Unions and Health Care Don’t Mix

I entered the field of Health Care through Social Work and moved into Administration because of a desire to not only help patients, but to also protect Medical Professionals. Prior to the 1980’s it was possible to profitably run a medical office or facility. With the dawn of HMOs and other restrictive payment programs to Providers, it is now impossible to be profitable. Payments have been decreased so that now not only are the majority of Providers employees of large hospitals or groups, but Hospitals are also having difficulty making ends meet. As a result, policies are put into place that may seem draconian to some, but are done to ensure that the lights stay on.

In America there is the ability to protest against an employer if a group of employees feel that they are not being treated correctly. We have a system of Unions and Labor Laws to protect the employees. In recent years medical staff have jumped on the Union bandwagon, but the financial realities are not compatible.

On November 26, if negotiations between University of Chicago Medical Center and the National Nurses Organizing Committee/National Nurses United are not concluded the Nurses will strike. This strike will result in the closing of this Level 1 trauma center for adult and pediatric patients:

“In preparation for the strike, UCMC announced earlier this week that it is moving about 50 babies and 20 children in its neonatal and pediatric intensive care units to other facilities.”

“Negotiations between UCMC and National Nurses Organizing Committee/National Nurses United began earlier this year. Medical center leaders say incentive pay — and whether the hospital should end the pay for newly hired nurses — is a sticking point in negotiations, according to the Chicago Tribune. The union has continued to express concerns about staffing levels.”

Usually strikes impact a business’s finances because the workers make the widget that the business sells for profit, thus without the widget the business does not make money. In this case, however, Nurses are not money generators for medical facilities. Nursing Care is a net loss for hospitals. In the Medical Field, only Providers generate money. That is, the Doctors, Technicians, Therapists, etc. who provide a medically necessary service or procedure to a patient, and for which they can then bill the patient, usually through a Managed Care Organization, i.e. Insurance Company. Through this billing, funds are generated to pay for the person who performed the service or procedure. Funds are also generated to pay for the equipment used in the procedure.

Nurses do remarkable work, but their services are not billable for payment. Thus any salary paid to a nurse has to come from monies generated by Providers. Thus a strike will not affect the bottom line of a Hospital, it will only affect care that the Hospital can provide.

“The nurses said they plan to strike unless an agreement is reached.”

Why MLR is such a joke

It's been a while since we last visited MLR (Medical Loss Ratio):

"In case you didn't know, the ACA requires carriers to pay out (at least) 80% of premiums collected in claims. For large groups, that requirement is 85%. Anything less and they have to send the difference to their insureds."

The idea was to encourage (require) carriers to be more carful stewards of the premiums they receive and their obligation to pay out as much of those in claims as possible.

Anyone else see the glaring logical fallacy here?

Well, FoIB Ed Swan sure did:

Understanding MLR.

15% of a higher number is...a higher number. This is why insurance carriers have no incentive to negotiate lower prices for healthcare services. They just pass the costs back to the insured in the form of higher premiums. https://t.co/dDEcS9fa4E

— Ed Swann (@Epic_Ed) November 8, 2019

#PieceOfThePie

It's funny because it's true

Our friend Rick B sends us the link to this satirical(?) piece on modern health "care:"

"Supreme Court Allows Victims Of Heart Disease, Obesity To Sue Utensil Manufacturer"

He points out that there are some very real issues at play here:

"I know this is a joke but interesting idea for a blog post. Who is responsible for us?"

A most cromulent question, no?

#Medicaid4All

404Care.gov Enrollment: Week 2 Results

Hunh:

[click to embiggen]

Let's see how that compares to last week.

[ed: recall that week one comprised but 2 days]

Plan Selections were up an average of 23%/day, and the number of New Consumers also increased (by about 15%/day). Current policyholders renewing coverage were up by almost 25%.

On the other hand, Window Shoppers fell an incredible 57% per day (to be fair, not sure that's meaningful, yet).

Interesting, no?

Outstanding Agent Tricks

This is so cool:

"Quick-thinking hunters in central Michigan have rescued two deer who literally became locked in battle."

