraud and Malice [/h1]
Today, a Clark County, Nevada jury convincingly ruled favorably for three Nevada-based TeamHealth affiliates, who took legal action against insurance giant United over substantiated claims of drastic underpayments. After more than three weeks of testimony and two days of deliberation, the Nevada jury found that United engaged in unfair and abusive reimbursement practices by deliberately failing to pay the frontline emergency room doctors adequately for care provided to patients. The jury found the evidence clear and convincing and found that United was guilty of oppression, fraud and malice in its conduct, prompting the jury to assess punitive damages against United. Several current and former United executives came under scrutiny for revelations uncovered in testimony throughout the trial. Among them:
John Haben, the former head of Uniteds Shared Savings Program,[b] confirmed Uniteds role in colluding with Yale University professor Zack Cooper to produce a controversial study used to promote the false view that TeamHealth engaged in balance billing. The study misled Congress into passing legislation giving insurers significant leverage over frontline providers.[/b]United exposed their members to surprise medical bills.Haben also stated under oath that United paid as little as 20% of the clinicians billed charges.Uniteds Shared Savings Program takes up to a 50% administrative fee on the difference between billed charges and Uniteds arbitrary payments.United often receives more money on their shared savings fee than they pay to the provider.Throughout all of Uniteds bad behavior, TeamHealth maintained its policy of not balance billing patients.
On behalf of our more than 15,000 clinicians, TeamHealth is thrilled by the jurys decision to hold UnitedHealthcare accountable for the considerable harm they have caused to Nevada emergency room clinicians and their patients, said TeamHealth President & CEO Leif Murphy. The court evidence clearly demonstrated that Uniteds refusal to adequately reimburse emergency medicine physicians was intentional and will no longer be tolerated. TeamHealth looks forward to continuing its efforts to ensure that our frontline clinicians have the resources to provide the high-quality lifesaving care and services patients rely on, from coast to coast.
(this is Zack Cooper –[link=https://news.yale.edu/2021/01/15/yale-research-guided-policy-end-surprise-medical-bills)]https://news.yale.edu/202…urprise-medical-bills)[/link]
