Friday, August 31, 2007
Thursday, August 30, 2007
Wednesday, August 29, 2007
Tuesday, August 28, 2007
Monday, August 27, 2007
It's hard for the average working stiff to contemplate a number as vast as the $23.5 billion the federal government has allocated to Mississippi for Katrina recovery.
Think of it this way:
It's enough money to buy two average-sized houses for each of the 65,000 families in Mississippi who lost their homes.
And, there would be enough left over to buy each family a brand-new Honda Accord to drive between their two $166,000 houses. That's the EX-L, V-6 four-door sedan Accord, with all the extras and navigation, not a base model.
What does the government think they are doing with OUR money?
Apparently they have no clue.
As it has with so many things, Katrina has forever changed how federal tax dollars can be spent after disasters. And as with most things in the aftermath of the storm, the rules are in large part being made up as we go along.
Well that's certainly comforting . . .
Sunday, August 26, 2007
Well, maybe not everywhere, but in a lot of places.
Some liked them. Some didn't. Regardless, they are here to stay and serve a much needed function. That being, providing on the spot medical treatment for minor conditions with little or not wait time. Quicker, more efficient and less costly than a trip to the ER, these clinics are now considered respectable.
Now comes the retail based clinics in the form of MinuteClinic, RediClinic and others. These quick treatment centers are located in retail establishments such as WalMart, CVS & Eckerd Drugs.
One difference in these clinics and the urgent care centers is, most are staffed by nurses, PA's & NP's.
This has some crying foul.
But concerns are rising in the medical industry that these operations remain largely unregulated and are prone to conflicts of interest. Some physicians are also concerned that the clinics could disrupt the continuity of care and result in serious underlying health conditions going undetected.
Is there a conflict of interest when your PCP refers you to a lab or MRI facility where they have ownership? How about a geriatric physician who suggests you check into a skilled nursing facility he just happens to own? Or a doc writing a script on a pad given to him by the pharmacy in the building where he practices and get's a kickback based on the number of scripts filled there?
Is there a conflict of interest when a doc is paid a bonus to keep you out of the hospital or suggest an alternative form of treatment that is less expensive but maybe not as effective? What about docs who are provided with continuing education on an exotic isle, courtesy of a pharmaceutical company?
Sounds like the pot calling the kettle black.
Support among health insurance companies is also growing; about 40 percent to 50 percent of clinics accept insurance from providers like Humana Inc., UnitedHealth Group Inc. and Aetna Inc., according to CCA
Carriers view this as an effective cost cutting tool, but would not reimburse for care in these facilities if they felt the care was substandard.
A visit to a store-based clinic averages about $60, but a doctor's visit costs twice as much, particularly in urban markets, according to Barry Barnett, a health care consultant for PricewaterhouseCoopers. That compares to about $300 for an emergency room visit, according to Barnett. About 40 percent to 50 percent of clinics take insurance. Hansen-Turten estimated 50 percent of clinic customers pay cash, but she noted that the majority have insurance.
In addition to the cost savings, this relieves some of the strain of overcrowding in doctors waiting rooms & ER's.
Sounds like a good idea to me.
Saturday, August 25, 2007
Friday, August 24, 2007
Thursday, August 23, 2007
They set their commission structure higher than Blue and rates about 15 - 20% lower than Blue. They talked about how their plans stack up against Blue in roll out meetings.
They even hired folks away from Blue to staff their new marketing offices.
Did I mention their rates are 15%+ less than Blue?
Oh but, those are just TEASER rates.
You see, once the application goes to underwriting all bets are off.
Most carriers will give brokers enough information on underwriting that they can prepare the client for the final offer.
Not these folks.
Most carriers field underwriting guides are 15 - 60 pages.
This one is barely 6.
Many carriers tell you about how much they will adjust the rates for medical conditions and scripts.
This just tells you the rate may be modified.
Did I mention their starting rates beat just about everyone?
This carrier who is new to the individual business paid (what I presume to be) a big basket of cash to Milliman for an underwriting guide and rate manual. Milliman is perhaps the premier actuarial firm for medical rates & data.
They also are ivory tower kind of folks, but then, they ARE actuaries.
So it seems this carrier had Milliman set their rates with the idea of insuring mostly folks who can walk on water.
Everyone else needs to open their wallet a bit more.
