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.”

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

 

 

What Medicare Pays Physicians

For the first time, totals of what Medicare pays individual healthcare providers is now freely available to download and browse on a government website.

Patients, other healthcare providers, journalists, and anybody else willing to sift through an Excel spreadsheet nearly 900,000 rows deep can discover what each physician, nurse practitioner, and other professional who billed Medicare Part B earned from the program in 2012.

Read more here: http://www.medpagetoday.com/PublicHealthPolicy/Medicare/45166?isalert=1&uun=g436319d1067R5533480u&utm_source=breaking-news&utm_medium=email&utm_campaign=breaking-news&xid=NL_breakingnews_2014-04-09

Coming Soon: Dollars to Docs

The federal government will begin releasing information how much it pays individual physicians in Medicare starting next week, Centers for Medicare and Medicaid Services officials said Wednesday.

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