And Insurance Agent Mark Johnson saves the day.

Kudos!

[Hat Tip: Ace of Spades]

Global Underwriting Update

From our friends at Global Underwriters:

"Each year the number of people traveling for business purposes is astonishing. The Global Business Travel Association counts over 488 million trips taken annually. Each year business travelers take an average of 12 trips, typically lasting at least 5 days. An estimated 1.3 million business trips occur daily in the U.S. alone. These figures are expected to grow another 7% this year.

Even with video/web conferencing, online meetings, and daily conference calls business travel continues to increase and is vital to the success of many companies. Hectic schedules, missed flights, transportation issues, and hotel problems are the least of the employees' worries. Many employees are citing concerns related to personal security, terrorism, political unrest and infectious disease epidemics. 

It's also crucial that companies and organizations embrace Duty of Care obligations and take the necessary steps to reduce potential dangers or problems that could occur while their employees travel. Employers need to have a well communicated plan in place and part of this plan is providing Business Travel Accident (BTA) insurance for their employees. BTA insurance is an inexpensive benefit that supplements any employee benefit program. This World Class Protection is designed to offset the risk and potential loss of a key employee(s) and to compensate families of employees for their loss of income due to accidental death or permanent disability of a loved one."

If international business travel is on your itinerary, this is must-have info.

The Correct Words

In the medical world, we have our own language; well,actually multiple languages. The clinical has their languages, usually abbreviations, the medical administration has their own language, and the health insurers have their own language. Throughout my long medical administrative career, I have noted how incorrect language results in problems between health insurers and the medical office.

A case in point is this blaring headline from ProPublica:

“How One Employer Stuck a New Mom With a $898,984 Bill for Her Premature Baby”

The article was listing under a heading: “Health Insurance Hustle”.

 This is terrible, how could a medical facility and a health insurance company do this to a new mother with a critically ill patient?

A read of the article offers this tantalizing tidbit,

“Bard’s saga began, traumatically, when she gave birth to Sadie at just 26 weeks on Sept. 21, 2018, at the University of California, Irvine Medical Center in Southern California. Weighing less than a pound and a half, tiny enough to fit into Bard’s cupped hands, Sadie was rushed to the neonatal intensive care unit. Three days after her birth, Bard called Anthem Blue Cross, which administers her health plan, to start coverage. Anthem and UC Irvine’s billing department assured her that Sadie was covered, Bard said.” [emphasis added]

Right there in the paragraph, Anthem said the baby was covered. Mom took that to mean that baby was enrolled in the plan. This is a very common error on the part of the public. What Anthem meant by the comment was that the plan covered pre term births. What was not said by the Anthem representative, was that mom still had to go onto her employer’s website and enroll the baby in the plan. It had to be done in 31 days.

So, “Meanwhile, believing that everything with her health benefits was on track, Bard spent nine of those first 31 days recovering in her own hospital bed and then had to return to the emergency room because of a subsequent infection. She spent as much time as she could in the neonatal intensive care unit, where Sadie, in an incubator, attached to tubes and wires, battled a host of critical ailments related to extremely premature birth. At times, doctors gave her a 50-50 chance of survival.”

Mom thought everything was fine with her insurance, so she focused on her baby. “Then, eight days past the 31-day deadline, UC Irvine’s billing department alerted Bard to a problem with Sadie’s coverage. Anthem was saying it could not process the claims for the baby, who was still in the NICU.”

Then the bills begin to arrive, totaling almost One Million Dollars. Through the efforts of Social Media, the insurance company relented and retro activated the baby’s enrollment back to her date of birth.

This could have been so easily avoided if both mom and the insurance company had simply clarified what “covered” meant. Any reasonable person should know that you simply cannot call your insurance company and you or a family member are magically entered. It takes some effort on the patient’s part to make that happen.  

The most common complaint that I receive from patients regarding a bill is, “The Insurance Company said you coded wrong”. No, we did not code wrong.  You, the patient, presented with a flu during your Preventive Exam so you were billed for an office visit.

Or, “Why did I receive this bill, my Insurance Company said I was covered.” Yes, you are covered for that service, but not by this provider.