I just sent in a case that included a lady with GERD. Some carriers don't charge extra while others will surcharge up to 25%.
This one came back with a 50% rate up. Had it been 51% she would have been declined.
What kind of idiocy is that?
Of course my client is not happy. Neither am I.
This makes me look like I don't know what I am doing and in the case of this carrier that is true. They don't offer pre-screens. They don't want to tell what underwriting MIGHT do. We are expected to trust them.
Sure, I trust them.
Trust them to be totally unpredictable.
This is not fun.
This fall, United HealthCare is coming out with some new group plans (yippee). One of the interesting "twists" is that the co-insurance reimbursement rate (the "80" in "80/20") will be substantially lower for patients/insureds who choose not to go to a "designated provider." That is, it's not enough that your doc is "in the network;" he must be "designated" ("super qualified," whatever) in order for you to receive the best level of benefits.
Wednesday, August 22, 2007
Don't hear much about that any more.
Maybe workers are getting smarter.
some picketers say time may be running out. For Dresser Rand strikers like Jeffrey Bibalo, it's day 5 of walking the picket lines
A 5 day strike.
That's showing them.
But it's also another day without health insurance.
No health insurance.
Tell me, why are they striking?
One union leader tells us the union does provide catastrophic insurance. But he did not want to go into anymore details.
That gives me a lot of confidence in their leadership.
No health insurance.
5 days on strike and already they are hurting.
So, whose idea was it to go on strike?
Free health care. Seems like there is ignorance down under, not just here in the states.
How can anyone think that our current public/private marriage of political convenience is beneficial to all Australians both now and in the future?
Mix of public (taxpayer funded) and private insurance.
If the public (taxpayer funded) plan is so great, why does anyone need private insurance to subsidize?
No one ever addresses that question.
No one gets a private plan to subsidize public housing. So why health insurance?
Having private health insurance is not a choice. The poor, the old and the vulnerable wait in pain. The rest get served first.
Doesn't sound like the public system is all that great.
Last week I found myself on the Medi-Go-Round. It was one of those "it's probably nothing, it's probably nothing, it's probably nothing, maybe it's cancer" scenarios. After six months of niggles that had grown to excruciating discomfort, I was off to the doctor. There was talk of having something removed. I don't have private health insurance. I've never had it. I'm politically and philosophically opposed to it.
Politically & philosophically opposed to health insurance.
Would rather put up with the niggles.
Whatever that is.
[Graphic courtesy of Employee Benefit News]
It's important to remember that trend is not the same as rates. That is, how much higher health care is expected to be is but one factor in determining how much an insurer will charge. Lower trends have a positive impact on rates, of course, which is good. It also underscores our mantra here (originally and succinctly promulgated by Mike Feehan) that "health insurance costs increase because health care costs increase." Amen.
There's actually a lot of interesting information in the report; for example, carriers are expecting prescription drug costs to slow down a bit, an increase in EMR and other digital applications, and more widespread adoption of transparency tools. According to the report, prescription drug costs accounted for some 14% of all health care costs this past year, while physician charges represented the lion's share (35%).
I was pleased to see that HDHP rates are expected to rise much less (25% less, in fact) than more "traditional" HMO and PPO plans. That's good news, indeed. Of course, by shifting some of the costs of health care back to those who actually use it, it follows that there would be more careful utilization, resulting in lower health care expenditures (and cost). Kind of a win-win deal.
The report itself is pretty easy reading, and is available (in pdf form) here.
Tuesday, August 21, 2007
Monday, August 20, 2007
One one hand, I agree. Why should the taxpayer pay for things where the hospital (or other negligent party) is clearly liable.
On the other hand, who is going to decide the liability issue? Are the hospitals going to readily admit their wrong? Will the patient be caught in the middle?
"Our efforts in this arena and in other payment rules are to ensure that CMS is an active purchaser, not passive payer, of health care,"
That should be the case with any payor. It doesn't matter if the payor is the taxpayer, the carrier or the individual.
Hospitals in the future will be expected to pick up the cost of additional treatment required by a preventable condition acquired in the hospital.
"The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication," the final rules say.
This implies that hospitals could bill CMS with impunity in the past. Who made this rule?
Last year, Mark McClellan, then director of the Medicare and Medicare programs, said the government could save hundreds of millions of dollars a year if the Medicare program stopped paying for medical errors such as operations on the wrong body part or mismatched blood transfusions.
