Archive for the ‘Health Care / Medical Insurance’ Category

A hidden cost of ObamaCare: Docs getting stiffed.

March 14, 2017

ObamaCare’s high deductible plans pushing up bad debts.

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Chatting with a doctor-friend recently.

His is a very specialized 1-doctor practice (supported by a handful of well-trained techs).

Patients who are referred to him usually have a very serious condition needing sophisticated diagnostics.

My friend casually mentioned to me that – in the past couple of years — he has had to write-off more than $2 million in bad debts.

Way more than in prior years.

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Here’s what’s going on …

(more…)

Don’t faint: I agree with ObamaCare on this one …

March 9, 2017

For the record, I think that ObamaCare is an expensive, amateurish travesty that should be repealed and rebuilt from the ground up by professionals.  Keep the high risk pools for pre-exiting conditions, keep the subsidies for the poor … but lose the  micro-narrow provider networks and the junk mandated into policies (e.g. my favorite: universally free birth control for law schoolers).

And, I think that Dr. Dr. Ezekiel Emanuel – Rahm’s brother and one of the ObamaCare architects – is a complete butt.

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That said, I was on Zeke’s side when he sparred with O’Reilly  …

(more…)

Remember how healthcare costs were going to drop by $2,500 for every family?

March 7, 2017

In 2016, employees paid $11,000 out-of-pocket … up $2,500 since 2012.

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Milliman – a well-regarded actuarial consulting” firm – has published an annual recap of healthcare spending since 2001.

The Milliman Medical Index tracks the total costs of providing health care to an average family of four covered by an employer-sponsored “preferred provider plan” … that’s about 155 million employees and their dependents.

The total includes the health insurance premiums paid by both the employer and the employee, as well as the actual expenditures for health care paid by the insurance plan and out of pocket by the insured family.

The big news: In 2016, the average healthcare costs for a family of 4 surpassed $25,000 for the first time … the $25,826 is triple the cost to provide health care for the same family in 2001 … and up about $5,000 since 2012.

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The bad(est) news is the increased proportion of the healthcare costs being shouldered by individual employees …

(more…)

Should a family of 5 have to pay more at a restaurant than a family of 3?

January 23, 2017

The answer is obvious, right?

They take up more seats, require more server time, and eat more food.

Why do I ask?

As the GOP moves to Repeal & Replace ObamaCare, a constant refrain is ‘everybody agrees that two popular parts of ObamaCare should be saved: insurability for pre-existing conditions and allowable coverage of ‘adult- children’ on their parents’ policies until they are 26”.

I agree that there needs to be a way to cover pre-existing conditions, but … except for special needs situations, I respectfully disagree re: adult-children.

First, the term “adult-children” gives me the creeps. But, that’s beside the point.

More on point, I don’t care if insurance companies have to carry 26 year olds on their parents’ policies, but I don’t understand why they should “fly free” and that you & I should have to pay for it … not the adult-children’s parents.

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Let me explain …

Now, practically all employer-sponsored  health insurance plans charge premiums in tiers: employee only, employee plus spouse, employee plus children, and employee plus spouse and children. Note: it doesn’t matter if the employee has 1 child or a dozen children … same premium.

Say what?

For example, the United Healthcare plan through Georgetown — which is probably pretty typical — charges:

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Let’s dive a little deeper into those numbers …

(more…)

There are 3 Americas (not 2) … thanks to Obamacare.

January 11, 2017

ObamaCare is front & center on the legislative agenda again, so …

Last week, we reported that — according to Gallup — ObamaCare is under water by 7 points (51% to 44%) … and that 29% think their families have been hurt by ObamaCare versus 18% who think that their families have been helped).

obamacare-jan-2017

In other words, the disapproval is grounded in the program’s fundamentals.

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Cutting to the chase, an article in the WSJ quoted David Cutler, a Harvard health-care economist:

Obamacare may be “a story of three Americas.”

One group, the rich, can afford health care easily.

The poor can access public assistance.

But for lower middle- to middle-income Americans, “the income struggles and the health-care struggles together are a really potent issue.”

No kidding, Dr. Cutler …

HomaFiles was all over this one back in June:

Remember how healthcare costs were going to drop by $2,500 for every family?

We concluded that in 2016, employees will pay $11,000 out-of-pocket … up $2,500 since 2012.

“Employees” … you know the working class … the middle class.

Here’s the essence of our original post …. worth re-reading …. glad others are catching up to it.

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Milliman – a well-regarded actuarial consulting” firm – has published an annual recap of healthcare spending since 2001.

The Milliman Medical Index tracks the total costs of providing health care to an average family of four covered by an employer-sponsored “preferred provider plan” … that’s about 155 million employees and their dependents.

The total includes the health insurance premiums paid by both the employer and the employee, as well as the actual expenditures for health care paid by the insurance plan and out of pocket by the insured family.

The big news: In 2016, the average healthcare costs for a family of 4 surpassed $25,000 for the first time … the $25,826 is triple the cost to provide health care for the same family in 2001 … and up about $5,000 since 2012.

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The bad(est) news is the increased proportion of the healthcare costs being shouldered by individual employees …

(more…)

ObamaCare has bent the cost curve …

October 20, 2016

Unfortunately, it has bent it up, not down.

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Hillary’s lucky that the MSM is burying ObamaCare coverage, so she can continue to tout it as a resounding success.

Remember how ObamaCare was going to save each family $2,500?

Well, turns out to be just the opposite.

