How Health-Care Reform Could Hurt Doctor-Owned Hospitals

X

xiaodaoyoumeng

Even as Congress struggles with how to pay for health-care reform, the
White House keeps doing it its best to accentuate the positive. Last
week, Vice President Joe Biden hosted the country's three largest
hospital trade groups as they announced they will accept $155 billion
in Medicare and Medicaid cuts over the next 10 years. It's all part of
an inspiring storyline, the idea that everyone is doing their part to
make this most ambitious undertaking a reality. But no one actually
thinks that the hospitals — or for that matter other key players like
pharmaceutical manufacturers or doctors — are giving up something for
nothing. On the contrary, any health-reform package passed by Congress
will likely deal a major blow to an upstart competitor of many
hospitals.
Buried in the 850-page House health-reform draft is a provision that
could in effect ban further construction of doctor-owned, for-profit
specialty hospitals and prohibit existing ones from expanding. (The
provision would prevent new facilities from receiving any Medicare
payments and would limit changes to current facilities.) Senators
Charles Grassley and Max Baucus, who lead the body's powerful Finance
Committee, have been vocal critics of the doctor-owned specialty-
hospital model and the industry expects similar language to be
included in any upcoming Senate health-reform bill as well. Doctor-
owned specialty hospitals would "wither on the vine," says Molly
Sandvig, executive director of the industry lobbying group Physician
Hospitals of America. "Any business that can't grow or adjust to the
market won't be around too long."
Specialty hospitals that focus on providing care for children or
cancer patients have long existed, but the target of the House
legislation is something else entirely — for-profit health-care
facilities owned by doctors that perform some of the most lucrative
medical procedures in fields like orthopedics and cardiology. There
are now some 220 such facilities operating mostly in the South and
Midwest — up from 110 in 2001 — generating some $40 billion in annual
revenue. According to Sandvig, more than 80 additional facilities are
currently under development.
While these places are known as specialty hospitals, most do not
resemble acute-care, all-purpose community health-care institutions.
For one thing, they tend to sell themselves on the promise of comfort,
if not luxury, with at least a few offering wine with gourmet meals
and on-campus hotels for friends and family. More importantly, about
half don't have any kind of emergency department and of those that do,
more than half have only one bed available, according to a 2008 report
from the inspector general of the Department of Health and Human
Services. Even more troubling to critics is the fact that, despite
being physician-owned, only about 30% have a doctor on site at all
times, and about two-thirds actually tell staff to call 911 in case of
an emergency, according to the same report.
This has created a dangerous situation, according to critics. The
inspector general's report came about after a 44-year-old spinal-
surgery patient at a doctor-owned specialty hospital in Texas — the
state with the highest number of such facilities — developed breathing
problems and died, despite being taken by ambulance to a larger
community hospital. The staff had called 911 after noticing the man's
respiratory function was poor, but there was no doctor present to
help. And just last month, a female patient at the physician-owned
Colorado Orthopaedic and Surgical Hospital died after she became
unresponsive following surgery and was transferred to a community
hospital. The facility has suspended all outpatient surgeries and the
state health department has ordered the hospital to change its
protocol in order to have a board-certified emergency doctor on site
at all times.
As disturbing as those incidents are, the more widespread concern
about the newfangled hospitals is money. Although there is not ample
hard data yet available to prove that specialty hospitals take a large
bite out of community hospitals' bottom lines, a quick scan of the
list of the common procedures performed at the highly focused
institutions suggests just that. Orthopedic and cardiac care bring in
some of the highest margin reimbursements from insurers, money
community hospitals use to cover the cost of low-margin or money-
losing services like burn units, neonatal care and treating the
uninsured. When healthier, fully insured patients migrate away from
community hospitals to specialty facilities, their reimbursements go
with them. Overall profit margins at specialty hospitals, sometimes as
high as 30%, dwarf those of community hospitals. Plus, specialty
hospitals don't typically treat many Medicaid patients, which bring in
some of the lowest reimbursements available.
"When these specialty hospitals come in, they take out the better
reimbursed cases, the easier ones with less complications, and they're
able to benefit financially by skimming the cream," says Rick Pollack,
executive vice president of the American Hospital Association
Perhaps an even more pressing problem in the context of health reform
is the risk of overutilization of services. According to a 2006 report
from the federal Medicare Payment Advisory Commission, just the
presence of a doctor-owned heart hospital in a community increases the
rate of cardiac surgery by 6% among Medicare beneficiaries. The
upshot, according to a House staffer involved in health reform, is
that "people are getting things they probably don't need." Plus, says
the staffer, "the community hospitals go to war, bulk up their own
specialty centers and all of a sudden you see these ads around town
that 'You should get your heart checked.'"
For their part, doctor-owned specialty hospitals say they're providing
more access to better quality care — and in some respects, this may be
true. Patient satisfaction rates at such facilities are generally high
and it's logical that a facility dedicated to just one or a few
specialties could operate more efficiently. "Rather than compete in
the marketplace they want to legislate us out of business," says Dr.
John Harvey, president and CEO of the Oklahoma Heart Hospital.
But it's the built-in conflict of interest that causes some patient
advocates to bristle. In effect, they contend, doctors double dip —
earning money from procedures as well as the overall operation of the
hospital, of which they are shareholders. That provides plenty of
incentive for physicians, who typically also work part-time at the
local community nonprofit hospital, to recommend their easy-to-treat
patients go across town to have procedures done at the private
hospital where the doctors are investors. The House bill would address
this issue by closing a loophole that has allowed doctors to send
patients to hospitals they had a stake in, so long as that hospital
served a rural population, or the stake was in a "whole hospital," not
just a wing or department; the Congressional Budget Office predicts
closing this loophole would mean fewer overall procedures, saving $1
billion in Medicare costs over ten years.
The controversy over physician-owned hospitals isn't actually new.
Representative Pete Stark, a Democrat from California, began a crusade
against doctor conflicts of interest more than two decades ago, and
successfully got legislation passed in 1989 that prohibited doctors
from, among other things, having a financial stake in labs that
performed tests for their patients. The Stark Law, as it became known,
has been strengthened over the years to include more facilities and
apply to Medicare and Medicaid payments. But the loophole allowing for
doctor-owned specialty hospitals has remained open despite repeated
attempts to close it. Now that the country is grappling with how to
reform the entire health-care system, Congress has another chance to
decide whether the costs of this kind of proprietary specialized care
are simply too high to bear.

