The title of the article says it all: “The Battle over Billing Codes.”
On Marketplace Tuesday (April 10, 2012), Gregory Warner did a report about one physician who has decided to use the billing codes, known as CPT’s to the maximum effect for maximum revenue. The physician states that by maximizing codes he has increased his revenue “by 70 percent -- hundreds of thousands of dollars per year” by doing the same thing he did.
The article also states that we are paying for medicine the way we have been doing it for years, by procedures. As a business professional, with over 15 years in retail and medicine, I have a question for Mr. Warner. How else are we to pay for services rendered than for the service rendered?
At the end of the segment there is a tease related to ObamaCare:
“So can we get rid of the codes? Well, some doctors and hospitals are already signing up for a new program under the health care reform law that would pay doctors by a lump sum instead of per procedure. “
The new program is the ACO initiative, which is a revised capitation HMO program. A capitation program is where the provider is paid a lump sum at the beginning of a set time frame, usually the beginning of the year, to take care of a patient. What is left at the end of the year, i.e Fee Paid less Medical Expenses = Physician Revenue, is the doc's to keep. But wait: if the care for the patient exceeds the fee paid, can the doctor go back and request more money to take care of the patient? The answer is no, because that would be fee for service. The doctor then has to take money from other patients to pay for the really sick patient or take money from his own coffers. Once the docs realized they were on the losing end in capitation, it went the way of the dinosaurs and the only docs who do capitation today are the ones straight out of med school.
Mr Warner continues:
“But other doctors don't want to give up their independence. Larry Rabon and his family have gotten used to playing the chess game. And if every doctor played as well as they do, then our deficit would really be in trouble. “
Mr. Warner refers to payment for procedure as a chess game, meaning there are winners and losers. The implication is that doctors are “winners” because they want to be paid for their services rendered, as any other service professional. Payment for services rendered is how all services are paid. We pay our hairdresser for a haircut, we pay our tarot card reader for a tarot card session, we pay for a ticket to see a movie or play, etc.
Then as a winner, he states that if all doctors understand the CPT rules and bill as Dr. Rabon does, then it will expand our deficit. I hate to tell Mr. Warner, but with people living longer, 86 is now average, and with the Baby Boomers entering Medicare in droves, that is enough to destroy the Medicare system. Dr. Rabon is not only billing Medicare, which has the strictest billing rules, but also the private insurers in order to maintain his revenue stream.
After years of berating doctors to take coding more seriously, which results in them getting paid for what they do, it is refreshing to find out that one doctor has decided his time has worth.
Monday, April 16, 2012
Sunday, April 15, 2012
Drink up, Think up?
Turns out, a drink or two really does lubricate the brain-pan:"Scientists found that men who either drank two pints of beer or two glasses of wine before solving brain teasers not only got more questions right, they also were quicker in delivering correct answers ... alcohol may enhance creativity problem solving by reducing the mind’s working memory capacity"
It appears that Cliff was right.
Friday, April 13, 2012
Friday Exchange Update
FoIB (and Director of Health Policy for the Cato Institute) Michael Cannon has 2 words of advice for the 58 state departments of insurance: Civil. Disobedience:"The most important front right now is to ensure that states do not create the health-insurance exchanges [ObamneyCare©] needs ... Refusing to create exchanges is the most powerful thing states can do ... Think of it as an insurance policy in case the Supreme Court whiffs."
Even I can applaud the mandate for this kind of policy.
On the other hand, Empire State Governor Mario Cuoma has not heeded Michael's sage advice:
"New York Gov. Andrew Cuomo is being heralded as brave for moving forward to set up a statewide health exchange by executive decree ... The Executive Order allows for regional advisory committees of all stakeholder representatives to make recommendations on the establishment and operation of the Exchange."
And so what, you ask?
So this:
"Sen. Greg Ball ... does not see cost savings but more spending the state can ill afford ... “any rush towards enacting [ObamneyCare©] is more political than reality. The promise of federal funding is not without strings and the program itself will ultimately ... cost New York taxpayers billions of additional dollars that we do not have."
Now that's an expensive insurance policy.
The Neasham Chronicles: A Contrarian's Take
For those just tuning in, a quick summary: (now former) California insurance agent Glenn Neasham sold an annuity to an elderly woman. Her family, claiming that she was in fact suffering from Alzheimer's at the time, took umbrage. Mr Neasham, stripped of his license, now sits in jail for felony theft.
The longer version is here and here.
From the first, I've been on the fence regarding this case. For one thing, I fail to see how the "victim" was actually harmed. For another, I fail to see how forwarding a check to an insurance company constitutes "theft." And as much as has been written about this case in the industry media, we still don't have all the facts.
This morning, I came across a terrific analysis of the case written by Sheryl Moore, herself a licensed agent and the grand-daughter of two Alzheimer's patients. She points out several details which, if not disregarded by that media, has seen precious little airtime:
"It is a known fact that the state of California is one of the worst insurance departments to deal with ... they also have a senior-protection law (SB620) that imposes severe penalties for insurance agents selling “unsuitable” annuities to seniors."
Was the indexed annuity product "unsuitable?" We don't know, but it's not a question to be taken lightly.
She notes also that "[t]he bank that held the certificate of deposit [the funding vehicle] ... had discussed with Mr. Neasham their concerns about the prospective annuitant’s decisions, independence and ability to understand the annuity purchase."
This is actually a two-edged sword: the fact that Mr Neasham agreed to accompany Ms Schuber to the bank at all would seem to be a net positive regarding his character and belief that she was, in fact, competent to make the purchase decision.
On the other hand, once he had heard these concerns, perhaps a call to the carrier's compliance department would have been prudent.
I think Ms Moore is a little premature in letting Allianz off the hook. As she (correctly) notes, Mr Neasham represented the carrier, and had a fiduciary duty to it. But it seems to me that this is not a one-way street: the carrier processed the application; as we've been noted, indexed products receive additional scrutiny compared to their fixed-design counterparts.
On the whole, though, I find Ms Moore's analysis to be a refreshing change from the hand-wringing that's characterized this case. Again, my natural sympathies lie with Mr Neasham, and I do believe - based on the facts as we know them - that jail-time was a clear abuse of prosecutorial power. But there is certainly more here than initially met the eye.
The longer version is here and here.