According to Federal Reserve data, once the full program kicked in, real personal healthcare expenditures — the “net total” of insurance premiums, deductibles and other out-of pocket spending, adjusted for inflation — has turned up, not down.

obamacare-bending-the-cost-curve-up

Her are some details …

(more…)

There are 3 Americas (not 2) … thanks to Obamacare.

September 1, 2016

Article in yesterdays WSJ quoted David Cutler, a Harvard health-care economist:

Obamacare may be “a story of three Americas.”

One group, the rich, can afford health care easily.

The poor can access public assistance.

But for lower middle- to middle-income Americans, “the income struggles and the health-care struggles together are a really potent issue.”

No kidding, Dr. Cutler …

HomaFiles was all over this one back in June:

Remember how healthcare costs were going to drop by $2,500 for every family?

We concluded that in 2016, employees will pay $11,000 out-of-pocket … up $2,500 since 2012.

“Employees” … you know the working class … the middle class.

Here’s our original post …. worth re-reading …. glad others are catching up to it.

========

Milliman – a well-regarded actuarial consulting” firm – has published an annual recap of healthcare spending since 2001.

The Milliman Medical Index tracks the total costs of providing health care to an average family of four covered by an employer-sponsored “preferred provider plan” … that’s about 155 million employees and their dependents.

The total includes the health insurance premiums paid by both the employer and the employee, as well as the actual expenditures for health care paid by the insurance plan and out of pocket by the insured family.

The big news: In 2016, the average healthcare costs for a family of 4 surpassed $25,000 for the first time … the $25,826 is triple the cost to provide health care for the same family in 2001 … and up about $5,000 since 2012.

clip_image002

======

The bad(est) news is the increased proportion of the healthcare costs being shouldered by individual employees …

(more…)

Remember how healthcare costs were going to drop by $2,500 for every family?

June 1, 2016

In 2016, employees will pay $11,000 out-of-pocket … up $2,500 since 2012.

========

Milliman – a well-regarded actuarial consulting” firm – has published an annual recap of healthcare spending since 2001.

The Milliman Medical Index tracks the total costs of providing health care to an average family of four covered by an employer-sponsored “preferred provider plan” … that’s about 155 million employees and their dependents.

The total includes the health insurance premiums paid by both the employer and the employee, as well as the actual expenditures for health care paid by the insurance plan and out of pocket by the insured family.

The big news: In 2016, the average healthcare costs for a family of 4 surpassed $25,000 for the first time … the $25,826 is triple the cost to provide health care for the same family in 2001 … and up about $5,000 since 2012.

clip_image002

======

The bad(est) news is the increased proportion of the healthcare costs being shouldered by individual employees …

(more…)

Would your boss fire you if your project underperformed plan by 50% ?

October 20, 2015

Answer: Apparently not if your boss is President Obama …  and your project was ObamaCare.

In a conference call with reporters last week, HHS Secretary Sylvia Burwell said “We believe 10 million is a strong and realistic goal” for 2016 enrollment in ObamaCare Exchanges.  That represents an increase not significantly different from zero.

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Let’s put that number in context … and show how performance against plan is even worse than it initially appears.

(more…)

ACA: More Americans insured, but vast majority are less insured …

September 3, 2015

I’ve  been wrestling with a conundrum ..…

Mainstream media continues to tout the success of ObamaCare … always focusing on the number of previously uninsured folks who now have insurance.

Most recent CBO numbers say that about 19 million previously uninsureds now have insurance – mostly from Medicaid and subsidized ACA Exchange policies.

Now, about 80% of the non-elderly population is covered … but, about 36 million are still uninsured.

Said differently, over half of the previously uninsureds are still uninsured.

Huh?image

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Let’s look at the cost …

ObamaCare added about $100 billion in annual government spending .

So, the cost per newly insured person is roughly $5,000 per newly insured person per year.

That sounds about right since an average individual health insurance policy is about $5,000 per year.

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OK, so what’s the rub?

Some simple arithmetic suggests that the aggregate monetary amount of insurance provided to the full population of non-elderly citizens has actually declined.

Here’s my logic …

(more…)

Stiffing Docs: High deductible plans pushing up bad debts … thanks, ACA

September 2, 2015

Chatting with a doctor-friend recently.

His is a very specialized 1-doctor practice (supported by a handful of well-trained techs).

Patients who are referred to him usually have a very serious condition needing sophisticated diagnostics.

My friend casually mentioned to me that – in the past couple of years — he has had to write-off more than $2 million in bad debts.

Way more than in prior years.

image

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Here’s what’s going on …

(more…)

Remember how your healthcare costs were going to go down by $2,500 per family?

August 18, 2015

Recently, a friend casually mentioned to me that his family finances were being strained by healthcare costs.

Why?

His family’s annual deductible had gone up from $2,500 to $12,500.

What?

Think about that for a moment … a 10-grand bump in out-of-pocket healthcare costs before the insurance even kicked in (with co-pays, of course).

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The discussion piqued my curiosity, and I did some digging to put my friend’s predicament in perspective … what I found was surprising (and certainly under-reported in the main stream media)

(more…)

Should a family of 5 have to pay more at a restaurant than a family of 3?

January 20, 2015

The answer is obvious, right?

They take up more seats, require more server time, and eat more food.

Family of 5

Why do I ask?

Since ObamaCare premiums have been back in the news, we have to ask the question.

Virtually all articles re: ObamaCare are saying “at least save the popular parts like allowing adult children on their parents’ policies until they are 26”.