http://www.51orders.com/
 
C

Cari \(MS-MVP\)

OK, so it's health care reform down the tube or the doctors won't be able to
afford shiny new printers?

Go off and do your spamming someplace else.

I'll take the health care reform and the doctors can live with their older
printers, thanks.
--
Cari (MS-MVP)
Windows Technologies - Printing & Imaging
http://www.coribright.com/windows



Even as Congress struggles with how to pay for health-care reform, the
White House keeps doing it its best to accentuate the positive. Last
week, Vice President Joe Biden hosted the country's three largest
hospital trade groups as they announced they will accept $155 billion
in Medicare and Medicaid cuts over the next 10 years. It's all part of
an inspiring storyline, the idea that everyone is doing their part to
make this most ambitious undertaking a reality. But no one actually
thinks that the hospitals — or for that matter other key players like
pharmaceutical manufacturers or doctors — are giving up something for
nothing. On the contrary, any health-reform package passed by Congress
will likely deal a major blow to an upstart competitor of many
hospitals.
Buried in the 850-page House health-reform draft is a provision that
could in effect ban further construction of doctor-owned, for-profit
specialty hospitals and prohibit existing ones from expanding. (The
provision would prevent new facilities from receiving any Medicare
payments and would limit changes to current facilities.) Senators
Charles Grassley and Max Baucus, who lead the body's powerful Finance
Committee, have been vocal critics of the doctor-owned specialty-
hospital model and the industry expects similar language to be
included in any upcoming Senate health-reform bill as well. Doctor-
owned specialty hospitals would "wither on the vine," says Molly
Sandvig, executive director of the industry lobbying group Physician
Hospitals of America. "Any business that can't grow or adjust to the
market won't be around too long."
Specialty hospitals that focus on providing care for children or
cancer patients have long existed, but the target of the House
legislation is something else entirely — for-profit health-care
facilities owned by doctors that perform some of the most lucrative
medical procedures in fields like orthopedics and cardiology. There
are now some 220 such facilities operating mostly in the South and
Midwest — up from 110 in 2001 — generating some $40 billion in annual
revenue. According to Sandvig, more than 80 additional facilities are
currently under development.
While these places are known as specialty hospitals, most do not
resemble acute-care, all-purpose community health-care institutions.
For one thing, they tend to sell themselves on the promise of comfort,
if not luxury, with at least a few offering wine with gourmet meals
and on-campus hotels for friends and family. More importantly, about
half don't have any kind of emergency department and of those that do,
more than half have only one bed available, according to a 2008 report
from the inspector general of the Department of Health and Human
Services. Even more troubling to critics is the fact that, despite
being physician-owned, only about 30% have a doctor on site at all
times, and about two-thirds actually tell staff to call 911 in case of
an emergency, according to the same report.
This has created a dangerous situation, according to critics. The
inspector general's report came about after a 44-year-old spinal-
surgery patient at a doctor-owned specialty hospital in Texas — the
state with the highest number of such facilities — developed breathing
problems and died, despite being taken by ambulance to a larger
community hospital. The staff had called 911 after noticing the man's
respiratory function was poor, but there was no doctor present to
help. And just last month, a female patient at the physician-owned
Colorado Orthopaedic and Surgical Hospital died after she became
unresponsive following surgery and was transferred to a community
hospital. The facility has suspended all outpatient surgeries and the
state health department has ordered the hospital to change its
protocol in order to have a board-certified emergency doctor on site
at all times.
As disturbing as those incidents are, the more widespread concern
about the newfangled hospitals is money. Although there is not ample
hard data yet available to prove that specialty hospitals take a large
bite out of community hospitals' bottom lines, a quick scan of the
list of the common procedures performed at the highly focused
institutions suggests just that. Orthopedic and cardiac care bring in
some of the highest margin reimbursements from insurers, money
community hospitals use to cover the cost of low-margin or money-
losing services like burn units, neonatal care and treating the
uninsured. When healthier, fully insured patients migrate away from
