Category Archives: insurance
Making the Case for a “HAI Category of Spend”
One in twenty patients contract infections in U.S. hospitals they didn’t have before they arrived. Tens of thousands of these patients die each year from these same infections. The government and most all insurers have told U.S. hospitals to clean up their act. Medicare simply won’t pay for certain hospital acquired infections (HAI) anymore and payments for patients who are readmitted with complications related to HAIs are also being steadily eliminated. In fact, the CDC claims that HAIs cost the U.S. healthcare system greater than $30 billion annually –a number, by the way, that many regard as absurdly low. And [...]
[More...]
Comments (2)
What A Hospital Charges Vs. What Medicare Pays — Yet Another Case for Pricing Transparency
According to “A Study of Hospital Charge Setting Practices” by the Lewin Group, “the Medicare Payment Advisory Commission (MedPAC) has expressed concerns about the accuracy and fairness of the current Medicare hospital in- and out-patient prospective payment systems (PPSs). Payment rates for these systems are based, to varying degrees, on hospital charges. However, little is known about how hospitals set their charges.” Really? Isn’t it getting old. Why the “shell game” with hospital charges? Charging everyone the same published price –a la Walmart—is exactly what Walmart will do at thousands of outpatient clinics, so saying it can’t be done is, [...]
[More...] Comments (0)
Fee For Service On Life Support in Michigan –New BCBS & Trinity Contract Sets Industry Example
The new contract between Trinity Health (Trinity owns a dozen hospitals in Michigan that include Saint Mary’s Health Care in Grand Rapids and Mercy Health Partners in Muskegon, both of which now operate under the Mercy Health banner) and BCBS of Michigan puts a heavy spotlight on reform era reimbursement models. This deal highlights the latest and preferred compensation mentality –one that eliminates fee for service in favor of putting the focus on patient outcomes instead. BCBS and Trinity both refer to the agreement as a “value-based contract,” saying it should improve care quality and drive costs lower, not only [...]
[More...] Comments (0)
ObamaCare’s List of Unintended Consequences Conspicuously Alarming –And Growing
Just last week, the Kaiser Family Foundation released a study that indicates that ObamaCare has caused annual family health insurance premiums to increase at a rate three times higher than in 2010. It’s just one more unintended and negative consequence that has been added to a list that continues to grow at a conspicuously alarming rate. Remember that provision that guaranteed health insurance for children? And what about the simplest goal of all –how Obamacare was supposed to quickly reduce the number of uninsured? Not only are less people insured these days, but health insurance costs significantly more. In fact, [...]
[More...] Comments (0)
Surprise Surprise –”Competitive” Exchanges Promise More of the Same
Thanks to the Kaiser Health News for the following guest post: In Alabama, if you get your health insurance through your employer and you lose your job, you quickly realize there aren’t a lot options for purchasing coverage on your own. Blue Cross and Blue Shield of Alabama has had a virtual monopoly in the state since the Great Depression, and today it covers a whopping 89 percent of Alabamians. In part, Blue Cross and Blue Shield is dominant in Alabama simply because it has been there for so long — it sold its first policy in 1936 — and [...]
[More...] Comments (0)
Michigan Blues get Governor’s Reprieve
The U.S. DOJ and the state of Michigan have asked the U.S. District Court in Detroit to dismiss an antitrust lawsuit filed against Blue Cross Blue Shield of Michigan (BCBSM) over its use of “most-favored nation” clauses in some of its hospital contracts. The lawsuit alleged that BCBSM pushed some hospitals into signing contracts with clauses that required them to charge higher prices to competing health insurers. If you aren’t yet properly nauseated, read on. In a motion filed jointly with BCBSM, the parties agreed that injunctive relief is no longer necessary, however, because legislation signed into law this month [...]
[More...] Comments (0)
California –Just 1 of 36 U.S. States to Earn a D or F in Pricing Transparency
According to two studies conducted independently by Catalysts For Payment Reform and Healthcare Incentives Improvement Institute, 36 U.S. states are getting a failing grade when it comes to healthcare consumer pricing transparency. But for just a moment, forget about how many U.S. states are stinking up the joint. Wouldn’t we all be better off if the government officials responsible for “improving” this situation were being graded for their performance? Obviously, their efforts are failing so miserably that it begs us to consider if their ineptitude is intentional. Indeed, there are so many ironies related to the system’s persistent ability to [...]
[More...] Comments (0)
HMS Delivers New COB Solution –Right on Time for Commercial Insurers
We all have certain experiences that stand out in our respective memories and will forever remain vivid. For many of us, it’s the birth of a child. For me, it was a short period of time between late 1992 and early 1994 when there were actually two incomes in our household –two paychecks. My wife was gainfully employed during that time. I get wispy even thinking about it. We not only had two paychecks, but two sets of benefits. She worked for Glaxo at that time and I worked for a no-name start-up. Her benefits were gold-plated and mine, well, [...]
[More...] Comments (1)
New Yorkers Are Celebrating: “Do the Dew!”
Today was to have been the last day you could legally purchase a large, sugary soda in the big apple. Yes, today should have been that day, but alas, a New York judge intervened and added some ice. How gauche but, thank goodness. I’m reminded of a similar course correction made by Doc Holliday in the movie Tombstone. When presented with a law badge he refused to wear, the good Doctor commented, “my hypocrisy only goes so far.” But at his end, when given his last rights he acknowledged, “it appears my hypocrisy knows no bounds.” In the city that [...]