First, the term “adult-children” gives me the creeps. But, that’s beside the point.

I don’t care if insurance companies have to carry 26 year olds on their parents’ policies, but I don’t understand why you & I have to pay for it … not the adult-children’s parents.

Now, practically all employer-sponsored  health insurance plans charge premiums in tiers: employee only, employee plus spouse, employee plus children, and employee plus spouse and children. Note: it doesn’t matter if the employee has 1 child or a dozen children … same premium.

Say what? Let’s take a look at the nums …

(more…)

Bitter pill: Harvard faculty thought ObamaCare didn’t apply to them … oops.

January 7, 2015

According to the NY Times , the Harvard faculty is throwing a collective hizzy fit.

What’s their beef?

In a touch of irony, the same folks who cheer-led the passage of ObamaCare now feel aggrieved because they’re being forced to shoulder some of the costs.

To quote my grandson Ryne, “Oh me oh my.”

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Here’s the scoop … with some priceless snippets from the Times’ article

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Have you even looked at YOUR health insurance premiums?

November 17, 2014

This headline in the NY Times caught my eye:

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The article leads with:

The Obama administration on Friday unveiled data showing that many Americans with health insurance bought under the Affordable Care Act could face substantial price increases next year — in some cases as much as 20 percent.

Now, those are exchange premiums so they don’t apply to me.

Still, the headline was shocking enough to make me take a serious look at the premiums that I pay.

What I discovered is very interesting …

(more…)

I’ve seen the future of healthcare … and it’s not pretty.

October 10, 2014

Before I start grousing,  let me be clear about a couple of things.

First, the medical team at Georgetown Hospital is totally awesome.

Second, I like my doctor and I got to keep my doctor … mostly because I’m still working.

But, I’ve discovered that insurance and access aren’t synonymous …. and that appointment slots are getting scarcer and scarcer.

 

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In the past couple of weeks I’ve had personal experiences that have me a bit worried …

(more…)

Surviving a post-med school residency …

August 20, 2014

We’ve been spending a lot of time at Georgetown Hospital recently.

In the process, we’ve developed a deep respect for some of the key cogs in the system: nurses, nurse practitioners and doctor-residents.

In casual conversation, our surgeon mentioned how she had managed to “survive her surgical residency”.

That got me wondering, about the life of a resident.

 

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Here’s what I found …

(more…)

POTUS says: “When veterans do get into the system, they get great healthcare” … oh, really?

June 5, 2014

When Obama finally commented on the VA scandal, he gave the usual “outraged, will investigate and hold accountable” … then asserted that “when veterans do get into the system, they get great healthcare”.

No questions from the media.  Not much follow-up.

Must be true since the President said it, right?

Of course, my BS detector started screeching.

Fortunately, the WSJ started to dig and found “significantly higher rates of mortality and dangerous infections at some VA hospitals compared with others” … and compared to private hospitals.

For example, the Boston area VA hospital is rated 5-stars … the embattled Phoenix VA draws a single star.

 

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Source

The WSJ concluded that the Phoenix VA doesn’t appear to be an outlier.   

Here’s where things get interesting …

(more…)

More: The doctor will see you … eventually

June 4, 2014

Last year, I needed to see an eye surgeon, when I called, I was given an appointment within 2 weeks.

This year, I called the same doctor and was told the the first open slot was in 8 weeks.

Hmmm.

Can’t project off one observation, right?

 

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Last week, the VA waiting times were revealed to be 115 days … almost 4 months.

That got me to wondering: What are waiting times in some other countries often cited as ObamaCare models .

Here’s a sampling …

(more…)

The doctor will see you … eventually

May 29, 2014

Yesterday, VA Hospitals’ Inspector General released an interim investigative report on patient wait times.

 

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Here are the headline findings …

(more…)

Boomerang Effect: Bending the cost curve … the wrong direction.

May 14, 2014

Two related articles caught my eye ….

First, Business Insider reported that “spending on healthcare grew an astounding 9.9% in Q1 … the biggest percent change in healthcare spending since 1980”

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The article goes on to say: “Analysts said it’s primarily due to a consumption boost from the implementation of the Affordable Care Act.”

That makes sense.

Some folks rushed to their docs in the last quarter of 2013 to beat the jump in their deductibles and to jump the line ahead those becoming newly insured.

Nonetheless, the fact remains that, adjusted for inflation, America is spending more on healthcare than ever before..

Here’s the big takeaway … (more…)

Boomerang Effect: Bending the cost curve … the wrong direction.

May 8, 2014

Two related articles caught my eye ….

First, Business Insider reported that “spending on healthcare grew an astounding 9.9% in Q1 … the biggest percent change in healthcare spending since 1980”

image

The article goes on to say: “Analysts said it’s primarily due to a consumption boost from the implementation of the Affordable Care Act.”

That makes sense.

Some folks rushed to their docs in the last quarter of 2013 to beat the jump in their deductibles and to jump the line ahead those becoming newly insured.

Nonetheless, the fact remains that, adjusted for inflation, America is spending more on healthcare than ever before..

Here’s the big takeaway … (more…)

What happens when you cut doctors’ reimbursement rates?

April 24, 2014

Here’s a shocker …

They spend less time seeing patients.

Medscape does an annual hours and pay survey.

For 2013, the Medscape survey said that the average doctor was face-to-face with patients about 41 hours …. with about 2/3s of them in the 40 to 50 hours cluster.

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How does the 41 hours compare to historical rates?

