Friday, 16 June 2017
Thursday, 15 June 2017
Regulations vs Productivity, Medical-style
Interesting article today in MedPage about how five doc's manage their practices (or have bailed on them) through years of increasingly onerous paperwork and record-keeping reg's.
For example:
"Around 2005, Dr. A was starting to fatigue. He was well into his sixties and did not like the direction medicine was going. The hours were too strenuous, the documentation requirements were getting increasingly complicated, and he saw the writing on the wall. Regulation was coming, and the results would be devastating. So, he decided to retire."
What happens next is a cautionary (true) tale, including the experience of FoIB Dr Gerard Gianoli. And it seems likely to get worse before getting better (if that's even possible at this point). Frustrating information, but a good, well-written piece.
Kudos.
For example:
"Around 2005, Dr. A was starting to fatigue. He was well into his sixties and did not like the direction medicine was going. The hours were too strenuous, the documentation requirements were getting increasingly complicated, and he saw the writing on the wall. Regulation was coming, and the results would be devastating. So, he decided to retire."
What happens next is a cautionary (true) tale, including the experience of FoIB Dr Gerard Gianoli. And it seems likely to get worse before getting better (if that's even possible at this point). Frustrating information, but a good, well-written piece.
Kudos.
from InsureBlog http://ift.tt/2sftfmi
MMO on the Board
So got this in email from Medical Mutual this morning:
"Earlier this month, Anthem announced it would be exiting the Ohio ACA market for 2018. We at Medical Mutual understand this announcement adds uncertainty for brokers around the 2018 open enrollment period. We want to take this opportunity to alleviate some of that uncertainty for you, our valued broker partners."
Which is nice, and they go on to reassure us that they've already filed to offer ObamaPlans next year, and that they're "committed to offering individual health insurance options where it is feasible for us to do so."
While I appreciate the goodwill inherent in these kinds of non-committal messages, they really only serve to make a carrier look good by comparison (not exactly a high bar). And, as co-blogger Patrick points out:
"There wasn't a doubt they would participate. Likely they add a few counties but not the full 20 without an insurer. Plus, you haven't seen the rates yet."
Indeed. Considering that they may well be the only option in some areas, the likelihood is that rates will be even higher (after all, absent competition, what's to hold them down?).
And that's just one carrier, in one state. Our friend Holly R sent us this link to a map of the US showing states which will have at most one carrier next year:
Which is nice, and they go on to reassure us that they've already filed to offer ObamaPlans next year, and that they're "committed to offering individual health insurance options where it is feasible for us to do so."
While I appreciate the goodwill inherent in these kinds of non-committal messages, they really only serve to make a carrier look good by comparison (not exactly a high bar). And, as co-blogger Patrick points out:
"There wasn't a doubt they would participate. Likely they add a few counties but not the full 20 without an insurer. Plus, you haven't seen the rates yet."
Indeed. Considering that they may well be the only option in some areas, the likelihood is that rates will be even higher (after all, absent competition, what's to hold them down?).
And that's just one carrier, in one state. Our friend Holly R sent us this link to a map of the US showing states which will have at most one carrier next year:
[click to embiggen]
Yikes!
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Wednesday, 14 June 2017
Falling through the cracks, CIA-style
This is just a complete tragedy all the way around:
"Former CIA contractor, former SEAL, falls through medical insurance loopholes"
While serving as a contractor for the "CIA’s Global Response Staff in a Middle East outpost," he suddenly began experiencing severe chest pains. But because of his position as a contractor, not an employee, he was shunted off to "a local hospital – and seen by a doctor who did not speak English – who misdiagnosed him simply as having heartburn."
Turns out, it was actually much more serious, and he was eventually sent home - on a commercial flight, no less - where he underwent open heart surgery and other significant health care.
Okay, not ideal, but at least his employer's insurance covered all this, right?
Turns out, not so much:
The Defense Base Act (DBA), on which Mr Wojciechowski relied to pay his medical bills, really isn't set up to do so. In fact, it's basically structured to **not** cover most, perhaps all, of his care in this situation.
Why is that?
Well, as usual, the MSM can't be bothered to do 10 minutes of research by reaching out to folks who actually, you know, do this for a living, like our good friend Peter Schulteis at Global Underwriters. As usual, Peter was happy to share with me how the DBA works, and what it's designed to do.
The first thing to know is that, at its core, the DBA is Worker's Comp. Nothing more, nothing less. And just as one wouldn't expect a heart attack or liver disease to be covered under WC stateside, the DBA doesn't cover these things either.
