Posted in Access to healthcare, Affordable Care Act (ObamaCare), CPT billing, Direct-Pay Medicine, Direct-Pay Practice Models, Economic Issues, Employer-Sponsored Health Plans, Essential Benefits under the ACA, Free-Market, Government Regulations, Health Insurance, Healthcare financing, Medical Costs, medical inflation, Medical Practice Models, Network Discounts, Policy Issues, Third-Party Free Practices, third-party payments, Uncategorized

Irrational Healthcare Payment System Drives Costs And Why Payers Go Along With It | Robert Nelson, MD | LinkedIn


Our third-party payer system, by the nature of how coding & billing is contractually mandated, promotes increased health spending on aggregate – and the economic design of the system includes a perverse incentive to keep the spending going. 

real-health-care-expenditures-and-third-party-largerThis occurs in large part due to price insensitivity on the consumer-patient side due to the low marginal cost of entry compared to the inflated CPT billed charges which serve as a pivot point for network discounts. i.e. ~ once a co-pay is paid, patients don’t have any incentive to know or care what is done or how much it costs. 

 

These perverse motivations are what keeps premiums going up and up… Without utilization (claims), there is no other way to grow the pie because payers are not free to make a higher profit margin beyond the mandated cap, even if they do things to lower aggregate utilization which might lower premiums for everyone.  In other words, payers are not rewarded for efficiency, they reap financial reward to the extent that utilization, thus costs, continue to rise. 

Source: Irrational Healthcare Payment System Drives Costs And Why Payers Go Along With It | Robert Nelson, MD | LinkedIn

Posted in Access to healthcare, Consumer-Driven Health Care, Direct-Pay Medicine, Direct-Pay Practice Models, Disease Prevention, Doctor-Patient Relations, Doctor-Patient Relationship, Economic Issues, Entrepreneurs, Evidence-based Medicine, Government Regulations, Medical Costs, medical inflation, Medical Practice Models, Medicare, Organizational structure, Patient Safety, Patient-centered Care, Policy Issues, Prevention, primary care, Quality, Technology, Telemedicine Trends, The Triple Aim, Third-Party Free Practices, third-party payments, Uncategorized, Unsettled Science

The Sovereign Patient Top 10 most viewed posts of 2015

 

top-10-list

  1. Medicine Is About to Get Personal | TIME
  2. MyDoc – Personal Physician Services | Robert Nelson, MD.
  3. Statins in Primary Prevention: Welcome to the Gray Zone

  4. Atrial Fibrillation Care: Put the Catheter (and Rx Pad) Down

  5. About This Blog

  6. How Government Regulations Made Healthcare So Expensive | Blog | Mises Institute

  7. Not Running a Hospital: The Triple Aimers have missed the mark

  8. The 7 Organizations That Will Turn Healthcare Upside Down In 2016 – Forbes

  9. Video: The Importance of Market Forces and The Effect of Government Intervention in Healthcare Costs – by Eline van den Brock of the European Independent Institute

  10. The Core Beliefs of the Delightfully Successful | LinkedIn

Posted in Consumer-Driven Health Care, CPT billing, Direct-Pay Practice Models, Medical Costs, medical inflation, third-party payments

The Trouble with the Healthcare Bubble | Robert Nelson, MD | LinkedIn

Bubble-TroubleIn this self-perpetuating cycle, all of the dollars get sent through tightly controlled and mandated billing channels making it nearly impossible to render care or receive medical care unless you subjugate yourself to the process.  All of this, of course, is being fueled by exorbitant health plans premiums.

Source: The Trouble with the Healthcare Bubble | Robert Nelson, MD | LinkedIn