Prescription Data-Mines and Insurance “Credit-Reports”

The End to “Rx” Privacy? 
Staff Reporters
Collecting and analyzing [HIPAA protected?] personal health information [PHI] in commercial databases is a fledgling, but exploding industry, despite privacy concerns.
Industry Leaders
For example, Milliman’s IntelliScript provides personal drug profiles to insurers. And, Ingenix’s MedPoint is owned by UnitedHealth, the corporation that owns UnitedHealthCare. UHC is also the nation’s second-largest [...]

Medicare GAO Report on Radiology

Prior Imaging-Authorization Suggested
Staff Reporters
As reported in the Wall Street Journal, on July 14, 2008, Medicare may be soon requiring prior authorization to curtail unnecessary utilization of CT scans, MRIs and other forms of medical imaging, a new Government Accounting Office [GAO] report suggests.
The Medicare Report
To cut imaging costs, Medicare has been reducing certain physician [...]

Patients Challenging Medical Invoices

Root Cause is Money, Failure-to-Disclose and Frustration
Staff Reporters
Patients are challenging their medical bills with lawyers and lawsuits, out of frustration about the lack of up-front disclosure over costs by doctors and hospitals.
Involve More than a Few Cases
For example, after being charged $82,282 for a 23-hour stay in doctor-owned Westfield Hospital for two operations on [...]

Blue Cross - Blue Shield Administrative Survey

Cost Trends Demonstrate a Decline in 2007
By Douglas B. Sherlock; CFA
PRESS RELEASE REPORT
Gwynedd, Pennsylvania
The per-member [pm] administrative cost growth for BC/BS declined from 6.1% in 2006, to 4.3% in 2007. Adjusted to eliminate the effect of a shift in product mix, administrative expense growth declined from 6.5% in 2006 to 2.5% in 2007. Administrative expenses [...]

Consumer Health Plan Satisfaction Survey

New Deloitte Center for Health Solutions Survey
Staff Reporters
Nine out of 10 Americans are not completely satisfied with their health plans, according to “The Deloitte Center for Health Solutions 2008 Survey of Health Care Consumers.”
The Survey:
According to the survey of what more than 3,000 Americans thought about a variety of healthcare issues; these findings [...]

RAC Contractors to be Identified

CMS Aims to Reduce Fraud
Staff Writers
This month, the Centers for Medicare and Medicaid Services [CMS] will name the auditing firms that will review hospitals’ books for payment mistakes, while hospital officials say results in other states suggest the auditors will give priority to recovering overpayments.
The RAC Program
Under the so-called Recovery Asset Contractor [RAC] program, [...]

Doctors Unite!

On the “Open Letter from America’s Physicians”
By Dr. David Edward Marcinko; MBA, CMP™
Publisher-in-Chief
As we have seen in this healthcare-charged election season, almost every form of political activism or debate has moved online. So, it is no surprise that a coalition of disgruntled physicians would electronically socialize and network together, as seen with www.sermo.com
About Sermo - Peer [...]

The Cure for Claims Campaign [CCC]

Reducing Healthcare Administrative Burdens and Costs
Staff Writers
To help reduce the administrative burden of ensuring accurate insurance payments for physician services, the American Medical Association [AMA] recently launched the “Cure for Claims” Campaign [CCC] and unveiled the first AMA National Health Insurer Report Card on claims processing.
Goals
The goal of the AMA campaign is to hold [...]

Bernanke on Healthcare Spending

The Federal Reserve Chairman’s Report
Staff Writers
Benjamin S. Bernanke, chairman of the Federal Reserve, recently told Congress that health spending would “rise relentlessly” unless lawmakers overhauled the health care system.
Senate Finance Committee
Of course, this comes as no surprise to Executive-Post subscribers, and us all. Mr. Bernanke’s remarks opened a daylong bipartisan symposium convened by the [...]

Survey on Convenient Care Medical Clinics

Possible Solution to the Healthcare Dilemma?
Staff Reporters
Another new survey suggests that convenient care medical clinics (CCMCs) could be a potential solution to health care issues, if fears can be alleviated; at least in the Keystone State.
The Survey
The survey by Widener University in Elder Pennsylvania, found that while baby-boomers aged 43 to 64 were most [...]

Paying for Health Care and Insurance

New Survey Reveals 28% Report Financial Problems
Staff Reporters
A new survey by the Kaiser Family Foundation recently asked this question.
Q: As a result of recent changes in the economy, have you and your family experienced any of the following problems, or not? Was this a serious problem, or not?
A: Results are included in the summarized [...]

Milliman Medical Index Components of Spending

Components of Medical Costs
Staff Reporters 
According to the just released Milliman Medical Index Components of Spending [MMICS], the total medical costs for a domestic family of four reached $15,609 in 2008, as allocated below.
 

