Posted in Access to healthcare, American Exceptionalism, Consumer-Driven Health Care, Dependency, Direct-Pay Medicine, Direct-Pay Practice Models, Doctor-Patient Relationship, Economic Issues, Free Society, government incompetence, Government Regulations, Health Insurance, Healthcare financing, Independent Physicians, Medical Costs, Medical Practice Models, News From Washington, DC & Related Shenanigans, Organizational structure, Patient Choice, Patient Safety, Patient-centered Care, Policy Issues, primary care, Quality, Technology, Telemedicine Trends, Third-Party Free Practices, Uncategorized

Shelter In-Place Care: Another “Box Checked” for the Value of Direct Primary Care

HEADLINE:

FCC Unveils COVID-19 Telehealth Program, Updates Connected Care Pilot

The Federal Communications Commission is using $200 million in funding from the CARES Act to launch a new program to help providers access the broadband resources they need to support telehealth programs.

Wow, the government has discovered remote digital technology medical care!  Although, maybe a little late. What would we do without those innovative minds in D.C. ?!?

But there’s a better solution that’s been up and running for more than a decade; private citizens being free to act and chose what services they value.  It is a solution which occurred organically when an innovative supply side acted to solve other people’s problems within a cooperative marketplace driven by mutual benefit.  It is called Direct Primary Care (DPC). And it is only possible because we still have some semblance of healthcare freedom within our society.  No thanks to Washington, D.C.

But step aside, the FCC with money to burn is coming to the rescue after COVID is already in full crisis mode.

The DPC Consumer Guide -- Now Available for office/clinic use and and an educational/marketing resource for your patients.Never mind that Direct Primary Care physicians have routinely integrated remote care technology platforms into their practices for a more than a decade.  And set aside the fact that revenue in a DPC business model doesn’t rely on office visits (the opposite of social distancing) to trigger a billable encounter, the claim against which is paid out of a grossly over-priced pre-paid 3rd party fund that we call health insurance.  Instead, the Direct Primary Care physician is paid to be available to solve problems, answer questions, triage illness/injury, provide treatment and advice via the most appropriate venue for each patient.

And last, no disrespect meant to the media outlet below for featuring this story.  They are just reporting the healthcare news, as is their mission.

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https://mhealthintelligence.com/news/fcc-unveils-covid-19-telehealth-program-updates-connected-care-pilot

Posted in Access to healthcare, big government, Economic Issues, Government Spending, Government Stimulus, Health Insurance, Healthcare financing, Medical Costs, Medicare, Organizational structure, Philosophy, Policy Issues, Uncategorized

5 Charts That Explain the Student Debt Crisis – Foundation for Economic Education

The commonality between the insatiable rise in both healthcare costs and college tuition, post 1965, should be obvious:  Massive amounts of other people’s money in the form of government programs, payments, subsidies and loan guarantees; which economists call the 3rd-party payer effect.

As exposited in the FEE article below, the U.S. Higher Education Act introduced “incentives” into the market for higher education, encouraging both the supply side and the demand side to make decisions that they would not be as likely to make under “non-stimulated” market situations.

Similarly, the passage of Medicare in 1965 sent huge surge of money into the healthcare system. The predictable consequence of this massive revenue stream was an incentive for healthcare providers to enter the market and expand services at an unprecedented magnitude and rate.  Essentially, demand was spurred by new source of financing.  Amy Finkelstein, et.al have done excellent work in this area.  Her work indicates that Medicare funding may have allowed hospital to spend 6-fold more than what individual levels of insurance would have predicted.  And that the spread of 3rd party insurance from 1950 – 1990 may explain about 50% of the increase in real per capita spending over that time period. https://economics.mit.edu/files/788

 

 

“As Bernie Sanders tweeted last year, the cost of education, in nominal dollars, has increased by roughly 3,800 percent since the mid 1960s.

What Sanders didn’t mention was that this was when the US Higher Education Act was passed (1965), which directed taxpayer dollars to low-interest loans for students pursuing college. This increased accessibility to higher education, but the flood of federal money also caused a surge in demand and costs.

