Go Back   Irish Envy | Notre Dame Football Discussion > Outside The Lines > The Leprechaun Lounge > Political Threads
Front Page Forums REGISTER NOW! Members List Calendar Mark Forums Read
Live Chat Game Arcade Varsity Club

Welcome to IrishEnvy.com! Founded in September of 2004, IrishEnvy.com has grown into the premiere web portal on the Internet for mature and intelligent Notre Dame Fighting Irish athletics discussion!

You are currently viewing our boards as a Guest, which gives you limited access to view most discussions, articles and access our other FREE features. By joining our FREE online community, you will have access to post and respond to discussions, communicate privately with other members, and access many other special features.

Registration is fast, simple and absolutely FREE, so join the IrishEnvy.com Community today! If you have any problems with the registration process, please contact support and we will assist you.

If you already have an IrishEnvy.com membership account but forgot the username and/or password, use our password recovery tool to access your account information.

Reply
 
Thread Tools Display Modes
Old 07-11-2016, 06:15 PM   #15
NOLAIrish
May Contain 10% Ethanol
 
NOLAIrish's Avatar
 
Join Date: Jul 2012
Location: New Orleans
Posts: 339
Cash: 1,550.33
Bank: 496,231,558,156,303.25
Total Bankroll: 496,231,558,157,853.62
Donate
NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!
New Orleans Hornets New Orleans Saints Notre Dame

Quote:
Originally Posted by Legacy View Post
From ulukinatme's post in Dallas Police Shooting #80:


Some important considerations concerning health insurance rate increases:

-- Obamacare health insurance covers those Americans at 100-140% of poverty level. Minimum wage rates, which are set by states for private companies, currently puts many families in this category.
One tweak: premium assistance covers Americans at 100-400% of FPL. I think you're thinking of the expanded Medicaid coverage which caps out at 138% of FPL (133% + 5% income disregard).

Quote:
Originally Posted by Legacy View Post
-- Health insurance companies, who received incentives to enter the Obamacare market for the first few years which are now ending, have to justify rate increase requests from state regulatory agencies. Approval requirements may vary from state to state. Forty-five of the fifty states have effective state regulatory agencies.

-- Obamacare-qualified participants are in separate programs within health insurance groups requiring separate rate requests. This does not mean that those companies, like BCBS, won't attempt increases in their other groups, but they have to justify those increases to state regularoty agencies for that group.
Rate review and rate approval are two pretty distinct concepts in insurance. Effective rate review is a step in the right direction, but it's a pretty small one. When you're dealing with such a broad range of risk with a lot of unprecedented elements, the actuarially sound range -- the basis of many states' review -- can be pretty broad, which weakens this control.

Quote:
Originally Posted by Legacy View Post
-- Rate increases for all groups may reflect soaring drug costs, which are not regulated.
Probably the most disappointing part of the law, for me, was that it avoided the opportunity to go after some low-hanging fruit in the pharmaceutical industry. That's an incredibly complex market with huge risk if you screw it up, so I can't entirely blame the administration or legislators for avoiding the fight, but it's one of the areas in health care where there are real, identifiable failures in the market. On just about every side.

Quote:
Originally Posted by Legacy View Post
-- Denials for exorbitant rate requests by insurance companies for Obamacare as Blue Cross/Blue Shields could exceed 50-70% in states like Texas. Many other insurances requested rate requests less than 10%.
The last part was true before ACA. I haven't seen much on the change in the rate of high requests in the wake of the law. Then again, there were several elements (e.g. risk corridors, HIT, structure of premium assistance) of ACA designed to stabilize rates during the first several years, so I wouldn't expect any shift to be especially visible at this point.

Quote:
Originally Posted by Legacy View Post
-- Less low use participants entered Obamacare than expected and pay the tax penalty.

-- More employers to reduce their costs are going towards contract or part-time workers, who then fall into the Obamacare category of participants.

-- Most national or regional health insurers like BCBS or United Health Care are seeing record profits, are most in favor of Obamacare, and would not want to change the program.
I would expect the last of these, even if margins are being squeezed. I haven't looked up insurance uptake rates in over a year, but last I can remember, the rate of uninsureds fell by about 50% (~10 percentage points if memory serves). Even if your margin is smaller, a large insurer is going to more than make that up with volume. More than that, those insurers got significant subsidies through ACA, and not just the direct ones. Medicaid is overwhelmingly a managed care model these days and the big players in the private market are also the big players in Medicaid. Expanded coverage under ACA is a multi-billion dollar infusion of new lives into that side of their book of business.

