AHRQ Report on Uninsured Hospitalizations

Posted on March 17, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Differs from Insured Hospitalizations

By Staff Reportershorizontal-nurses

According to Tracey Walker, Senior Editor of Healthcare Executive News on March 13, 2009, the number of uninsured hospitalizations increased by 34%, over the last 10-year period, and the number of Medicaid hospitalizations increased by 36%. However, a newt report from the Agency for Healthcare Research and Quality (AHRQ) suggests the number of privately insured hospitalizations remained about the same.

AHRQ Report

According to the report, hospital charges increased for the uninsured faster than for overall hospital charges (76% for compared with 69% for all hospital stays). The average hospital charge for an uninsured stay in 2006 was $19,400 compared to $11,000 in 1997 (after adjusting for inflation). The average length of stay for the uninsured remained the same at about 4 days per hospital visit. Other findings included: 

  • Compared to all hospital stays, uninsured hospitalizations begin in the emergency department much more frequently (60% for the uninsured compared to 44% for all hospital stays).
  • The number of uninsured hospitalizations for skin infections rose sharply over the 10-year period, increasing from about 28,000 stays in 1997 to about 75,000 stays in 2006. Early appropriate outpatient treatment for skin infections can usually prevent the need for hospitalization.
  • There was a 36% increase in hospitalizations billed to Medicaid during the 10-year period.

Assessment

According to AHRQ, on average the costs (not charges) to provide hospital care to the uninsured are about $1,500 less expensive ($6,800 vs. $8,400 per hospital stay) than costs for all other hospital stays.

Assessment

Lack of health insurance has serious consequences on individuals and societies. For example, the uninsured may be more likely to delay or forgo necessary medical care until eventual hospitalization makes care much more expensive. And philosophically,

“As spending on Medicaid increases; the number of uninsured hospitalizations ought to decrease proportionally—adjusted for population increases”

So says, Hope Hetico; RN, MHA, CMP™ of www.HealthcareFinancials.com.

“But, this was not the case, and determining exactly why will require more studies.”

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Does a similar inverse relationship hold for public versus private education, housing and transportation?

Why or why not? Some pundits wonder if it is due to private entities having more “skin-in-the game?” Please opine?

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About the Hospital Debt Justice Project

Posted on March 5, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Aggressive Debt Collectors Take to the Web

By Staff Reportersradar2

Thousands of patients face crippling debt to hospitals and healthcare systems across the country; even though they may have qualified for free care.

www.HealthcareFinancials.com

Yale-New Haven Health System

Now, the Yale-New Haven Health System, Yale-New Haven Hospital and Bridgeport Hospitals are pursuing aggressive debt-collection practices—including liens, wage garnishments and foreclosures—even though they have millions of dollars set aside for free care for patients who can’t pay. Others have colossal endowments as well, and often pay their CEOs handsomely.

Assessment

But, according to their website, the Hospital Debt Justice Project is only fighting for fair treatment and accountability from our community hospitals.

Link: http://www.hospitaldebtjustice.org

Industry Indignation Index: 85

Conclusion

Your thoughts and comments on this Medical Executive-Post are appreciated. Isn’t it a charity hospital standard that not-for-profits typically charge the poor and indigent up to four times the UCR of insured patients? Your experiences are welcomed. 

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Meet Dr. Gary L. Bode CPA MSA CMP™ [Hon]

Posted on March 2, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Introducing our Newest Thought-Leader

Dr. Gary Bode; CPA, MSA, CMP

[By Ann Miller RN MHA]

The Medical Executive-Post is proud to introduce Dr. Gary L. Bode as our newest thought-leader for healthcare financial modernity. Dr. Bode was the Chief Financial Officer [CFO] for a private mental healthcare facility, and previously the Chief Executive Officer [CEO] of Comprehensive Practice Accounting, Inc, in Wilmington, NC. The firm specialized in providing tax solution to medical professionals. Dr. Bode was a board certified practitioner and managing partner of a multi-office medical group practice for a decade before earning his Master’s of Science degree in Accounting [MSA] from the University of North Carolina. He is a nationally known forensic health accountant, financial author, educator and speaker.