That's why employers here offer (or provide) health insurance for employees, to cover their non-WC-related claims. Mr W's employer could have also done so, but instead chose to provide the bare minimum coverage that they were statutorily required to obtain. It's analogous to buying liability insurance on one's car: sure, you can buy the state-mandated minimums, but they're hardly going to be much help when you hit a station wagon full of nuns. This is what’s known as “necessary, but insufficient;” that is, doing the bare minimum to avoid breaking the law, while missing the larger point that that’s just not good enough.
So what would constitute "sufficient" in this case?
Well, as Peter explains it, the current buzzwords in his world are Duty of Care" and "Best Practices." What those really boil down to is treating one's employees with respect, and making sure they have not just the statutory (minimum) level of coverage and access to care. That could include something as simple as a travel medical plan that would cover illnesses and med-evac expenses, as well as accidental death coverage and the like.
On the other hand, it seems to me that Mr W is himself not blameless in this:
"By law of the Defense Base Act (DBA), Wojciechowski assumed his health was covered." [emphasis added]
And we all know what happens when we assume.
In this case, a call to his agent (or a few minutes' web-searching) would have shown him that he was not, in fact, covered for non-work-related medical care, and that such coverage is generally available. Alternatively, he could have checked with his employer to see what options they offered.
And so, Mr Wojciechowski continues to languish in deep physical and financial trouble.
"Former CIA contractor, former SEAL, falls through medical insurance loopholes"
While serving as a contractor for the "CIA’s Global Response Staff in a Middle East outpost," he suddenly began experiencing severe chest pains. But because of his position as a contractor, not an employee, he was shunted off to "a local hospital – and seen by a doctor who did not speak English – who misdiagnosed him simply as having heartburn."
Turns out, it was actually much more serious, and he was eventually sent home - on a commercial flight, no less - where he underwent open heart surgery and other significant health care.
Okay, not ideal, but at least his employer's insurance covered all this, right?
Turns out, not so much:
The Defense Base Act (DBA), on which Mr Wojciechowski relied to pay his medical bills, really isn't set up to do so. In fact, it's basically structured to **not** cover most, perhaps all, of his care in this situation.
Why is that?
Well, as usual, the MSM can't be bothered to do 10 minutes of research by reaching out to folks who actually, you know, do this for a living, like our good friend Peter Schulteis at Global Underwriters. As usual, Peter was happy to share with me how the DBA works, and what it's designed to do.
The first thing to know is that, at its core, the DBA is Worker's Comp. Nothing more, nothing less. And just as one wouldn't expect a heart attack or liver disease to be covered under WC stateside, the DBA doesn't cover these things either.
That's why employers here offer (or provide) health insurance for employees, to cover their non-WC-related claims. Mr W's employer could have also done so, but instead chose to provide the bare minimum coverage that they were statutorily required to obtain. It's analogous to buying liability insurance on one's car: sure, you can buy the state-mandated minimums, but they're hardly going to be much help when you hit a station wagon full of nuns. This is what’s known as “necessary, but insufficient;” that is, doing the bare minimum to avoid breaking the law, while missing the larger point that that’s just not good enough.
So what would constitute "sufficient" in this case?
Well, as Peter explains it, the current buzzwords in his world are Duty of Care" and "Best Practices." What those really boil down to is treating one's employees with respect, and making sure they have not just the statutory (minimum) level of coverage and access to care. That could include something as simple as a travel medical plan that would cover illnesses and med-evac expenses, as well as accidental death coverage and the like.
On the other hand, it seems to me that Mr W is himself not blameless in this:
"By law of the Defense Base Act (DBA), Wojciechowski assumed his health was covered." [emphasis added]
And we all know what happens when we assume.
In this case, a call to his agent (or a few minutes' web-searching) would have shown him that he was not, in fact, covered for non-work-related medical care, and that such coverage is generally available. Alternatively, he could have checked with his employer to see what options they offered.
And so, Mr Wojciechowski continues to languish in deep physical and financial trouble.
from InsureBlog http://ift.tt/2t1zbz4
Tuesday, 13 June 2017
Tuesday Afternoon Potpourri
■ First up, FoIB Notorious MWR tips us to a very interesting new-baby technique:
"Courtney Buss, like many first-time mothers, wanted all the white, goopy film washed off her baby immediately after delivery.
Three years later, Buss said she knows better."
