Jump to content
carolina_corpsman

Improving Price and Quality Transparency in American Healthcare To Put Patients First

Recommended Posts

Trump signed this executive order in June, and we are starting to see some of the effects, which I think are positive and help consumers " shop" for competitive pricing for healthcare.  This month, the CMS wrote a regulation requiring hospitals provide an easy to access and understand pricing sheet that contains the "standard charges" for many (300) "standard procedures". Hospitals must comply by 2021.

What say you fellow PF-ers?  Is this a good "free market" step in the direction of controlling healthcare costs?

(if you want to read the actual order or the CMS's response)

https://www.federalregister.gov/documents/2019/06/27/2019-13945/improving-price-and-quality-transparency-in-american-healthcare-to-put-patients-first

https://www.cms.gov/newsroom/fact-sheets/cy-2020-hospital-outpatient-prospective-payment-system-opps-policy-changes-hospital-price

Share this post


Link to post
Share on other sites
1 minute ago, MFB said:

Definitely a crucial part of the problem. It will still always be a cluster as long as for profit insurance companies are the major players

I agree to some extent, but now that their billing is more obvious, you may see them start to compete a bit more for business. I hope to see regulations lifted that allows more competition between insurance providers which should also address costs. 

 

Share this post


Link to post
Share on other sites
1 minute ago, carolina_corpsman said:

I agree to some extent, but now that their billing is more obvious, you may see them start to compete a bit more for business. I hope to see regulations lifted that allows more competition between insurance providers which should also address costs. 

 

Yea, I think they need to expand the HSA and similar investment type accounts and have an equally clear "cash" payment option pricing. I think a lot of people could navigate healthcare without insurance save some sort of catastrophic coverage 

Share this post


Link to post
Share on other sites
3 minutes ago, MFB said:

Yea, I think they need to expand the HSA and similar investment type accounts and have an equally clear "cash" payment option pricing. I think a lot of people could navigate healthcare without insurance save some sort of catastrophic coverage 

There is a sub section in there that addresses this as well. 

"expand the ability of patients to select high-deductible health plans that can be used alongside a health savings account, and that cover low-cost preventive care, before the deductible, for medical care that helps maintain health status for individuals with chronic conditions."

also: "issue guidance to increase the amount of funds that can carry over without penalty at the end of the year for flexible spending arrangements." 

Share this post


Link to post
Share on other sites
2 minutes ago, carolina_corpsman said:

There is a sub section in there that addresses this as well. 

"expand the ability of patients to select high-deductible health plans that can be used alongside a health savings account, and that cover low-cost preventive care, before the deductible, for medical care that helps maintain health status for individuals with chronic conditions."

also: "issue guidance to increase the amount of funds that can carry over without penalty at the end of the year for flexible spending arrangements." 

nice

Share this post


Link to post
Share on other sites
On 11/20/2019 at 12:30 PM, MFB said:

nice

quick, print this post and frame it before he deletes it!!!! lol

 

Seriously though, I've noticed some positive changes with regards to FSA's.  I got an email saying they bumped up the medical FSA another $50.  Also, you can use the medical and dependant care fsa's for a couple months into the following year, which is a change that has been needed for some time.  It's stupid to think that people should plan out either a year ahead of time, and then screw people out of their own money if they don't spend it all.  I still think it's stupid that it expires at all....should be rolled over indefinitely, or perhaps be able to be placed into something like a 401k.  

Share this post


Link to post
Share on other sites
12 minutes ago, TheKOB said:

quick, print this post and frame it before he deletes it!!!! lol

 

Seriously though, I've noticed some positive changes with regards to FSA's.  I got an email saying they bumped up the medical FSA another $50.  Also, you can use the medical and dependant care fsa's for a couple months into the following year, which is a change that has been needed for some time.  It's stupid to think that people should plan out either a year ahead of time, and then screw people out of their own money if they don't spend it all.  I still think it's stupid that it expires at all....should be rolled over indefinitely, or perhaps be able to be placed into something like a 401k.  

I agree. Why would I delete that post??

Share this post


Link to post
Share on other sites

Man, ABC is really doing high quality journalism. They have identified that healthcare costs have increased, yet they seem clueless as to why they are going up, but I am sure it is somehow Trumps fault. 

https://abcnews.go.com/Health/middle-class-americans-crushed-rising-health-insurance-costs/story?id=67131097&cid=social_twitter_abcn

(they also neglect to mention the largest increase in premiums across the board came after *drum roll* the ACA. https://www.forbes.com/sites/theapothecary/2017/03/22/yes-it-was-the-affordable-care-act-that-increased-premiums/#360d30de11d2

 

Share this post


Link to post
Share on other sites
2 hours ago, MFB said:

giphy.gif

 

lol I have no problem giving credit when it is due, just like with CJ reform...I do think more can be done in both areas too

Healthcare reform, CJ reform, gun legislation, Trump is a better Democrat than Obama was  lol. 

Share this post


Link to post
Share on other sites
Just now, carolina_corpsman said:

@STS

How has this EO affected your line of work if any? 

None for me as I am not contracted to insurance companies (I am fee for service) ...however I always file insurance for patients on their behalf  In fact I would have no problem leaving my fees out on the coffee table in my waiting room! 