A Multi-Faceted Healthcare Financial Expert

Areas of expertise include producing customized managerial accounting reports, practice appraisals and valuations, restructurings and innovative financial accounting, as well as proactive tax positioning and tax return preparation for healthcare facilities. Currently, Dr. Bode is Chief Accounting and Valuation Officer (CAVO) for the Institute of Medical Business Advisors, Inc. He is also a Certified Medical Planner™ http://www.CertifiedMedicalPlanner.org  He provides litigation support in his areas of expertise and has been previously accepted as a legal expert witness www.MedicalBusinessAdvisors.com

Assessment

Gary has promised to publish his most exciting ideas and innovative work on our blog. He is also available for private consulting engagements and related professional work on an ad-hoc, or interim basis. So, let’s give a warm ME-P “shout-out” to Dr. Gary L Bode; our newest thought-leader.   

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Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Health Insurance versus Mental Health Parity

Posted on February 9, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Understanding Physical Health and Mental Health Insurance

By Carol Miller; RN, MBA

Carol S. Miller

There is a difference between the benefits covered under medical insurance compared to those covered under mental health benefits.

Mental Health Parity Act

There has always been a disparity resulting in caps on the annual number of visits allowed, higher co-pays, higher deductibles, and reduction of covered benefits such as partial hospitalization and number-of-treatment limits for mental health. Congress touched on this issue in 1996 with the Mental Health Parity Act. This federal law prevented group health plans from placing annual or lifetime dollar limits on mental health benefits that are lower¾less favorable¾than annual or lifetime dollar limits for medical and surgical benefits.

Group Health Plan Exclusions

However, the law did not require group health plans and their health insurance issuers to include mental health coverage in their benefits package¾it only applied to group health plan insurances that already did include mental health benefits in their benefit package.

MHETA Attempts at Correction

In 2003, Senators Pete Domenici, Edward Kennedy, and Representatives Patrick Kennedy and Jim Ramstad introduced S. 486 and H.R. 953, called the Mental Health Equitable Treatment Act. In March 2005, the Mental Health Equitable Treatment Act [MHETA] was passed and with the passage of this bill a loophole – insurers may no longer arbitrarily limit the number of hospital days or outpatient treatment sessions for people in need of mental health care – was closed.

Assessment

Nevertheless, even though states are encouraged by the government with this new bill to enact stronger parity laws, the final decision of parity still rests with the states.  Many states have not enforced the law and therefore, insurers may still be inclined to limit

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Why the mental versus medical health care insurance disparities?

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Weighted Role of Commercial Health Insurance

Posted on January 13, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Disproportional Influence

By Dr. David Edward Marcinko; MBA,

ho-journal4Most domestic health care is paid for by some type of insurance, whether private or governmental. Most private health insurance is purchased through employers who, to a great degree, make most of the buying decisions. Employer coalitions have emerged but, in general, most command leverage on price rather than quality or value. This often leaves healthcare providers as the only advocates for the quality, choice and access concerns of consumers.

Business Impact

According to Robert James Cimasi, writing and opining in the print journal: Healthcare Organizations [Financial Management Strateges] www.HealthCareFinancials.com, despite the fact that businesses bear less of the total U.S. healthcare premium dollar (approximately 25%) than government or individuals; corporate buyers and their coalitions and associations have asserted substantial, if disproportionate, influence over healthcare companies.

Best Community Interest Debate

Whether or not this is necessarily always in the best interests of consumers or the community at large is a matter of heated debate. What is generally acknowledged is that the relative bargaining position of buyers and providers in a given market has a dramatic impact on healthcare provider financial performance.

Healthcare is Different

Much like F. Scott Fitzgerald’s different-rich; keep in mind that healthcare differs in several respects from other industry sectors, in that:

  • There is more than one class of buyers: there are patients, families (proxies), insurance companies, and employers, each with different objectives.
  • The single largest payer, the government, both dictates a large portion of the healthcare pricing structure and strongly influences the rest.
  • There is a crucial divide or (“disconnect”) between consumer and payer.
  • A lack of information regarding consumer needs and quality of providers impedes the purchasers of health insurance from selecting the optimal plan.