community hospitals to specialty facilities, their reimbursements go
with them. Overall profit margins at specialty hospitals, sometimes as
high as 30%, dwarf those of community hospitals. Plus, specialty
hospitals don't typically treat many Medicaid patients, which bring in
some of the lowest reimbursements available.
"When these specialty hospitals come in, they take out the better
reimbursed cases, the easier ones with less complications, and they're
able to benefit financially by skimming the cream," says Rick Pollack,
executive vice president of the American Hospital Association
Perhaps an even more pressing problem in the context of health reform
is the risk of overutilization of services. According to a 2006 report
from the federal Medicare Payment Advisory Commission, just the
presence of a doctor-owned heart hospital in a community increases the
rate of cardiac surgery by 6% among Medicare beneficiaries. The
upshot, according to a House staffer involved in health reform, is
that "people are getting things they probably don't need." Plus, says
the staffer, "the community hospitals go to war, bulk up their own
specialty centers and all of a sudden you see these ads around town
that 'You should get your heart checked.'"
For their part, doctor-owned specialty hospitals say they're providing
more access to better quality care — and in some respects, this may be
true. Patient satisfaction rates at such facilities are generally high
and it's logical that a facility dedicated to just one or a few
specialties could operate more efficiently. "Rather than compete in
the marketplace they want to legislate us out of business," says Dr.
John Harvey, president and CEO of the Oklahoma Heart Hospital.
But it's the built-in conflict of interest that causes some patient
advocates to bristle. In effect, they contend, doctors double dip —
earning money from procedures as well as the overall operation of the
hospital, of which they are shareholders. That provides plenty of
incentive for physicians, who typically also work part-time at the
local community nonprofit hospital, to recommend their easy-to-treat
patients go across town to have procedures done at the private
hospital where the doctors are investors. The House bill would address
this issue by closing a loophole that has allowed doctors to send
patients to hospitals they had a stake in, so long as that hospital
served a rural population, or the stake was in a "whole hospital," not
just a wing or department; the Congressional Budget Office predicts
closing this loophole would mean fewer overall procedures, saving $1
billion in Medicare costs over ten years.
The controversy over physician-owned hospitals isn't actually new.
Representative Pete Stark, a Democrat from California, began a crusade
against doctor conflicts of interest more than two decades ago, and
successfully got legislation passed in 1989 that prohibited doctors
from, among other things, having a financial stake in labs that
performed tests for their patients. The Stark Law, as it became known,
has been strengthened over the years to include more facilities and
apply to Medicare and Medicaid payments. But the loophole allowing for
doctor-owned specialty hospitals has remained open despite repeated
attempts to close it. Now that the country is grappling with how to
reform the entire health-care system, Congress has another chance to
decide whether the costs of this kind of proprietary specialized care
are simply too high to bear.

http://www.51orders.com/
 
P

Paul Heslop

Cari (MS-MVP) said:
OK, so it's health care reform down the tube or the doctors won't be able to
afford shiny new printers?

Go off and do your spamming someplace else.

I'll take the health care reform and the doctors can live with their older
printers, thanks.

The worst thing is here in the UK they are heading towards the kind of
health 'care' you have in the US. Actually they'll sell their
grandmothers rather than keep anything under state control.
 
T

TJ

Paul said:
The worst thing is here in the UK they are heading towards the kind of
health 'care' you have in the US. Actually they'll sell their
grandmothers rather than keep anything under state control.
While here in the US we move in the direction of the kind of health care
you and the Canadians have. Many of us believe we can't afford
government-run health care, because there doesn't seem to be anything
the government runs as efficiently as private enterprise. Our Medicare
system, which is all but bankrupt, is a great example. Our current
President believes that the rich folks have enough extra money to
provide health care for everybody else. He's wrong, but try to convince
him and his followers of that. And I say this as a self-employed person
whose health insurance is the biggest single expense he has - and I
can't afford for it to go any higher.

Maybe the best thing to do is meet somewhere in the middle.