Quote:
Originally Posted by Legacy View Post
-- State health insurance companies like BCBS are part of regional BCBSs. Their increases in your state may also reflect attempts to regain any losses in other states where their rate requests are denied or lowered.
There are a few regional BCBS's, but the overall structure is a federated system of independent companies, and most of those are single-state insurers. Moreover, most (if not all; I'm not positive on the ubiquity) states prohibit this kind of external risk shifting. It may be possible in states without rate review, but it wouldn't generally be a valid component of an actuarial analysis. Of course, see the proviso above about slack in those analyses, but this wouldn't expand the range.

Quote:
Originally Posted by Legacy View Post
-- Local hospitals and their for-profit insurances are most-effective in keeping their high-use patients out of the hospital with case management. Regional or national health insurers have case managers that can be reached by phone for approvals, who often ask for faxed information for approvals, which sometimes delay discharge and thereby increase costs.
This is interesting. I've not actually heard much about prior approval increasing costs. It's a tool to control care, and a lot of providers have strongly negative opinions about it, but I've not heard the argument that it increases our aggregate health care spend. I would think it would be less popular in managed care if it were true, but that's based on a lot of assumptions on my part.

Quote:
Originally Posted by Legacy View Post
-- Provider fraud is now being identified in large amounts due to now required electronic medical records, but those are identified by federal record billing requests at random. That does not mean that much provider fraud is not identified.

-- More Americans need higher care for chronic diseases often due to increased rates of obesity and life expectancies, though for the first time in quite a while life expectancy went down last year.
Is obesity an increase in lifetime cost? I've actually not heard that obesity or overweight have this effect. I've read that underweight does, but only slightly. Most of the chronic conditions from obesity and overweight are on the less expensive side of the spectrum and I would expect them to be offset by shorter life expectancies and less time spent in the end-of-life stage. Again, relying on my faulty memory here.

Quote:
Originally Posted by Legacy View Post
-- All private health insurers rates of payment generally follow the rates set by federal insurance rates, which are lower than what they would set. The halcyon days of rate increases without any regulations so that hospitals can build new wings, etc. as in the 50s are over.

In general, the health care system in America reflects the combination of for profit and not for profit institutions with varying levels of commitment to regulation of health insurance companies.
I agree with all of this (and the post overall was great). I would add that we haven't really yet seen the either side of the effects of two of the centerpieces of the private insurance changes in ACA, guaranteed issue and community rating. Those are two pieces with a great deal of potential to affect insurance risk, and one of the few remaining avenues available to externalize that risk is onto providers. As some of the market stabilizers imposed on the first few years of ACA fall away and some of the suppressed downside risk of the law comes into play, we may see more changes hit providers. I'm not clever enough to give you a prediction about what those could look like.
NOLAIrish is offline   Reply With Quote

Sponsored Links
Don't like this ad? Register to make it go away!

Old 07-12-2016, 03:29 PM   #16
Legacy
Team MVP
 
Join Date: Dec 2006
Posts: 6,880
Cash: 5,062,942.30
Bank: 0.00
Total Bankroll: 5,062,942.30
Donate
Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!



Quote:
Originally Posted by NOLAIrish View Post
One tweak: premium assistance covers Americans at 100-400% of FPL. I think you're thinking of the expanded Medicaid coverage which caps out at 138% of FPL (133% + 5% income disregard).

Thanks for the clarification. I was thinking of expanded Medicaid.

Rate review and rate approval are two pretty distinct concepts in insurance. Effective rate review is a step in the right direction, but it's a pretty small one. When you're dealing with such a broad range of risk with a lot of unprecedented elements, the actuarially sound range -- the basis of many states' review -- can be pretty broad, which weakens this control.

Here's where how much the state regulation commissions' effectiveness and their criteria for approval varies. The pressure from the health insurance companies is dumping their participants onto the marketplace.

Probably the most disappointing part of the law, for me, was that it avoided the opportunity to go after some low-hanging fruit in the pharmaceutical industry. That's an incredibly complex market with huge risk if you screw it up, so I can't entirely blame the administration or legislators for avoiding the fight, but it's one of the areas in health care where there are real, identifiable failures in the market. On just about every side.