Operations on wrong body parts. I don't want to go there.
Private insurers are considering similar changes.
And they should . . .
Friday, August 17, 2007
"CANCER patients are still waiting up to seven months for treatment. Patients are supposed to be treated within 62 days of urgent referral...In the worst cases, sufferers were kept hanging on for 220 days."
To be fair, some 85% of Scottish cancer patients are seen in the recommended "window" of 62 days. However, the two-year old target is 95% of those affected to be seen in that time frame.
One region, Lanarkshire, "had the poorest performance, with just 70.3 per cent of patients being seen within the target time." Ooops.
Our neighbors to the north strive for a 66 day maximum wait.
In fairness, I have not been able to find the relevant numbers for the US. I encourage IB readers to share that information (with links and facts) in the comments section; I'll update this post early next week.
Thursday, August 16, 2007
How does mom feel about Mexico?
For $1,300 a month — a quarter of what an average nursing home costs in Oregon — Douglas gets a studio apartment, three meals a day, laundry and cleaning service, and 24-hour care from an attentive staff, many of whom speak English. She wakes up every morning next to a glimmering mountain lake, and the average annual high temperature is a toasty 79 degrees.
So the staff speaks English, huh. Guess that means the menu doesn't have pictures where the guests can point to the Value Meal for $3.95.
"It is paradise," says Douglas, 74. "If you need help living or coping, this is the place to be. I don't know that there is such a thing back (in the USA), and certainly not for this amount of money."
$1300 per month, that's $43 per day. About the price of a Motel 6 in the U.S.
"You can barely afford to live in the United States anymore," said Harry Kislevitz, 78, of New York City. A stroke victim, he moved to a convalescent home on the lake's shore two years ago and credits the staff with helping him recover his speech and ability to walk.
I haven't been to NYC in a while. Last time was probably 25 years ago. I do recall breakfast at the Sheraton was expensive. Seems like I had a glass of OJ ($4), one egg ($2.75) and "assorted" toast ($4).
Turns out assorted toast was one whole wheat slice, one rye.
Richard Slater has a good deal too.
He gets 24-hour nursing care and three meals a day, cooked in a homey kitchen and served in a sun-washed dining room. His cottage has a living room, bedroom, kitchenette, bathroom and a walk-in closet.
For this Slater pays $550 a month, less than one-tenth of the going rate back home in Las Vegas. For another $140 a year, he gets full medical coverage from the Mexican government, including all his medicine and insulin for diabetes
That's $140 per YEAR for health care, not per month.
I may have to look into this.
Wednesday, August 15, 2007
So what does this have to do with insurance?
Quite a bit. Mostly on the P&C side but it can also impact the health of our children and may have a ripple effect on health insurance costs & premiums.
Of course this is not just about Mattel, or toys. The picture is much bigger.
But the latest recall could feed growing international worries about the quality and safety of consumer products made in China.
It would follow a series of other recalls by manufacturers this year involving a wide range of products from contaminated pet food ingredients to defective tires to tainted Chinese-made toothpaste.
Food products, toiletries, toys. Will the list continue to grow?
In a desire to deliver cheaper products to the American consumer manufacturers of all kinds of products are continually outsourcing the manufacturing to foreign soil where cheap labor rules. The result is products that are unsafe and could cause harm to those who use them.
Earlier this month, Mattel recalled over one million toys, including Sesame Street and Dora the Explorer products made by its Fisher-Price unit because they were contaminated with excessive levels of lead paint, which if ingested could pose health hazards to children.
Mattel said Lee Der Industrial was responsible for producing the toys that contained excessive levels of lead paint.
Lead paint has been banned in the U.S. for years due to health hazards. Parents are being warned not only to check out toys in use but to be concerned about the health of their child if the toy has been in their possession for more than a month. Parents who suspect their child may have ingested toxic levels of lead are being encouraged to take their child to their pediatrician for testing.
The problem with lead poisoning is that the symptoms & side effects may not manifest themselves for years.
If your child has any of these symptoms of lead poisoning and he is at risk for lead exposure then you should see your doctor immediately. Most children with lead poisoning do not have any symptoms, so if your child is at risk you should still have him tested even if he is not having any problems.