The problem isn’t unsolvable, but it will require significant changes to universities and the federal loan program. “Free” tuition and student debt forgiveness will only make the problem worse.

Instead, as University of Maryland economist Peter Morici recently argued, market discipline must be brought back to our institutions of higher learning as part of any debt forgiveness.

While policy wonks offer no shortage of proposals for tweaking the federal loan program to improve it, perhaps the best solution would be to get the federal government out of the loan business all together.”

https://fee.org/articles/5-charts-that-explain-the-student-debt-crisis/

Posted in Access to healthcare, advance-pricing, Economic Issues, Health Insurance, Healthcare financing, Medicaid, Medical Costs, medical inflation, Medical Practice Models, Medicare, out-of-pocket costs, Patient Choice, Price Tansparency, Quality, Uncategorized

G. Keith Smith, M.D. — Health “Coverage” as a Distraction


I think it is good to be alert to any discussions that are “downstream of a flawed premise.” Let me explain.

When I hear, for instance, that the “flat tax” is preferable to the current income tax, I think to myself that this is a discussion of the knife versus the axe, a conversation far downstream of one addressing government spending or the very legitimacy of denying someone their earnings. After all, victims don’t generally care what the mugger does with their money. They just resent being mugged and no discussion about whether the mugger used a knife or a gun will likely provide any solace.

Similarly, I would argue that arguing for everyone to have health “coverage” is far downstream of the more original problem: the cost of healthcare. To provide “coverage” for everyone in the current climate of gross overcharging primarily serves the interests of those who employ the “what can I get away with” method of medical pricing.

The fierce push back against true price transparency by the cronies in the medical industry makes more sense in this context, as price honesty denies them access to everyone’s blank checkbook as the health cronies are well aware.

Supporters of government-guaranteed “coverage” object with the following arguments.

First, coverage is equated with healthcare. While millions of Canadians streaming across the border to secure their health needs could be used to refute the idea that coverage is synonymous with care, this disconnect has become more apparent in this country. Each passing day reveals Medicaid and Medicare “coverage” to be a “black mark,” an actual obstacle to obtaining care, as these government programs and their associated rationing through price controls and hassles are creating the lines the central planners intended. Physicians are either dropping out of these programs altogether or they are limiting their exposure to patients with this “coverage.”

Another objection points to the relief from financial devastation that having “coverage” represents. Keep in mind that not only are well over half of the bankruptcies in this country medically related, but almost three quarters of those filing for medical bankruptcy have insurance. This points powerfully to cost as the root cause of medical economic ills.

Acknowledging this is a slippery slope for the objector, however, for no economic system better provides for resource allocation than the market and the cronies and their government pals know this as well as anyone.

The market is the only source of price deflation with simultaneous improvement in quality. This powerful competitive mechanism has brought affordability to countless products and services in all industries and has begun to bring rationality to health care pricing as more physicians and facilities honestly post their prices for all to see.

Rather than focus on “coverage,” which allows the cronies to continue their financial feeding frenzy, we should remain unalterably focused on cost. The competition unleashed will result in a medical price deflation the likes of which will cause even the most skeptical objector to re-evaluate the role of “coverage” in the provision of payment for health care.

This is no prediction. This is exactly what is happening here in Oklahoma where so many health professionals have embraced the same market discipline every other industry must endure. The reasonable prices and high quality of care, have had such a wide appeal that Oklahoma City has evolved into a medical tourist destination for many patients far from here, while simultaneously bringing savings in the millions of dollars to those who actually pay for healthcare, locally.

This is my answer to another objection from those who claim the inapplicability of market competition to health care.  Whether the focus on “coverage” is a deliberate distraction by the crony propaganda machine or a well-meaning but misguided attempt to provide better access to care, we must keep our eyes on the “price transparency ball.” The Oklahoma market is already harshly judging those attempting to avoid this gaze and I believe this trend will continue as long as we identify, challenge and reject conclusions downstream of their flawed premises.