Why we cannot negotiate reasonable drug prices like with the VA does not make sense to most of us. But, it is the product of a legislative commitment to minimal regulation of a free marketplace dominated by a few companies. I know of people who have to take a trade drug, whose price has increased five-fold in the past seven years, though the drug is seventy years old. Anyone with a need for a specialty or orphan drug is at the mercy of whatever rates are set.

The last part was true before ACA. I haven't seen much on the change in the rate of high requests in the wake of the law. Then again, there were several elements (e.g. risk corridors, HIT, structure of premium assistance) of ACA designed to stabilize rates during the first several years, so I wouldn't expect any shift to be especially visible at this point.

BCBS of Texas dropped their individual PPO plans in 2015 and 367,000 members went looking for another insurance. BCBS is requesting a 60% rate increase for Obamacare program with 603,000 participants. Will they drop out if not? They opted out in N.M. when they did not get a 53% rate request. BCBS is the only insurer in all counties in Texas.

Rising Healthcare Costs: Insurers Want Higher Obamacare Premiums In 2017, But Actual Amounts Likely To Vary Significantly

I would expect the last of these, even if margins are being squeezed. I haven't looked up insurance uptake rates in over a year, but last I can remember, the rate of uninsureds fell by about 50% (~10 percentage points if memory serves). Even if your margin is smaller, a large insurer is going to more than make that up with volume. More than that, those insurers got significant subsidies through ACA, and not just the direct ones. Medicaid is overwhelmingly a managed care model these days and the big players in the private market are also the big players in Medicaid. Expanded coverage under ACA is a multi-billion dollar infusion of new lives into that side of their book of business.



There are a few regional BCBS's, but the overall structure is a federated system of independent companies, and most of those are single-state insurers. Moreover, most (if not all; I'm not positive on the ubiquity) states prohibit this kind of external risk shifting. It may be possible in states without rate review, but it wouldn't generally be a valid component of an actuarial analysis. Of course, see the proviso above about slack in those analyses, but this wouldn't expand the range.

True, but rate requests are often similar in the states of the parent company. Blue Cross premium hikes in Texas, Oklahoma could mean Illinois sticker shock
BCBS of Illinois's (or HCSC) subsidiaries are BCBS in Texas, Oklahoma, New Mexico, and Montana.



This is interesting. I've not actually heard much about prior approval increasing costs. It's a tool to control care, and a lot of providers have strongly negative opinions about it, but I've not heard the argument that it increases our aggregate health care spend. I would think it would be less popular in managed care if it were true, but that's based on a lot of assumptions on my part.

Patients should not have to stay in hospitals when they are ready for discharge to another facility for lower level of care. This happens. A local insurance plan that hospital case managers can contact and obtain approval for payment to an accepting assisted care facility with 24/7 coverage to review faxed documents is most effective use of health care dollars. What I meant was that some national offsite insurance case managers may delay hospital discharge with transfer to that facility slow responses before approving payments for that lower level of care. Hospital care payments are much more expensive and not appropriate. In general, case management has significantly lowered costs and saved those facilities who commit to that a good deal of money.

Is obesity an increase in lifetime cost? I've actually not heard that obesity or overweight have this effect. I've read that underweight does, but only slightly. Most of the chronic conditions from obesity and overweight are on the less expensive side of the spectrum and I would expect them to be offset by shorter life expectancies and less time spent in the end-of-life stage. Again, relying on my faulty memory here.

Obesity Prevention Source: Economic Costs (Harvard School of Public Health)

NEW DATA SHOWS OBESITY COSTS WILL GROW TO $344 BILLION BY 2018


I agree with all of this (and the post overall was great). I would add that we haven't really yet seen the either side of the effects of two of the centerpieces of the private insurance changes in ACA, guaranteed issue and community rating. Those are two pieces with a great deal of potential to affect insurance risk, and one of the few remaining avenues available to externalize that risk is onto providers. As some of the market stabilizers imposed on the first few years of ACA fall away and some of the suppressed downside risk of the law comes into play, we may see more changes hit providers. I'm not clever enough to give you a prediction about what those could look like.
Thanks for your comments, NOLAIrish.

One of the biggest factors of health care rate increases relates to instability, specifically Obama vs Congress. Insurance hates instability. Congress authorized the creation of it, approved tax credits, and initial funding but has held up ongoing funding from being spent. Obama went ahead and spent the $7 billion necessary to fund the program, but was taken to court by the Republican Congress. A Federal District Court has found that Obama's actions were unconstitutional. This will be appealed to the Supreme Court. Meanwhile, we have the Presidential election which will determine which way a health care legislation may go. The reaction by those who expected government subsidies for participant costs - and which are now unsure - has been predictable. The health insurance companies have shifted the burden to the consumer with rate increases. Or opted out leaving people without providers, insurance or hospitals.

