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Coverage Fact Labels For Various Medical Services: Will They Be Useful

It’s official now.  The government has proposed that descriptions of health insurance policies will resemble those nutritional labels on canned and packaged foods—the ones you look at to find out how much sodium there is in Birds Eye peas versus the A&P brand.  Instead of getting the scoop on salt or sugar, shoppers will learn what they have to pay out-of-pocket for various medical services.  They’ll also get some general information, like what services are not covered, and how much they’ll have to pay for maternity and diabetes care and breast cancer treatment, all organized in a standard format designed for easy comparison shopping.  Insurers will have to translate common insurance jargon into plain English.

The health reform law requires these “Coverage Fact Label” disclosures, and tasked the National Association of Insurance Commissioners (NAIC) with creating them.   The NAIC released some samples a few weeks ago.  Theoretically, consumers armed with this information will choose wisely, and as free-market advocates say, their choices will regulate prices that insurers will charge.   If consumers choose the low-cost plans, Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Why Would Health Insurers Tell Congress: Please Hurry!?

One would think American health insurance companies would be caterwauling about the provisions laid out for them in the healthcare reform legislation which Harry Reid (and a few of his elves) assembled for us Americans in their secret workshop just before Christmas.

On their face, those provisions do not appear to allow insurance companies a viable business model. Insurers under Reid’s bill would be required to accept all comers, regardless of age or underlying medical conditions. They would be required to cover all manner of healthcare services, including outpatient and inpatient services, maternity and newborn care, mental health and substance abuse services, rehabilitative services, lab services, preventive and wellness services, chronic disease management, prescription drugs, dental care, and eye care. They would be limited in what they can charge in the way of insurance premiums, and their profits (if by some miracle there were any), would be strictly capped. Read more »

*This blog post was originally published at The Covert Rationing Blog*

The Health Plan Lobby’s War For Survival

This past weekend, AHIP – the American Health Insurance Plan trade group – seemed to turn at last against healthcare reform. For nearly a year the AHIP stood silently by, and indeed often made noises in support of the administration’s reform efforts, despite being cast by reformers as the chief villains of American healthcare. Then suddenly, a few days ago AHIP released a study produced for them by Price Waterhouse Cooper which concluded that healthcare reform (at least as advanced by the Baucus Senate Finance Committee) would result in massive increases in insurance premiums for Americans.

Becoming an apostate has always been far worse than being a mere infidel, and the AHIP action (seen as a act of betrayal and not merely an expression of opposition) has invoked the wrath of the powers that be. Democrats and progressives everywhere have quickly responded. Read more »

*This blog post was originally published at The Covert Rationing Blog*

Who’s Taking A Swipe At Physicians Now? AHIP

AHIP, the trade group representing the nation’s health insurers, released a study decrying excessive physician charges.  There’s some amazing stuff in there: office visits being billed at $6200, a lap chole being billed at $9,000 (just for the physician’s portion).  Truly egregious, if true — and that’s the qualifier.

The methodology of this “survey” is not really honest.  They cherry-picked an insurance database looking for the highest billed charges for various CPT codes.  Supposedly they “excluded high charge outliers that may reflect billing or coding errors.”   Really?  How on earth, one wonders, could they have concluded that an office visit billed at 5,000% the medicare rate was not an error?  Were there more outrageous charges that were excluded?  Sounds fishy.

Moreover, the survey is promoted as exposing the outrageous fees that doctors charge, when in no way are these fees representative of physician fees.  Physician fees, as any other group of data points, fall into a more-or-less normal distribution.  There’s a median point around which most practices cluster, and the further out you get the fewer physicians that are charging those fees, high or low.  The cited fees are certainly in the 3+ standard deviation tail of this graph, but you wouldn’t know it from the AHIP press release.

They present these outrageous charges as if they are accurate and as if they represented a widespread abuse of consumers by greedy doctors.

The annoying thing about this is that there is a valid argument to be made that the uninsured do face higher fees than the insured.  This is of course more of a factor with the much-higher hospital costs, but physician fees are also higher for the uninsured.  The reason for this is that insurers demand a discount off the standard fee in order to contract with physicians.  This gives physicians an incentive to crank up their fee schedule as high as they can get away with.

So if UnitedHealth comes to me and offers to pay me 75% of billed charges (I wish!), I need to make sure that my fee schedule puts that figure at a level that is going to return a reasonable per-patient compensation.   This is less of an issue nowadays, since most insurers prefer to settle on a conversion factor and contract by the RVU, or as a percentage of the standard medicare rates (110-150% most commonly).  That’s easier for their billing systems to manage.  So there is less incentive for us to keep charges high.  But still, a few insurance plans like to do the old way, and there are occasional patients who are insured but we don’t have a contract with their insurer.  In those cases, we expect compensation in full, and the insurer usually pays some arbitrary sum that they feel is reasonable, with the patient responsible for the balance.

Does this screw the folks without insurance?  Yes, to a degree.  Most of the uninsured don’t pay a dime.  They just throw out the doctor’s bill, along with the much-bigger hospital bill, and we wind up writing it off as bad debt.  Most hospitals, and our practice, will also write it off as charity if the patient asks for it and can show some hardship.  So the uninsured will get a huge bill, but they very very rarely have to pay a huge bill.

The ultimate solution for this “problem” of the uninsured being “overcharged” is not, as AHIP implies, to somehow regulate physician charges, but to eliminate the uninsured.  Get everybody covered under some sort of insurance plan, and this problem goes away.

*This blog post was originally published at Movin' Meat*

Dr. Val’s Inaugural Photos

Today I live-blogged the inauguration via Twitter. Thanks for all of you who followed my personal anecdotes and to those who felt it was TMI, sorry. I chatted about everything from Susan Sarandon’s Visine addiction, to police security instructions, to a near fight that broke out in a group of cold and frustrated people who weren’t allowed onto the parade route. And best of all, I speculated as to whether there may be an official “inaugural pooper scooper” to clean up after the horses in the parade.

I promised the folks on Twitter that I’d have photos on my blog later today. So here they are. Photo 1 was taken of me and my “peeps” in our parade perch at 601 Pennsylvania Avenue (thank you, AHIP). The rest are pretty self explanatory. It was a really fun and momentous occasion.

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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