insurance

Gaming the Medicaid System

It seems the folks in DC are very good at spending money, but not so good at accounting for how it is spent or why they do what they do.  <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUi6P3yRmoWoAzdYsgqds0mK4s2GZ1GdYJ-V2wNzThda4T_oBgwC4ogcHvM1AI1CUTnL2jAahDm68qRHBUMnHUS6cVWOLrkXxjcFJfqQoSPOI3H-siCbYnLmxYQd7bPZIPrtqJcbaoag4/s1600/cash+register.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUi6P3yRmoWoAzdYsgqds0mK4s2GZ1GdYJ-V2wNzThda4T_oBgwC4ogcHvM1AI1CUTnL2jAahDm68qRHBUMnHUS6cVWOLrkXxjcFJfqQoSPOI3H-siCbYnLmxYQd7bPZIPrtqJcbaoag4/s1600/cash+register.jpg" width="200" /></a></div> It is too costly to erect a fence at the Mexican border but not too costly to care for every physical need of those who cross over illegally. Medicare and Medicaid dollars are in the crosshairs as DC tries to convince the voting public they want to provide health care that is efficient and effective. When it comes to patient care under Medicaid (and Medicare) the rules are quite simple.  The more care the provider can justify the more they are paid. Given the paltry sums that are paid to doctors is it any wonder why some of them may be tempted to "pad" their bill? <blockquote class="tr_bq" style="background-color: white; color: #333333; line-height: 20px; margin-bottom: 20px; padding: 0px;">I get paid by Medicaid to see patients. How much?</blockquote><blockquote class="tr_bq" style="background-color: white; color: #333333; line-height: 20px; margin-bottom: 20px; padding: 0px;">Exactly $52.28 if it is an easy patient issue, like a cold, and $78.54 for a harder one, like a kidney stone. Who decides when the issue is easy and when it is hard? I do.</blockquote><div style="background-color: white; color: #333333; line-height: 20px; margin-bottom: 20px; padding: 0px;"><a href="http://www.kevinmd.com/blog/2014/07/conflicting-state-versus-federal-incentives-confuse-doctors.html" target="_blank">Kevin MD</a></div><div style="background-color: white; color: #333333; line-height: 20px; margin-bottom: 20px; padding: 0px;">I have had a cold, and a kidney stone and from a patients perspective Dr. Mom can probably diagnose and treat a cold as well as anyone with a diploma.</div><div style="background-color: white; color: #333333; line-height: 20px; margin-bottom: 20px; padding: 0px;">Kidney stones are generally easy to diagnose (and now that I have first hand experience I can probably tell you what the problem is if there is a next time).</div><div style="background-color: white; color: #333333; line-height: 20px; margin-bottom: 20px; padding: 0px;">The initial diagnosis of a stone is a bit more complicated, and more costly, since confirmation requires imaging of some sort (usually an MRI).</div><blockquote class="tr_bq" style="background-color: white; color: #333333; line-height: 20px; margin-bottom: 20px; padding: 0px;">These rules are followed by Medicare (a national program), Medicaid (a state program), and every private insurance company. This system was intended to pay more when you do more complicated work, but over time it has evolved into a backwards game of doing more complicated work in order to get paid more. Of course the government has hired folks to chase doctors who are flagrantly upcoding.</blockquote><div style="background-color: white; color: #333333; line-height: 20px; margin-bottom: 20px; padding: 0px;">Hard to believe doctors are not satisfied with $52 and change for a routine office visit.</div><blockquote class="tr_bq" style="background-color: white; color: #333333; line-height: 20px; margin-bottom: 20px; padding: 0px;">This is the health care over utilization that you hear about, how doctors and hospitals are incentivized by the amount of visits, tests, prescriptions, and procedures, rather than by the quality of care. In the last few years, there have been many initiatives to reform this system. In Colorado Medicaid, the initiatives are called the accountable care collaborative (ACC). In the ACC, I am the primary doctor of about 800 Medicaid patients, and my office gets a monthly bonus of $3 per person ($2,400 per month) just for participating in the program.</blockquote><blockquote class="tr_bq" style="background-color: white; color: #333333; line-height: 20px; margin-bottom: 20px; padding: 0px;">The ACC goals are to reduce the number of ER visits, reduce the number of people who leave the hospital and return a few days later (readmissions), reduce the number of CT scans and MRIs, and increase the number of annual child checkups. Each of these goals are proxies for reducing health care spending. If I can achieve all of these goals to some extent, then my $3 bonus goes up to $4, and my office gets about $800 more per month.</blockquote><div style="background-color: white; color: #333333; line-height: 20px; margin-bottom: 20px; padding: 0px;">Can you hear the cash register drawer opening?</div>

Gaming the Medicaid System

It seems the folks in DC are very good at spending money, but not so good at accounting for how it is spent or why they do what they do. It...

