News In Healthcare

I can­not believe that we needed to con­duct a study in order to know that indi­vid­u­als who under­stand their health insur­ance cov­er­age require­ments, will make bet­ter choices about seek­ing med­ical ser­vices.  The Boston Her­ald recently pub­lished the find­ings of just such a study.  What was found was that indi­vid­u­als who knew what their co-payments were for med­ical ser­vices were more cost-conscious when decid­ing when to seek those med­ical ser­vices.  These indi­vid­u­als were con­sid­ered “savy.”

I don’t call it being savy.  I call it using com­mon sense.  If you know that each emer­gency room visit is going to require you to pay $250 out of your pocket  ver­sus $25 for each physi­cian office visit, com­mon sense says that you will visit your physi­cian and not the hos­pi­tal emer­gency department.

In a let­ter to Health and Human Ser­vices Sec­re­tary Kath­leen Sebe­lius, Karen Ignagni head of America’s Health Insur­ance Plans and the nation’s top health insur­ance indus­try offi­cial, said that the indus­try will fully com­ply with new reg­u­la­tions pre­vent­ing cov­er­age denials for chil­dren with pre-existing con­di­tions.  The reg­u­la­tions are expected to be issued within the next few weeks.

It is trou­bling that Ms. Ignagni was in a posi­tion where she had say to the fed­eral gov­ern­ment that the health insur­ance indus­try will fol­low the rules and not cause prob­lems.  How­ever it is believ­able that this was required given the recent actions by health plans to hap­haz­ardly rescind cov­er­age based upon pre-existing conditions.

I can’t believe that it was back on 9/28/06 when we posted our first item on the prob­lems Cal­i­for­nia insur­ers were fac­ing for wrong­fully rescind­ing patients’ poli­cies.  Almost three years later, we are still hear­ing about cases where Blue Shield of Cal­i­for­nia and Health­Net are still under fire for rescind­ing poli­cies.   The AP is report­ing that Health­Net just entered into a set­tle­ment with a class of patients where Health­Net will cre­ate a $1.95 mil­lion fund to pay those patients’ out­stand­ing med­ical costs.  Blue Shield, on the other hand, has seen a dif­fer­ent turn of events.  A Cal­i­for­nia judge ruled yes­ter­day that Blue Shield was right to drop the pol­icy of a man who sued the insurer for wrong­fully ter­mi­nat­ing his pol­icy.  The judge foudn that Blue Shield con­ducted an appro­pri­ate inves­ti­ga­tion of the mat­ter and deter­mined that the patient’s spouse did in fact know­ingly mis­rep­re­sent infor­ma­tion on the patient’s insur­ance application.

I love to see where the largest pay­ers rank when it comes to per­cent­age of claim denials, days in A/R, denial trans­parency.  That is why I was so excited to see the new report issued by Athena Health.  This site allows you to ana­lyze payer per­for­mance by region and by issue.  Can you believe that Unit­ed­Health Group ranks #1 in the nation for the per­cent­age of denied claims that close with only one addi­tional resub­mis­sion?  Of course they ranked 4th in the per­cent­age of denied claims requir­ing addi­tional work on the back-end.

The fed­eral lit­i­ga­tion attack on not-for-profit hos­pi­tals might have ended in case dis­missals but that didn’t mean that the IRS didn’t pick up on the tax-exempt sta­tus issue.  In a recent news release,  the IRS sum­ma­rized its find­ings from a sur­vey con­ducted in 2006 of almost 500 tax-exempt hos­pi­tals.  In a nut­shell, the IRS found that there is no con­sis­tent def­i­n­i­tion of “uncom­pen­sated care” across all hos­pi­tals and there is no con­sis­tency of how the uncom­pen­sated care is reported.  One rec­om­men­da­tion that came out of the report is that a form 990 spe­cific to hos­pi­tals should be drafted.

 You may remem­ber that last sum­mer Sen­a­tor Chuck Grass­ley released find­ings from his own sur­vey of 10 tax-exempt hos­pi­tal sys­tems and found sim­i­lar results as the IRS.  See the Novem­ber 2006 blog entry which details his posi­tion that hos­pi­tals should adopt the Catholic Health­care Association’s stan­dard of report­ing com­mu­nity ben­e­fit to develop some consistency. 

Do you remem­ber 2 years or so ago hear­ing all about the illicit prac­tices of not-for-profit hos­pi­tals and health sys­tems for charg­ing unin­sured patients full price for their health care?  One attor­ney, Richard Scruggs, led the charge in fed­eral court on behalf of the class of unin­sured vic­tims to get the tax-exempt sta­tus of these not-for-profits revoked.  Well, that really didn’t go any­where but there was one hos­pi­tal sys­tem that fell vic­tim at the hands of a local author­ity who took mat­ters into their own hands.  Four years ago, Provena Covenant Med­ical Cen­ter in Illi­nois had their tax-exempt sta­tus revoked by the Cham­paign County Board of Review.  After years of fight­ing the revo­ca­tion, and pay­ing over $6 mil­lion in taxes, the hos­pi­tal has finally won.  Mod­ern Health­care recently reported that a cir­cuit court judge sided with the hos­pi­tal to rein­state its prop­erty tax exemp­tion.  The county has not yet decided to appeal. 

Can you believe that another insurer has received cita­tions by the Cal­i­for­nia Depart­ment of Insur­ance for wrong­fully can­celling mem­bers health insur­ance poli­cies?  The L.A. Times reports that BC Life & Health, owned by Well­point, can­celled 1,880 indi­vid­ual poli­cies in 2004 and 2005.  After a review of 83 sam­ple cases, the CDI issued 49 cita­tions against the insurer which could lead to fines of up to $10,000 a piece.  Blue Cross of Cal­i­for­nia has already been fined for improp­erly can­celling poli­cies.  Blue Shield of Cal­i­for­nia, Aetna, Health­net, and Cigna are cur­rently being inves­ti­gated by the CDI for improper can­cel­la­tion of policies.

Well maybe health­care facil­i­ties aren’t quite tak­ing the Domino’s approach but it is close.  MSNBC recently reported on tac­tics health sys­tems are tak­ing to ease the pain of long waits in hos­pi­tal emer­gency rooms.  One hos­pi­tal issued movie tick­ets to patients wait­ing over 30 min­utes to see a doc­tor while another hos­pi­tal gave away tick­ets to the local base­ball game.  One hos­pi­tal in Illi­nois is promis­ing no wait­ing at all.  It seems that patients can skip the wait­ing room and go right up to a pri­vate room and be seen by a physi­cian or a nurse. 

A report in the Port­land Busi­ness Jour­nal explains how the increased usage of e-mail by patients may actu­ally have a pos­i­tive impact on the health­care indus­try.  It seems that the more e-mail com­mu­ni­ca­tion between  a patient and his/her physi­cian, the less office vis­its incurred.   This has a pos­i­tive impact on the health insur­ance indus­try.  Less office vis­its means less claims paid.   How­ever, not every­one is jump­ing to the com­puter to com­mu­ni­cate on-line.  With the decrease in office vis­its comes less rev­enue for physi­cians.  So it seems that e-mail will put more money in the pock­ets (the very deep pock­ets) of the insur­ance com­pa­nies, and less money in the pock­ets of the physi­cians.  The one aspect miss­ing from the arti­cle is the finan­cial impact felt by the patients.

Do you want to know how your state ranks in terms of health cov­er­age?  Check out Kaiser Fam­ily Foundation’s state-by-state syn­op­sis of what per­cent­age of your pop­u­la­tion is cov­ered by dif­fer­ent sources.  The infor­ma­tion was recently updated to show sta­tis­tics through 2005.