[More...] Comments (0)
If Fee-For-Service is Dead –What are Reform’s Essential New Attributes?
In doing my research for this morning’s post, I became more familiar with The Commonwealth Fund and the work it is doing. Definitely some practical, down-to-earth stuff designed to help everyone get on the same page. After all, time is not standing still. The “new rules” of the game are actually being implemented. And because “getting paid” has always been a favorite topic of mine, especially when dealing with complex or evolving systems, I thought the following summary –a summary of the current “ideal” pulled together by The Commonwealth Fund– might be a useful primer. As our current system (U.S. [...]
[More...] Comments (0)
Rick Scott Decides to “Take the Money” –Florida Now On Board w/ Medicaid Expansion
Florida Governor Rick Scott (R) held a press conference yesterday where he announced that he would accept Obamacare funding in order to expand his state’s Medicaid program. To date, six other Republican governors — in Arizona, Michigan, New Mexico, North Dakota, Ohio, and Nevada — have decided to expand their Medicaid programs, after making it very clear, initially, that they were fully opposed to it. Even Wisconsin’s Scott Walker seems to be coming around. “I believe in a different approach,” Scott told reporters at a news conference Wednesday. “But it doesn’t matter what I believe. The Supreme Court made its [...]
[More...] Comments (0)
2013: Five Top Healthcare Trends –An Entrepreneur’s Take
Healthcare Matters would like to welcome the following guest post from Melissa Thompson, CEO of Talk Session, an online counseling platform that will soon connect users with professionals for on-demand, mobile therapy. Melissa offers her opinions on five trends that will dominate the healthcare front in 2013. We know where the analysts stand, so let’s consider an entrepreneur’s take. Despite the regulatory difficulties, 2013 will surely be an exciting year for healthcare. We will see an increase in self-management and collaboration. We will see an influx of innovation in mainstream health-related consumer products, data will be more readily available, and [...]
[More...] Comments (0)
Varian Runs a “Clinic” in Effective Lobbying –Harry Reid Rides Shotgun
When lawmakers make last minute “inserts” and/or bury curious provisions “deep in the bowels” of an otherwise huge piece of legislation, there’s usually a reason for it, and it’s not because someone was forgetful. Let me put it this way, when you deliberately bury something “deep in the bowels” of something else, that “thing” you buried will generally carry a stench with it. A story will run in today’s WSJ where Alicia Mundy looks at a last-minute provision in the fiscal-cliff bill that sharply cut Medicare payments for Sweden’s Elekta AB EKTA-B.SK -0.36%, a maker of radiation tools, while leaving unchanged those [...]
[More...] Comments (2)
Kill The Term “Reimbursement”
I recently ran across a post written by Paul Teague, a contributing writer to the Procurement Leaders Executive Network. In his post, Paul talks about risk management for procurement professionals and why healthcare procurement and financial executives have it tougher than most. He points out that “risk” is hard to manage because you never know where it’s coming from. And while I agree with most of what Paul had to say, I have to say that I take issue with that last statement. Because when it comes to managing risk, even in this era of reform, the sources aren’t hard [...]
[More...] Comments (0)
UPMC and Highmark Soap Opera Continues…
The whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety) by menacing it with an endless series of hobgoblins, all of them imaginary. –H. L. Mencken That Mencken quote might well describe UPMC’s public relations strategy in Western Pennsylvania. Because “yes,” UPMC is at war with Highmark (over the insurance giant’s desire to establish West Penn Allegheny Health System (WPAHS) as a viable competitor) and because “yes,” the local populace has grown accustomed to being horrified. Despite that, most folks fail to realize that UPMC surrendered on the PR front [...]
[More...] Comments (0)
Patient Centered Care: Tastes Great, Less Filling
Healthcare has been evolving away from a “disease-centered model” and toward a “patient-centered model.” In the disease-centered model, physicians would make almost all treatment decisions based on clinical experience and data from various medical tests. In the patient-centered model, patients become active participants in their own care and receive services designed to focus on their individual needs and preferences. In fact, the IOM (Institute of Medicine) defines patient-centered care as a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they need [...]
[More...] Comments (0)
- Healthcare in the Cloud: Forecast Still Hazy : HIMSS 2013: Top Takeaways Gathering Clouds said: [...] to David McCament’s mind, the future of healthcare cloud is not so clear. In a gue... more
- Time Definite Logistics –MNX Expands Global Network and Adds Track & Trace : Daniel said: Everything is very open with a precise description of the issues. It was definitely inform... more
- Varian Runs a “Clinic” in Effective Lobbying –Harry Reid Rides Shotgun : Thomas Finn said: Thanks for your comment Bo. I do not fully comprehend the differences between the two opti... more
- Varian Runs a “Clinic” in Effective Lobbying –Harry Reid Rides Shotgun : Barton 'Bo' Cooke said: Tom, you nailed it. This rider, put in at the last minute and was rushed into the Congres... more
Spend Matters Compass research is based on a year-long editorial calendar, exploring bigger picture areas and issues
Next Level Sourcing and Commodity Management
New Paper P2P and Working Capital
Services Procurement Innovation
ERP Procurement and Spend Management Applications
Spend Matters Perspectives research is focused on targeted topics that impact specific areas in procurement