From the first, I've been on the fence regarding this case. For one thing, I fail to see how the "victim" was actually harmed. For another, I fail to see how forwarding a check to an insurance company constitutes "theft." And as much as has been written about this case in the industry media, we still don't have all the facts.
This morning, I came across a terrific analysis of the case written by Sheryl Moore, herself a licensed agent and the grand-daughter of two Alzheimer's patients. She points out several details which, if not disregarded by that media, has seen precious little airtime:
"It is a known fact that the state of California is one of the worst insurance departments to deal with ... they also have a senior-protection law (SB620) that imposes severe penalties for insurance agents selling “unsuitable” annuities to seniors."
Was the indexed annuity product "unsuitable?" We don't know, but it's not a question to be taken lightly.
She notes also that "[t]he bank that held the certificate of deposit [the funding vehicle] ... had discussed with Mr. Neasham their concerns about the prospective annuitant’s decisions, independence and ability to understand the annuity purchase."
This is actually a two-edged sword: the fact that Mr Neasham agreed to accompany Ms Schuber to the bank at all would seem to be a net positive regarding his character and belief that she was, in fact, competent to make the purchase decision.
On the other hand, once he had heard these concerns, perhaps a call to the carrier's compliance department would have been prudent.
I think Ms Moore is a little premature in letting Allianz off the hook. As she (correctly) notes, Mr Neasham represented the carrier, and had a fiduciary duty to it. But it seems to me that this is not a one-way street: the carrier processed the application; as we've been noted, indexed products receive additional scrutiny compared to their fixed-design counterparts.
On the whole, though, I find Ms Moore's analysis to be a refreshing change from the hand-wringing that's characterized this case. Again, my natural sympathies lie with Mr Neasham, and I do believe - based on the facts as we know them - that jail-time was a clear abuse of prosecutorial power. But there is certainly more here than initially met the eye.
Cavalcade of Risk #155: Call for submissions
Jaan Siderov hosts next week's CavRisk. Entries are due by Monday (the 16th).
To submit your risk-related post, just click here to email it.
You'll need to provide:
■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post ("Remarks")
PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).
Thanks!
To submit your risk-related post, just click here to email it.
You'll need to provide:
■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post ("Remarks")
PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).
Thanks!
Update - Mandated Contraception Coverage
On March 21, 2012, the Federal Register contained an Advance Notice of Proposed Rulemaking [ANPR] released jointly by the Departments of the Treasury, Labor, and HHS. This ANPR concerns the recent dust-up over coverage of contraceptives under the Affordable Care Act.
For anyone who is interested, the complete ANPR can be found here [.pdf file].
In the Overview of Intended Regulations (Section II, page 16503) we read:
"The starting point for this policy development includes two goals"
"First, the Departments aim to maintain the provision of contraceptive coverage without cost sharing to individuals who receive coverage through non-exempt, non-profit religious organizations with religious objections to contraceptive coverage"
"Second, the Departments aim to protect such religious organizations from having to contract, arrange, or pay for contraceptive coverage."
Later in the same section, we read:
"For such religious organizations that sponsor self-insured plans, the Departments intend to propose that a third-party administrator of the group health plan or some other independent entity assume this responsibility."
Notice that the first aim quoted above makes it crystal clear that the administrations’ consistent use of the term “accommodation” is both significant and deliberate. No compromise is intended, and accordingly this ANPR does not seek ideas for any compromise.
Second, the remark regarding self-funded plans reminds me of every manager’s last desperate hope when completely out of ideas: “ . . . and then a miracle happens.” It will be fascinating to see which, and how many, third-party administrators or other independent entities will actually agree to assume this responsibility. It will be equally fascinating to find out how it will be paid for. Who knows, maybe there will be a miracle - I'm guessing that’s what the administration hopes, anyway.
For anyone who is interested, the complete ANPR can be found here [.pdf file].
In the Overview of Intended Regulations (Section II, page 16503) we read:
"The starting point for this policy development includes two goals"
"First, the Departments aim to maintain the provision of contraceptive coverage without cost sharing to individuals who receive coverage through non-exempt, non-profit religious organizations with religious objections to contraceptive coverage"
"Second, the Departments aim to protect such religious organizations from having to contract, arrange, or pay for contraceptive coverage."
Later in the same section, we read:
"For such religious organizations that sponsor self-insured plans, the Departments intend to propose that a third-party administrator of the group health plan or some other independent entity assume this responsibility."
Notice that the first aim quoted above makes it crystal clear that the administrations’ consistent use of the term “accommodation” is both significant and deliberate. No compromise is intended, and accordingly this ANPR does not seek ideas for any compromise.
Second, the remark regarding self-funded plans reminds me of every manager’s last desperate hope when completely out of ideas: “ . . . and then a miracle happens.” It will be fascinating to see which, and how many, third-party administrators or other independent entities will actually agree to assume this responsibility. It will be equally fascinating to find out how it will be paid for. Who knows, maybe there will be a miracle - I'm guessing that’s what the administration hopes, anyway.
Thursday, April 12, 2012
Your papers, please.
Back in '97, my then Continuing Education partner and I What was so interesting (at least to us) about that was what each digit - or set of digits - represented. As I recall, there were 10 or so digits. The first 2 identified the carrier. Think about that: less than 100 possible carriers. That gave us pause.
The next 2 digits designated plan design. Again: less than 100 possible configurations, all pre-determined/defined. And then some other info I really don’t recall. Interesting/scary, no?
Well, flash forward some 15 years, and:
"Officials at the U.S. Department of Health and Human Services (HHS) are hoping they can start giving health plans Health Plan Identifier (HPID) numbers Oct. 1."
So, a decade-and-a-half late, but at least there's movement.
I'm actually ambivalent about this: of course, the fact that we had to pass the bill to find that what's in it is old news, but why - if this identifier was already included in HIPAA - was it necessary to "reinvent the wheel?" Why not just, you know, implement HIPAA?
The article, by the way, notes (erroneously) that "the HPID project is a sister to other HHS identification number projects spawned by the Health Insurance Portability and Accountability Act of 1996 (HIPAA)."
No, it's not.
But that's a small quibble; I can actually see a benefit to this type of card. As we've noted, medical ID theft is a growing and onerous problem. This may well be an effective tool in the fight against it. For another, Bob opines that "[i]n principle I have no problem (with the NPID). Anything to get away from using SSN for identification purposes . . . especially when your SS card says "not for identification purposes."