TJ
 
P

Paul Heslop

TJ said:
While here in the US we move in the direction of the kind of health care
you and the Canadians have. Many of us believe we can't afford
government-run health care, because there doesn't seem to be anything
the government runs as efficiently as private enterprise. Our Medicare
system, which is all but bankrupt, is a great example. Our current
President believes that the rich folks have enough extra money to
provide health care for everybody else. He's wrong, but try to convince
him and his followers of that. And I say this as a self-employed person
whose health insurance is the biggest single expense he has - and I
can't afford for it to go any higher.

Maybe the best thing to do is meet somewhere in the middle.

TJ
it's the stories of hospitals dumping people on the street when they
can't pay for themselves and so forth which scares us. But the present
govt, though supposedly socialist, is certainly hell bent on giving as
much as it an to private companies. the difference is that the
companies have often simply bailed out when expenses have proven too
great and the govt has still had to find a way to keep things going,
or they have actually paid companies to keep services going. Not just
health care, things like railways and schools. Yeah, a half way house
would be good, but money should not be the first priority.
 
O

olip

Even as Congress struggles with how to pay for health-care reform, the
White House keeps doing it its best to accentuate the positive. Last
week, Vice President Joe Biden hosted the country's three largest
hospital trade groups as they announced they will accept $155 billion
in Medicare and Medicaid cuts over the next 10 years. It's all part of
an inspiring storyline, the idea that everyone is doing their part to
make this most ambitious undertaking a reality. But no one actually
thinks that the hospitals — or for that matter other key players like
pharmaceutical manufacturers or doctors — are giving up something for
nothing. On the contrary, any health-reform package passed by Congress
will likely deal a major blow to an upstart competitor of many
hospitals.
Buried in the 850-page House health-reform draft is a provision that
could in effect ban further construction of doctor-owned, for-profit
specialty hospitals and prohibit existing ones from expanding. (The
provision would prevent new facilities from receiving any Medicare
payments and would limit changes to current facilities.) Senators
Charles Grassley and Max Baucus, who lead the body's powerful Finance
Committee, have been vocal critics of the doctor-owned specialty-
hospital model and the industry expects similar language to be
included in any upcoming Senate health-reform bill as well. Doctor-
owned specialty hospitals would "wither on the vine," says Molly
Sandvig, executive director of the industry lobbying group Physician
Hospitals of America. "Any business that can't grow or adjust to the
market won't be around too long."
Specialty hospitals that focus on providing care for children or
cancer patients have long existed, but the target of the House
legislation is something else entirely — for-profit health-care
facilities owned by doctors that perform some of the most lucrative
medical procedures in fields like orthopedics and cardiology. There
are now some 220 such facilities operating mostly in the South and
Midwest — up from 110 in 2001 — generating some $40 billion in annual
revenue. According to Sandvig, more than 80 additional facilities are
currently under development.
While these places are known as specialty hospitals, most do not
resemble acute-care, all-purpose community health-care institutions.
For one thing, they tend to sell themselves on the promise of comfort,
if not luxury, with at least a few offering wine with gourmet meals
and on-campus hotels for friends and family. More importantly, about
half don't have any kind of emergency department and of those that do,
more than half have only one bed available, according to a 2008 report
from the inspector general of the Department of Health and Human
Services. Even more troubling to critics is the fact that, despite
being physician-owned, only about 30% have a doctor on site at all
times, and about two-thirds actually tell staff to call 911 in case of
an emergency, according to the same report.
This has created a dangerous situation, according to critics. The
inspector general's report came about after a 44-year-old spinal-
surgery patient at a doctor-owned specialty hospital in Texas — the
state with the highest number of such facilities — developed breathing
problems and died, despite being taken by ambulance to a larger
community hospital. The staff had called 911 after noticing the man's
respiratory function was poor, but there was no doctor present to
help. And just last month, a female patient at the physician-owned
Colorado Orthopaedic and Surgical Hospital died after she became
unresponsive following surgery and was transferred to a community
hospital. The facility has suspended all outpatient surgeries and the
state health department has ordered the hospital to change its
protocol in order to have a board-certified emergency doctor on site
at all times.
As disturbing as those incidents are, the more widespread concern
about the newfangled hospitals is money. Although there is not ample
hard data yet available to prove that specialty hospitals take a large
bite out of community hospitals' bottom lines, a quick scan of the
list of the common procedures performed at the highly focused
institutions suggests just that. Orthopedic and cardiac care bring in
some of the highest margin reimbursements from insurers, money
community hospitals use to cover the cost of low-margin or money-
losing services like burn units, neonatal care and treating the
uninsured. When healthier, fully insured patients migrate away from
community hospitals to specialty facilities, their reimbursements go
with them. Overall profit margins at specialty hospitals, sometimes as
high as 30%, dwarf those of community hospitals. Plus, specialty
hospitals don't typically treat many Medicaid patients, which bring in
some of the lowest reimbursements available.
"When these specialty hospitals come in, they take out the better
reimbursed cases, the easier ones with less complications, and they're
able to benefit financially by skimming the cream," says Rick Pollack,
executive vice president of the American Hospital Association
Perhaps an even more pressing problem in the context of health reform
is the risk of overutilization of services. According to a 2006 report
from the federal Medicare Payment Advisory Commission, just the
presence of a doctor-owned heart hospital in a community increases the
rate of cardiac surgery by 6% among Medicare beneficiaries. The
upshot, according to a House staffer involved in health reform, is
that "people are getting things they probably don't need." Plus, says
the staffer, "the community hospitals go to war, bulk up their own
specialty centers and all of a sudden you see these ads around town
that 'You should get your heart checked.'"
For their part, doctor-owned specialty hospitals say they're providing
more access to better quality care — and in some respects, this may be
true. Patient satisfaction rates at such facilities are generally high
and it's logical that a facility dedicated to just one or a few
specialties could operate more efficiently. "Rather than compete in
the marketplace they want to legislate us out of business," says Dr.
John Harvey, president and CEO of the Oklahoma Heart Hospital.
But it's the built-in conflict of interest that causes some patient
advocates to bristle. In effect, they contend, doctors double dip —
earning money from procedures as well as the overall operation of the
hospital, of which they are shareholders. That provides plenty of
incentive for physicians, who typically also work part-time at the
local community nonprofit hospital, to recommend their easy-to-treat
patients go across town to have procedures done at the private
hospital where the doctors are investors. The House bill would address
this issue by closing a loophole that has allowed doctors to send
patients to hospitals they had a stake in, so long as that hospital
served a rural population, or the stake was in a "whole hospital," not
just a wing or department; the Congressional Budget Office predicts
closing this loophole would mean fewer overall procedures, saving $1
billion in Medicare costs over ten years.
The controversy over physician-owned hospitals isn't actually new.
Representative Pete Stark, a Democrat from California, began a crusade
against doctor conflicts of interest more than two decades ago, and
successfully got legislation passed in 1989 that prohibited doctors
from, among other things, having a financial stake in labs that
performed tests for their patients. The Stark Law, as it became known,
has been strengthened over the years to include more facilities and
apply to Medicare and Medicaid payments. But the loophole allowing for
doctor-owned specialty hospitals has remained open despite repeated
attempts to close it. Now that the country is grappling with how to
reform the entire health-care system, Congress has another chance to
decide whether the costs of this kind of proprietary specialized care
are simply too high to bear.