Posted in Access to healthcare, Canadian Health System, Economic Issues, Government Regulations, Healthcare financing, Medical Costs, Organizational structure, Policy Issues, Uncategorized

Alberta ends master agreement with doctors, new rules to be in place April 1 | CBC News

HEALTHCARE ECONOMIC REALITY CHECK:

  • Supply is limited (it is a service & commodity that is rendered by others)
  • Demand is inexhaustible (innumerable definitions of healthcare needs and wants)
  • Fixing prices exacerbates shortages (resources flow to where they are valued)

This article instantiates the snares and trappings of gov’t financed systems where gov’t functions as a buyer, payer and regulator!  

In the case of this Alberta Canada conundrum, cutting fees is a surrogate for rationing. It encourages providers to short-cut care by reducing time spent with complex patients.  The dangerous flip side of that ugly coin is that the cuts encourage emphasis on increasing the number of shorter visits.

 

tyler-shandro
Health Minister Tyler Shandro says enforcing new rules on Alberta doctors is necessary to meet budget targets. (Colin Hall/CBC)

Last fall, Premier Jason Kenney’s United Conservatives passed Bill 21, which gives the government the right to unilaterally end the agreement.

A decade ago, Alberta added in an extra fee — called a complex modifier — to recognize that some patients have multiple or complex issues and doctors should be compensated for overly long visits.

If a visit went more than 15 minutes, doctors were able to extend it 10 minutes and bill the province a complex modifier fee of $18, for a total of $59.

As of April 1, the fee will be halved from $18 to $9, for a new total fee of $50.

As of April 1, 2021, the $18 complex modifier will return. But physicians won’t be allowed to bill for it until the 25-minute mark.

Doctors warn of cutting visits

Shandro’s ministry says the change is necessary for two reasons: more time is needed to assess complex patients and the current complex modifier is being abused, with too many doctors billing the $59 right at the 15-minute mark.

At a news conference announcing the changes, Shandro said the modifier was being used for almost 50 per cent of visits.

The Alberta Medical Association, the bargaining arm for doctors, has said extending the length of a visit to 25 minutes would reduce fees by a total of $200 million and devastate many family and rural practices.

The AMA has argued the complex modifiers are not only for exceptional cases and take into account all the work — preparation, follow-up and face-to-face time — needed for patients with complex needs. It also says it keeps those patients out of the hospital.

The issue has riled up some doctors, many of whom have put up signs warning patients they may have to cut future visits short to recoup funds needed to keep their practices going.

https://www.cbc.ca/news/canada/calgary/alberta-government-doctors-pay-ama-agreement-1.5470352

Posted in Access to healthcare, Consumer-Driven Health Care, Defined Contribution Benefit Plans, Direct-Pay Medicine, Direct-Pay Practice Models, Economic Issues, Employer-Sponsored Health Plans, Health Insurance, Healthcare financing, Independent Physicians, Medical Costs, Medical Practice Models, Policy Issues, Tax Policy, third-party payments, Uncategorized

Who Pays for Your Healthcare Matters

By Robert Nelson

Zero co-pays. No co-insurance. No surprise medical bills! Considering the inflated prices we pay for healthcare, who could pass up that deal, right?

Are the new generation of value-based employer-sponsored Direct Contracting Health Plans, which often include Direct Primary Care, a great deal and more efficient use of our healthcare dollars? Absolutely yes!

real-health-care-expenditures-and-third-party-largerBut we can’t lose sight of the economic reality that individuals always pay the cost of benefits, either directly or indirectly.  And linking benefits to employment has been a colossal policy mistake and the genesis of job-lock and our 3rd-party payer system, which has been the source of runaway costs for 50 years. As the graph illustrates, insurance (3rd party payer) is now a near surrogate for total healthcare costs!

Don’t be fooled. Within the modern paradigm of healthcare financing, employers don’t pay for our healthcare. Our healthcare expense, no matter how it is structured, IS part of our compensation and a huge portion of of it.

images-223535545945618981307.jpgFACT: Every dollar of tax-favored benefits paid by our employer reduces our take-home pay.

The beauty of Direct Primary Care is the portability (no job lock) and affordability which can exist independent of the size or benefit package of the employer. But the foundation which aligns the incentives is based on the identity of the customer. This is why we have to be careful to match the buyer with the recipient of care whenever possible. To insert another 3rd party, even the employer, undermines the sovereignty of the patient and the independence of the physician.

