Posted in Access to healthcare, advance-pricing, CPT billing, Economic Issues, Health Insurance, Healthcare financing, Independent Physicians, Medical Costs, medical inflation, Medical Practice Models, Policy Issues, Uncategorized

Wheel of Misfortune: The Fix

downloadHealthcare Transparency initiatives like the Alexander-Murray bill are getting a tremendous amount of press lately; deservedly so. But are these measures a fix or a baidaid?

Keep in mind, out-of-network “surprise” bills would not exist if not for the market surrogate (poor surrogate that it is) that we call PPO networks, which serve to suppress competition by obscuring prices & quality.

So, it is not a stretch to say that surprise bills occur by design. The way we’ve chosen to finance medical care allows prices to hide among the placeholders in the billing cycle because doctors have become defacto billing agents for the carrier networks and their anti-competitive, contractually-mandated CPT billing protocols. And the rights to those codes are owned by the AMA and the RVU dollar conversion factor is determined by CMS which guarantees upward trajectory of billed charges which make the process impervious to price competition.

This whole problem evaporates when providers remove themselves from the contract and replace these unholy inflationary-prone agreements with real prices and/or transparent service agreements.

Fix the problem: Keep the contract between the subscriber and the insurer.

Posted in Access to healthcare, Affordable Care Act (ObamaCare), CPT billing, Economic Issues, Essential Benefits under the ACA, Government Regulations, Health Insurance, Healthcare financing, Medical Costs, medical inflation, Medicare, out-of-pocket costs, Policy Issues, Price Tansparency, third-party payments, Uncategorized

Medicare Turns Health-Care Prices Into a Guessing Game – WSJ

https://www.wsj.com/articles/medicare-turns-health-care-prices-into-a-guessing-game-11558282907

Posted in Access to healthcare, Economic Issues, Government Regulations, Health Insurance, Healthcare financing, Medicaid, Medical Costs, medical inflation, Medicare, out-of-pocket costs, Policy Issues, Uncategorized

The Pernicious Impact of Government Intervention in Healthcare, Captured in a Chart

AdministratorGrowthVS.PhysiciansAs Dan Mitchell mentions in his post, much of the dysfunction we witness in healthcare are simply symptoms of the distortions that arise when we rely on a third-party payer system, with heavy government involvement, and all its perverse incentives which distort decision making for all participants. And so often the proposed “fixes” are aimed at mitigating symptoms caused by the third-party effect, rather than peeling back the layers to get to the root cause. Is it any wonder things aren’t improving despite billions and billions of subsidies, massive intervention, regulations and various forms of scrutiny!

International Liberty

America’s healthcare system is a mess, largely because government intervention (Medicare, Medicaid, Obamacare, and the tax code’s healthcare exclusion) have produced a system where consumers almost never directly pay for their medical services.

This “third-party payer” system basically means market forces are absent. Consumers have very little reason to focus on cost, after all, if taxpayers or insurance companies are picking up the tab for nearly 90 percent of expenses.

As a result, we get ever-higher prices.

But we also get a lot of featherbedding and inefficiency because providers want to take advantage of this system.

Athenahealth offered some sobering analysis on the system last year.

The number of physicians in the United States grew 150 percent between 1975 and 2010, roughly in keeping with population growth, while the number of healthcare administrators increased 3,200 percent for the same time period.

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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, Affordable Care Act (ObamaCare), CPT billing, Economic Issues, Health Insurance, Healthcare financing, medical inflation, Medical Practice Models, out-of-pocket costs, Policy Issues, primary care, Uncategorized

Bastiat Society | Nashville

“Healthcare Economics 101: The Bubble is the Trouble” with Dr. Bob Nelson

ADS Security Nashville3001 Armory Dr #100, Nashville, TN 37204, USA map 

Join the Nashville chapter on November 30th at 6:00 pm for their last event of 2017.

Dr. Bob Nelson will give a talk on healthcare. The event is free and open to the public, but you are encouraged to register so that there will be enough refreshments.

About the speaker:

Dr. Robert (Bob) Nelson is the Publisher and editor of The Sovereign Patient, a blog and information resource tool dedicated to Promoting Freedom in Healthcare Using the Power of Free-minds and Free-markets.

Dr. Nelson is a founding member and spokesperson for the Georgia Chapter of the Free Market Medical Association. The FMMA is a non-partisan association that provides resources, support and education to members and to the public about the free market movement and why it is important.

He has authored of over 50 articles and essays focusing on the consequences of unwise tax laws, public policy and pricing failure which have contributed to our healthcare debacle, while proposing free-market solutions to bring down costs and improve access to care.