Last edited by Legacy; 07-12-2016 at 04:53 PM..
Legacy is offline   Reply With Quote
Old 07-12-2016, 03:41 PM   #17
Legacy
Team MVP
 
Join Date: Dec 2006
Posts: 6,880
Cash: 5,062,942.30
Bank: 0.00
Total Bankroll: 5,062,942.30
Donate
Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!



Payments for cost sharing increasing rapidly over time

Quote:
Rising cost-sharing for people with health insurance has drawn a good deal of public attention in recent years. For example, the average deductible for people with employer-provided health coverage rose from $303 to $1,077 between 2006 and 2015.
Quote:
We find that, between 2004 and 2014, average payments for deductibles and coinsurance rose considerably faster than the overall cost for covered benefits, while the average payments for copayments fell. As can be seen in the chart below, over this time period, patient cost-sharing rose substantially faster than payments for care by health plans as insurance coverage became a little less generous.
Legacy is offline   Reply With Quote
Old 07-12-2016, 04:57 PM   #18
Legacy
Team MVP
 
Join Date: Dec 2006
Posts: 6,880
Cash: 5,062,942.30
Bank: 0.00
Total Bankroll: 5,062,942.30
Donate
Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!



Health Insurance Marketplace Share

Evaluating the Impact of Health Insurance Industry Consolidation: Learning from Experience

Quote:
Between 2006 and 2014, the four-firm concentration ratio for the sale of private insurance increased significantly, from 74 percent to 83 percent. By comparison, the four-firm concentration ratio for the airline industry is 62 percent.
Marketshare of Health Insurance 2014
BCBS 37%
Anthem 15%
United 13%
Aetna 11%
Cigna 6%

Others 17%
Legacy is offline   Reply With Quote
Old 07-12-2016, 10:05 PM   #19
NOLAIrish
May Contain 10% Ethanol
 
NOLAIrish's Avatar
 
Join Date: Jul 2012
Location: New Orleans
Posts: 339
Cash: 1,550.33
Bank: 496,231,558,156,303.25
Total Bankroll: 496,231,558,157,853.62
Donate
NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!NOLAIrish should be giving advice to Kelly!
New Orleans Hornets New Orleans Saints Notre Dame

Quote:
Originally Posted by Legacy View Post
Why we cannot negotiate reasonable drug prices like with the VA does not make sense to most of us. But, it is the product of a legislative commitment to minimal regulation of a free marketplace dominated by a few companies. I know of people who have to take a trade drug, whose price has increased five-fold in the past seven years, though the drug is seventy years old. Anyone with a need for a specialty or orphan drug is at the mercy of whatever rates are set.
Thanks, again, for several more fantastic posts. The irony of this mindset among legislators is that the pharmaceutical marketplace is almost the polar opposite of a functional, free market. Much of the business model is premised on capturing profits during the period of government-sponsored monopoly (i.e. patents) and discouraging competitors from bringing their products to market. The ACA actually increased the monopoly power of innovators in the expensive biologic drug market, which still boggles my mind. One of the big fights in the pharmaceutical industry over the past several years has been for control of the generics market. To oversimplify: as patents expire and generics become possible, would-be generic manufacturers still have to pass FDA approval before bringing their drug to market. Historically, rather than take their generic through the lengthy clinical trial process, they've taken advantage of an alternative route: if a generic manufacturer can show that its drug is (substantively) chemically identical to an approved drug, it can use its data to pass FDA muster, making the process far quicker, simpler, and cheaper. Well, ACA gave major manufacturers a huge carrot in this process in terms of biologics (a particular, new class of complex pharmaceuticals manufactured using biological rather than chemical processes) -- data exclusivity for 14 years following approval of a biologic. In other words, even if a biologic's patent expires earlier, a generic (in this case, called "biosimilar") drug manufacturer cannot bring its product to market unless it a) conducts its own clinical trials or b) waits 14 years following approval of the original. On top of that, biosimilarity has become a pretty huge issue with the FDA, with Phrma and a few non-Phrma pharmaceutical companies pushing hard for a narrow classification, which would cut off many drugs from using past data at all (effectively making bringing them to market cost-prohibitive even after the patent and data exclusivity terms lapse on the original biologic).