On the other hand, though, he echoes this warning: "I suppose the HPID can also be used to scarf up even more medical data on me that will go in to the government database." Not too far-fetched, that.
On balance, though, this may well turn out to be "a good thing."
Constitution State says: Take a Hike!
Or maybe not:
"Health insurers and HMOs in Connecticut have agreed to begin notifying their individual and small group policyholders each time they submit a rate request to the state Insurance Department for review."
This appears to be a "good thing" inasmuch as it obviates the need for additional legislation requiring that they do so.
What's unclear to me - and potentially a deal-breaker - is whether or not those carriers will be permitted to explain why they're seeking these increases. In the past, government entities have resisted such efforts at transparency.
"Health insurers and HMOs in Connecticut have agreed to begin notifying their individual and small group policyholders each time they submit a rate request to the state Insurance Department for review."
This appears to be a "good thing" inasmuch as it obviates the need for additional legislation requiring that they do so.
What's unclear to me - and potentially a deal-breaker - is whether or not those carriers will be permitted to explain why they're seeking these increases. In the past, government entities have resisted such efforts at transparency.
Health Wonk Review - Green Jacket edition
Brad Wright hosts this week's Masters-themed collection of interesting and provocative health care policy posts.
Wednesday, April 11, 2012
Honey Badger Rules
FoIB Tom T has designed a unique new game based on the hit Honey Badger internet meme. Called Hungry Honey Badgers™, it looks to be fast and fun.The game's currently in development, and you can get in on the ground floor as he's seeking initial funding. Depending on your pledge level, you can score special dice and even limited edition artwork.
And speaking of pledges, Tom's using a very cool fundraising widget called Kickstarter: your card isn't charged unless and until the pre-determined goal is reached.
Click here for your opportunity to support an entrepreneur, and possibly see your name in lights (or at least the instruction booklet).
MLR: More Loony Reg's
First, the good news:"A House panel plans to act on and report out ... legislation that would exempt agent commissions from the Medical Loss Ratio (MLR) provision of [ObamneyCare©]."
It's never made much sense to me that they would have been included in the first place. but there you go. This is far from a "done deal," but it bodes well for those who actually sell and service this product.
The bad news is pretty significant, and it comes back to something we discussed last month:
"Foremost among these is the April 1 filing of a Supplemental Health Care Exhibit (SHCE) ... to assist state regulators in identifying and defining elements that make up MLR."
The issue here is the rebates themselves. By definition, a carrier must wait until all the previous year's claims have been settled before calculating its Medical Loss Ratio (MLR). This isn't really a problem with claims from, say January or February of the benefit year, but what about someone who has emergency surgery on New Year's Eve? It may well be April or May of the following year before all the dust has settled, and the refunds calculated and mailed out.
Here's the rub: taxes are due by mid-April, and you might not (heck, probably won't) get your MLR refund until late April or May (or even June!).
So what, Henry? It's not like they're taxable, right?
Right?!
Good question. As FoIB Patrick P points out:
"It would appear that one would either have to re-file or amend a return. Think about the ramifications for employers and their tax implications. Why would any business continue offering insurance if they were going to have to dissect this mess?
The Commonwealth Fund just released an issue brief estimating the MLR impact on a State-by-State basis. It says in Ohio the average rebates would be: $268 individual market, $78 small group, and $48 in large group. It’s going to cost more to deal with the hassle than the rebate is worth."
And thus ends the most recent episode of the bill we had to pass to learn what's in it.
Tuesday, April 10, 2012
Death, Taxes and Health Care
As if the new and improved ObamneyCare© taxes weren't enough, the Feds are calling for new taxes on ... wait for it ... health care:"A report Tuesday from the Institute of Medicine says the U.S. health system has a "fixation" on clinical care, or treating people when they get sick, rather than preventing them from getting ill in the first place."
Yeah, it's funny how that works out, isn't it?
So it seems pretty simple to dodge this tax: just don't get hurt or sick.
Seems fair.
UPDATE: More here (Thanks Bob!)
Key quote:
"It may sound counterintuitive, but a panel of experts ... has concluded that the best way to slow the nation's breakneck spending on medical care is to impose a tax on every health care transaction."
Yup, that'd do it.
Van's the Man
Van Mayhall runs the Insurance Regulatory Law blog, a must-read for folks interested in the legal aspects of risk-management. Recently, he posted a three-part series on the insurance industry and the current recession. It's a fascinating look at how law, finance and risk all interact with each other.
Part One notes that the expected carrier insolvency crisis never really materialized.
Part Two is about misconceptions regarding government bailouts of the industry.
And Part Three explores how life insurers seemed to be affected more than other lines.
Fascinating stuff, well-researched and written.
Part One notes that the expected carrier insolvency crisis never really materialized.
Part Two is about misconceptions regarding government bailouts of the industry.
And Part Three explores how life insurers seemed to be affected more than other lines.
Fascinating stuff, well-researched and written.
Monday, April 09, 2012
Exchange News
When last we looked, the 58 states were at various stages of implementing (or passing on implementing) the so-called Insurance Exchanges precipitated by ObamneyCare©. This afternoon, we have some new news to share:First up, the National Association of Insurance and Financial Advisors (NAIFA) - and trust me, this is an oxymoron of the highest caliber - is applauding HHS Secretary Shecantbeserious for deigning to acknowledge “the significant role agents will play in the state health care exchanges.”
Yeah....thanks but no thanks, Kathy.
And if you're more of a right-brain type, then this interactive map may be helpful in tracking the Exchange status of those states.
We're from the Government...
And we're here to "help" you:"Amid a wave of research on the subject, the federal government is seeking ways to measure what some have called gross national happiness ... a panel of experts in psychology and economics ... began convening in December to try to define reliable measures of “subjective well-being.”
Oh frabjous day!
What's that you ask? Who's footing the bill for this groundbreaking, critical research project?
Well, you are, of course:
"Funded by the U.S. Department of Health and Human Services ... including Nobel laureate Daniel Kahneman"
Look for HHS Secretary Shecantbeserious to announce the new "Happiness Mandate" to be covered by all health insurance policies. Although I suppose one could argue that the new
The beatings will continue until morale improves.
