Posted in Access to healthcare, advance-pricing, Affordable Care Act (ObamaCare), CPT billing, Deductibles, Dependency, Direct-Pay Medicine, Direct-Pay Practice Models, Economic Issues, Employee Benefits, Health Insurance, Healthcare financing, Individual Market, Medical Costs, medical inflation, Medical Practice Models, Organizational structure, outcomes measurement, Patient Choice, Policy Issues, Price Tansparency, Self-Insured Companies, Self-Insured Plans, The Triple Aim, Uncategorized

U.S. Healthcare: A Case Study of What Happens When “Insurance” Supplants Price-Transparent Markets

By Robert Nelson, MD

Our health insurance-based third-party payer protocols have pernicious and nefarious economic consequences on the cost of medical care; and in many ways has diminished access due to regulatory complexities that accompany these interventions.

The undeniable result continues to be a rampant increase in healthcare prices, which is catalyzed by the economic distortions of the 3rd party payer effect and perpetuated by the price-obscuring distortions of the CPT billing cycle.

We have taken the concept of insurance, designed to pay out rare higher-priced claims on unpredictable events, and turned it into a product whose design promotes an incentive for everyone to use it as often as possible.

Insurance is sustainable only when the financial risks of individually rare events are spread over a large population. When it also becomes a funding source for anticipated and affordable events, combined with a perverse incentive to utilize it to the margin, the result is the creation of a perpetual payout fund.

The costs of sustaining this model are never satisfied, being squeezed by patients who are chasing the benefits and providers who chase the billing codes to achieve maximal reimbursement.

As evidence for the negative consequence of misusing insurance as a pass-through system for virtually every healthcare expense (accelerated by passage of the ACA), we can examine the employer-sponsored group market premiums.

From 2007 – 2017 the average premium for family coverage increased by 55% and employee contribution rate as a share of premium cost increased by 74% over the same 10-year period; while median household income went up by only 3%.

To add financial injury to insult, the percentage of employees with an out-of-pocket maximum of greater than $3,000 doubled, going from 30% to 60% of employees.

“Eighty-one percent of covered workers have a general annual deductible for single coverage that must be met before most services are paid for by the plan. Among covered workers with a general annual deductible, the average deductible amount for single coverage is $1,505.” ~KFF.org

Between 2012 – 2017, the percentage of covered workers with a general annual deductible of $1,000 or more for single coverage has grown substantially, increasing from 34% in 2012 to 51% in 2017. Thirty-seven percent of covered workers in small firms are in a plan with a deductible of at least $2,000, compared to 15% for covered workers in large firms.

In the ACA individual market insurance exchanges, single coverage premiums (unsubsidized) increased by 62% and family coverage premiums increased by 75% just since implementation of ObamaCare!

Our third-party payer system has created a dependency trap!  The same financial tool we rely on to pay our healthcare providers also contributes to runaway costs; making us more dependent on it for access. This guarantees that Healthcare will cost significantly more than the sum of its individual parts, and will continue to escalate faster than our ability to pay for it.

The costs associated with health plan premiums (aka insurance) have become a surrogate for health-care costs.

Now let that sink in!

In what other market does the cost of an insurance product act as substitute for the aggregate cost of the product or services that it insures?

Now apply a similar scenario to the auto insurance market. It doesn’t take much imagination to extrapolate how that would play out. But if you want some help visualizing the scenario, here’s a brief vignette. https://lnkd.in/eUGeCKv

Self-insured employer health plans are in a unique position to break out of this dependency paradox.

By contracting with a Direct Primary Care practice and re-routing subsequent encounters away from the more expensive insurance-based protocols, Self-insured employers can utilize creative plan designs to cut costs and improve employee satisfaction.

Data from the Qliance experience, and supported by other self-insured employer’s experiences, utilization of efficient primary care via the DPC model reduces unnecessary downstream care by approximately 50%, with the resultant aggregate cost savings of nearly 20%.

The caveat being, as we double the number of primary care visits combined with longer visits to adequately address problems, the need for emergent visits, ER visits and specialty intervention drop significantly.

A similar level of savings for direct-pay lab tests was noted in data published in 2014 by CMT journal comparing lab fees charged to a Direct Pay practice by the lab vs. the CPT billed charges by the lab (assuming patient had no coverage or had not met their deductible). For five common blood tests the savings was 89% by not using insurance, with lab billed charges of approximately $782 compared to a direct pay cost of $80. Plum Health, a direct primary care practice in Detroit, shows similarly impressive lab test savings of 87% on six common blood tests; $811 vs $106.