In medicine, as in all businesses, it is imperative that the consumer, the patient be aware of what they are asking. Insurance Companies Representatives are limited as to what they can tell a patient, so when calling your insurance company, make sure that you are both speaking the same language.

LTCi in the news

Fresh off the presses:

Just Released: 2020 LTC insurance premium deduction and tax-free benefit increases! https://t.co/GFpR5KIDrX pic.twitter.com/9viLCFMYY1

— Bill Comfort, CLTC® (@comfortltc) November 7, 2019

Potential good news for folks considering an LTCi purchase.

Not sure about timing? Well, consider this timeless post from our friend Herman Bruns:

"As more and more baby boomers become aware of the devastating financial and emotional effects that a long term care need can have on their family, the average age at which people purchase LTC insurance has been steadily dropping every year."

A Tale of Two Networks

For plan year 2020, history repeats:

"The other issue is that, at least in Ohio in 2019, all plans are built on an HMO chassis, which means basically zero out-of-network coverage."

One way carriers have found to reduce their costs has been to offer ever-shrinking networks. For some, this isn't an issue, but for many, who have longstanding relationships with their current providers, this can be a problem.

Take, for instance, Larry: he's a long-time client, lives up in the Cleveland area (Geauga County). As with most of the state, almost all of the plans available on the 404Care.gov site are offered by erstwhile Medicaid carriers, with two notable exceptions: Medical Mutual and new kid in town Oscar Health.

Larry's in his late 50's, and has some medical issues that make the Guaranteed Issue/Pre-ex coverage available on ACA plans attractive. He also has some specific doc's that he likes, including some at Cleveland Clinic.

Now, it turns out that The Clinic is in-network for only one carrier here: Oscar. And the question arises, how much is that relationship worth, in actual dollars? I have long wondered this, but until now had no way to quantify it.

Now, I can, and it's breathtaking:

[click to embiggen]

The  plan on the left is from CareSource (one of the aforementioned "Medicaid carriers") and the one on the right is from Oscar. The only substantive difference (other than the fact that the latter actually has higher potential out of pocket exposure) is that Oscar includes the Cleveland Clinic, and CareSource does not.

So, is The Clinic worth $3,600 a year?

404Care.gov: Week One Report

Hunh:

"In week one of the 2020 Open Enrollment period, 177,082 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday. Consequently, week one was only two days long this year - from Friday to Saturday."

This tracks with what we've seen in previous years: a big rush up front, then things taper off, and a last-minute flurry as folks actually pull the trigger the last few days of Open Enrollment.

Of course "selecting" a plan doesn't necessarily mean buying one: just as with eBay and Amazon, people often leave their shopping carts unclaimed. Which we can sort of see in this infographic:

[click to embiggen]

I must admit that I'm puzzled by what, exactly, "Consumers on Applications Submitted" means.

MVNHS© News

Courtesy FoIB Dino R:

"NHS waiting list hits another record high: 4.4million people are now waiting for routine operations as the figure is the worst ever for a third month in a row"

And for those right-brained among us:

 [click to embiggen]

But wait, there's more:

NHS 'abandoning' thousands by rationing hepatitis C drugs https://t.co/e25kltBgiA. @JoeSilverman7

— Jim Schneider (@vaoncsurgeon) November 4, 2019

But hey: Free!

#Medicaid4All

 

Everything Old...

Regular readers may recall this from a few years back:

"Due to the significant changes carriers have made to their compensation schedules (aka commissions), I don’t believe that I can continue to offer the kind of comprehensive service to which I, and you, have become accustomed."

I still do the annual re-certification, and dabble in the individual market as needed (current clients, referrals, that kind of thing).

Recently, Senator Iron Eyes Elizabeth Warren had this observation about folks like me under her #Medicaid4All plan:

Q: Where do those who work in health insurance go when private insurance is eliminated?

Sen. Warren: "No one gets left behind. Some of the people currently working in health insurance will work in other parts of insurance. In life insurance, in auto insurance, in car insurance." pic.twitter.com/KGJ4Eg9VKR

— The Hill (@thehill) November 2, 2019

Hunh.