http://www.51orders.com/

Insurance reform + medical provider reform = health care reform,
right? Utah health insurance reform has been center focus for the
state, UAHU and private insurance carriers over the past 24 months.
Mike Oliphant (UAHU board webmaster) runs a small Utah based health
insurance website http://www.healthinsurancetexas.biz as well as
http://www.DentalInsuranceUtah.net . Mike’s viewpoint provides a
unique analysis which comes from being a “fly on the wall” observer in
countless state session and insurance meetings. “Utah has been thrust
into a state insurance reform pressure cooker which isn’t necessarily
negative where I am an insurer, insured and patient”. Several
interesting changes took place with H.B. 188 passage earlier this year
which seems all too familiar to the ongoing federal health care reform
attempt under Obama’s administration. The spirit of the bill allows
private Utah market place remedies. It essentially guarantees a Utah
health insurance carrier a "no loss" or "no gain" premise over
competing carriers that operate within the “Utah Insurance Exchange
portal”. On the surface it would seem unattractive to a carrier’s
consideration (voluntary at this point). But you have to understand
the carriers’ goal is to cover their administration fees and maintain
a 3% profit. The Utah health insurance reform model claims this can be
accomplished now by legislation and the watchful eye of the state’s
risk adjuster board. The medical claim risks are essentially shared
equally among the participating carriers. Therefore, the carriers can
focus on administration efficiencies more so than competition over a
fluctuating market share. Insurance carriers such as SelectHealth have
efficiencies and risk management experience polished by long tested
actuarial tables with health statistics and claim trends. Is it a bad
idea to share that experience with a national carrier such as Humana?
Would it surprise anyone to know that maternity NICU and anti-
depressants represent the highest utilization in health insurance
costs for medical and pharmacy in Utah? Compare this to Texas which
suffers from abnormally high levels of diabetes and liver disease per
capita.
The other half of the “health care reform equation” is medical
provider and billing practices. The state claims this is on the
agenda. It is popular belief among Utah legislators that reform stops
with the insurance carrier. However, how can the insurance carrier
continue to bear the risk and re-distribution of health insurance
premiums back out the door in claims without provider billing reform?
Add to this obstacle a continuing shrinkage of the insured populace.
Obama’s administration proposes mandatory participation in a health
insurance policy by employers of all sizes, self employed and
unemployed populace. The logic being to shore up the unhealthy with
healthy premium. When analyzing the Massachusetts’s system, you
actually pay a penalty if you have no proof of coverage. The benefit
level and health insurance price is nowhere close when you compare
Utah health insurance quotes through HealthInsuranceSource.net or
dental insurance quotes at DentalInsuranceUtah.net. Utah premium is
easily half. This insight comes from a Utah health insurance agent
whom often interacts with employers and residents looking for
affordable coverage, making sure claims are paid correctly,
implementation and explanation of the many policy procedures and
putting a complex SelectHealth insurance language in understandable
terms. Yet legislators claim agents to be of no value all in the name
to save 3-4 off of Utah health%
With the latest announcement of hospitals agreeing to contribute $155
billion, where are the costs going to be shifted for this donation? In
Utah, studies conducted by BenefitsManager.net revealed that cost
shifting already exists in the ER. There is apparent lack of
legislators in Utah and on the federal level proposing TORT REFORM.
It is factual that a majority of US senators and representatives are
lawyers. To push liability insurance premiums down that absorb as much
as 15% in expenses with most medical providers is significant. Take
15% off total medical expenditures in US and you will see savings in
the trillions.
If we go down the path of nationalized health care reforms, will we at
some point be forced to address usage and ration? Will we have to
define when to refuse further care for patients receiving critical
illness treatments, intensive care unit, disease management, neonatal
intensive-care unit for? SelectHealth documents that the single most
expensive bills are NICU for newborns and seniors in acute / intensive
care / pre-hospice.
Without TORT REFORM, medical provider costs will never drop. Liability
insurance costs are approaching nearly half of the operating expenses
for specialty care physicians, units and facilities. Humana health
plans state that their costs of medical liability and defensive
medicine accounts for nearly 10 cents out of every premium dollar
collected. Compare that to Humana’s reported pharmaceutical claims of
15 cents out of every premium dollar collected. Or better yet, 21
cents out of every premium dollar collected is paid back to physicians
for physician treatments.
 