 

 

According to Medscape:

A 2010 study in JAMA found that after no significant change between 1977 and 1997 in the hours per week that physicians spend with patients’

Patient hours decreased steadily from 54.6 to 51.0 between 1997 and 2007.

The study authors attributed the decrease to a parallel 25% inflation-adjusted decline in fees between 1996 and 2006.

Shocker, right? 54.6 to 51 to 41 …

Pay somebody less and they’re less incentivized to bust their humps.

Think about that each time you hear about the Feds and insurance companies ratchet down the reimbursement rates to “fix” the healthcare system,

I’m betting the under on that one.

#HomaFiles

Follow on Twitter @KenHoma                             >> Latest Posts

Should a family of 5 have to pay more at a restaurant than a family of 3?

March 28, 2014

The answer is obvious, right?

They take up more seats, require more server time, and eat more food.

Why do I ask?

Virtually all articles re: ObamaCare are saying “at least save the popular parts like allowing adult children on their parents’ policies until they are 26”.

First, the term “adult-children” gives me the creeps. But, that’s beside the point.

I don’t care if insurance companies have to carry 26 year olds on their parents’ policies, but I don’t understand why you & I have to pay for it … not the adult-children’s parents.

Now, practically all employer-sponsored  health insurance plans charge premiums in tiers: employee only, employee plus spouse, employee plus children, and employee plus spouse and children. Note: it doesn’t matter if the employee has 1 child or a dozen children … same premium.

Say what?

For example, the United Healthcare plan through Georgetown — which is probably pretty typical — charges:

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Note that it costs  $7,346 to tack a spouse (or equivalent) — presumably an adult — onto an employee’s policy.

(more…)

Don’t faint: I agree with ObamaCare on this one …

March 6, 2014

For the record, I think that ObamaCare is an expensive, amateurish travesty that should be repealed and rebuilt from the ground up by professionals.  Keep the high risk pools for pre-exiting conditions, keep the subsidies for the poor … but lose the  micro-narrow provider networks and the junk mandated into policies (e.g. my favorite: universally free birth control for law schoolers).

And, I think that Dr. Dr. Ezekiel Emanuel – Rahm’s brother and one of the ObamaCare architects – is a complete butt.

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That said, I was on Zeke’s side when he sparred with O’Reilly this week …

(more…)

More about those young folks that ObamaCare is targeting …

November 14, 2013

Conventional wisdom, summarized by the WSJ, is that”ObamaCare’s financing won’t work unless “young healthies”  … pay through the nose for coverage  … via the individual mandate.”

The Obama administration estimates that 2.7 million people between the ages of 18 and 30 need to buy health insurance through the federal and state marketplaces to offset the health care needs of older, less healthy Americans.

The 18-26 age group is the lowest user of care.

For example, the average male sees a physician only six times between the ages of 21 and 35.

But, ObamaCare now limits insurers to charging the sickest seniors no more than three times the amount they charge their youngest customers.

Since an average 64-year-old uses six times as much health care as 19-year-olds, young healthy enrollees have to pay considerably more than the cost of their own care.

So, the Administration is pulling out all stops to get young healthies enrolled.

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But, there are some flies in the ObamaCare ointment …

(more…)

Adverse selection: Will “adult children” destroy ObamaCare economics?

October 22, 2013

I’ve railed for awhile re: one of ObamaCare’s most popular benefits … forcing insurance companies to allow “adult-children” to be appended to their parents’ health insurance policies.

I wouldn’t mind if they – or more accurately, their parents – were paying for the coverage … but they typically aren’t

All other folks are being forced to pay higher premiums to cover the added costs.

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Let me explain the economics and tie it to another likely ObamaCare “glitch” …

(more…)

Gotcha: Health insurance premiums soaring

March 22, 2013

Remember this?

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Hmmm.

Let’s fast forward to today’s WSJ headline:

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The numbers are staggering (and virtually certain):

(more…)

Symptoms & causes: Why diabetes strips are $18 on a hospital bill and less than a buck on Amazon.

February 25, 2013

On Sunday, Business Insider ran a piece called The Most Infuriating Paragraph You Might Ever Read About The Healthcare System

It referenced rants on “Steven Brill’s epic cover story for Time on why healthcare costs so much.”

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The paragraph that set them off from the Brill article should – according to Business Insider — “legitimately get anyone’s blood boiling.”

By the time Steven D. died at his home in Northern California the following November, he had lived for an additional 11 months. And Alice had collected bills totaling $902,452. The family’s first bill — for $348,000 — which arrived when Steven got home from the Seton Medical Center in Daly City, Calif., was full of all the usual chargemaster profit grabs: $18 each for 88 diabetes-test strips that Amazon sells in boxes of 50 for $27.85; $24 each for 19 niacin pills that are sold in drugstores for about a nickel apiece.

There were also four boxes of sterile gauze pads for $77 each. None of that was considered part of what was provided in return for Seton’s facility charge for the intensive-care unit for two days at $13,225 a day, 12 days in the critical unit at $7,315 a day and one day in a standard room (all of which totaled $120,116 over 15 days). There was also $20,886 for CT scans and $24,251 for lab work.

As for why we can have a system where diabetes-test strips are sold for $18/each in one place, while Amazon sells a box of 50 for $27.85, see this, great piece by Sarah Kliff on the lack of price controls in the US.

My opinion: Apparently these guys have never heard of “absorption costing” or bothered to really ask “why is healthcare so costly?”