11:17 AM

High Risk Heisman

<div class="separator" style="clear: both; text-align: center;"><a href="http://www.shermanreport.com/wp-content/uploads/2013/12/heisman-trophy.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="98" src="http://www.shermanreport.com/wp-content/uploads/2013/12/heisman-trophy.jpg" width="140" /></a></div><div style="text-align: justify;">If you follow college football,you're most likely familiar with FSU quarterback Jameis Winston. As a quarterback, he's in a risky position, so it makes sense that he's amenable to risk management tools. Insurance, of course, is an invaluable such tool, and pretty much custom made for someone in his position. So what kind of insurance purchase did Jameis make that would make the news? How about a $10 million combination Disability/Loss-of-Value plan? Regular readers are familiar with <a href="http://insureblog.blogspot.com/2013/05/cost-of-living-di-ltci.html" target="_blank">disability insurance</a>: if Jameis gets hurt or sick bad enough to never play again, the disability plan will pay out. The Loss-of-Value policy is interesting in that, instead of replacing his current salary, it "w<a href="http://msn.foxsports.com/college-football/story/jameis-winston-insurance-policies-loss-of-value-disability-10-million-dolars-florida-state-070114" target="_blank">ould pay should Winston fall in the draft because of injury or illness</a>." In other words, it would pay out based on what he would have made had his career not been cut short due to injury or illness. Sounds like a winner.</div>

High Risk Heisman

If you follow college football,you're most likely familiar with FSU quarterback Jameis Winston. As a quarterback, he's in a risky po...

7:42 AM

Is Health Care a Right?

This question (and others) are posed by Conservative bloggers Daisy and Mockarena at <a href="http://chicksontheright.com/posts/item/26098-i-have-some-questions-for-liberals" target="_blank">Chicks on the Right.</a>       <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTWN4QMIa23GQX5l1DAJ5kWtYlkR62n2y0hyphenhyphenW4HHNoJNEqrEOxzxsbqo1ODk_tpVd6Z8OdRe3XW4xm-ZBqlEbJPtcbPqn5Ofj0xZ5rkLD65MyFbNrEIz7DXHEZbFRpDfTbzZV6CB0k8BE/s1600/flaming-liberal.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="246" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTWN4QMIa23GQX5l1DAJ5kWtYlkR62n2y0hyphenhyphenW4HHNoJNEqrEOxzxsbqo1ODk_tpVd6Z8OdRe3XW4xm-ZBqlEbJPtcbPqn5Ofj0xZ5rkLD65MyFbNrEIz7DXHEZbFRpDfTbzZV6CB0k8BE/s1600/flaming-liberal.jpg" width="320" /></a></div> If you believe in shirking personal responsibility for the basics of life in favor of "shared responsibility", in other words, someone other than you should pay for your personal hygiene items, then you might be a liberal. <blockquote class="tr_bq" style="background-color: white; line-height: 23.799999237060547px; margin-bottom: 15px;">1. Do you think that feminine hygiene products should be covered expenses under Obamacare (or employer healthplans as mandated by Obamacare?)  Do you believe that a monthly menstrual cycle should be included under the broad definition of "women's reproductive health?" If not, why not? 2.  Do you think that over-the-counter medications and diapers for kids should be covered expenses under Obamacare (or employer healthplans as mandated by Obamacare?) If not, why not?3.  What does "healthcare is a human right" mean to you exactly?  If I have neck strain due to my job sitting at a computer, and the only thing that eases that tension is a good deep-tissue massage, should that be a covered expense under Obamacare (or employer healthplan as mandated by Obamacare?) If not, why not?</blockquote><div style="background-color: white; line-height: 23.799999237060547px; margin-bottom: 15px;"><a href="http://1.%20do%20you%20think%20that%20feminine%20hygiene%20products%20should%20be%20covered%20expenses%20under%20obamacare%20%28or%20employer%20healthplans%20as%20mandated%20by%20obamacare/?)%20%20Do%20you%20believe%20that%20a%20monthly%20menstrual%20cycle%20should%20be%20included%20under%20the%20broad%20definition%20of%20%22women%27s%20reproductive%20health?%22%20If%20not,%20why%20not?%20%20%202.%20%20Do%20you%20think%20that%20over-the-counter%20medications%20and%20diapers%20for%20kids%20should%20be%20covered%20expenses%20under%20Obamacare%20(or%20employer%20healthplans%20as%20mandated%20by%20Obamacare?)%20If%20not,%20why%20not?%20%203.%20%20What%20does%20%22healthcare%20is%20a%20human%20right%22%20mean%20to%20you%20exactly?%20%20If%20I%20have%20neck%20strain%20due%20to%20my%20job%20sitting%20at%20a%20computer,%20and%20the%20only%20thing%20that%20eases%20that%20tension%20is%20a%20good%20deep-tissue%20massage,%20should%20that%20be%20a%20covered%20expense%20under%20Obamacare%20(or%20employer%20healthplan%20as%20mandated%20by%20Obamacare?)%20If%20not,%20why%20not?" target="_blank">Click here</a> for the rest of the test.</div>