Assessment

Of course, the impact of the Obama administration on this topic has yet to be seen. 

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Is this commercial influence on health insurance good or bad; please share your experiences with us.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Health Insurers Secrets

Posted on August 31, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Seven Things you don’t Know about Health Insurance

By Staff Reporters

“Myth Busters”

Wrapped up in all the noise these days are myths on health insurance that were perhaps once true – or maybe never were.

So, here’s a look at seven things you probably didn’t know about your health insurer.

Link: http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/7SecretsOfHealthInsurers.aspx

Conclusion

Your thoughts are appreciated; especially from insurance agents, industry insiders and medical providers; please opine and comment.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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The Cure for Claims Campaign [CCC]

Posted on July 9, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Reducing Healthcare Administrative Burdens and Costs

Staff Writers

To help reduce the administrative burden of ensuring accurate insurance payments for physician services, the American Medical Association [AMA] recently launched the “Cure for Claims” Campaign [CCC] and unveiled the first AMA National Health Insurer Report Card on claims processing.

Goals

The goal of the AMA campaign is to hold health insurance companies accountable for making claims processing more cost-effective and transparent, as physicians divert substantial resources – as much as 14 percent of their total revenue – to ensure accurate insurance payments for their services.

The National Health Insurer Report Card [NHIRC]

The AMA’s new National Health Insurer Report Card provides physicians and the public with information on the timeliness, transparency and accuracy of claims processing by health insurance companies. Based on a random sample pulled from more than 5 million electronically billed services, the NHIRC examines the claims processing performance of Medicare and seven national commercial health insurers: Aetna, Anthem Blue Cross Blue Shield, CIGNA, Coventry Health Care, Health Net, Humana and United Healthcare.

Study Results

According to the June 16, 2008 AMA study: 

  • There is wide variation in how often health insurers pay nothing in response to a physician claim (from less than 3 percent to nearly 7 percent), and in how they explain the reason for the denial. There was no consistency in the application of codes used to explain the denials, making it expensive for physician practices to determine how to respond.
  • Health insurers reported to physicians the correct contracted payment rate only 62 to 87 percent of the time. When health insurers report an amount that does not adhere to the contracted rate, it adds additional, unnecessary costs to the physician practice to evaluate the inconsistency.
  • More than half of health insurers do not provide physicians with the transparency necessary for an efficient claims processing system.
  • There is wide variation among payers as to how often they apply computer generated edits to reduce payments (from a low of less than .5 percent to a high of over 9 percent). Payers also varied on how often they use proprietary rather than public edits to reduce payments (ranging from zero to as high as nearly 72 percent).

Assessment

The use of undisclosed proprietary insurance claims edits, only serve to inhibit the flow of transparent information to physicians, adding additional administrative costs to reconcile their health insurance claim issues.

Conclusion

Your thoughts and comments are appreciated. Will likely outcomes of the CCC and NHIRC be real, or illusionary?

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Paying for Health Care and Insurance

Posted on June 6, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

New Survey Reveals 28% Report Financial Problems

Staff Reporters

A new survey by the Kaiser Family Foundation recently asked this question.

Q: As a result of recent changes in the economy, have you and your family experienced any of the following problems, or not? Was this a serious problem, or not?

A: Results are included in the summarized chart below.

 

 

Percent saying each was a “serious problem”

Problems paying for gas

44%

Problems getting a good-paying job or a raise in pay

29%

Problems paying for health care and health insurance

28%

Problems paying your rent or mortgage

19%

Problems paying for food

18%

Problems with credit card debt or other personal debt

18%

Losing money in the stock market

16%

Source: Kaiser Family Foundation Health Tracking Poll: Election 2008 (conducted April 3-13, 2008). www.kff.org.

Conclusion

Your thoughts, opinions and comments are appreciated?

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