Dr. Nelson has spoken about healthcare economics and free-market healthcare principles to the Bastiat Society of Charleston, SC. He had the privilege of addressing the 3rd Annual Palmetto Panel at Clemson University about the importance of healthcare economic freedom within our Republic. Dr. Nelson also had the pleasure of speaking to medical students at the Philadelphia College of Medicine campus in Suwanee, Georgia about the role of Direct Primary Care.

He has been a guest on radio shows such as “Your Health Matters” 89.7 WGLS-FM, Doc Talk on WGST 640 in Atlanta and The Vince Coakley show on 103.6 FM in Greenville, SC.

Dr. Nelson received his M.D. degree at the Ohio State University College of Medicine in 1985. He is the Founder and Owner of Encompass Health Direct, in Cumming, GA; providing low-cost primary care for a flat monthly fee.

Bob lives with his wife, Tammy, in Cumming, GA.

Register Now!

Schedule:

6:00 pm Happy Hour
6:30 pm Speaker
7:00 pm Q&A

Continue reading “Bastiat Society | Nashville”

Posted in Access to healthcare, advance-pricing, Economic Issues, Electronic Health Records, Government Regulations, Health Insurance, Healthcare financing, Medical Costs, medical inflation, Organizational structure, out-of-pocket costs, outcomes, Patient Choice, Patient Safety, Patient-centered Care, Policy Issues, Portable Insurance, Price Tansparency, Quality, Technology, Uncategorized, Uninsured

Health Care: You Are Not the Customer (David Goldhill) – YouTube

David Goldhill

Health “insurance” is NOT…INSURANCE. When everyone’s house is on fire at the same time we’re not talking about managing risk, we’re talking about a perpetually increasing spend.

Please listen to this insightful explanation by David Goldhill where he discusses this phenomenon and explains why Healthcare is not the economic Island that we made it out to be. Instead, much of what we believe and what we’ve done to healthcare, as far as economics and regulations, has made it an island unto itself. This is a huge part of the problem and one that has largely been self inflicted.

Posted in Access to healthcare, advance-pricing, Affordable Care Act (ObamaCare), big government, Direct-Pay Medicine, Direct-Pay Practice Models, Economic Issues, Free Society, Free-Market, Health Insurance, Healthcare financing, Liberty, Medical Costs, medical inflation, Network Discounts, Policy Issues, Rule of Law, Tax Policy, Uncategorized

Dr. Bob Nelson speaks to the Palmetto Panel about importance of Healthcare Freedom in our Republic

Georgia Chapter Free Market Medical Association spokesperson, Dr. Bob Nelson, had the honor of addressing the 3rd annual Citizens in Action, Palmetto Panel held at Clemson University on February 25th about healthcare freedom and the importance of liberating markets with price honesty in healthcare.


<p><a href=”https://vimeo.com/205822572″>Palmetto Panel: Dr. Bob Nelson, Free Market Medical Association</a> from <a href=”https://vimeo.com/user1416051″>Thomas Hanson</a> on <a href=”https://vimeo.com”>Vimeo</a&gt;.</p>

Posted in Access to healthcare, Affordable Care Act (ObamaCare), British National Health Service, Consumer-Driven Health Care, Deductibles, Direct-Pay Medicine, Direct-Pay Practice Models, Doctor-Patient Relationship, Economic Issues, Education, Electronic Health Records, Employee Benefits, Employer-Sponsored Health Plans, Government Regulations, Health Insurance, Health Savings Accounts (HSA's), Healthcare financing, Individual Market, Medicaid, medical inflation, Medical Practice Models, Medicare, Organizational structure, out-of-pocket costs, outcomes, Patient Choice, Patient Compliance, Patient Safety, Patient-centered Care, Policy Issues, Prevention, primary care, Quality, Reforming Medicaid, Reforming Medicare, The Quadruple Aim, The Triple Aim, Uncategorized

David Goldhill on Cost Drivers and Price Distortions in Healthcare

Minus the introduction and Q&A, the 45 -50 minute presentation is well worth your time. Engaging delivery and compelling case to consider… the cost drivers and distortions come from HOW we access and bill, as opposed to WHAT services are actually exchanged or provided. The key to understanding healthcare costs and pricing is to acknowledge that the answer is contained within our insurance card…and the processes it dictates and the tax/regulatory environment that it operates in. It is kind of like hiding something right out in the open; we look for clues everywhere except for what’s right in front of us. We tend to point fingers at easily identifiable components but fail to see what links them.