The cost of healthcare is significant for every employer. And increasingly, large employers, frustrated with cost inflation and lack of transparency by the insurance companies, are looking to take charge of their pricing negotiations. Setting rational and affordable reimbursement rates has become a focus. For years, the state of North Carolina has requested transparency in… [Read More]
Disproportionate Share Hospital Payments Clarified by the Courts
The court system has once again stepped into a seemingly clear case of abuse. It is common knowledge that Medicaid often pays providers less than the cost of their services and that hospitals are burdened with the cost of providing care for indigent uninsured patients who are unable to pay. In fact, the federal government… [Read More]
Cautionary Tale: New York State’s Rising Prices
Continuing a theme developed in my blog post last month, New York State is providing us with a cautionary tale about what happens to healthcare costs as policymakers look away from the real drivers. Over the last several years, the New York State Assembly has actively pursued “single-payer” as the potential panacea to rising health care… [Read More]
If There’s a Way to Earn Profits, Someone Will Find It
As the political heat increases with the presidential election approaching, health insurance companies are once again under fire. But as Adam Okun pointed out in his recent blog, it’s not just the insurance carriers. A recent Berkeley Research Group study highlights how every constituency in the system shares responsibility for rising healthcare costs. The federal… [Read More]
Surprise Billings Should Be a Thing of the Past
There has been a lot of focus in the states (particularly the blue ones) to limit billings from providers in cases where a patient is not aware the provider’s services would be out-of-network. So, for example you are hospitalized at an in-network facility and during your surgery a non-network anesthesiologist treats you. Even if you… [Read More]
Chipping Away at Healthcare Costs
We are learning more about the proposed Amazon-Berkshire-JPMorgan healthcare initiative from an employment-related lawsuit filed by Optum, the former employer of a senior pharmaceutical hire made by the joint venture. Documents disclosed in connection with the lawsuit indicate that the new venture will seek to simplify and reduce confusion in accessing care – a prospect that… [Read More]
The Latest in Medical Cost Trends
Healthcare spending increased by 4.2% in 2017 according to a study by the Health Care Cost Institute, increasing to $5,641 per person for individuals covered by employer sponsored plans. This is almost double the 2.13% general inflation rate as reported by the U.S. Bureau of Labor Statistics in 2017. The study attributes this increase to… [Read More]
It’s Going to Get Noisy
At a recent Empire BlueCross BlueShield broker advisory panel meeting, I was both enlightened and surprised to learn that the in-network status of some hospitals and their systems may drastically change in the foreseeable future. We have all lived through the negotiation process of the big bad insurance company informing the public that a certain… [Read More]
Does Cuba Have the Answer to Remaking U.S. Healthcare?
As the transformation of healthcare in the United States continues, it was interesting to read a New York Times article about Cuban healthcare. While food and other basic living conditions are a concern in Cuba, healthcare is not. The government completely funds universal care and the results, as measured by infant mortality, are quite good – 4.0… [Read More]
Hospital Chargemaster Under Fire
If you’re paying attention to healthcare news you’ve seen the headlines before – hospitals suing patients for tens of thousands in emergency room charges or for a life-saving surgery. Just when you think you’ve seen it all, more outrageous news breaks and the uproar ensues. Centura Health recently sued a patient for charges not paid… [Read More]