2008 MMI Component of Spending

Total Medical Cost*

Percentage

Physician

$5,435

35%

Inpatient

$4,724

30%

Outpatient

$2,516

16%

Pharmacy

$2,302

15%

Other

$633

4%

Total

$15,609

100%

 
*Includes both the portion of the costs paid by an employer’s benefit plan and the portion paid [...]

Convenient Medical Clinics in Wal-Mart

Survey Profile of Customers
Staff Reporters 
Demographics:
·                                 79% are visits for Adults
·                                 21% are visits for Children
Insurance Status:
·                                 Approximately 55% uninsured
Alternative Considerations:
·                                 40-50% Primary Care Provider
·                                 20-35% Urgent Care
·                                 10-15% ER
·                                 5-10% would have foregone treatment
Conclusion
Your comments and opinions are appreciated
Source: “Wal-Mart’s Perspective: Retail Care,” as presented by [...]

Genworth Financial Reports on LTC

LTC Survey Results
Staff Reporters
A new study by Genworth Financial Inc., suggests that costs for nursing homes, assisted living facilities and some in-home care services have increased for a fifth consecutive year, and could rise further if a shortage of long-term care workers isn’t resolved.
Results
The survey found that the average annual cost for a private [...]

HD-HCPs Gaining Ground

Popularity of Consumer Driven Plans Increasing
Staff Writers 
 
Results of the Aon Consulting / ISCEBS Survey 
Read it now: Complimentary by email request. And, then feel free to comment and opine?
Terms: www.HealthDictionarySeries.com
Institutional: www.HealthcareFinancials.com
 

New Health Insurance Compliance Issues

Implications of US Patriot and Bank Secrecy Acts on Hospitals
Dr. David E. Marcinko; MBA, CMP™
Hope R. Hetico; RN, MHA, CMP™ 
 
With the recent popularity and growth of personal health insurance plans (PHIPs), health savings accounts (HSAs) and / or medical savings accounts (MSAs), compliance with the USA PATRIOT Act has become an important issue for these new [...]

Values-Based Health Insurance

Another New Idea?
Staff Writers 

According to Mark Fendrick MD and Michael E. Chernew PhD, instead of the one size fits all approach of traditional health insurance, a “clinically-sensitive” cost-sharing system that supports co-payments related to evidence-based value for targeted patients seems plausible.  
In this model, out-of-pocket costs are based on price and a cost/quality tradeoff in clinical [...]

A Decade of Desperate Patients

Patients Disenfranchised from the System
Staff Writers 

“When was the last time you had freedom of choice in, of all places, a hospital? One choice is no choice at all, and it only makes people feel frustrated and powerless. People have a fundamental need to choose for themselves-give your customers the power of choice.”
-Roger Dow and Susan [...]

2008 CMS Updates for HDHCPs

 
HDHCP Minimum Deductibles
Staff Writers 

 
 
For 2008, the minimum annual deductible amounts are unchanged from 2007:
Single Minimum Deductible: $1,100
Family Minimum Deductible: $2,200
 

HDHP Maximum Out of Pocket Expense:
The 2008 maximum out of pocket amounts are:
Single Annual Maximum: $5,600
Family Annual Maximum: $11,200

Maximum Annual HSA Contributions:
The 2008 maximum for HSA contributions are:
Single Annual Contribution: $2,900
Family Annual Contributions: $5,800
 
Your experiences [...]

One Health Insurance Policy Solution

A Real Insurance Solution 
By Dr. David Edward Marcinko; MBA, CMP™
Publisher-in-Chief

Market Driven Health Insurance Alternatives
 
According to Michael K. Evans, former chief economist for the American Economics Group, Washington, DC, a real market driven insurance model may be a solution to the current health insurance coverage crisis.
It would work like a Medical Savings Account [MSA], or Health [...]

Beware “Faux” Health Insurance Models

The Proliferation of Fraudulent Silent (“Mirror”) Healthcare Models - Should I Join?
By Dr. David Edward Marcinko; MBA, CMP™
Publisher-in-Chief 

Beware the Silence

A silent, faux, or “mirror” PPO, HMO or other provider model is not a formal managed care organization.  Rather, it usually is simply an intermediary attempt to negotiate practitioner fees downward by promising a higher volume of [...]

High Deductible Health Care Plans

Providing Health Care in a High-Deductible World
By: Steven Podnos MD, CFP®

With the increasingly common use of  High Deductible Health Care Plans (HDHCP) (often combined with a Health Savings Account), health care providers are seeing a growing population of health care consumers that are paying “out of pocket” in some fashion for the first several thousand [...]