That's a narrow example, but it's a very expensive one. These are the kinds of drugs you hear about alongside the new Hep C drugs in terms of crazy pricing. With the Medicaid drug rebate program rules (which require state Medicaid programs to cover drugs manufactured by participating manufacturers, regardless of price), these are driving crazy cost spikes in the market. I remember a few years back when Sovaldi came to market with a sticker price north of $80,000 for a round of treatment and very limited prior authorizations out there. The cost ran into the tens of millions for several states before they could crack down and it still runs into the millions every year for pretty much every state. That's for a drug that is only necessary and appropriate for a few hundred covered people.

Quote:
True, but rate requests are often similar in the states of the parent company. Blue Cross premium hikes in Texas, Oklahoma could mean Illinois sticker shock
BCBS of Illinois's (or HCSC) subsidiaries are BCBS in Texas, Oklahoma, New Mexico, and Montana.
I think that article mistakes rate increases moving in tandem with rate increases driven by costs in other states. I'm actually not sure if it's the article (which really doesn't go there) so much as the headline writer (which does, implicitly). Hikes in TX/OK/NM/MT may be predictive of hikes in IL, but they generally cannot be causative of those hikes. Late in the article, one of the experts they interviewed actually references the set of laws I was referring to in my original reply when he says that insurers aren't permitted to make up losses from previous years in rate increases. There are fairly tight controls on what elements can be used to generate an insurance rate -- historical trends, known changes to risk mix, utilization projections, sometimes market-specific inflation -- but an insurer is generally prohibited from baking losses or external costs into their rates. Commissioners' level of control is going to vary by state, but that's a standard from NAIC, so it should be at least fairly ubiquitous.

Quote:
Obesity Prevention Source: Economic Costs (Harvard School of Public Health)

NEW DATA SHOWS OBESITY COSTS WILL GROW TO $344 BILLION BY 2018
So, there's an issue I have with all of these kinds of studies (well, not with the studies per se, but more with their use for present purposes) -- obesity costs are certainly rising and they have an annual cost relative to the costs of a healthy person, but determining that they represent a cost to the system requires more than an annual cost, it requires a lifetime cost. What I mean by that is really opaque, so I'm going to try to clarify through very (absurdly) extreme examples. Imagine that the annual chronic care cost of an obese individual is $1, the annual chronic care cost of a healthy individual is $0, and the annual chronic care cost of an aged individual is $10. Imagine further that an obese individual lives 50 years and a healthy individual lives 70, the last 20 of which fall into the "aged" category. So, an obese person will cost $50 over the course of his life, while a healthy person will cost $200, simply by virtue of the fact that the obese person dies before they can pass into the truly expensive "aged" category. Now, even if the costs of obesity triple (roughly in line with the Emory study), obesity will still be a net savings to the health care system simply because the typical obese person died before he could become truly expensive. The Harvard study also falls into this gap -- it compares the cost of care of an obese person to the cost of care of a healthy person, which is perfect for figuring annual cost (e.g. for determining insurance risk) but is incomplete for determining whether obesity costs the country money.

I want to be clear that I'm not saying obesity is a savings. Just that it's extremely difficult to determine the cost of chronic disease on the overall cost of care. It's the same problem we run into when trying to find savings through improved population health -- it's an incredibly complicated and murky issue. One more thought and I'll leave it: an individual is virtually free to insure for most of his life. It's expensive to be born and then it's almost free to live from 1 to about 55. After that, your costs skyrocket to the point that we'll spend roughly as much in your last year of life as we did on your first 50. Extending life is a wonderful thing, but it's also had the effect of extending the amount of time our population spends in this incredibly expensive span of life. I don't have a good answer for how we bring that in line -- healthy living isn't it -- but it's one of the hard questions of health care funding.

Quote:
We find that, between 2004 and 2014, average payments for deductibles and coinsurance rose considerably faster than the overall cost for covered benefits, while the average payments for copayments fell. As can be seen in the chart below, over this time period, patient cost-sharing rose substantially faster than payments for care by health plans as insurance coverage became a little less generous.
I actually think that's a bit of a positive outcome of the change. Health insurance is an inherently unhealthy mechanism for financing the purchasing of health care services. To the extent that the change creates the use of prices as actual signals, I think that's a positive change. Of course, it's an unstable, painful change, as well.