(more…)

Will ObamaCare close the biggest tax loophole?

November 28, 2012

First, what’s the biggest tax loophole?

Answer: The non-taxable payments that companies make towards employees health insurance premiums.

These days, the policy to cover a husband, wife and a couple of kids is about $15,000.

Employers typically pick up about 2/3s of the bill … call it $10,000.

The $10,000 is tax deductible for the company, and isn’t taxed as employee compensation – even though it’s clearly part of an employee’s compensation package.

In total, the health insurance loophole amounts to over $170 billion annually … about twice the mortgage interest deduction … and about twice the “Bush tax cuts for the wealthy”.

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Source:  Credit Suisse,  Neal Soss

= = = = =

So, how might ObamaCare close this loophole?
(more…)

Electronic medical records cut costs … oops, make that raise costs.

October 17, 2012

Interesting expose In the NY Times of all places.

Punch line:

When the federal government began providing billions of dollars in incentives to push hospitals and physicians to use electronic medical and billing records, the goal was not only to improve efficiency and patient safety, but also to reduce health care costs.

But, in reality, the move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services.

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How can this be?

Simple, Watson.

First, a system can provide docs with a checklist of separately billable procedures that they might perform … ensuring a complete check-up and making sure that no billing stone is left unturned.

Second, an e-system can make it easier for doctors to “upcode” a procedure in a way to maximize reimbursement rates.

For example, when a doctor enters a billing code, the system can present him with alternative codes for very similar procedures that get higher reimbursement payments … and tell the doctor what addition work needs to be done to qualify for the higher paying code.

So, maybe just asking the patient a couple of more specific questions  may upgrade an examination from ‘simple’ to ‘ complex.  The doc can then ask the questions (or not) and check the higher paying box.

Third, an e-system makes it easy for docs to “clone” common ‘boiierplate’ findings from one patients chart to another patient’s chart … saving time and, perhaps, implying a more detailed examination.

The Times says:

As software vendors race to sell their systems to physician groups and hospitals, many are straightforward in extolling the benefits  of those systems in helping doctors increase their revenue.

In an online demonstration, one vendor promises that it “plays the level-of-service game on your behalf and beats them at their own game using their own rules.”

An expert says “What’s happening is just the problem we feared” … unintended consequences.

For the record, I think that cutting healthcare costs by reducing doctors’ pay is nuts … there is lots of waste, fraud and unnecessary expense in a grossly inefficient system.

>> Latest Posts

Your doctor will see you … in a couple of months.

August 2, 2012

Fairly balanced piece in the NY Times last Sunday re: the impacts of ObamaCare

Punch line: In 2015 the country will have 62,900 fewer doctors than needed … that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care.

The problem, in a nutshell …

  • There is a shortage of every kind of doctor, except for plastic surgeons and dermatologists
  • Primary care doctors make about $200,000 a year. Specialists often make twice as much.
  • ObamaCare adds about 30,000 people to insurance rolls … the majority via Medicaid
  • Fewer than half of primary care clinicians are accepting new Medicaid patients
  • Medicare will surge to 73.2 million in 2025, up 44 percent from 50.7 million this year.
  • “Older Americans require significantly more health care,”
  • And about a third of the country’s doctors are 55 or older, and nearing retirement.
  • Younger doctors are on average working fewer hours than their predecessors.
  • It typically takes a decade to train a doctor.
  • Medical schools are at capacity and Federal training subsidies have been cut.

 

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While ObamaCare mandates broader insurance coverage, it does little to fundamentally restructure the healthcare delivery … save for government administered rationing.

Part of real answer: more doctors (new and retained), more walk-in clinics (public & private), and more authority to RNs and PAs.

Note: the Times failed to mention that the CBO’s current estimate for ObamaCare’s costs has tripled since the law was passed. 

>> Latest Posts

How many “Minute Clinics” are there in the U.S.?

June 28, 2012

Trick question.

CVS operates about 550 in store clinics under the the Minute Clinic brand umbrella.

More broadly, there are about 1,200 total in-store clinics … run by CVS, Walgreen, Wal-Mart, Kroger and Target.

Ken’s Take: These are great providers of routine health care … I’d like to see them spread like wild fire … and, I’d be all for government run “free clinics” in under-served urban and rural area.

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>> Latest Posts

What should a family of 5 have to pay more at a restaurant than a family of 3?

June 21, 2012

The answer is obvious, right?

They take up more seats, require more server time, and eat more food.

Why do I ask?

Virtually all articles re: ObamaCare are saying “at least save the popular parts like allowing adult children on their parents’ policies until they are 26”.

First, the term “adult-children” gives me the creeps. But, that’s beside the point.

I don’t care if insurance companies have to carry 26 year olds on their parents’ policies, but I don’t understand why you & I have to pay for it … not the adult-children’s parents.

Now, practically all employer-sponsored  health insurance plans charge premiums in tiers: employee only, employee plus spouse, employee plus children, and employee plus spouse and children. Note: it doesn’t matter if the employee has 1 child or a dozen children … same premium.

Say what?

For example, the United Healthcare plan through Georgetown — which is probably pretty typical — charges:

image

Note that it costs  $7,346 to tack a spouse (or equivalent) — presumably an adult — onto an employee’s policy.

Then it costs an additional $5,746 to tack one or more children onto the policy.

Said differently, it costs $5,746 to add one child to the policy and nothing to add more kids to the policy.

So, those kids are free, right?

Only in Obama Land.

