tag:blogger.com,1999:blog-32053362.post6213167905383886413..comments2024-03-29T06:37:18.029-04:00Comments on Not Running a Hospital: Recapping and handicapping the MA insurance "market"Paul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger10125tag:blogger.com,1999:blog-32053362.post-73568996249878462612011-04-14T11:10:44.812-04:002011-04-14T11:10:44.812-04:00If we want to get the free market to work we need ...If we want to get the free market to work we need to a much clearer idea of what healthcare costs.<br />As a receiver of healthcare I find it obnoxious that I receive invoices from the parking attendant all the way to the specialist and the lab and this cost is NEVER disclosed up front.<br />Government publish what the total (actual) cost of a procedure is at given service provider. The insurances then should be allowed to post what their subscribers cost is after any annual deductible. <br />Such transparency would allow the consumer to choose who they wish to insure with (assuming they even have a choice) and all government would have to do is ensure that the reporting is accurate and comprehensive.GreenLeaveshttps://www.blogger.com/profile/16159362981477129396noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-64487077227237623192011-04-13T20:30:41.827-04:002011-04-13T20:30:41.827-04:00Isn't this the American way? The rich get ric...Isn't this the American way? The rich get richer and get to use their excess capital to shove everyone else out of the market.<br /><br />After all, goverment should just get out of the way and stop trying to regulate buisiness and health care. The market will figure it out. Right?<br /><br />That way, the big providers can continue to run gobs of tv commercials touting their great services, while hiding their true quality statistics. <br /><br />I look forward to this pending medical nirvana!Keithnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-45119329296959321272011-04-13T20:08:27.962-04:002011-04-13T20:08:27.962-04:00nonlocal –
Christensen suggested that the solutio...nonlocal –<br /><br />Christensen suggested that the solution shop part of the hospital needed to be paid fee for service, as I recall. He noted that numerous diseases and conditions have similar symptoms and it’s hard to predict just how quickly and at what cost a definitive diagnosis can be determined. The fee for service payment model certainly encourages more testing rather than less. So does the fear of litigation over a failure to diagnose. If the patient turns out to have something rare or unusual, the docs want to find it. I don’t know what the answer to this conundrum is except, perhaps, utilization review. If some hospitals consistently perform more tests than others to discover, say, gallstones, payers would be on sound ground to put them in a non-preferred tier, at least for diagnostic work. If the same hospital does a great job performing value added process work, it could be in the preferred tier for those procedures. Obviously, there is a lot more work that needs to be done to pay providers, especially hospitals, in a way that drives practice patterns toward the results we want – high quality, cost-effective care.Barry Carolnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-33063156184387766902011-04-13T17:27:36.749-04:002011-04-13T17:27:36.749-04:00Barry, I can't remember what (or if) Christens...Barry, I can't remember what (or if) Christensen suggested as a payment mechanism for the diagnostic solution shops but mark my words - they are in as dire need of cost containment incentives as the treatment arm. The over-ordering of tests is well discussed already, but I have personally observed an alarming scattershot approach to diagnostics involving friends and relatives recently, which seems to expose a loss of rationale and coherent thought among at least community physicians. (And they are the majority of physicians, of course) Perhaps the fee for service payments have had the unintended consequence of producing widespread loss of cognition in diagnosis. It certainly looks that way from my perspective. I don't know what solution is best, but we need to think carefully about this aspect.<br /><br />nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-75268722133064598272011-04-13T16:38:49.289-04:002011-04-13T16:38:49.289-04:00I am not a philosophical fan of rate setting, livi...I am not a philosophical fan of rate setting, living as I do in the state with, I believe, the most comprehensive, all-payor rate-setting mechanism of all 50. However, I must say that compared to what you are describing, our Md. rate setting system seems much more even handed.I know with your experience as a former regulator, you do not make your last point lightly. <br />And btw, whatever happened to the feds' antitrust investigation of Partners? It would seem a fairly open and shut case. It just goes to show how impotent an enforcement tool this is, beyond empty threats.