Wednesday, April 30, 2008
If John McCain is going to be successful with his healthcare strategy of less regulation I sure wish he would figure out how to level the playing field for consumers; so that hospitals, doctors and insurance companies had to disclose in advance what services will actually cost out of the consumer’s pocket. I realize for many services it might be a range but for many services it can be an exact price.
Talk with you soon
Friday, April 25, 2008
Robert called in to talk about Therapy Services. He said that Erin, the person who took care of him was great and that he was more than satisfied with his care. If he ever needed such services again, he said this would be the first place he would come.
Kathleen wrote regarding our E.R. She said of her first visit to the ACH ER, “Each one (of the staff members) was friendly, caring and most professional. My husband and I were very impressed. A note has been sent to the E. R. also.”
What a great way to end the day.
April 24th, 2008
“The Third Path…Systematic Change Will Focus on Returning Value” is an article written by Greg Poulsen, SVP at Intermountain Healthcare that appears in Modern Healthcare’s, April 21st issue on page 26.
It is a must read; one of the most insightful, clear, forward-thinking approaches to health care…I hope all of the presidential candidates and their teams start listening, - and that whoever is elected stops listening to the special interest lobbyists.
In his article, for those of you who might not have access to it, he clearly points out that neither a consumer-driven approach nor the concept of universal insurance coverage addresses the core health care challenges we face: that of providing quality and value.
The core flaws, as he points out, are:
1. A fundamental flaw is not one of access or insurance – but rather, one of cost issues, structure and the need to align incentives.
2. Patients who lack complete medical histories must navigate a sea of provider settings. Poor communication increases the chances for errors. There is also a lack of real peer accountability.
3. The current system has powerful incentives to increase utilization; physician fees are affected by treatment decisions. Physicians can substantially increase their incomes by performing procedures versus providing consultations. Patients often request more expensive testing and medications. Finally, physicians with ownership in delivery systems such as ambulatory centers or imaging have their utilization incentives greatly magnified. Most physicians do what is right because they take their professionalism seriously; otherwise we would find our problems to be much greater.
1. That the payment system move away from the fee-for-service structure to a more bundled approach.
2. Patients need to be motivated to opt for a high value approach.
3. The regulatory environment should change to better facilitate cooperation and coordination among the providers, doctors, hospitals and others.
4. Health information technology and EMRs need to be expanded.
Talk to you soon.
Thursday, April 17, 2008
For many of the services we provide, our prices charged to both our insurance companies and consumers have been kept lower than those of many of our competitors for the past several years.
As a Community hospital struggling to make more than a 2% operating margin, we hope to drive more business here, particularly in the areas in which we offer some of the best equipment and prices around -- yet people don’t know how, nor do they have the information they need to shop. Once they experience the value ACH offers and they meet the colleagues who practice and provide the services here, I am confident we will create even more loyal customers.
How ironic: Today I look at an Explanation of Benefits (service) on an x-ray for one of my immediate family members. Of course, this service was performed out of town in one of the most expensive areas of health care in the state, Toledo. The list price here in Alliance is $91.00 for that service, while, at the hospital in Toledo, it’s $249.00. Naturally, my family member’s deductible is not any where near being met, so what will we end up paying?
Well according to my EOB, if the service had been provided here, my plan would have covered 100% of the charge at an in-network facility -- it would have paid the full $91.00. But, with regard to the out-of-network facility, I will find out later. My plan did inform me that the usual and customary charge would be $109 – which means that $140 of the list price in Toledo would not even have been paid. I sure wish I’d have known, in advance, which outpatient center to send this family member to --since we will end up paying cash.
Please email me or comment on my blog if you have questions on how to become a knowledgeable buyer of medical services -- and let us learn together.