Each additional kid probably costs about the same as the first one — $5,746.

That unpaid cost simply gets spread across all policy holders in the form of higher premiums.

So, back to the 26 year old adult-children …. I’m ok if they get tacked onto their parents’ policies and pay $5,746 … but, I’m not ok being forced to pay for them.

All of which raises a broader issue: Why are children of any age riding free on health insurance policies?  Why not charge $5,746 for all kids, not just the first one?

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In the UK, it’s better to be fat than to be old.

April 6, 2012

Recent editorial in the UK’s  Telegraph pointed out that the National Health Service (NHS) discriminates against elderly folks … rationing their care by dealying or denying medical services.

According to the Telegraph, the elderly are displaced in the medical queue by overweight folks whose “conditions, though, are the direct result of bad habits, poor diet, and the wrong choices. These conditions range from obesity and diabetes to smoking-related diseases like emphesema.”

If a 20-stone, 30-something woman comes into hospital with a bad diabetic attack, does she deserve to be at the front of the queue or the back?

She has chosen to stuff her face with Mars bars and Coke, and is now suffering the consequences of her choice.

She cannot claim ignorance of the dangers of her diet: the Government has carpet-bombed us with health advice, from schools to GP practices.

Class no longer regulates access to healthy living: everyone who can watch the telly, let alone read the magazines, knows that a high-fat diet will make you look bad and feel worse.

So what?

The Telegraph’s view:

The septuagenarian who develops breast cancer has done nothing wrong – except grow old.

The NHS has to consider that there are deserving cases and undeserving ones.

Age should not be a barrier to optimum care; but bad habits should be.

As my personal odometer races forward, I gotta agree with the Telegraph.

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Get out your wallet: CBO says ObamaCare to cost twice the original estimates.

March 14, 2012

According to a new projection released by the Congressional Budget Office, ObamaCare will cost $1.76 trillion over a decade,  rather than the $940 billion forecast when it was signed into law.

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The CBO now projects  that more people will be obtaining insurance through Medicaid than it estimated a year ago at a greater cost to the government, but fewer people will be getting insurance through their employers or the health care law’s new subsidized insurance exchanges.

According to the Washington Examiner:

Democrats employed many accounting tricks when they were pushing through the national health care legislation.

The most egregious of the accounting tactics was to delay full implementation of the law until 2014, so it would appear cheaper under the CBO’s standard ten-year budget window and, at least on paper, meet Obama’s pledge that the legislation would cost “around $900 billion over 10 years.”

When the final CBO score came out before passage, critics noted that the true 10 year cost would be far higher than advertised once projections accounted for full implementation.

The projection for 2022, the last year available, indicate that the cost is likely to exceed $2 trillion over the first decade, or more than double what Team Obama advertised.

Surprise, surprise, surprise.

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Why aren’t there Minute Clinics next to every ER?

February 28, 2012

That’s a question I often ask.

Everybody knows that some people use ERs in place of a primary care physician or an urgent care clinic.

That’s costly to the healthcare system since an average ER bill is around $1,000 while an average bill at a Minute Clinic or one of Walmart’s ProCare clinics is about around $50.

Currently, Federal law requires ER physicians to look at everyone who comes to the ER and treat those who have life-threatening illnesses or injuries.

So, the “system” has pay a $950 premium and seriously hurt or ill patients get to wait in long queues to get treated.

Bad deal all around..

A hospital in Odessa Texas is trying to attack the problem buy requiring patients to post a $250 deposit if they want to be treated in the ER minor ailments

According to OAOA.com

When someone comes into the Medical Center Hospital ER, they’re assessed to determine the severity of their ailments.

Based on the examination a doctor decides whether or not the person’s injury or illness requires a stay in the ER.

If the injury or illness is determined to be minor, they’ll be directed to a local clinic rather than be treated in the ER.

People with chest pains, abdominal pains or high risk conditions like tuberculosis are the types of patients who would not be redirected to a clinic.

In addition, children younger than 10 years-old and adults older than 65 years old will not be redirected either.

But if that person chooses to remain in the ER and have their minor ailment treated there, they will have to pay a $250 deposit,

The new measure is part of an effort to redirect those without serious issues to more appropriate places for treatment and streamline the ER.

Sounds like a step in the right direction, but I still gotta ask: Why aren’t there Minute Clinics next to every ER?

Have a stern triage nurse out front directing folks to turn right into the ER or turn left into the clinic.

Everybody gets appropriate treatment and we actually save some healthcare costs … rather than just shuffling around who pays for what.

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How much healthcare do free-riders “take”?

December 21, 2011

Interesting tidbit from the WSJ

On average, people without health insurance consume only about half as much health care as everyone else.

Of the amount of care they consume, they pay for about half.

Thus the “free ride” for the average uninsured person is about one-fourth of what everyone else spends on health care.

Raises an interesting question: do free-riders consume too little health care, or do riders consume too much?

Hmm …

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DIY ultrasounds … all you need is a smartphone

December 14, 2011

In a recent Advanced Marketing Strategy class, we were talking about “disruptive innovation” … stripped down technologies that attack the low-end of markets (i.e. “low-end encroachment”).

One of the examples in healthcare are ultrasound machines.  It used to be that all ultrasound machines were big, sophisticated and costly.

The full-featured ultrasounds got scaled down in functionality and price.  Many of the low-cost machines have found their way into ob-gyn offices where non-radiologist docs scan pregnant women for views of their babies.

Now, those machines have been scaled down … to a smartphone app.