N

NotMe

}}

Without TORT REFORM, medical provider costs will never drop. Liability
insurance costs are approaching nearly half of the operating expenses
for specialty care physicians, units and facilities. Humana health
plans state that their costs of medical liability and defensive
medicine accounts for nearly 10 cents out of every premium dollar
collected. Compare that to Humana’s reported pharmaceutical claims of
15 cents out of every premium dollar collected. Or better yet, 21
cents out of every premium dollar collected is paid back to physicians
for physician treatments.

{{

Long term experience has proven TORT reform has little impact on med mal
rates and thus the cost of care. Insurance reform OTOH has proven to make a
difference. This is most notable in California over the past 10+ years.

As example ERISA protects the insurance industry from a lot of exposure yet
the rates for groups under ERISA (private companies) and exempt from ERISA
(schools and government) are remarkably similar.
 
T

TJ

NotMe said:
}}

Without TORT REFORM, medical provider costs will never drop. Liability
insurance costs are approaching nearly half of the operating expenses
for specialty care physicians, units and facilities. Humana health
plans state that their costs of medical liability and defensive
medicine accounts for nearly 10 cents out of every premium dollar
collected. Compare that to Humana’s reported pharmaceutical claims of
15 cents out of every premium dollar collected. Or better yet, 21
cents out of every premium dollar collected is paid back to physicians
for physician treatments.

{{

Long term experience has proven TORT reform has little impact on med mal
rates and thus the cost of care. Insurance reform OTOH has proven to make a
difference. This is most notable in California over the past 10+ years.

As example ERISA protects the insurance industry from a lot of exposure yet
the rates for groups under ERISA (private companies) and exempt from ERISA
(schools and government) are remarkably similar.
Maybe they just need to stop using OEM ink...

TJ
 
A

Arthur Entlich

I was going to stay out of this discussion, but since it won't go away,
and as someone who has lived within about 6 different health care
systems, from the US and Canada to several countries in Europe and
Africa, I really can't sit by while I read some of the comments I have
here. I am FURIOUS, and I rarely get that passionate about things, but
I am going to lay it down as I see it even if in angers or insults some
people.

By far, of all those countries where I have experienced medical
services, the US has the costliest and more inefficient system. I lived
under the US health system for over 25 years AND I was studying to be a
doctor there, so I have a pretty good sense as to how it "works". It was
the only system of those I experienced that did not have any inherent
sense of responsibility for those who cannot afford health care. It is
the only system I saw that regularly refused people treatment or
literally dumped people onto the streets when their money ran out. Not
just for emergency, or acute care, but also basic extended care for the
elderly and rehab. Yes, the US has a lot of hospitals filled with the
top of the line equipment, and sometimes even doctors who care about
their patients, but too bad only those on good insurance plans or with
big bucks get to use them. Other countries may find themselves rationing
health care, but it is not based upon if you can afford it, but based
upon how much resource can be made available to everyone equally. That
means that those at the top will no longer be able to get every health
whim met, but it also means that even the most impoverished will get the
same quality health care as others within the society.