[Hat Tip: FoIB Karen Y]
Twisting in the Wind: MVNHS© Style
My dear, sweet, 92 year-old aunt is dying. It's not exactly unexpected: her health has been failing for a while. Like her younger sister - my late mother - it's been a long, slow trajectory. Her daughters have been taking turns coming in to help her and my 95 year-old uncle, and as Passover approached, all three of them, their husbands and children, came in for a (presumably) final Seder.
It is at once gut-wrenching and hope-inspiring for me to experience this: my best half arranged for us to fly in last weekend for a final visit with our family matriarch.
You're probably thinking "that's touching, Henry, really; but what does that have to do with the Much Vaunted National Health System?"
Just this:
"When Kenneth Warden was diagnosed with terminal bladder cancer, his hospital consultant sent him home to die, ruling that at 78 he was too old to treat."
Under MVNHS© guidelines, health care is free, but it's also rationed (but of course!). At 78 years young, Mr Warden was deemed too old to benefit from extended, expensive, even palliative care, and was thus denied it. Now, think about your own grandfather, or father.
Or self.
Fortunately, his daughter wasn't taking "no" for an answer, and arranged for private care for her beloved father. Thanks to her (and, of course, the private doc and presumably deep pockets), her father beat the cancer,
Yet here is the lesson: This is the very basis of ObamneyCare©. And do you really think, even for a moment, that those with the means (aka "cash") to pay for this care will be denied it?
Yeah, that's what I think, too.
[Hat Tip to co-blogger Nate and FoIB Peter K]
It is at once gut-wrenching and hope-inspiring for me to experience this: my best half arranged for us to fly in last weekend for a final visit with our family matriarch.
You're probably thinking "that's touching, Henry, really; but what does that have to do with the Much Vaunted National Health System?"
Just this:
"When Kenneth Warden was diagnosed with terminal bladder cancer, his hospital consultant sent him home to die, ruling that at 78 he was too old to treat."
Under MVNHS© guidelines, health care is free, but it's also rationed (but of course!). At 78 years young, Mr Warden was deemed too old to benefit from extended, expensive, even palliative care, and was thus denied it. Now, think about your own grandfather, or father.
Or self.
Fortunately, his daughter wasn't taking "no" for an answer, and arranged for private care for her beloved father. Thanks to her (and, of course, the private doc and presumably deep pockets), her father beat the cancer,
Yet here is the lesson: This is the very basis of ObamneyCare©. And do you really think, even for a moment, that those with the means (aka "cash") to pay for this care will be denied it?
Yeah, that's what I think, too.
[Hat Tip to co-blogger Nate and FoIB Peter K]
Wednesday, April 04, 2012
It ain't easy bein' green: MVNHS© Edition
So your primary doc's practice is two miles away, and you rely on him to help manage your health care. Two miles? No biggie, right?Um:
"Avril Mulcahy, 83, was told to address the “green travelling issues” over her journeys from her home in Westcliff-on-Sea, Essex, to the West Road Surgery. The surgery wrote to Mrs Mulcahy, telling her to register with a new GP within 28 days. "
That's right: this poor British senior citizen has apparently failed to placate the Green Gods©, and must now try to find a new primary care doc. That, of course, pre-supposes that this is even possible.
Adding insult to injury, Miss Avril relies on her doc for her prescription med refills, theoretically putting her health (if not her life) at risk.
Now, there are those that would say "well, that could never happen here." But how do you know? What's to stop HHS Secretary Shecantbeserious to find a Carbon Footprint mandate inside the bill we had to pass to learn what's in it?
[Hat Tip: Best of the Web]
Cavalcade of Risk #154: Healthcare Mandate Edition now up
Ken Faulkenberry makes his CavRisk hosting debut with a great edition, focusing on last week's SCOTUS hearings, and including his own take on many of the posts. Great job, Ken!
And Now for Something Completely Different . . .
. . . real news for a change about public health around the U.S, posted at the WSJ Healthblog.
The article contains a link to the results of the study; click on any state to see that state's data summarized by county, with comparisons to statewide and national U.S. averages.
One of the commenters brilliantly points out that the report classifies being "uninsured" as a "clinical care" factor, and inquires what the ICD-10 code may be for uninsured.
Any InsureBlog reader happen to know?
The article contains a link to the results of the study; click on any state to see that state's data summarized by county, with comparisons to statewide and national U.S. averages.
One of the commenters brilliantly points out that the report classifies being "uninsured" as a "clinical care" factor, and inquires what the ICD-10 code may be for uninsured.
Any InsureBlog reader happen to know?
Monday, April 02, 2012
Do we really have an affordability crisis?
"Americans spent nearly $1.5 billion for a chance to hit the jackpot, which amounts to a $462 million lump sum"
Where did $1.5 billion come from in 4 days?
We can't afford our healthcare but we can gamble away $1.038 billion in four days?
We don't have an affordability problem we have a priority problem. Until we view it as such we won't have any realistic solutions.
If we eliminated $100 billion in health care spending annually where would that money go? We assume it would lesson the debt, improve education, or go to some other worthy cause. Do we have anything to support that desired outcome?
Washington has never shown any problem spending money if it was available or not.
No matter how much we fund education it gets worse every year.
It is just as likely that any savings would be spent on more foreign imported electronics, maybe houses bigger then our already largest in the world. Maybe we would smoke more or drink top shelf instead of draft. If you look at our spending as a whole we sure don't appear to be suffering from a crimped budget. If we are going to blow the money on something healthcare is better then smoking, drinking, or gambling.
Where did $1.5 billion come from in 4 days?
We can't afford our healthcare but we can gamble away $1.038 billion in four days?
We don't have an affordability problem we have a priority problem. Until we view it as such we won't have any realistic solutions.
If we eliminated $100 billion in health care spending annually where would that money go? We assume it would lesson the debt, improve education, or go to some other worthy cause. Do we have anything to support that desired outcome?
Washington has never shown any problem spending money if it was available or not.
No matter how much we fund education it gets worse every year.
It is just as likely that any savings would be spent on more foreign imported electronics, maybe houses bigger then our already largest in the world. Maybe we would smoke more or drink top shelf instead of draft. If you look at our spending as a whole we sure don't appear to be suffering from a crimped budget. If we are going to blow the money on something healthcare is better then smoking, drinking, or gambling.