Be a hit at the next party … bring your smartphone ultrasound and start scanning.

Here’s a demo …

click to view
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>> Latest Posts

US Healthcare: Ripe for Disruption

December 9, 2011

Punch line: Clayton Christensen – the guru of disruptive innovation – says that the US healthcare system needs some seriously disruption … to improve quality and cut costs.

Here’s a summary of his prescription.

Excerpted from MIT Sloan Review: Good Days for Disruptors – An Interview with Clayton Christensen Spring 2009

Every disruption has three components to it: a technological enabler, a business model innovation and a new commercial ecosystem.

In health care, the enabling technology is the ability to diagnose diseases precisely.

Now, through molecular diagnostics, enabled by our understanding of the genome, and through imaging technology that allows people to look inside the body with remarkable clarity, we are acquiring the ability to precisely diagnose more diseases by their cause, not by their symptoms.

That ability then enables us to develop rules-based treatment and a predictably effective therapy.

Our hospitals are, like mainframe computer companies, hopelessly complicated and very expensive.

To ever expect today’s hospitals to become cheap is a pipe dream.

Instead, we need to bring technology, in the form of precise diagnostics and predictably effective therapy, to outpatient clinics so you can do more and more and more of the things there that in the past required a hospital.

And then we need to bring better diagnostic technology to doctors’ offices, so you can do more and more things there that previously required a clinic.

And to nurse practitioners, so they can take on more and more of the things that in the past required a doctor.

Yes, I’m a big fan of MinuteClinics — walk-in clinics that inexpensively treat common disorders such as strep throat and bladder infections.

The hospital is really not a viable business model because, in general, its costs are driven by overhead, which is driven by complexity.

In a large general hospital, much of the cost is overhead cost that’s not expended in the direct care of a patient.

While cost is driven by complexity, quality is driven by integration. It’s when we don’t integrate things correctly that problems fall through the cracks.

Specialized health care institutions, whether they are focused hospitals or focused diagnostics clinics, can integrate correctly, and because of their focus, they have much lower overhead costs.

You get better quality and lower cost.

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The USPS is needed .. to deliver all of those gov’t checks.

October 7, 2011

Punch line: According to the  WSJ, nearly half of all U.S. households now receive some type of government benefit.

  • Over 1/3 of Americans lived in a household that received benefits such as food stamps, subsidized housing, cash welfare or Medicaid.
  • Almost 15% lived in homes where someone was on Medicare or Social Security, or both.

Reminder: Some 46.4% of households will pay no federal income tax this year, according to the nonpartisan Tax Policy Center. That’s up from 39.9% in 2007

My bet: All of these households think spending cuts are a bad idea …
and tax hikes on other folks are strokes of brilliance.

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Medicaid eye-opener: 1/3 of spending to nursing homes …

August 23, 2011

When most people (i.e. me)  think of Medicaid, they think of gov’t funded medical care for the poor.

Surprised me to learn that about 1/3 of Medicaid spending supports elderly patients in long-term care facilities (e.g. nursing homes).

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Source

* * * * *

According to the Georgetown Health Policy Institute:

“Although most long-term care is provided by family members on an unpaid basis, most of the nation’s long-term care spending (75%) is
concentrated on nursing home care, and Medicaid, the nation’s health care program for poor and low income Americans, is the largest source of payment for that care.”

Some basic stats:

  • Over 1 million total Medicaid nursing facility residents
  • Over 400 million Medicaid nursing facility days per year
  • Medicaid nursing facility per diem rate ~ $85

“Nearly half of the nation’s nursing home bill was paid by Medicaid in 2003, while just over a quarter was paid out-of-pocket, and less than 10 percent was covered by private insurance.”

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Source

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Why people – especially Medicare insureds – see the doctor way too much …

August 22, 2011

According to the WSJ:

Medicare utilization is roughly 50% higher than private health-insurance utilization, even after adjusting for age and medical conditions.

In other words, given two patients with similar health-care needs—one a Medicare beneficiary over age 65, the other an individual under 65 who has private health insurance—the senior will use nearly 50% more care.

Why?

People who have comprehensive health coverage like Medicare tend to use more care, and more expensive care — with no noticeable improvement in health outcomes — than those who have basic coverage or high deductibles.

Prof Mark Perry extends the observation, to partially explain why healthcare costs are so high … in general, folks have a decreasing amount of skin in the game (think deductibles and co-pays) … and when consumers are insulated from costs, they consume more … and more … and more.

The graph below tells the story.

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Seriously, would you trade our healthcare system for Canada’s or England’s?

August 18, 2011

A recent “Investor’s Business Daily” article has been making the email circuit.

Provides statistics from a survey by the United Nations International Health Organization:

* * * * * *

Percentage of men and women who survived a cancer five years after diagnosis:

U.S. 65%  Canada 42% England 46%

* * * * *

Percentage of patients diagnosed with diabetes who received treatment within six months:

U.S. 93% Canada 43% England 15%

* * * * *

Percentage of seniors needing hip replacement who received it within six months:

U.S. 90%  Canada 43% England 15%

* * * * *

Percentage referred to a medical specialist who see one within one month:

U.S. 77% Canada 43% England 40%

* * * * *

Number of MRI scanners (a prime diagnostic tool) per million people:

U.S. 71 England 14 Canada 18

* * * * *

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Bending the Medicare-Medicaid cost curves … upward (again)

August 4, 2011

Dems are adamant: “Don’t touch Medicare & Medicaid”.