Quote:
Marketshare of Health Insurance 2014
BCBS 37%
Anthem 15%
United 13%
Aetna 11%
Cigna 6%

Others 17%
And here's the inverse -- an extremely negative change. Unless you're a fan of single payer, I suppose.
NOLAIrish is offline   Reply With Quote
Old 07-13-2016, 06:46 AM   #20
Rizzophil
Junior
 
Rizzophil's Avatar
 
Join Date: May 2006
Posts: 1,674
Cash: 1,366,224,655,037.92
Bank: 0.00
Total Bankroll: 1,366,224,655,037.92
Donate
Rizzophil should be giving advice to Kelly!Rizzophil should be giving advice to Kelly!Rizzophil should be giving advice to Kelly!Rizzophil should be giving advice to Kelly!Rizzophil should be giving advice to Kelly!Rizzophil should be giving advice to Kelly!Rizzophil should be giving advice to Kelly!Rizzophil should be giving advice to Kelly!Rizzophil should be giving advice to Kelly!Rizzophil should be giving advice to Kelly!Rizzophil should be giving advice to Kelly!

For everyone that doesn't know, bundled payments are coming next year for hip and knee procedures. Basically the government is going to dictate length of stay, home visits, etc.

Getting sick or being an outlier is going to be a extremely frowned upon and medicate will not pay the same in that event. Buckle your seat belts bc customer service is going down the drain quickly
Rizzophil is offline   Reply With Quote
Old 07-13-2016, 12:20 PM   #21
Legacy
Team MVP
 
Join Date: Dec 2006
Posts: 6,880
Cash: 5,062,942.30
Bank: 0.00
Total Bankroll: 5,062,942.30
Donate
Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!Legacy should be giving advice to Kelly!



Quote:
Originally Posted by Rizzophil View Post
For everyone that doesn't know, bundled payments are coming next year for hip and knee procedures. Basically the government is going to dictate length of stay, home visits, etc.

Getting sick or being an outlier is going to be a extremely frowned upon and medicate will not pay the same in that event. Buckle your seat belts bc customer service is going down the drain quickly
For those who do not know, bundled payments are the standard reimbursement method in which a hospital is paid for a certain amount of days based on the classification of a diagnosis. For example, a heart attack will be classified as an Inpatient stay, reimbursed for three days, which can be extended day-by-day if a patient has complications and not meeting criteria for discharge. (The other classification is Observation or Outpatient - a one day reimbursement.) Bundled payments have been around for a few years with different diagnoses and procedures being phased in.

The hospital can divide up the money however it wants to for the different professions and costs involved in the patient's care. They must justify any extension and, if the patient is ready and discharged earlier like a two day stay, the hospital keeps the full three day payment. If they discharge in four days when the patient is ready for discharge at three days, they eat the fourth day.

The idea is to lower overall health care costs by shifting the burden of managing effective care to the hospital and provider. From the health insurance company's standpoint - or the payer, this simplifies things and they can deny payment if a hospital cannot justify the admitting diagnosis, the treatments, or prolonged hospitalized stays. Prior to this, the federal government and private health insurance paid bills and, obviously, had difficulty determining inflated costs.

Private insurances do not have to follow federal reimbursement guidelines for federal reimbursement, but they almost always do. It's not that the federal government is telling them what to do. They can choose another payment method.

These can also stimulate some innovative solutions, but may increase tensions between providers and hospitals - and sometimes patients.

Replacing joints faster, cheaper and better?

Quote:
Building on advances in surgical technique, anesthesia and pain control, a small but growing number of surgeons around the country are moving more of their total joint replacement procedures out of the hospital, performing these lucrative operations in outpatient facilities. Some are sending their patients home within a few hours, while others have their patients recover overnight in the surgery center or hospital during 23-hour stays. These surgeons say very few of their patients require skilled nursing, rehab or home healthcare.

Last edited by Legacy; 07-13-2016 at 12:37 PM..
Legacy is offline   Reply With Quote
Reply


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is On
Forum Jump




Copyright © 2004 - 2013 IrishEnvy.com. All Rights Reserved. All material on this Notre Dame Fighting Irish discussion forum is strictly for entertainment purposes only. This site and any pages within are in no way affiliated with the University of Notre Dame, the Big East Conference or the National Collegiate Athletic Association. Any images, copyrights, or trademarks used on this site are used under the "Fair Use Provision" of the Copyright Act for purposes of comment, criticism, and news reporting. SEO by vBSEO 3.7.4