If your child starts to show symptoms of lead poisoning, you may not be able to trace it back to a particular source. That means the financial burden of treating and caring for your child could fall on your health insurance plan.
This is a Pandora's box no one wants to open.
And which kinds of bills are those? Well, they include "any new federal program that is not paid for, or anything that might duplicate another program, or anything that might be unconstitutional."
And that's why he's put the (temporary) kibosh on the Senate version of legislation prohibiting the use of genetic information in insurance underwriting (H.R.493). Among other things, the bill would "prohibit a group health plan from adjusting premium or contribution amounts for a group on the basis of genetic information."
On the face of it, the bill seems innocuous enough: after all, why should folks be penalized for things over which they have no control (i.e. their genes)?
Would that it were that simple.
But the fact is, such prohibitions already exist at the state level, so a federal limitation would be redundant. Even more important, it's a bad idea: underwriters have a number of tools at their disposal, and genetic testing just isn't one of them.
But for the sake of argument, let's say that it was, and that it was used.
How is that any different than testing for HIV, or tobacco, or cocaine? On a group basis, any one of those factors may (or may not) go into the mix in order to arrive at a reasonable final rate. Thanks to HIPAA, groups can't be declined on the basis of health, and states have put caps on how much a given group may be surcharged.
Speaking as one whose own genetic makeup would fall squarely in the sights of such a tool, I would have no problem with its use. Why not? Because insurance is a mechanism of risk management, and in order to effectively manage a given risk, one must have an accurate assessment of it.
There's another problem with the proposed legislation, as well: it's poorly written.
How's that, you may ask?
Well, as "Dr No" points out, "the current language of the bill is that the definition of genetic test is inconsistent.” One has only to read the bill to see that this is so. While that may seem an excercise in picking nits, it is actually a major flaw: since the definition of what constitutes such a test is fluid, the trial bar would have a field day interpreting what underwriters use as criteria in their assessment of a group. This in turn could (would?) lead to even higher premiums.
And nobody wants that.
Tuesday, August 14, 2007
You strategically place your business in an area where you can expect optimum traffic. You are required by law to offer your services to anyone who needs them regardless of their ability to pay.
Some people who come in the door of your business will have unlimited lines of credit to pay their bill. Others will have only what is in their pocket.
Those with lines of credit will pay their bills at 50% of your going rate.
Those without a line of credit will only pay about 8 - 12% of billed charges.
Have you figured it out yet? Who am I?
I am a hospital.
Bad debts are increasingly driving a little-discussed vicious circle. Hospitals seeing more debt from insured patients can react by pushing insurers to help them offset it. This in turn can push insurers to charge higher premiums to employers, which can force employers to place more of the risk of healthcare costs on to their employees.
We are a nation who is overweight, over-stressed and have demonstrated an ability to take on more debt and save less than any prior generation.
We are also more lax in accepting personal responsibility for our debts.
When is this cycle going to stop?
They get on the internet.
What's so bad about that?
Nothing as long as you know where you are going and have an idea about the accuracy of the information that comes up.
Microsoft’s software animates more than 90 percent of all personal computers, while Google is the default starting point for most health searches. And people are increasingly turning to their computers and the Web for health information and advice. A Harris poll, published last month, found that 52 percent of adults sometimes or frequently go to the Web for health information, up from 29 percent in 2001.
52% go to the web in search of answers. But what kind of answers are they getting?
According to the Harris survey, 58 percent of people who look online for health information discussed what they found with their doctors in the last year.
This is a good thing, up to a point. But how many people will self diagnose, and then self treat a problem that may be more serious than they suspect (or even want to admit)?
How many more will find themselves disagreeing with the doctor, and then start looking for a practitioner who will confirm their diagnosis?
Yet personal health records promise to be a thorny challenge for practical and privacy reasons. To be most useful, a consumer-controlled record would include medical and treatment records from doctors, hospitals, insurers and laboratories. Under federal law, people can request and receive their personal health data within 90 days. But the process is complicated, and the replies typically come on paper, as photocopies or faxes.
Protected health information is a thorny topic. How will this information be handled without compromise?
Monday, August 13, 2007
Worried about potential abuse.
"A monopoly is a monopoly no matter what face you put on it," said Carol Austin-Fink, cancer survivor.
Austin-Fink is a cancer survivor. She's against the merger because she says UnitedHealth denied her claims for jaw and mouth treatments after chemotherapy. But she's not the only one casting a critical eye.