And, they were equally adamant that ObamaCare would “bend the cost curve”.

Yep, the cost curve is bending …. unfortunately, in the wrong direction.

According to USA Today … Medicare, Medicaid tab keeps growing

Medicare and Medicaid spending rose 10% in the second quarter from a year earlier to a combined annual rate of almost $992 billion.

The two programs are on track to rise $90 billion in 2011 and crack the $1 trillion milestone for the first time.

The latest spending surge in federal health care is driven by more people getting more treatment, not by price increases.

Health care inflation is at its lowest level in more than a decade — a 1.7% annual rate.

Medicare and Medicaid paid a record 57.5% of patient bills for hospital, doctors, drugs and other care in the last quarter, up from 49.3% in 2005.

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Ken’s Take:

(1) Good news for Obama: edging closer to single-payer system

(2) No surprise, costs are rising not falling …. did anybody really believe the “bending the cost curve” riff?

(3) Debt deal says that if the super-committee fails to find cuts, doctors’ reimbursement rates will be cut … good luck to Medicare-Medicaid patients trying to find an MD.

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The Obamacare effect on hiring …

July 22, 2011

Interesting analysis by the Heritage Foundation

While correlation doesn’t necessarily imply causation, there are reasons to believe:

  • Companies under 5o people get waivers … so the cost of adding the 51st employee is very high
  • Bigger companies aren’t sure what plans will qualify and what the costs will be …. few believe the bull that healthcare costs will go down.

Draw your own conclusion.

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Pareto is alive and well … and haunting the U.S. healthcare system.

July 15, 2011

According to the National Health Care Management Association analysis of  2008 healthcare spending:

  • The top 1 percent of the population was responsible for 20.2 percent of spending.
  • The top 5 percent of the population accounted for almost half (47.5 percent) of all health care spending.
  • ABout 60% of the top 5 percent (and top 1 percent) are 55 and older; about 40% is 65 and over
  • The top 10 percent of the population accounted for 63.6 percent of all spending.
  • 15.6 percent of the civilian, non-institutionalized population had no health care spending at all in 2008
  • The half of the population with the lowest spending accounted for only 3.1 percent of all expenditures.

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>> Latest Posts

Viva McKinsey …. study was “rigorous”

June 23, 2011

Of course, I’ve got horses in this race since I’m a McKinsey alum …

When dufass Henry Waxman started attacking McKinsey for lack of credentials and poor methodology, I just had to laugh.

* * * * *

From the WSJ: Shutting Up McKinsey

The White House routinely tries to intimidate its health-care critics, but the campaign against McKinsey & Co. is something else.

The management consultants attempted to find out how U.S. business will respond to ObamaCare,

Democrats don’t like the results, and so McKinsey must pay with its reputation.

The firm’s sin was to canvass some 1,300 companies and report that nearly a third will “definitely” or “probably” stop offering insurance to employees after 2014, dumping them instead into ObamaCare’s subsidized exchanges.

Democrats immediately blasted the results, attacked McKinsey’s integrity and demanded that it release its methodology and full responses.

So this week McKinsey opened its books, and what do you know, the survey was rigorous.

Respondents were a representative cross-section of businesses of many sizes and across industries and regions, and the questions were impartial.

* * * * *

The White House shills declared that the study  was not a “predictive economic analysis.”

For truth, they point to the ever-dutiful Congressional Budget Office which – after the CBO got an all expenses paid trip to meet with Obama in the oval office —  thinks the law will have little effect on employer coverage.

* * * * *

Viva McKinsey.

McKinsey: 78 million Americans could lose employer health coverage … thanks, ObamaCare.

June 8, 2011

 Punch line: ObamaCare will lead to a dramatic decline in employer-provided health insurance—with as many as 78 million Americans forced to find other sources of coverage.

* * * * *

Currently,  156 million non-elderly Americans get their coverage at work.

Before ObamaCare passed, the CBO estimated that only 9 million to 10 million people, or about 7% of employees who currently get health insurance at work, would switch to government-subsidized insurance.

A new study by McKinsey – reported in the WSJ — suggests that ObamaCare will lead to a “radical restructuring” of job-based health coverage with  as many as 78 million Americans could lose employer health coverage.

The McKinsey study, “How US health care reform will affect employee benefits,” predicts that employers will either drop coverage altogether, offer defined contributions for insurance, or offer coverage only to certain employees.

Up to 50% of employers say they will definitely or probably pursue alternatives to their current health-insurance plan when ObamaCare takes effect in 2014.

And, “something in the range of 80 million to 100 million individuals are going to change coverage categories in the two years” after the insurance mandates take effect in 2014.

* * * * *

Whatever happened to: “After we pass it you’ll like it”

March 25, 2011

The Heritage Foundation points out that:

“Last year at this time Newsweek showed 40 percent of Americans supporting Obamacare and 49 percent opposing it. Today, only 37 percent support it while 56 percent oppose.

According to Quinnipiac, after Obamacare passed last year, 44 percent of Americans approved of President Obama’s handling of health care while 50 percent opposed. Today, only 44 percent approve while opposition has grown to 56 percent.

And according to the Kaiser Family Foundation, after Obamacare passed, 62 percent of Americans thought the law would either have no effect on them or make them worse off. Today that number is up to 69 percent.”

Just in case you think that’s right-wing malarkey, here’s a broad based survey summary from  Pollster.com … now, a unit of that right wing bastion — the Huffington Post:

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