It's true that home and auto insurance share a common principle:

"Yes, they are both predicated on the principle of "indemnification," but then so are disability and homeowners insurance."

But that's where it ends. For one thing, they are two completely different licenses, and markets, and marketing strategies.

For another, she seems to be forgetting all the support folks at various home offices, not to mention plan administrators and the like. And of course, this also means the end of Medicare Supplement and Advantage plans (why does her party keep throwing seniors under the bus?).

And, of course, there's the matter of how much this whole shebang's going to cost.

But hey: details, shmetails.

[Hat Tip: FoIB Bob G]

History Lesson

So last week my Better Half and I took a long-anticipated, week-long trip to The Big Easy. I had been there as a very young lad, so no real memories, and she had never been. Had a great time, ate too much really good food, and spent some time in some amazing museums (among other things).

Mid-week we spent the day at the United States World War II Museum. We spent the day, but could easily have spent several more. Just extraordinary.

But what was very special was the completely unanticipated personal connection to one of the exhibits.

As we rounded a corner, we found a display of a carpenter's tool kit, and a plaque explaining it:

[click to embiggen]

The gentleman's name (redacted for privacy reasons, which you'll soon understand) rang a very loud bell:

Some 30 years ago, one of our carriers imported a new rep from Louisiana. Roger D and I soon became fast friends, and he's since become my local Medicare "guy." His last name is unusual for Ohio, but maybe not for Cajun country, and it appeared on that plaque. So I texted him the pic, and asked "Anyone you know?"

He replied "Wow, will have to ask my Dad about this."

A few minutes later he texted again:

"Turns out this is my grandfather's brother. My dad knew about him and told me stories about how he went to Hawaii to help rebuild. Came back and opened several grocery stores. Thanks for sharing this photo."

Wow, traveled over 800 miles for that connection...

Worth the trip all by itself.

How much is $52 trillion?

$52 trillion is the amount Elizabeth Warrens campaign is conceding her Medicare for All proposal will cost over its first 10 years.  That would be $5.2 trillion each year.  All of this ignores inflation which Senator Warrens plan would supposedly make vanish.

Anyway, after the laughter subsided, I wondered how to express $5.2 trillion in more understandable terms.    Here’s one way.

The CBO projects 2019 federal spending to be about $4.4 trillion. 

Senator Warren is saying that the projected annual cost of her plan is greater than this year’s total annual federal expenditures.

Show of hands please.  Who wants your taxes more than doubled? Anyone?  Anyone?

Sure, sure, but hey: Free!!

In case you were wondering:

If you want government to take over healthcare, here’s what’s in store...

➡️ wait times in some Canadian provinces average almost 1 YEAR

➡️ 4.4 million Brits waiting for treatment

➡️ 115k Brits got cancer diagnosis too late

MUST READ by @sallypipes ⬇️https://t.co/HfyoTAoVHp

— Kayleigh McEnany (@kayleighmcenany) October 24, 2019

#Medicaid4All

Medicine Should Not Have a Buyer Beware Clause

There are preventive tests that we should all do regularly, and for women that includes the annual Mammogram. This simple, but albeit, uncomfortable test is very effective in finding breast cancer which can lead to early treatment. Additionally, it falls under Preventive Care, thus it is paid for at 100% by insurance companies. Seems relatively simple, but there are a few landmines that can catch women unawares, turning a no-cost procedure into one that will result in a bill.

The first landmine is when you enter the room. The technician will ask the women if she has any problems with her breasts. If the women answers in the affirmative, regardless of the issue (sore from an ill-fitting bra, soreness from exercise, etc.), that test has suddenly become a Diagnostic Test, no longer covered at 100% and it now needs a diagnosis of a problem from a doctor. I lost count of how many times a lab would contact our office asking for a diagnosis to do a Diagnostic Mammogram, instead of a Screening/Preventive test. We would tell the lab that there was not a problem, we ordered a Screening Mammogram and please do what was ordered. Meanwhile, the patient is worried that there is something wrong and the patient needs to reschedule, thus delaying the test. 