"Nevada does not need a monopoly on insurance products.
Isn't universal health insurance a monopoly?
Someone please explain the difference to me.
This is a good idea as long as it works.
Plans like this have been tried before without much long term success. Eventually it starts to fall apart. Premiums start to rise to cover claims. Those who are healthy enough to find something better leave. New entrants drop off and the plan goes into a death spiral.
This might be different. Only time will tell.
By combining numerous small businesses together into one health care pool, Costco is able to get better insurance rates. The company also tries to negotiate cheaper high-deductible insurance policies that carry enough benefits to be feasible. The discount is also due to lower commission to Costco and lower administrative costs. Unlike other insurance brokers, who manage a large number of plans, Costco only manages one or two in every state — the same way the company runs its warehouse stores.
Lower commission. Group insurance usually doesn't pay that much commission to start.
Only offering 1 or 2 plans is nice but has minimal impact on the rates.
Between a lower commission and (presumably) lower admin fees, I can't see a savings of more than 2 - 4% overall.
The insurance service is not a profit driver for Costco, but the company says it fits perfectly into serving its most important customer base, small-business owners, who make up one-third of its members and contribute two-thirds of its revenue.
Not a profit center? So this is a loss leader?
Some state governments are also experimenting with insurance-pooling ideas to support small-business owners. Most recently, Oklahoma expanded a program under which the state pays 60 percent of the insurance costs for small businesses by moving some Medicaid dollars that were used to pick up the bills for the uninsured.
But one problem with most state-sponsored insurance pools is that they often experience low enrollment and higher administrative costs. Minnesota installed a public-administered program in 1993 but discontinued it five years later due to lack of financial viability.
Wonder how many of the states who have recently decided to get in the insurance business bothered to check out the MN plan?
My guess would be none.
If the answers were easy everyone would be jumping on the wagon.
Saturday, August 11, 2007
"(T)he folks in the ER at Los Angeles' Martin Luther King Jr.-Harbor Hospital and two different 911 dispatchers, who refused to send an ambulance to help the poor woman find some of that reasonable and necessary care. As a result, the 43 year old woman died of massive internal bleeding."
That was apparently the last straw (or close to it):
"Martin Luther King Jr.-Harbor Hospital shut down its emergency room Friday night and will close entirely within two weeks, a startlingly swift reaction to a federal decision to revoke $200 million in annual funding because of ongoing lapses in care."
On the one hand, that will most certainly create a major health care shortage in that area of LA; on the other, I'm not convinced that's a bad thing, compared with the incredibly poor care MLK was providing.
Hat Tip to Captain's Quarters.
"An alliance between the Health Alliance -- minus two members -- and Premier Health Partners could be in the works...the Health Alliance and/or Jewish Health System are exploring a merger or affiliation with the Dayton system."
Gee, didn't see that one coming.
The reality is, as problematic as the health insurance market is hereabouts, it's really no more dysfunctional than the health care market. And, as we've pointed out numerous times, the latter drives the former.
If I had to guess (and heck, that's the beauty of blogs: we get to opine all the livelong day), I'd say that this bodes more seriously for the Cincinnati market than the Dayton. Why, you ask? Well, Premier has recently signed relatively long-term deals with the two 800 pound insurance gorillas (guerillas?), Anthem and UHC. But the Cincinnati market is in flux; it's a much larger market, as well, serving southern Ohio as well as northern Kentucky.
The truly interesting geographical wild card here is Middletown (so-called because it's roughly halfway between Dayton and Cincinnati): Premier is based in Dayton, but "owns" Middletown Regional (MRH), which also serves the northern suburbs of Cincinnati.
The two outlyers (Christ Hospital and the St. Luke's) left the Cincinnati-based Health Alliance earlier this year, presumably hoping to make up for lost contracts with increased revenues. Looks like they may have miscalculated.
Don't you just hate when that happens?
It's all very incestuous.
The two larger communities continue their inexorable crawl towards each other, which may ultimately leave MRH in an enviable position. Of course, Christ and St Luke's are now calling foul, but it seems to me that their own voluntary exile from the Health Alliance mitigates any such claim. The real winners here may be us consumers, as competition drives down costs.
On the other hand, the real losers here may be us consumers, as former competitors link up, squelching competition.
We'll keep you posted.