Friday, March 30, 2012
How 'bout ANOTHER $17 Trillion ObamneyCareBux©?
Last time we looked, ObamneyCare© had racked up an additional $111 billion cost overrun, and we remarked at the time how ironic it was that that might have been a low-ball guesstimate.Little did we suspect, though, a "massive $17 trillion funding gap."
Ooopsies.
"The $17 trillion in extra promises was revealed by an analysis of the law’s long-term requirements ... when combined with existing Medicare and Medicaid funding shortfalls, leaves taxpayers on the hook for an extra $82 trillion in health care obligations"
Which begs the continuing question: How many more of these little nuggets still lurk in the belly of the beast we had to pass in order to find out what's in it?
Wouldn't you like to be a pepper, too?
No, not that kind of Pepper, this kind:
"The food that inspires wariness is on course for inspiring even more wonder ... scientists reported this week ... that chili peppers are a heart-healthy food with potential to protect against the number one cause of death in the developed world."
The key ingredient, capsaicin, is why a lot of Asian restaurants include those little pepper symbols next to their spicy dishes. Many folks already use skin care and pain relief products containing the fiery capsaicinoids; this is apparently the first study to suggest that they help the heart in more ways than one:
"They lower cholesterol levels ... They also block action of a gene that makes arteries contract, restricting the flow of blood to the heart and other organs."
As with all things, moderation is the key; Dr Zhen-Yu Chen, Ph.D., who was involved in the study, warns that "we certainly do not recommend that people start consuming chilies to an excess."
Of course.
Now please pass that glass of cold milk.
[Hat Tip: FoIB Holly R]
"The food that inspires wariness is on course for inspiring even more wonder ... scientists reported this week ... that chili peppers are a heart-healthy food with potential to protect against the number one cause of death in the developed world."
The key ingredient, capsaicin, is why a lot of Asian restaurants include those little pepper symbols next to their spicy dishes. Many folks already use skin care and pain relief products containing the fiery capsaicinoids; this is apparently the first study to suggest that they help the heart in more ways than one:
"They lower cholesterol levels ... They also block action of a gene that makes arteries contract, restricting the flow of blood to the heart and other organs."
As with all things, moderation is the key; Dr Zhen-Yu Chen, Ph.D., who was involved in the study, warns that "we certainly do not recommend that people start consuming chilies to an excess."
Of course.
Now please pass that glass of cold milk.
[Hat Tip: FoIB Holly R]
Cavalcade of Risk #154: Call for submissions
Ken Faulkenberry hosts next week's CavRisk. Entries are due by Monday (the 2nd).
To submit your risk-related post, just click here to email it.
You'll need to provide:
■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post ("Remarks")
PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).
Thanks!
To submit your risk-related post, just click here to email it.
You'll need to provide:
■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post ("Remarks")
PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).
Thanks!
Thursday, March 29, 2012
Disingenuous ObamneyCare© Proponents
Since the train-wreck itself is indefensible on any logical or legal grounds, it just make sense to hire union members to astro-turf ginned up protests. Here, a gaggle of SEIU-related "women" explicitly discuss how much they were paid for their participation:
[Courtesy of The Daily Caller]
SwedishCare: "Shut up or die"
Welcome to SvenCare©, where your nurses are hot (or not), you can literally be saved by the bell (or not), and you can call 911 but you better not say anything when you do:"Swedish health authorities have come under criticism over the death of a woman whose repeated calls to emergency services were ignored because she was still able to talk."
But not, of course, for long. In Sweden, apparently, those cell phone minutes can kill you.
Literally:
"Jill Soderberg, 22, died in her home... shortly after she had placed her third and last call ... requesting an ambulance"
Hey, just because she was having major respiratory failure is no reason to be alarmed, right? After all, she could still talk, right?
Right?!
[Hat Tip: FoIB Jeff M]
Nate vs Chad: Entering the Ring
[Regular readers may recognize Nate Ogden as a frequent commenter and occasional guest-blogger here at InsureBlog. Well, it's our pleasure today to welcome Nate on board as a full-fledged Contributor. Nate's a Third Party Administrator in Northeast Ohio, and brings a very unique perspective to the whole insurance and risk-management business. In his debut post, Nate corrects the MSM on the subject of how self-funded plans are taxed. Welcome aboard, Nate! HGS]
Writing in the LA Times, Chad Terhune offers up his take on " a new type of self-insurance for small businesses with as few as 25 workers." While he does a better job than most media types (talk about a low bar), he still missed the mark. For one thing, this is not new at all. Some 15-20 years ago, there used to be a huge self-funded market for small groups. This is just a normal market cycle that repeats itself all the time. My family owns three TPAs(Third Party Administrators), we process the claims for self funded employers, and were based in Costa Mesa from 1980-2006. We had tons of 15 life, self-funded groups. There were carriers like Vasa Brougher that specialized in small group self funding.
For numerous reasons the market disappeared:
• Provider contracting favored the large carriers who did not rent their PPO networks. When you're self funded, you have to rent a PPO; generally, rental PPO's didn't have the deep discounts available to the "big boys." This was especially true in California until the Blues starting giving access to their PPOs 10 or so years ago.
• Poorly written COBRA laws made it extremely risky for small groups. Congress wrote the law, then left it up to the courts to interrupt the details. Large employers could afford a lawsuit while it put small employers out of business.
• The reinsurance market didn’t recognize the different needs of small employers compared to large ones, and thus the stop-loss policies didn’t provide all the protection small employers needed.
When we have these debates about health care reform and insurance it's important that the public be given accurate information. Small group self-funding is not some new concept just invented to circumvent State Regulation or PPACA reform. It has been around since the late 70's and early 80's. The failure of heavily regulated small group reform is just making it incredibly attractive right now. I would argue the reason you're seeing it more in California is that you have higher regulation there.
In most other States employers have been buying $5000+ deductible, fully insured plans, and then self-funding that deductible down. In California, most of the carriers worked hard to forbid this or to put enough restrictions on it to make it impossible.