Many Self-insured companies are beginning to discover the value and savings in this approach, while breaking free of the coverage trap and the myth that health insurance equates to health care; and the realization that so-called “access” to inflated pricing and the phony discounts used to fleece the buyer is no longer a conversation they are willing to have.

Posted in Access to healthcare, Affordable Care Act (ObamaCare), American Presidents, Defined Contribution Benefit Plans, Economic Issues, Employee Benefits, Employer Mandate, Employer-Sponsored Health Plans, Government Regulations, Health Insurance, Health Reimbursement Arrangement (HRA), Healthcare financing, Individual Market, Individual ObamaCare Market, Individual Underwriting Standards, Medical Costs, News From Washington, Patient Choice, Policy Issues, Portable Insurance, Pre-existing Conditions, The Triple Aim, Uncategorized

Donald Trump Takes A Big Step Toward Personal And Portable Health Insurance

READ THIS ARTICLE below if you want to understand the degree to which this ruling is an important step for healthcare reform.

But as John C. Goodman points out, administrative ruling can only go so far without being codified by legislative action.

Some believe the Individual Market is too weak to revive, given the hit it took as as result of the ACA.

I am optimistic that this ruling to utilize HRA is this manner will be a “shot in the arm” and revitalize the market again.

This hopefully highlights the benefits, and spurs popularity, of a defined contribution approach as a means to purchase health insurance.

Anything that makes us less dependent on ESI and gives more portability & options, freeing the labor market from job-lock is a good thing. -Forum for Healthcare Freedom

John C. Goodman

https://www.forbes.com/sites/johngoodman/2019/06/18/donald-trump-takes-a-big-step-toward-personal-and-portable-health-insurance/

Posted in Access to healthcare, Economic Issues, Education, Government Regulations, Healthcare financing, Influence peddling, Medical Costs, Medical Practice Models, Organizational structure, outcomes, outcomes measurement, Policy Issues, Protocols, The Quadruple Aim, The Triple Aim, Uncategorized

Aim your baloney detector at the BS in health care – STAT


BS, what Princeton philosopher Harry Frankfurt once calleda “lack of connection to a concern with truth — this indifference to how things really are,” has probably been around since the beginning of language.

Health care has an acute BS problem, in part because BS can sometimes fill the bill.

“Suppose you are asked to address an ageless problem in health care: reduce costs while simultaneously raising quality. If you were knowledgeable to begin with or did some research, you would know there is no easy solution. You could respond with a message of failure or a discussion of inevitable trade-offs.

But you could also pick an idea with some internal plausibility and political appeal, surround it with careful but conditional language, and launch a program. It will, you note, take several years before it is successful, but you and your colleagues will argue for the idea in concept, with the details to be worked out later.

At a minimum, unqualified acceptance of such ideas, even (and especially) by apparently qualified people, will waste resources that could have been used to make the best of what we currently have, and will lead to enormous frustration for the audience of politicians and outraged critics of the current system who want answers and want them now.

The incentives to generate BS are not likely to diminish — if anything, rising spending and stagnant health outcomes strengthen them…

…educator, media theorist, and cultural critic Neil Postman said that “helping kids to activate their crap-detectors should take precedence over any other legitimate educational aim …
We have carried Postman’s banner into academia with two reports, one in 2018and another this year, that identify 21 different forms of BS in health care. Here are our top 10:”

https://www.statnews.com/2019/05/03/bs-health-care-baloney-detector/

Posted in Access to healthcare, advance-pricing, Direct-Pay Practice Models, Economic Issues, Education, Employee Benefits, Free-Market, Health Insurance, Healthcare financing, Independent Physicians, Influence peddling, Liberty, Medical Costs, medical inflation, Medical Practice Models, Patient Choice, Policy Issues, Price Tansparency, The Quadruple Aim, The Triple Aim, third-party payments, Uncategorized

Annual Conference | Free Market Medical Association

Forum for Healthcare Freedom is proud to be a Mobile App & WiFi Sponsor for the 2019 Free Market Medical Association annual conference, to be held at the Hyatt Regency in downtown Dallas, TX.

Since 2014, the mission of the FMMA has transformed from Education to Insurrection.  Our mission is to rouse and provoke those suffering because of the broken system and motivate them to fight back.

The 2019 Conference speakers will motivate, energize, influence, and empower attendees to eliminate the option of retreat, reject the status quo, and emancipate themselves from the deteriorating ship.

