Tenet Healthcare scandal leads “60 minutes”
“60 minutes” on CBS reports on what appears to be incredible mismanagement of a Tenet Healthcare hospital in Redding, CA. Regardless of the facts, the company’s stock has been hammered and is likely to remain in the dumps for years. More top executives will be forced to resign, and every hospital in the country needs to re-evaluate how it monitors its medical staff and responds to complaints about individual physicians from nurses, patients and other members of the medical staff.
Question: How did Tenet’s regional and corporate managers miss all of the indicators of possible misconduct and over-use of the Redding hospital’s cardiology services? And did those who complained and warned the hospital’s administrators about the out-of-control cardiology and heart surgery departments go over those administrators’ heads to corporate. If so, who did they appeal to? If not, why not?
Auto no fault could affect small business health insurance costs
The Colorado auto no-fault health insurance reform bill, HB03-1225, backed by Gov. Bill Owens, could increase health insurance costs for small employers because private health insurers may have to cover some costs currently covered by auto insurance. Here are the Denver Business Journal’s excellent article and the Rocky Mountain News report on the story. And here is the News’ editorial in Sunday’s Denver Post.
MEWAs (METS) may not solve health cost problems for small businesses
Colorado Medicaid HMOs sue state; small businesses should sue, too
Colorado’s Medicaid HMOs were underpaid during the 1990s, when the state failed to live up to its contracts, and now they’re winning in court battles over whether the state has to pay them hundreds of millions of dollars, according to Peter Blake’s column in the Rocky Mountain News. Blake seems to feel that the HMOs shouldn’t be trying to collect the money they are owed by a state government that’s deep in the red. The real story is that under-paid HMOs and providers shifted their Medicaid costs to small businesses, and they’re the ones who should be suing for damages.
Association health plans for small businesses explained
The national center for policy analysis explains the pros and cons of using association health plans to reduce health care costs for small businesses and other small employers.
Deborah Ghose says association health plans designed to reduce small business health insurance costs are a fraud, among other things.
National Small Business United opposes association health plans
“National Small Business United (NSBU) is concerned the Association Health Plan (AHP) legislation introduced today in the U.S. House of Representatives is the wrong prescription for America’s small business health care crisis,” the association said in a press release. The 65,000-member association’s statement continued:
Rural hospitals may get Medicare relief
Congressional negotiators over Medicare rates may give rural hospitals some financial relief, reports GrandForks.com.
Builders association supports association health plans
A builders association in Boston supports association health plans as a solution to the small business health cost problem. As noted below, there are many reasons to oppose this legislation.
Health insurance for 50-64 cohort offered by AARP
The Washington Post reports that AARP and UnitedHealthcare Group are offering kind of gap insurance for those between 50 and 64 years old, and that health insurance experts say the promise is greater than the actual benefits.
Association health plans could increase cost of health insurance
Association health plans (AHP) could make health insurance more expensive for small businesses instead of reducing their health care costss, said Len M. Nichols, Ph.D., of the Center for Health System Change, in an in-depth essay on Association Health Plans and Alternative Ways to Increase Health Insurance coverage for small businesses. In Feb. 5, 2003, testimony before Congress, Nichols argued that AHPs ultimately would cost small employers more due to adverse selection and the instability in the market. He also said that he believes mandated benefits imposed by states do little to increase premiums for small businesses. And he suggested putting small businesses into states’ risk pools or Medicaid risk pools, which seems impractical and politically difficult, especially since those risk pools may be riskier than community-rated pools of non-governmental beneficiaries. He also suggested that businesses join health insurance purchasing cooperatives, but most states’ laws are written to favor insurers. So few, if any small business purchasing cooperatives are doing well. In any case, if you’re really interested in a profile of the small groups health insurance market, this is testimony is well done.
Specialists have more freedom from managed care rules
If small business owners wonder why health insurance premiums are soaring, they can thank the patient backlash against HMOs that dominated the news in the mid and late 1990s. UPI reports on a study by the Center for Health System Change that found specialists have more freedom in treating their patients under current managed care (HMO, PPO) contracts than they had several years ago. This is one reason health care costs are going up faster than they used to, and it is an example of how managed care organizations have implemented their own “patients bill of rights” without legislation. “HSC researchers found that between 1997 and 2001 the proportion of specialists that believe they gained more power over clinical decisions increased from 72.7 percent to 85.7 percent. They also found a marked increase in the proportion of specialists who believe they can maintain their income level while making the best clinical decisions and sustaining long-term relationships with patients,” UPI’s Christian Bourge reported.
$98.9 billion spent on uninsured patients; $35 billion in uncompensated care
The Kaiser Family Foundation released an Urban Institute study on government spending on uninsured , saying some $98.9 billion is spent on the uninsured (see below). And about $35 billion is uncompensated care The $35 billion number is derived from government and provider surveys conducted to estimate the amount of uncompensated care. The question is whether those numbers are based on highly inflated list prices, or charges, or on transaction costs, or the contract rates paid by managed care organizations, Medicaid and Medicare. In the Health Affairs article on the survey, the authors report that providers ask what they would have been paid by private insurers for services provided to the uninsured. Here’s Reuters
take on the story.
Bloomberg reports on The Business Word’s health costs
How The Business Word has responded to rising health insurance costs leads this Bloomberg.com [link no longer available] story about the impact of rising health insurance premiums on small business and large business hiring. This story doesn’t put us in the best light, but it shows how we’ve had to deal with economic reality even though we’ve provided the best possible (affordable) health insurance to our employees since we started the company 17 years ago.
S. Dakota senate votes to strip mandated benefits
Utah considering mandated benefits
At least one Utah legislator still hasn’t gotten the message—-small businesses can’t and won’t afford more mandated benefits. Brooke Adams reports in the Salt Lake Tribune that a state legislator wants several preventive procedures to be covered by insurers. That makes as much sense as asking Allstate to cover oil changes and winterizing your car. Why should consumers pay insurers to hold their money for them until they get around to getting a physical, if they ever do? This is just a make work bill for already busy physicians, and it won’t save enough lives or money to pay for itself. What it is is enforced common sense for patients who won’t pay for the procedures themselves. Many states are trying to cut mandated benefits, not add new ones.