Does government sometimes make a mess of things? Absolutely, but that is
often because corruption has been allowed to fester in lower ranking
management and employees as has been within upper politicians who
control the government. A bandaid charged to medicare at $20, well,
yes, the hospitals are cheating medicare (and other insurance programs),
but someone in the medicare offices is paying that bill without any
questions, and most likely getting a kick back for doing so, as well.

I lived in the US for nearly half my life, and for years Americans have
been moronic in their voting behavior and this has lead to the level of
corruption in government. They either ignore or tacitly approve it.
They may simply not vote, or if they do, they don't know the issues and
voting records and affiliations of their politicians, or they vote for
someone based upon one issue only, and often one they think will fill
their pockets with gold. With all the foresight of a nearsighted
squirrel, they voted Bush and Cheney in twice and almost did so a third
time with McCain.

Even after that, Obama was voted in by the thinest of majorities, mainly
out of despair and desperation of enough of the electorate. Now the
American people are allowing the Republicans to again try to sabotage
the efforts of a visionary who actually might have the best interests of
the "regular" American at heart. Americans just don't know what to make
of such a president, it is so out of character of the position.

And now the Republicans are brainwashing the voters, with the millions
of dollars of lobbyist and insurance companies and private interests, to
vote against their own best interests, and they will probably succeed
because they will convince less thinking Americans (most of them are
after all) that Obama's government will use the same tactics the
Republicans used during their time in office, that being to fill their
pockets and those of their wealthy friends.

I've now lived in Canada for about 25 years, and I have watched a very
well functioning and reasonably well financed health system degrade
considerably over the last 15 years because literally Republican
interests have been funding political movements up here. Basically,
they want Canada's health system to fail to prove it a bad idea for the
US. Private insurance companies, big pharma, and others who stand to
gain by ruining the nationalized medical system here are doing
everything in their power to undermine our system, because they stand to
make much more money in a privately run system that provides the best
service to those who will pay the highest value for it.

As someone who has experienced several variations of health care from
'pay as you go' to fully taxpayer supported systems, I've noticed
private services are always trying to get a bigger slice of the pie.
Instead of rejecting nationalized health insurance because "government
can't do anything right" start demanding and voting in governments which
do things right.

As for private systems being cheaper and more efficient, well, I have
only this to say. Private companies always have to build profit into
their finances to pay owners, stockholders, etc, to provide payments for
their investments. Government services only have to break even. If
things are done as they always have been in government in the US, then
yes, you'll continue to have $20 bandaids and you best either watch
closely or if you prefer, get ripped off by private medical services,
the difference being they "do it" with flowers (which you have also paid
for). But, if, just by some chance, Obama is as sincere as he appears
to be, and you can suspend disbelief just for a moment, you might want
to consider listening to what he is saying and take that risk of
supporting a plan that might actually provide equal health services for
all, and protect people from their pain, suffering and bankruptcy due to
illness and not being wealthy. Believe me, if nationalized health care
doesn't work, the private suppliers will be right there ready to grab
the whole pie again, with gusto.

My apologies for using this forum in this manner, but occasionally other
topics are important enough to use whatever platform becomes available.

Art
 
P

Paul Heslop

Arthur said:
My apologies for using this forum in this manner, but occasionally other
topics are important enough to use whatever platform becomes available.

excellent post Art. sadly the state of Canadian healthcare sounds so
like ours in the UK, no doubt with the same intentions.
 
N

NotMe

: Personally, I have insurance coverage provided by a very good HMO. The
: most popular in the Western half of the country, Kaiser Permanente.
: They have and run their own facilities including their own hospitals.
: They are very proactive, believing it is more cost affective to keep
: their clients healthy than to wait until they are ill. Governments send
: representatives to KP to see how they run their operation and provide
: the qlty of service for the cost they do. I don't want to loose that
: kind of coverage and it is for sure if the Dem's and the President get
: their way, I will. Maybe not quickly but at some point down the road,
: it will be gone.
:
: Mickey

Med mal awards are less than 2% of total billing and is reflected in the
data at many state insurance commissions. Tort reform has proven to be
ineffective in impacting the fess for med mal coverage. Insurance reform
OTOH has made a significant difference.

Tort reform has been targeted to keeping the little guy out of the court
house (see ERISA). There has been no action WRT tort reform for B2B
actions.