We have an incredible lineup of general session speakers, including our Keynote Luncheon speaker, the Honorable Ron Paul, M.D.  All attendees will find something of value in one of our eight breakout sessions covering topics such as Incorporating the Free Market into your Benefit Plan, HMOs & the Free Market, Pricing of Specialty Care, Lies Employer’s Believe, Creating Bundled Pricing, and more! The conference will close with our Founder Panel where Dr. Keith Smith and Jay Kempton will present Burning the Ships: Going All In!

Space is limited, so register today!

Source: Annual Conference | Free Market Medical Association

Posted in Access to healthcare, Consumer-Driven Health Care, CPT billing, Direct-Pay Medicine, Direct-Pay Practice Models, Doctor-Patient Relationship, Economic Issues, Employee Benefits, Employer-Sponsored Health Plans, Health Insurance, Healthcare financing, Medical Costs, Medical Practice Models, Patient Choice, Patient-centered Care, primary care, Quality, The Triple Aim, Third-Party Free Practices, Uncategorized

DPC and Self-insured Employers: Lifestyle-friendly Care for the 21st Century

http://ushealthmedia.com/dpc-and-self-insured-employers-lifestyle-friendly-care-for-the-21st-century/

In a typical insurance-based practice, meaningful face-to-face time between doctor and patient is somewhere between 5-10 minutes. Interesting, but surprisingly, shorter visits tended to result in more prescriptions being written and less time trying to get to the root of clinical problems.  And prescribing is usually a poor surrogate for good counsel and reassurance.

“What do you get when you mix low overhead with high technology and wrap it around an excellent physician-patient relationship? You get an ideal medical practice – a practice model designed to enhance doctor-patient relationships, increase face-to-face time between doctors and patients, reduce physician workloads, instill patients with a sense of responsibility for their health and cut wasted dollars from the entire system.”

The quote above is NOT from a Direct pay doctor or advocate, even though it precisely describes the attributes of DPC.  The quote is from the American Association of Family Physicians: The Ideal Medical Practice Model: Improving Efficiency, Quality and the Doctor-Patient Relationship.  

Notice how many of the characteristics of the Ideal Medical Practice looks very similar to the characteristics of a typical Direct Primary Care practice.  The ability to provide exemplary service is a natural element that arises from Direct Primary Care and other direct-pay models.

This direct engagement, absent the complexities and barriers created by the third-party network billing apparatus, enables a level of lifestyle-friendly involvement that naturally leads to a more satisfactory patient-doctor relationship and potentially superior clinical outcomes.

It’s hard to argue with cheaper and better.

Source: DPC and Self-insured Employers: Lifestyle-friendly Care for the 21st Century

Posted in advance-pricing, CPT billing, Direct-Pay Practice Models, Economic Issues, Health Insurance, Healthcare financing, Medical Costs, medical inflation, Medical Practice Models, out-of-pocket costs, outcomes, Policy Issues, Protocols, Quality, Tax Policy, The Triple Aim, Uncategorized

How to Control Healthcare Costs: Know Why They are High

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by Robert Nelson, MD

 

The formula for excessive Healthcare spending:

Most healthcare $$ resources tied up in premiums/billing cycle + lack of price transparency + Patients chasing benefits + Doctors chasing billing codes + No incentives to care about costs + Small Direct Pay market + Treatment Bias + Defensive Medicine + Unwise public policy and tax laws =

EXCESSIVELY HIGH SPENDING with low health value and low economic value.

Learn it.

Affect change where you can.

Pass it on.

Posted in Access to healthcare, advance-pricing, CPT billing, Direct-Pay Medicine, Direct-Pay Practice Models, Economic Issues, Education, Employee Benefits, Employer-Sponsored Health Plans, Health Insurance, Healthcare financing, Independent Physicians, Medical Costs, medical inflation, Medical Practice Models, Policy Issues, Price Tansparency, The Quadruple Aim, The Triple Aim, Third-Party Free Practices, Uncategorized

The Change We Seek We Must Create

lightbulb.solutionsThe reach and effectiveness of healthcare innovation and change is ultimately staked to how we pay for healthcare in aggregate. Building economic paradigms with more attractive price-value relationships will be the conduit through which change will emerge.

1.Employer education & engagement about the benefits of alternative health plan design based on maximal uncoupling from the BUCAHs.

2. Promoting opportunities for physician independenc apart from the price-concealing contractual third-party payment arrangements, and their co-conspirators, the giant NFP hospital systems.

3. Promoting / facilitating specialty and ancillary service cooperation / agreements which provide them revenue alternatives to the standard price-gouging CPT insurance billing protocols.