Anyone arguing that self-funding only peels off the healthy risks has no idea what they are talking about. The vast majority of our business is groups that are moderately to very sick. Super healthy groups have premiums too low to make self-funding attractive. If everything works perfectly, they save a couple percent; if anything goes wrong, as it does on average once every five years, they pay considerably more. The groups flocking to self-funding are those that have been getting double digit rate increases year after year with no help from the carrier to fix the problem. Mr Terhune does mention getting claims data but doesn’t give it nearly as much discussion as it merits. Educating employees, often face to face, fighting with providers, finding waste and inefficiency is where the savings come from. Isn’t that what all groups should be looking to do?
Two more things: Mr Terhune is incorrect that self-funded groups don’t pay premium tax: they do, just on a smaller amount. This is one error the media always repeats and has for decades. Premium taxes apply to premiums (imagine that!), so the stop-loss premium is subject to them. For the most part, the claims paid by the employer are not subject to premium taxes (a handful of states have taxes based on claims).
Also, claiming that self-funded plans don’t contribute to the pools in PPACA is absolutely incorrect: self-funded plans have to pay the same per employee tax that fully insured plans do.
It sure would be nice to see the media care as much about accuracy as framing their message.
Health Wonk Review: SCOTUS in the news edition
FoIB David Williams hosts this week's round-up of wonky posts, focusing (unsurprisingly) on the health "care" reform case before the Supremes. If you've been following this (and who hasn't been?), here's your chance to see how folks on all sides see the case.Wednesday, March 28, 2012
Wednesday ObamneyCare© Update
Even as the Supremes wrap up their little shindig, the train-wreck itself keeps on keepin' on:"As the first quarter of 2012 comes to an end, more activities related to the Medical Loss Ratio (MLR) provision of [ObamneyCare©] will occur ... Foremost among these is the April 1 filing of a Supplemental Health Care Exhibit (SHCE) ... to assist state regulators in identifying and defining elements that make up MLR."
But that's just the beginning; there's more!
"In early April, [carriers] will mail letters concerning MLR to two groups of customers ... employers that are non-ERISA and non-government entities (such as churches and tribal groups) and may also be eligible for a rebate ... request that these employers provide written assurance that a certain portion of any potential MLR rebate paid to them will be used for the benefit of their subscribers."
Did you know about this requirement? Does your employer?
And there's this:
"[Carriers] will be legally required by [HHS Secretary Shecantbeserious] to pay the entire amount of any owed rebate directly to the subscribers of any terminated groups that cannot be located."
Of course! What could possibly go wrong with that?
FuneralCare©
Bob's been doing a yeoman's job of reporting on the SCOTUS ObamneyCare© trial, for which we're very grateful. Something came up yesterday, though, that I don't think got a lot of play in the MSM, and which seems to me to surpass even the "broccoli" argument. Justice Alito asked SG Verrilli:"Do you think there is a, a market for burial services?"
The Solicitor General affirmed that he believed there was such a market, which allowed Justice Alito to ponder:
"[S]uppose that you and I walked around downtown Washington at lunch hour and we found a couple of healthy young people and we stopped them and we said, "You know what you're doing? You are financing your burial services right now because eventually you're going to die, and somebody is going to have to pay for it, and if you don't have burial insurance and you haven't saved money for it, you're going to shift the cost to somebody else."
At first blush, this would seem a stretch; after all, no one forces us to buy life insurance (which is what burial or mortgage insurance really is). But upon reflection, one is reminded that ObamneyCare© proponents repeatedly argue that we're all going to use the health care system at some point (a rather dubious assumption, to be sure), and that we must have insurance in place to (help) pay for that care.
Well, it may or may not come to pass that a given person will need health care, but there's no escaping the Man with the Scythe. That is, unlike illness, death is inevitable, so why aren't we required to purchase burial insurance, as well? It's the same premise, after all, with the added benefit of being true.
[Hat Tip: Co-blogger Kelley]
GayCare©?
Actually, this is almost exactly what we've been preaching here at IB for over 7 years:
"[GOProud] argues that the problem with our tax code isn't just that it discriminates against gays. It's that it discriminates against every American who doesn't have his or her health insurance through an employer."
Hear, hear!
What the GOPRoud folks propose is something quite radical: equality. That is, a system where health insurance should not only not be tied to employment, but that everyone who buys a policy should get the same tax break as employers do now.
And they're also against "one-size-fits-all" insurance plans:
"We want a system where individuals and couples can make their own health-care decisions. Health-care needs are too important to be left to the discriminatory whims of a third party."
Now, they're also in favor of cross-state insurance sales, about which we're ambivalent: Bob, for example, has argued persuasively that opening up sales across state lines is no great shakes, while Mike favors lifting those restrictions.
YMMV.
Kudos to GOProud.
"[GOProud] argues that the problem with our tax code isn't just that it discriminates against gays. It's that it discriminates against every American who doesn't have his or her health insurance through an employer."
Hear, hear!
What the GOPRoud folks propose is something quite radical: equality. That is, a system where health insurance should not only not be tied to employment, but that everyone who buys a policy should get the same tax break as employers do now.
And they're also against "one-size-fits-all" insurance plans:
"We want a system where individuals and couples can make their own health-care decisions. Health-care needs are too important to be left to the discriminatory whims of a third party."
Now, they're also in favor of cross-state insurance sales, about which we're ambivalent: Bob, for example, has argued persuasively that opening up sales across state lines is no great shakes, while Mike favors lifting those restrictions.
YMMV.
Kudos to GOProud.
Tuesday, March 27, 2012
ObamneyCare© and the MVNHS©: Twin sons...
Back in the late 70's, two really talented guys got together and created some timeless tunes. Their first collaboration was an incentive for a host of others who followed in their footsteps.And so it is with the Much Vaunted National Health System© and ObamneyCare©. While the legal future of the latter is playing out as we speak, the former is well-established, and provides us a first-hand look at our own future under the bill we had to pass to learn what's in it:
"Thousands of elderly people are dying unnecessarily early because “despicable” age discrimination in the NHS is denying them treatment for cancer ... A lack of treatment or insufficient treatment is contributing to 14,000 deaths a year in people over the age of 75"
In England, they call that the NICE (National Institute for Health and Clinical Excellence). Here it's known as the IPAB (Independent Payment Advisory Board). They are, however, twin sons of different mothers.
Not exactly music to these ears.
