Earlier quoted context omitted.
So, I don't disagree that there are inefficiencies with private payers, but I do disagree that they're significant, or the reason US costs are so high, or that insurers deny so many services. You can see this for yourself with Medicare's admin overhead. Admin overhead is, roughly, the ratio of money spent by insurers to money insurers pay to providers. Medicare has "low" admin overhead --- but that's in large part be…
inefficiencies with private payers Inefficiencies like billions of dollars in overbilling annually?
Brave Care Has Closed
71–80 of 160 posts
Re: Brave Care Has Closed
#72Re: Brave Care Has Closed
#73Earlier quoted context omitted.
inefficiencies with private payers Inefficiencies like billions of dollars in overbilling annually?
Providers overbill. Insurers inappropriately deny coverage. This is pretty basic stuff. What would insurer overbilling even mean? You pay a fixed premium.
What would insurer overbilling even mean?
It would mean something like this:https://www.nytimes.com/2017/05/19/business/dealbook/unitedh...
Or this:
https://www.sacbee.com/news/local/health-and-medicine/articl...
Re: Brave Care Has Closed
#74Earlier quoted context omitted.
to wit: when Anthem tried to adopt Medicare's rules for anesthesiology comp, they were excoriated For everyone in the back: that's not what happened. BCBS tried to place arbitrary limits on anesthesia payment. Medicare does not do this. Physician complaints with Medicare payments revolve around the hourly rate. Physician complaints with BCBS revolve around arbitrarily setting a hard limit for the amount of time a pro…
No, that's precisely what they didn't do. Medicare has a schedule of anesthesia compensation rates broken down by procedure; the last time this came up on a thread, the schedule was literally posted. Anthem announced they were using it.
Re: Brave Care Has Closed
#75Earlier quoted context omitted.
Providers overbill. Insurers inappropriately deny coverage. This is pretty basic stuff. What would insurer overbilling even mean? You pay a fixed premium.
What would insurer overbilling even mean? It would mean something like this: https://www.nytimes.com/2017/05/19/business/dealbook/unitedh... Or this: https://www.sacbee.com/news/local/health-and-medicine/articl...
Fuck if I know what's going on between Medicare and UHC. It's a mess. Medicare Advantage is a hybrid Medicare/private system; once again, whatever fees were being passed to Medicare, they were coming from providers. Insurers can certainly inappropriately deny coverage, but they don't generally make de novo charges up. Charges come from providers.
Upcoding scandals, which literally appear to be what the UnitedHealth link you provided was about, were exactly what Anthem was trying to control for with its new announcement.
Re: Brave Care Has Closed
#76Earlier quoted context omitted.
No, that's precisely what they didn't do. Medicare has a schedule of anesthesia compensation rates broken down by procedure; the last time this came up on a thread, the schedule was literally posted. Anthem announced they were using it.
Yeah the last time this came up I posted the CMS handbook. If Medicare operated the way you falsely claim there would be an outcry similar to that over BCBS's behavior. BCBS was proposing something entirely different from how Medicare operates.
Re: Brave Care Has Closed
#77Real way to fix healthcare: facilities based on repurposed container ships offshore near cities with lots of flights into them, to be outside of US regulations, staffed by physicians shuffled from Eastern Europe. Will offer more than an order of magnitude price advantage and will quickly squeeze the existing systems making it irrelevant until what's left of it is forced to change.
Re: Brave Care Has Closed
#78Earlier quoted context omitted.
Yeah the last time this came up I posted the CMS handbook. If Medicare operated the way you falsely claim there would be an outcry similar to that over BCBS's behavior. BCBS was proposing something entirely different from how Medicare operates.
Clearly not, because this is how Medicare operates. In fact, it's the whole premise for why Medicare is meant to bring prices down!
Clearly not, because this is how Medicare operates.
Yeah, we've been over this: Medicare does not set arbitrary caps on the length of a procedure. They pay for anesthesia services from the time the patient goes under to the time the patient wakes up. In fact, it's the whole premise for why Medicare is meant to bring prices down!
In fact, it's not. Limiting care is pretty much the opposite of how Medicare operates and you can see this reflected in the claim denials. For-profit insurance companies deny claims at 2–3x the rate of Medicare because they are incentivized to deny care.From Medicare's policy manual:
https://www.cms.gov/files/document/chapter2cptcodes00000-019...
A unique characteristic of anesthesia coding is the reporting of time units.
Payment for anesthesia services increases with time. In addition to reporting
a base unit value for an anesthesia service, the anesthesia practitioner reports
anesthesia time. Anesthesia time is defined as the period during which an
anesthesia practitioner is present with the patient. It starts when the anesthesia
practitioner begins to prepare the patient for anesthesia services in the operating
room or an equivalent area and ends when the anesthesia practitioner is no longer
furnishing anesthesia services to the patient (i.e., when the patient may be placed
Now I made a good faith look through your comment history to see if you'd actually posted anything like that. Barring something I missed I can only assume you're working based on an incorrect assumption of how Medicare pays for the cost of anesthesia.There is a fixed component per procedure (base unit). This is based on the complexity of a procedure and roughly how long it's expected to take. That is why CMS would track how long a procedure is expected to take. There is a time based factor (time unit), and that is not limited in the way that BCBS was proposing.
Re: Brave Care Has Closed
#79Earlier quoted context omitted.
Clearly not, because this is how Medicare operates. In fact, it's the whole premise for why Medicare is meant to bring prices down!
Clearly not, because this is how Medicare operates. Yeah, we've been over this: Medicare does not set arbitrary caps on the length of a procedure. They pay for anesthesia services from the time the patient goes under to the time the patient wakes up. In fact, it's the whole premise for why Medicare is meant to bring prices down! In fact, it's not. Limiting care is pretty much the opposite of how Medicare operates and…
Later
(The comment I replied to was edited extensively after I replied to it.)
Re: Brave Care Has Closed
#80Earlier quoted context omitted.
Most people outside of healthcare will have a hard time disrupting anything until they realize the goverment has tilted the rules in favor of status-quo. Healthcare insurance in the US is heavily subsidized, and no number of revolutionary care delivery models will put you on level terms with the behemoth of US govt insurance subsidies. Your only hope as a non-provider is to come in with your own a-la-carte insurance…
You will still lose on the insurance front. If you’re on the exchange, you’ll get absolutely hammered by risk-adjustment. If you’re not, you’ll never be able to sell to anyone. You’ll have to lock up huge amounts of capital, which will grow as you grow, that you can’t invest or use. It will just sit in an account in case you can’t pay claims. You’ll have to accept horrible contracts with provider systems in order to…
The providers have leverage and the ones with the most will screw you over unless you’re big enough to throw some weight around.
I honestly don’t see much change unless the government comes in and sets new rules that actually make sense.