Turns out, that "goop" is actually "vernix caseosa," and it's now believed that it helps new-borns fight infections.
Nice!
■ Next, Dean Clancy provides a stunning visualization of just how far off CBO estimates tend to be:
Nice!
■ Next, Dean Clancy provides a stunning visualization of just how far off CBO estimates tend to be:
[click to embiggen]
■ And finally, FoIB Holly R alerts us to a related problem; namely, the increasing number of folks who've actually dropped their ObamaPlans:
"The number of Americans insured under Obamacare fell by nearly 2 million people between Jan. 31 and mid-March"
Let's do a little math, shall we?
1) January to March is 3 months (okay, 2 ½, but here that's a distinction without a difference)
B) Open Enrollment ObamaPlans become effective January 1.
III) On-Exchange plans have 3 month Grace Periods.
So it's actually quite easy to see what's happened: 2 million or so folks bought ObamaPlans with January 1 effective dates, didn't pay for them (but may well have **used** them), then ran out the clock.
Easy-peasey.
"The number of Americans insured under Obamacare fell by nearly 2 million people between Jan. 31 and mid-March"
Let's do a little math, shall we?
1) January to March is 3 months (okay, 2 ½, but here that's a distinction without a difference)
B) Open Enrollment ObamaPlans become effective January 1.
III) On-Exchange plans have 3 month Grace Periods.
So it's actually quite easy to see what's happened: 2 million or so folks bought ObamaPlans with January 1 effective dates, didn't pay for them (but may well have **used** them), then ran out the clock.
Easy-peasey.
from InsureBlog http://ift.tt/2tipagz
From the mailbag: How Many Doctors Does It Take...
"I've ended up with a herniated disk. Been to my regular doc, who referred me to an orthopedic surgeon, who referred to a pain management outfit for an epidural (this is Readers Digest version). Anyway, I'm wondering why this process has so many steps and is taking so long, and if it’s “normal.” Any thoughts?"
Well first, Thank You for reaching out to us, we're always happy to help our readers as best we can. Second, we're very sorry hear about your pain issues. To answer your question, is what is happening to you normal, yes it is. If it seems complicated, it is complicated.
As to why it seems so complicated, that came about primarily because of insurance. Before carriers convinced doctors that it would be better for the doctors to bill them directly (instead of patients paying doctors and then putting in paperwork for reimbursement), doctors were primarily General Practice or Surgeons, with a few specialties. Fast forward to today, all doctors have a Taxonomy Code (one of about a dozen different ID numbers that are needed to bill for medical care). This is a code that tells insurance companies the doctors’ area of medicine, i.e. General Practice (PCP), or a Specialist and what type of specialist. Within specialties are CPT (Procedure) codes and ICD (Diagnosis) codes that are linked with that specialty. For example, a PCP cannot bill a Massage Therapy code, even if the PCP did massage therapy on a patient; that is not listed as an area of expertise. That is why you need to go to different physicians to narrow down whom is best for what you need done.
In your case, while seeing an Orthopedic is normal for your condition, that doctor would only continue with you if you were to have a surgery. For non-invasive pain management, i.e., an epidural, this is done by another specialist, usually an Anesthesiologist that has special training in pain management. Often times these types of doctors will work in orthopedic offices as a service offered to patients.
I understand from a patient’s point of view it does seem to take longer; however, in our world we are working at warp speed. The problem is that there are fewer doctors and more patients, so it is harder to get in to see a doctor. Also, from now until the end of the year is our “busy season”. People think/feel they have met their deductible, but with 40% of all patients on high deductible plans, the old saw of meeting your deductible mid-year is a false narrative that unfortunately many still hold as “truth.” So in addition to having to see several specialists, you can experience delays due to the fact that right now demand is higher than supply.
The best time to get medical care is 1st Quarter. Most doctors run very slow.
As to the bureaucracy, yes, there are tremendous hoops that doctors must go through for any type of treatment. The biggest is getting the Prior Authorizations demanded by insurance companies for even the smallest procedure and/or medication.
/sigh
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Monday, 12 June 2017
Mazel Tov to Cornerstone
The great, helpful, patient folks at Cornerstone have scored again:
"Cornerstone is taking its place on the list of Enquirer Media’s Top Workplaces of 2017 for the third consecutive year."
Kudos!
"Cornerstone is taking its place on the list of Enquirer Media’s Top Workplaces of 2017 for the third consecutive year."
Kudos!
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