<br /><br />nonlocal MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-89751563808055757542011-04-13T14:06:12.585-04:002011-04-13T14:06:12.585-04:00Not only did the AQC offer financially enticing qu...Not only did the AQC offer financially enticing quality incentives to early adopters, it baked in the existing rate differentials. From the <a href="http://www.bluecrossma.com/visitor/pdf/aqc-results-white-paper.pdf" rel="nofollow">BCBS AQC Year One Results white paper</a>, "starting budgets for organizations in the AQC are based specifically on each organization’s historical rate of spending for its patient population".Keith Marplehttp://keithmarple.tumblr.comnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-41616393359649842582011-04-13T13:45:04.967-04:002011-04-13T13:45:04.967-04:00Recently, because I relish an interesting test, I ...Recently, because I relish an interesting test, I chose a community health center rather than a gleaming academic one for non-elective outpatient surgery, to compare what kind of experience I would have as a patient. My surgeon practices at both. I received excellent, highly safety-concious care (and I am a knowledgeable judge), with a warm, high touch patient focus at a much lower cost facility. As an insider to quality metrics, I found that the CHC has high ratings, and for some measures, higher than the academic centers. This includes infection rates and hand-hygiene by providers. My high cost private insurance rewarded me with a substantial bill for almost 50% of the CHC's cost - which was a fraction of what I would have been charged at an academic center. Am I and the CHC being punished for saving the insurer money? Or for not directing business to the high cost facility? <br /><br />Not only are comparative rates not transparent for public discussion, but the consumer has no ability to compare what their own personal financial cost and health risk will be. And it is no longer true that the insured only pay $20 for care. The increasing difference in negotiated rate and cost arrive from physician offices, hospitals, and imaging centers in bills to consumers each day. There is poor leverage to protest cost for something already consumed. And while hospitals may be rewarded by insurers for quality progress, these savings or comparative data are not passed on to patients. Consumer protections fail on many, many fronts in this battle.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-13596467702271329912011-04-13T13:39:45.456-04:002011-04-13T13:39:45.456-04:00While I’m a big believer in disclosure of actual i...While I’m a big believer in disclosure of actual insurer contract payment rates and bundled pricing for surgical procedures, I’m skeptical about how well capitation could work for the portion of hospital care that needs to take place in what Clayton Christensen calls a “solution shop” as opposed to a “value added process shop” where the surgeries take place. In the former, doctors need to first diagnose the patient’s problem. In the latter, they already determined what needs to be done. Even within primary care, patient non-compliance is a significant issue and the risk adjustment state of the art isn’t where it needs to be yet.<br /><br />I just learned today that Highmark is considering the purchase of West Penn Allegheny Health System in Pittsburgh which would put Highmark in the healthcare provider business for the first time if they strike a deal. This could be an interesting trend if it catches on. For hospitals, as more physicians who practice at the hospital become employees, it should become easier to reduce avoidable harm, improve discharge planning, and standardize on fewer medical devices. For payers, if there were default payment rates or some other reasonable approach to determine an acceptable payment for care delivered under emergency conditions, it would be easier to exclude hospitals from the insurer’s network if necessary. It would also be helpful if insurers could contract with hospitals to provide sophisticated care but not routine care if the prices demanded for routine care are deemed too high. Alternatively, we could try the Swiss approach where all insurers in a canton negotiate with providers as a group and they all pay a given provider the same rate for a given service, test or procedure. That, of course, would require an anti-trust exemption.Barry Carolnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-12877773666001089792011-04-13T12:13:24.988-04:002011-04-13T12:13:24.988-04:00Actually, I have made a number of suggestions over...Actually, I have made a number of suggestions over the years. Here's a good summary, though: http://runningahospital.blogspot.com/2010/06/three-ways-to-set-payment-rates.htmlPaul Levyhttps://www.blogger.com/profile/17065446378970179507noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-19763912978892626902011-04-13T12:01:19.211-04:002011-04-13T12:01:19.211-04:00So.. what is your solution to the payment problem?...So.. what is your solution to the payment problem? Enough with the complaints without any suggestions for improvement.Scott Haganhttps://www.blogger.com/profile/04838375048647117457noreply@blogger.com