Private vs. public prices

http://www.academyhealth.org/blog/2017-01/private-vs-public-prices

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You probably knew that the prices private health insurers pay hospitals are higher than those of Medicare and Medicaid. But you may not have known that the gap between private and public payers used to be a lot smaller and has grown tremendously in recent years.

Using Medical Expenditure Panel Survey (MEPS) data, by payer (private health insurance, Medicare, and Medicaid) and over time (1996-2012), the chart shows average hospital payment rates (in constant dollars), adjusted for age, sex, race/ethnicity, geography, income, health conditions, charges, length-of-stay, and whether or not a surgical procedure was performed. To produce figures for the chart, the authors used this model to predict hospital payment per stay for each MEPS observation, as if they were covered by private insurance, Medicare, or Medicaid, in turn.

As is clear from the chart, adjusted, average private pay rates have always been above public rates, but were closest in 1996-2000. Back then, private rates were no more than 10% above Medicare rates. Perhaps this was the effect of managed care, which kept growth in private rates down. Those rates began to grow during the managed care backlash, until 2005. From 2005-2009, adjusted, average private hospital rates—while considerably above Medicare and Medicaid rates—held steady. Then, in 2009, they took off again. In 2012, adjusted, average private rates were about 75% higher than Medicare rates.*

Medicaid payments were about 90% of Medicare’s in most study years.

Healthcare Triage: Donald Trump and Healthcare Cost Sharing

Healthcare Triage: Donald Trump and Healthcare Cost Sharing

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One of the few things that both Donald trump and Hilary Clinton seemed to agree on is that high out-of-pocket spending, specifically as it relates to the Affordable Care Act, is a problem. One of Clinton’s most popular health care proposals during her campaign was to reduce out of pocket spending to more “manageable” levels for many Americans. President-elect Trump sought to fix this problem by repealing the ACA and replacing it with something better.

Reducing out-of-pocket spending, however, will require some tradeoffs. No easy solution exists, but there are examples out there worthy of consideration. That’s the topic of this week’s Healthcare Triage.

Healthcare Triage News: Medicaid for Children Leads to Better Outcomes Later in Life

Healthcare Triage News: Medicaid for Children Leads to Better Outcomes Later in Life

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The recent election has caused many to question whether significant changes are about to happen to Medicaid. Repeal of the Affordable Care Act would, of course, lead to the elimination of the Medicaid expansion, which could result in significant numbers of adults losing their coverage overnight.

But even without repeal, many Republican replacement proposals also result in significant changes to Medicaid, whether it be through funding, eligibility, or benefits. So, again, let’s talk about what Medicaid does, and whether it’s long term benefits are worth it. This is Healthcare Triage News.

3 MUST-HAVES FOR EVERY GREAT TEAM MEMBER

3 Must-Haves for Every Great Team Member

success-is-always-about-people

#1. Only hire curious people.

Dolts and divots don’t ask questions. It doesn’t matter how smart they appear to be. An hour with a person who doesn’t ask questions is an hour with a toothache.

People who are committed to the pursuit of excellence ask questions.

Curious people:

  1. Have enough confidence to be interested in others.
  2. Haven’t arrived. Inquisitiveness is an expression of humility.
  3. Are accepting of their weaknesses. Curiosity is about growth.
  4. Are transparent and candid. The questions you ask reveal your values. If you want to learn what matters to a person, listen to their questions.

The longer you wait to ask dumb questions, the dumber you become. Pretending we know more than we know is one reason we don’t know more.

The more you learn, the more you want to learn.

Top managed care trends to watch in 2017

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/top-managed-care-trends-watch-2017?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=13012017

 

Top 10 challenges facing physicians in 2017

http://medicaleconomics.modernmedicine.com/medical-economics/news/top-10-challenges-2017

2016 was a challenging year on many fronts for healthcare providers.

Physicians have just started to digest the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its changes to physician reimbursement. A long presidential election finally reached its conclusion, but the consequences of a Republican Congress and President-elect Donald J. Trump for U.S. doctors and patients remain unclear. And running a private practice did not get any easier. Balancing the need to deal with patients who won’t listen or won’t pay while also seeking positive patient satisfaction scores remains a daily struggle for many. 

These were just some of the challenges physician readers told Medical Economics they experienced this year and anticipate continuing for the foreseeable future. 

For the fourth consecutive year, Medical Economics reveals its list of obstacles physicians will face in the coming year and, more importantly, how to overcome them. For this latest presentation, we asked readers to tell us what challenges they face each day and where they needed solutions.

Here are their responses, starting with the biggest challenge of the coming year.

How doctors can overcome payment obstacles in 2017

http://medicaleconomics.modernmedicine.com/medical-economics/news/how-doctors-can-overcome-payment-obstacles-2017?utm_source=TrendMD&utm_medium=cpc&utm_campaign=Medical_Economics_TrendMD_0