I recommend you do a bit of research on KP. They have a reputation for
running insider deals to the benefit of the upper management as well as a
history of denying services. Classic is the case of the two postal workers
infected with anthrax. KP elected a bogus 'evidence based treatment' that
ended in their deaths. Keiser then claimed they were exempt from liability
under ERISA (discover showed a lot of games being played with treatment).
Opps postal workers are not covered by ERISA.

Long story short the settlement was on the order of $200M but the workers
were no less dead.

Unless you are very very lucky you'll find that you're not getting the
appropriate treatment and are likely not being told there are better
options.

I know personally of a case involving an 8 by.of. Physicians recommend a
procedure. Insurance company denied certification requiring the family to
travel near 1000 miles for a lesser procedure that would cost the insurance
company much less.

It was only after the child's grand parents intervened and guaranteed the
cost of the procedure that the child was treated locally. Court records are
sealed but from what I know personally of the case there was ample evidence
that the treating physicians were blocked by contract from fully informing
the child's parent what was going on.

I spoken with several attorneys that represented (not the -ed) of the
insurance company and the logic is we lose more often than not in court but
the net is still in favor of the insurance company.

Is it any wonder that 50 to 75% of personal bankruptcies are the result of
massive medical bills?

I would mention that in areas were there are a surplus of high tag medical
equipment it's not uncommon to find local doctors investing in more of the
same. Interestingly enough the usage, as ordered by these physicians, goes
up exponentially as a function of the physicians financial interest in the
equipment.

Recall to a man with a hammer every problem mandates the use of his tool,
espically if it means money in HIS pocket.
 
P

Paul Heslop

Mickey said:
Art, you stated your position in a very civil way and hope you think I'm
doing so as well.

We can agree on a few things like the wisdom or lack there of, of the
average voter in this country.

You said you lived in the States for some time and even studied to
become a Dr. Then you should know and understand there are differences
between the USA and Canada At the very foundation of the issue is, is
it a Government responsibility, what does our Constitution say about
this. Well, there is the 10th amendment, the last of the amendments
referred to as The Bill of Rights. It says the only legitimate power the
Federal Government has is what the people have granted it and those
powers are stated in Article 1 Section 8. Much of what our Government
does today is outside the powers granted to them. I feel much of the
problem you see with the Republican Party is the fact generally
speaking, Republicans believe in the Constitution and want it to be
followed. They don't want to see the Government being involved in
everything some feel is desirable. If there is a real need for the
Constitution to change, then do so, there is a provision for that. Just
don't ignore the Constitution.

The USA is a very unique country and it didn't become the envy of much
of the world because it is the same as every other country. Our
founding Fathers gave us a Federation of independently sovereign states
only giving up a limited amount of that sovereignty to the Federal
Government. Regretfully, far too many have forgotten that fact.

As for the $20 band-aid, you should be aware of why the cost. You have
a costly facility staffed with professionals standing by 24/7 to take
care of everyones needs and that has to be paid for. You should also be
aware that 25% of the people hospitals see and treat DON'T PAY for
services rendered. Some how those costs have to be paid for. One way
they get paid for is to raise the cost on those that do pay. You should
also be aware that every time the Gov tries to control cost they pay
for, Dr's and hospitals usually take the brunt of the controls. Today,
Uncle Sam is only paying about 65% of the true cost of those services.

Another major problem is our laws and the fact anyone can sue for almost
any reason and the defending party has little way to recover the cost
for that defense when found innocent of the charges. Between people who
have false expatiations to "ambulance chasing" lawyers, hospitals and
doctors are force to practice defensive medicine which is a very high
cost way of doing things. Some years back I had the opportunity to spend
a week in a hospital's internship program (I worked for a major medical
equipment mfgr, Hewlett Packard). While standing at the head of a
patient undergoing heart surgery and in response to a question I ask, a
Dr. said in NZ they have the same success rate as in the States for the
procedure being undertaken but the procedure done there is done with a
lot fewer personnel and much less equipment. The difference was because
in NZ, they don't have the fear of facing a judge and jury if the
outcome is less than perfect. The Dem's have refused to address tort
reform to help control costs. The reason, lawyers are a big contributor
to the Dem party.

Personally, I have insurance coverage provided by a very good HMO. The
most popular in the Western half of the country, Kaiser Permanente.
They have and run their own facilities including their own hospitals.
They are very proactive, believing it is more cost affective to keep
their clients healthy than to wait until they are ill. Governments send
representatives to KP to see how they run their operation and provide
the qlty of service for the cost they do. I don't want to loose that
kind of coverage and it is for sure if the Dem's and the President get
their way, I will. Maybe not quickly but at some point down the road,
it will be gone.

Mickey

heh, these things will always have two sides, but I'm sorry if it
comes over the wrong way that your post feels like an "I'm alright
Jack" which always seems to happen when I read messages by americans
who are happy with their health 'system' Politics shouldn't even come
into it really, ALL parties should be wantin g what is best for
people, rather than their own agenda.
 

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