 

That being said, it is easy for me when I only file under like 15-20 codes period...I have my fees for those codes and we always give fees to all patients prior to treatment so that everyone has a clear understanding of costs and responsibilities.  Even though I have relatively no competition (only a few of us around) I am never about the 90% percentile in terms of fees for these procedures in my area.  I think it is funny when a general dentist (namely Aspen Dental) charges more for procedures than we do here in a specialty office.   I think that if physicians were able to treat patients this way then it would go over well. Here in our town we have had a somewhat hostile hopspital takeover and the fees have gone through the roof...so much so that one of the larger medical groups just published their fees relative to new Hospital fees and it was sickening.  It was almost like gouging!  I like the EO!  I like the ideas above about catastrophic insurance and then improves HSA accounts and a more fee for service model.  

Share this post


Link to post
Share on other sites
2 minutes ago, STS said:

None for me as I am not contracted to insurance companies (I am fee for service) ...however I always file insurance for patients on their behalf  In fact I would have no problem leaving my fees out on the coffee table in my waiting room! 

 

That being said, it is easy for me when I only file under like 15-20 codes period...I have my fees for those codes and we always give fees to all patients prior to treatment so that everyone has a clear understanding of costs and responsibilities.  Even though I have relatively no competition (only a few of us around) I am never about the 90% percentile in terms of fees for these procedures in my area.  I think it is funny when a general dentist (namely Aspen Dental) charges more for procedures than we do here in a specialty office.   I think that if physicians were able to treat patients this way then it would go over well. Here in our town we have had a somewhat hostile hopspital takeover and the fees have gone through the roof...so much so that one of the larger medical groups just published their fees relative to new Hospital fees and it was sickening.  It was almost like gouging!  I like the EO!  I like the ideas above about catastrophic insurance and then improves HSA accounts and a more fee for service model.  

In an ideal world more primary care physicians would be in private practice and would operate on a fee for service model. Unfortunately, I don't think private practice GP's make enough for it to be worth their while in many cases. 

The upstate is in a healthcare battle right now between 3 major competitors, not sure what it's doing to billing pricing, but I like what it's doing to salaries.  

Share this post


Link to post
Share on other sites
3 hours ago, STS said:

None for me as I am not contracted to insurance companies (I am fee for service) ...however I always file insurance for patients on their behalf  In fact I would have no problem leaving my fees out on the coffee table in my waiting room! 

 

That being said, it is easy for me when I only file under like 15-20 codes period...I have my fees for those codes and we always give fees to all patients prior to treatment so that everyone has a clear understanding of costs and responsibilities.  Even though I have relatively no competition (only a few of us around) I am never about the 90% percentile in terms of fees for these procedures in my area.  I think it is funny when a general dentist (namely Aspen Dental) charges more for procedures than we do here in a specialty office.   I think that if physicians were able to treat patients this way then it would go over well. Here in our town we have had a somewhat hostile hopspital takeover and the fees have gone through the roof...so much so that one of the larger medical groups just published their fees relative to new Hospital fees and it was sickening.  It was almost like gouging!  I like the EO!  I like the ideas above about catastrophic insurance and then improves HSA accounts and a more fee for service model.  

Good for you! I had a crooked ass dentist that eventually got busted for insurance fraud years ago. It seemed after every visit there was changes to costs and what insurance covered etc...always. I may just be clueless but it seems like there is a ton of room for fraud in dentistry. I have a client who is a good man, good dentist and very clear and fair with his pricing and payments. They are truly a valuable asset to the community

Share this post


Link to post
Share on other sites
14 hours ago, MFB said:

Good for you! I had a crooked ass dentist that eventually got busted for insurance fraud years ago. It seemed after every visit there was changes to costs and what insurance covered etc...always. I may just be clueless but it seems like there is a ton of room for fraud in dentistry. I have a client who is a good man, good dentist and very clear and fair with his pricing and payments. They are truly a valuable asset to the community

So I have known two dentists go to prison for insurance fraud...both were defrauding medicaid patients. One was overtreating children's teeth and doing unnecessary work while the other was changing codes after the fact.  The overtreater went to jail for like 18 months on charges of racketeering and the other spent like a month or two in prison for insurance fraud.  They are both out now on the lecture circuit and it is disgusting!  

Share this post


Link to post
Share on other sites
6 hours ago, STS said:

So I have known two dentists go to prison for insurance fraud...both were defrauding medicaid patients. One was overtreating children's teeth and doing unnecessary work while the other was changing codes after the fact.  The overtreater went to jail for like 18 months on charges of racketeering and the other spent like a month or two in prison for insurance fraud.  They are both out now on the lecture circuit and it is disgusting!  

That is disgusting 

Share this post


Link to post
Share on other sites
1 hour ago, SanAntonioCock said:

Hopefully the part of the 1% who own pharmaceutical companies and stocks.

While pharmaceutical costs are a problem, just arbitrary caps as he proposed don't really address the problem. On the other hand, patent reform would be more likely to be a fix rather than a "pass the buck" measure.

It doesn't fit in the give away free stuff platform the far left has decided to run on.

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


×
×
  • Create New...