[Hat Tip: PowerLine]
Monday, March 26, 2012
Shecantbeserious over-reaching - Again
Once again, Madame Secretary has weighed in on health insurers' legitimate rate-increase requests. This is clearly an over-step: nothing in ObamneyCare© grants her this power (and, in fact, it is solely the states' right to make these determinations):"The U.S. Department of Health and Human Services (HHS) and state insurance regulators started the rate review program to implement a section of [ObamneyCare©]"
And, once again, here's the uproar from the States.
Sunday, March 25, 2012
Essential Health Benefits and the Coverage of Contraceptives
A full and formal definition of essential health benefits (EHBs) is not yet available from HHS. Meanwhile, churches and church-affiliated benefit sponsors have strongly objected to the Administration's attempt to force them to cover contraceptives and "morning after" pills.
The Administration is now seeking comments by June 19 on how to address the objections - - while still ensuring that plan participants get contraceptive coverage. In other words, this Administration still wants to eat its cake and have it, too.
The Administration also recently released a set of “Frequently Asked Questions” that suggests employers determine EHBs using one of the HHS-designated benchmark plans. These FAQ's are found here (.pdf download).
Question/Response #10 is revealing:
First part of Q10. How would the intended EHB policy affect self-insured group health plans, grandfathered group health plans, and the large group market health plans?
A: Under the Affordable Care Act, self-insured group health plans, large group market health plans, and grandfathered health plans are not required to offer EHB.
The plain meaning of this sentence seems to be that these types of plans are NOT required to cover contraceptive services because they are not subject to federally-required EHBs in the first place.
Or so I thought.
Well not so fast, Sherlock.
Second part of Q10. How would employers sponsoring such plans determine which benefits are EHB when they offer coverage to employees residing in more than one State?
A - To determine which benefits are EHB for purposes of complying with PHS Act section 2711, the Departments of Labor, Treasury, and HHS will consider a self-insured group health plan, a large group market health plan, or a grandfathered group health plan to have used a permissible definition of EHB under section 1302(b) of the Affordable Care Act if the definition is one that is authorized by the Secretary of HHS (including any available benchmark option, supplemented as needed to ensure coverage of all ten statutory categories).
So the real test is: “if the definition is one that is authorized by the Secretary of HHS.“ Thus does Kathleen Sebelius keep her ultimate and final authority to personally approve or deny EHBs for any benefit plan- - even for those types of plans which the statute itself exempts. The government gave and the government has taken away; blessed be the name of the government.
This is further evidence that the Administration has no intention whatsoever to “compromise” with the sponsors of church and church-affiliated benefit plans. Expect no compromise even for church-affiliated plans that are self-insured, or in the large group market, or are grandfathered. Rather the Administration fully intends to force all plans to offer contraceptive coverage including those of church-affiliated sponsors who object on religious grounds, in apparent violation their First Amendment protections. Because Kathleen Sebelius says so – not because the statute says so.
My opinion: this issue is clearly about government overreach, not whether the particular social goal may be worthwhile. As citizens we should expect that our own government will always pursue its goals using legal and Constitutional means - rather than by double-dealing with us and by ignoring limitations placed on its powers in the Constitution and Bill of Rights. Maybe that's just me.
The Administration is now seeking comments by June 19 on how to address the objections - - while still ensuring that plan participants get contraceptive coverage. In other words, this Administration still wants to eat its cake and have it, too.
The Administration also recently released a set of “Frequently Asked Questions” that suggests employers determine EHBs using one of the HHS-designated benchmark plans. These FAQ's are found here (.pdf download).
Question/Response #10 is revealing:
First part of Q10. How would the intended EHB policy affect self-insured group health plans, grandfathered group health plans, and the large group market health plans?
A: Under the Affordable Care Act, self-insured group health plans, large group market health plans, and grandfathered health plans are not required to offer EHB.
The plain meaning of this sentence seems to be that these types of plans are NOT required to cover contraceptive services because they are not subject to federally-required EHBs in the first place.
Or so I thought.
Well not so fast, Sherlock.
Second part of Q10. How would employers sponsoring such plans determine which benefits are EHB when they offer coverage to employees residing in more than one State?
A - To determine which benefits are EHB for purposes of complying with PHS Act section 2711, the Departments of Labor, Treasury, and HHS will consider a self-insured group health plan, a large group market health plan, or a grandfathered group health plan to have used a permissible definition of EHB under section 1302(b) of the Affordable Care Act if the definition is one that is authorized by the Secretary of HHS (including any available benchmark option, supplemented as needed to ensure coverage of all ten statutory categories).
So the real test is: “if the definition is one that is authorized by the Secretary of HHS.“ Thus does Kathleen Sebelius keep her ultimate and final authority to personally approve or deny EHBs for any benefit plan- - even for those types of plans which the statute itself exempts. The government gave and the government has taken away; blessed be the name of the government.
This is further evidence that the Administration has no intention whatsoever to “compromise” with the sponsors of church and church-affiliated benefit plans. Expect no compromise even for church-affiliated plans that are self-insured, or in the large group market, or are grandfathered. Rather the Administration fully intends to force all plans to offer contraceptive coverage including those of church-affiliated sponsors who object on religious grounds, in apparent violation their First Amendment protections. Because Kathleen Sebelius says so – not because the statute says so.
My opinion: this issue is clearly about government overreach, not whether the particular social goal may be worthwhile. As citizens we should expect that our own government will always pursue its goals using legal and Constitutional means - rather than by double-dealing with us and by ignoring limitations placed on its powers in the Constitution and Bill of Rights. Maybe that's just me.
Contract Law vs ObamneyCare©
When I first posted on this late last month, I was skeptical that it would gain much traction.
As regards the (Evil) Individual Mandate that ostensibly free citizens must buy a product from a private vendor:
"[T]the age-old caveat that a contract entered into under duress is non-enforceable. Their stance is that, because insurance is, in fact, a contract, forcing one under penalty of law to sign on the dotted line renders it moot."
Now comes George Will, noting in the Washington Post that:
" [T]he elegant scholarship and logic with which it addresses an issue that has not been as central to the debate as it should be ... The individual mandate is incompatible with centuries of contract law. This is so because a compulsory contract is an oxymoron."
So maybe it is picking up steam.
As regards the (Evil) Individual Mandate that ostensibly free citizens must buy a product from a private vendor:
"[T]the age-old caveat that a contract entered into under duress is non-enforceable. Their stance is that, because insurance is, in fact, a contract, forcing one under penalty of law to sign on the dotted line renders it moot."