The supply side of healthcare has served the wrong customers for far too long. DPC should not make that same fatal error by exchanging its essence for a pipeline of patients.

This linkage highlights the importance of policy decisions regarding use of HSA funds; the importance of allowing HSA dollars to pay premiums AND DPC fees can’t be overstated.

For DPC, and Direct Contracting at-large, to dig us out from under the boot of the 3rd party apparatus it must remain accessible to the sole proprietor, independent contractor and very small businesses that don’t have “health plans.” And moving to defined contribution plans and away from defined benefit plans will help get us there.

third-party-2Getting first dollar decisions in hands of consumers will also be deflationary and spur competition; and essential to the goal of eventual portability & ownership of benefits. To do otherwise, with too much focus on a new & improved generation of employer-sponsored healthcare plans, will lead us right back to where we started.

Posted in Access to healthcare, advance-pricing, Direct-Pay Medicine, Direct-Pay Practice Models, Entrepreneurs, Healthcare financing, Independent Physicians, Medical Costs, Medical Practice Models, out-of-pocket costs, Patient Choice, Patient Safety, Patient-centered Care, Policy Issues, Price Tansparency, Quality, Uncategorized

Transparent Pricing for Medical Emergencies | The Emergency Center

What the status quo apologists and the naysayers said was impossible, is a reality:

Emergency services with transparent pricing and NO surprise bills!

“Always staffed with board-certified physicians, ICU- and ER-trained nurses, X-ray technologists and helpful administrative personnel, The Emergency Center offers the same comprehensive emergency care and treatment as a hospital ER, without the wait. State-of-the-art CT, ultrasound, x-ray, and lab services on-site combined with compassionate care provides an unparalleled patient experience.

The Emergency Center and OnDEC Health have partnered together to offer direct contracts for emergency room visits, urgent and primary care, plus telemedicine. OnDEC Health’s innovative direct contracting opportunities save employers significant dollars on ER claims, while offering their members 24/7, no-wait access to premier concierge style freestanding ERs and more.”

Peyton Vooletich

Director of Business Development

https://www.theemergencycenter.com/fort-worth-er/

Posted in Access to healthcare, advance-pricing, Direct-Pay Medicine, Direct-Pay Practice Models, Entrepreneurs, Healthcare financing, Independent Physicians, Medical Costs, Medical Practice Models, out-of-pocket costs, Patient Choice, Patient Safety, Patient-centered Care, Policy Issues, Price Tansparency, Quality, Uncategorized

Transparent Pricing for Medical Emergencies | The Emergency Center

What the status quo apologists and the naysayers said was impossible, is a reality:

Emergency services with transparent pricing and NO surprise bills!

“Always staffed with board-certified physicians, ICU- and ER-trained nurses, X-ray technologists and helpful administrative personnel, The Emergency Center offers the same comprehensive emergency care and treatment as a hospital ER, without the wait. State-of-the-art CT, ultrasound, x-ray, and lab services on-site combined with compassionate care provides an unparalleled patient experience.

The Emergency Center and OnDEC Health have partnered together to offer direct contracts for emergency room visits, urgent and primary care, plus telemedicine. OnDEC Health’s innovative direct contracting opportunities save employers significant dollars on ER claims, while offering their members 24/7, no-wait access to premier concierge style freestanding ERs and more.”

Peyton Vooletich

Director of Business Development

https://www.theemergencycenter.com/fort-worth-er/

Posted in Access to healthcare, Direct-Pay Medicine, Direct-Pay Practice Models, Economic Issues, Health Insurance, Healthcare financing, Independent Physicians, Medical Costs, Patient Choice, Price Tansparency, Self-Insured Companies, Uncategorized

Jay Kempton: An Unorthodox Benefits Solution – Healthcare Americana

Healthcare Americana, Chris is joined by Jay Kempton of The Kempton Group and co-founder of the Free Market Medical Association (FMMA).

Chris and Jay discuss novel ways of implementing employee benefits, why there are barriers to change, and the upcoming FMMA conference.

https://healthcareamericana.com/episode/jay-kempton-an-unorthodox-benefits-solution/