iLoveBenefits: Industry News Blog

What C-Suite Executives Want in 2017

Can anyone create a understandable explanation of benefits (EOB)

According to a recent survey, 95.5% of respondents had received a medical bill from a doctor, hospital, or health care provider in the past 12 months. Of those, 60.5% rated their medical bills as confusing or very confusing. Their frustrations included the following:

  • The relationship between bills from provider and the statements from insurance company: 50.6%
  • Not sure if the total owed was correct: 49.4%
  • The amount owed was a surprise: 48.8%
  • Unexpected expenses that were thought to be covered by insurance: 46.1%
  • Not sure if the insurance company had paid yet: 43.2%
  • The bill arrived a long time after the date of service: 42.3%
  • The relationship between the bill and insurance deductible: 35.1%
  • Didn’t understand the language on the bill: 23.5%
  • Wasn’t sure if everything listed on the bill really happened: 22.0%

Source: “A BILL YOU CAN UNDERSTAND RESEARCH REPORT,” Mad*Pow, May 6, 2016, http://static1.squarespace.com/static/5715100cf8baf3c79d443859/t/5730e1c4f699bbe627603424/1462821330491/DesignChallenge_ResearchReport.pdf

What revenue does a physician generate for their hospital?

According to a recent survey, the average net revenue generated on behalf of an affiliated hospital is as follows:

  • $1,560,688 by a single physician
  •  $2,746,605 by a full-time orthopedic surgeon
  •  $2,448,136 by an invasive cardiologist
  •  $2,445,810 by a neurosurgeon
  •  $2,169,693 by a general surgeon
  •  .$1,493,518 by a family physician
  • $1,830,200 by a general internist

Source: “Survey: Each Physician Generates an Average $1.56 Million a Year Per Hospital,” Merritt Hawkins News Release, April 12, 2016, http://www.merritthawkins.com/uploadedFiles/MerrittHawkins/Pdf/2016%20Merritt%20Hawkins%20-%20Inpatient-Outpatient%20Revenue-%20Press%20Release.pdf

Reimbursement is beginning to change in important ways

Effective January 1st, the Centers for Medicare and Medicaid Services (CMS) began reimbursing providers who actively manage care delivery for Medicare patients who have two or more chronic conditions. According to a recent health care provider survey, 76% of respondents planned to organize and structure to meet Medicare’s chronic care management program requirements within the next six months.

Source: “KRYPTIQ SURVEY: NINE OF TEN PROVIDERS PLAN TO PURSUE MEDICARE’S CHRONIC CARE MANAGEMENT PROGRAM,” Kryptiq Press Release, February 26, 2015, http://www.kryptiq.com/kryptiq-survey-nine-ten-providers-plan-pursue-medicares-chronic-care-management-program/

 

Open Payments website launches

The federal government today launched a highly anticipated website detailing at least $3.5 billion in financial ties in a five-month period between medical device and drug companies and physicians and teaching hospitals.

The Open Payments website is the first public repository of national data describing financial relationships between industry and healthcare providers. Critics of these payments say these payments can inappropriately influence clinical decisions.

The database was required by the Physician Payments Sunshine Act, a provision of the Patient Protection and Affordable Care Act that was spearheaded by Sen. Chuck Grassley (R-Iowa).

Hospitals save on uncompensated care

HHS released a report that projects “hospitals will save $5.7 billion this year in uncompensated care costs because of the Affordable Care Act, with states that have expanded Medicaid seeing about 74 percent of the total savings nationally compared to states that have not expanded Medicaid.”

After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know

Getting needed care is difficult by itself. Understanding what you will need to pay daunting. But making decisions about getting in network care is often well understood by patients. However, there are many care decisions that patients don’t make, are unable to make and are often made for them. This NYT article illuminates the practices that many patients encounter.

There needs to be public policy that sets forth the following: For an elective procedure, if a patient selects an in network hospital and an in network surgeon or primary care doctor then all other providers not selected by them must be handled, for insurance coverage purposes, as if they were in network as well…

“He was blindsided, though, by a bill of about $117,000 from an “assistant surgeon,” a Queens-based neurosurgeon whom Mr. Drier did not recall meeting.

. . .

In many other countries, such as Australia — where, as in the United States, people often rely on private insurance — it is seen as a patient’s right to be informed of out-of-pocket costs before hospitalization, said Mark Hall, a law professor at Wake Forest University.”

Read more here: http://mobile.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html?_r=1&referrer

Price Variation among Cities for Common Medical Services

Imaging if the price of milk or eggs varied as do medical services. . .

According to Castlight Health, analysis of in-network price differences in a U.S. commercially insured population shows within the 30 most populous U.S. cities, prices vary greatly for the same service:

Up to 23x for a lipid panel in Dallas (from $15 to $343)

Up to 12x for a CT scan (of head/brain) in Philadelphia (from $264 to $3,271)

Up to 11x for an MRI (of lower back) in New York City (from $416 to $4,527)

Up to 4x for an adult preventive primary care visit in Phoenix (from $40 to $195)

Castlight Health also ranked the most expensive and least expensive cities in the 30 most populous U.S. cities for four common outpatient services:

-For a lipid panel, Indianapolis came in most expensive (average price $89) and Pittsburgh the least (average price $19)

-For a CT scan (of head/brain), Sacramento came in most expensive (average price $1,404) and Orlando the least (average price $611)

-For an MRI (of lower back), Sacramento came in most expensive (average price $2,635) and Seattle the least (average price $907)

-For an adult preventive primary care visit, San Francisco came in most expensive (average price $251) and Miami the least (average price $95)

Source: Castlight Health

What hospitals charge Medicare matters . . . to everyone

This from the NY Times:

“Charges for some of the most common inpatient procedures surged at hospitals across the country in 2012 from a year earlier, some at more than four times the national rate of inflation, according to data released by Medicare officials on Monday.”

“While hospitals say they are unimportant — Medicare beneficiaries and those covered by commercial insurance pay significantly less through negotiated payments for treatments — others say the list prices are meaningful to the uninsured, to private insurers that have to negotiate reimbursements with hospitals or to consumers with high-deductible plans.”

Read more here: http://www.nytimes.com/2014/06/03/business/Medicare-Hospital-Billing-Data-Is-Released.html?emc=edit_th_20140603&nl=todaysheadlines&nlid=21022103

 

 

Making prices consumers pay transparent may help control prices

Seeking Lower Prices Where Providers Are Consolidated: An Examination of Market and Policy Strategies, by Paul B. Ginsburg and L. Gregory Pawlson. The authors discuss a wide range of strategies at the disposal of payers and policymakers to curb the market power wielded by providers. For example, they point to the information systems that many private insurers are developing to produce real-time estimates of patients’ out-of-pocket costs—data that patients could use to become more price-conscious when choosing providers.

Then there is this:

Tthe Health Care Cost Institute announced that it will work with three health insurance companies – United, Aetna, and Humana – to lead an industry-driven effort to provide transparency on prices paid for health-care services by making them available on-line.  The new initiative will offer consumers a “reference price” for health services in their communities, based on aggregated data from insurers. Customers will get more information about prices, including how much they’ll have to pay out of pocket.  “The public has been clamoring for this,” said David Newman of the Health Care Cost Institute.  “This was the next natural step for us as an institute to evolve to.”

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