Now comes George Will, noting in the Washington Post that:
" [T]he elegant scholarship and logic with which it addresses an issue that has not been as central to the debate as it should be ... The individual mandate is incompatible with centuries of contract law. This is so because a compulsory contract is an oxymoron."
So maybe it is picking up steam.
Friday, March 23, 2012
Friday LinkFest
A veritable smorgasbord of interesting items:■ First up, The Feds are starting to roll out new ObamneyCare© regulations in the hopes of answering lingering questions about implementation of this train-wreck.
Methinks they will generate more questions than answers.
■ FoIB Holly R sends us a pair of relevant stories. From The Atlantic, FoIB Avik Roy opines that ObamneyCare© proponents have it all wrong: the free market can provide the necessary answers to our health care financing and delivery woes.
■ She also tips us to the non-news that PresBo is still misrepresenting his own mother's health insurance "crisis;" apparently the man is incapable of differentiating between health insurance (which did, in fact, pay mom's health care bills) and disability insurance.
PresBo, lying? That's just crazy talk!
■ Bob D tips us to this little factoid:
"Computer Access to Patient Test Results Does Not Decrease Cost or Curtail Test Ordering"
So the digital age doesn't automatically cut costs? Hunh.
■ CareSource runs the Dayton (OH) Medicaid program; it's recently partnered up with Humana to "more effectively serve Medicare and Medicaid beneficiaries, particularly people who qualify for both programs." It's easy to see why Humana wants a piece of that action: they're a major player in the Cincinnati market, but not so much up the road here in Dayton.
■ And finally, loyal reader Patrick P points us to yet another Avik Roy piece, this one explaining the highly negative impact ObamneyCare© is already having on younger folks.
That's a wrap - Have a GREAT weekend!
Thursday, March 22, 2012
Stupid Agent Tricks: Annuity and Jail
First, let me be clear that the (unfortunate) victim of this story, (former) insurance agent Glenn Neasham, is not stupid. From all accounts, his conduct was appropriate and aboveboard; he appears to be the victim of a vindictive and over-zealous prosecutor.The "stupid" folks here are my fellow agents, who could give lemmings a run for their money (straight off a cliff). Stephen Forman, an agent himself, sums it up nicely:
"Should I not be optimistic that our fellow producers wish to band together and help Glenn Neasham? At first blush, you'd think so. But my experience in this industry leads me to believe the cavalry may not be coming ... I was only too happy to sign the pledge at America Needs Agents ... just over 1,100 have signed the pledge out of 228,000 health agents"
[ed: I just learned about the pledge and signed it; the current total is 1,136]
He goes on to list other, similar efforts, all doomed to failure because agents just can't be bothered to actually step up.
Now, you may be thinking: Henry, surely these are anomalies - agents care about their livelihoods, after all.
I wish.
Let me share my own experience in a similar situation. About 10 years ago, a major carrier decided to change their commission structure from a percentage of premiums to a flat per member fee. Fair enough. But they went a step further, making this change retroactive, in clear violation of the agent's agreement.
About two dozen of us met at a local restaurant to compare notes and plan strategy. One colleague brought along an attorney friend who specialized in arbitration. We agreed that we would proceed, in accordance with the agent's agreement.
One of the hats I wear is Continuing Education instructor, primarily for folks who work in the health side of the business. In that capacity, I had a fairly large contact list of agents all around the state, folks who would be directly impacted by this. I offered up my list, and we sent out a mass mailing to about 300 or so fellow agents, asking them to join us in our fight.
We got back maybe a handful of replies. In fact, by the time we eventually settled with the carrier, there were exactly 8 of us (out of the original 24 plus the additional 300 from the mailing) left standing.
Mind you, joining us would have required zero financial contribution, nor did we ask for any time or effort. Just some words of support.
Cue the sounds of crickets chirping.
So it comes as no surprise to me that Mr Neasham is left to twist alone in the wind, nor that out of hundreds of thousands of agents, less than one half of one percent can even be bothered to click a link and supply an email address.
So who's worse, the prosecutor or us?
Wednesday, March 21, 2012
Why's the beef?
Um, Henry, shouldn't that be "where's the beef?"Not so fast.
On the one hand:
"The study found that cutting the amount of red meat in peoples’ diets ... could prevent almost one in 10 early deaths in men and one in 13 in women."
On the other, those that survive may be happier:
"Women who reduce lamb and beef in their diets are more likely to suffer depression ... When we looked at women consuming less than the recommended amount of red meat ... we found that they were twice as likely to have a diagnosed depressive or anxiety disorder"
Make mine rare, please.
Cavalcade of Risk #153: Elite Eight edition
Jason Shafrin presents this week's collection of interesting risk-related bloggetry. Take a chance and stop on by.
NB: I'd like to apologize to all participants whose emails were bounced. I inadvertently mistyped the email addy (leaving off the crucial "v" in "cavrisk") and didn't catch that. Mea culpa!
NB: I'd like to apologize to all participants whose emails were bounced. I inadvertently mistyped the email addy (leaving off the crucial "v" in "cavrisk") and didn't catch that. Mea culpa!
Tuesday, March 20, 2012
Denial River
What is it with people completely ignoring reality? In this case, it's the folks at the Congressional Budget Office (CBO). Last time we checked, they'd just realized that ObamneyCare© is going to cost over $1.7 trillion to implement, or roughly double what they'd previously projected.Their current delusion is that ObamneyCare© won't lead to the mass extinction of the group health insurance market, despite widespread evidence that it will:
"Forecasters at the Congressional Budget Office (CBO) ... are refusing to predict that [ObamneyCare©] will lead to a sharp drop in enrollment in employer-sponsored health plans ... will require most employers over a certain size to offer health coverage ... will permit the employers to get out of offering coverage by paying a penalty for each employee"
Hmmm, let's see: Tens of thousands of dollars and major administrative headaches to comply with constantly changing plan design rules, or a few thou in fines.
The technical term here is: easy-peasy, lemon-squeezy.
Introducing: American Doctors 4 Truth
Last year's disingenuous take on Rep Paul Ryan's stance on Medicare has given birth to a new and formidable force:
Click here for more info on D4T.
Click here for more info on D4T.
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