The second landmine is the new 3D Mammograms. These have been available for several years, but incur a cost to the patient. While in the past, it was a passing question to the patient when the test was scheduled, it has now become a worrisome impediment to a vitally important screening test. 

“When Dr. Worta McCaskill-Stevens made an appointment for a mammogram last year, she expected a simple breast cancer screening―not a heavy-handed sales pitch.

A receptionist asked if she wanted a free upgrade to a “3D mammogram,” or tomosynthesis.

“She said there’s a new approach and it’s much better, and it finds all cancer,” said McCaskill-Stevens, who declined the offer.

A short time later, a technician asked again: Was the patient sure she didn’t want 3D?

Upselling customers on high-tech breast cancer screenings is just one way the 3D mammography industry aggressively promotes its product.”

A Kaiser Health News investigation found that there is a strong marketing push to the general public that the 3D Mammogram is better. These tactics include manufacturers paying influential doctors for their endorsement, there is marketing directly to consumers, manufacturers have lobbied state lawmakers to have insurers cover 3D Mammograms, and the funding of experts and advocates for positive reviews.

“Taxpayers write the check for many 3D screenings, which add about $50 to the cost of a typical mammogram. Medicare, which began paying for 3D exams in 2015, spent an additional $230 million on breast cancer screenings within the first three years of coverage. By 2017, nearly half the mammograms paid for by the federal program were 3D, according to a KHN analysis of federal data.”

Thus for all the hype, 3D Mammograms have not shown to be better at diagnosing Breast Cancer over the conventional digital 2D scan. Unfortunately, where there is money to be made, it seems the facts be damned. In the end, the only loser is the American Patient, by having additional costs added to their already expensive healthcare.

The VA has a Cleanliness Problem

The Veterans Administration gets a lot of bad press for inadequate services, most of it deserved, but now there is an issue with cleanliness.

“A new report from the Office of Inspector General for the Veterans Health Administration found VA facilities generally met requirements, but cited problems with facility cleanliness and panic alarms.”

Between Oct. 16, 2017 and Sept. 14, 2018, the OIG conducted surprise inspections to 51 randomly selected VA health facilities across the country. Issues that were discovered were dirty vents in patient care areas, furniture in patient care areas that were either dirty or broken and dirty floors.

I have spent time in VA facilities with my husband. He has received tremendous care, but I must agree with the report on cleanliness. Recently, sitting in a waiting room while my husband underwent outpatient surgery, a mouse ran across the floor and went into some cabinets. This room was on the interior of the facility and on the third floor. In all my years working in medical facilities, I have never encountered a mouse. Needless to say, it was a bit disturbing to those of us in the waiting room. One family member tried to alert a staff member to the mouse. Her response, “Well, that’s not good,” and then she walked away.

The report found that “environmental cleanliness noncompliance was often due to lack of oversight and staffing challenges.” Based on my experience, I would say the researchers got that right. 

The OIG made 16 recommendations, I hope pest control was one of those recommendations.

Government-run Health "Care" and Salad Bars

Helpful video about the pitfalls of Medicaid4All:



[Hat Tip: FoIB Mike B]

ObamaPlan Re-Cert Report [UPDATED]

[Scroll down for Update]

So, did my annual training/re-certification for the individual Marketplace (aka 404Care.gov):

[click to embiggen]

On the one hand, they've actually streamlined the process for those of us with prior certification, which is nice.

On the other, they've really gone to town on codifying what behaviors are kosher (helping clients set up an account) and which are not (setting one up for them). This latter seems, well, stupid, but of course they aren't interested in feedback.

Which is probably just as well...

UPDATE: Imagine that!

Agents and brokers have been better at getting people to sign up for coverage through https://t.co/7lOE348VIK than nonprofit navigators have been, says CMS chief Seema Verma.https://t.co/NxNKbqEgtj

— ThinkAdv Life/Health (@TA_LifeHealth) October 24, 2019

LTCi Rate Increases: The More You Know

From FoIB Scott Olson, the REAL reason why older long-term care insurance policies have had such large rate increases: