The board of Doctors Medical Center San Pablo/Pinole voted unanimously Wednesday to take the hospital into bankruptcy as a last resort to keep it open.
Why?
The hospital lost $1.5 million in July.
Why?
"There's no way we can meet payroll if we keep the ER open."
Ah! The money hole.
Why?
Later in the meeting, she declined Wallace's request to reconsider, after Hansen told her he could not guarantee the hospital would stay open if the emergency room closes. Managers long have identified the emergency room as a financial drain, because about 30 percent of the 47,000 patients it sees annually have no insurance
If even half those treated had cat cover perhaps the hospital would not be in this mess. Yet time and again we find those who would rather go naked than buy a plan that does not have low copays & deductibles.
Here are the demographics for San Pablo.
Cost of cat cover in zip 94806?
A 35 year old male will pay Health Net $75 per month for a plan that pays 100% of charges after a $4k deductible. That's about $2.50 per day.
Friday, September 15, 2006
A Package Deal...
It is my habit to pop home about noon or so, to get some lunch and let the dog out. One day late last month, I did so, and found a package waiting for me. The return address was enigmatic: HealthcareFacts, PO Box so-and-so, Minnesota, featuring an eye-catching, stylized cereal box. More interesting, perhaps, was that it was addressed to me, c/o InsureBlog.
Hmmm.
Since I wasn't expecting any packages, I was intrigued, and proceeded to open it up. Inside, I found a cover letter attached to a glossy marketing folder, inside of which was information on a new type of transparency program. There was also a small cereal box, containing a granola bar and some more marketing info (well done, too).
Turns out, Blue Cross Blue Shield (BX) of Minnesota has designed, and now implemented, a different kind of consumer empowerment program, and they wanted me to know about it. I suppose, too, that they hoped that I’d help promote it. Indeed, I was invited to call and interview the woman who had designed it. Very heady stuff, and intriguing, as well.
So, pick up a box of cereal, a package of pasta, or a can of peas, and you’ll find a handy little chart on the side. This is the Nutrition Facts label, which tells us how many calories, which vitamins, how much salt is in that product (among other things).
What if we could get comparable information about that upcoming knee surgery?
That’s the premise behind “HealthcareFacts,” a fairly new, definitely unique effort from the folks at the aforementioned BX.
In the past, I’ve touted the “McDonald’s” metaphor when discussing health care transparency. That is, positing that prices for services be available, in advance, so that consumers know upfront what a given service will cost.
HealthcareFacts goes one (or three) better, by disclosing not just prices, but quality of care, outcomes, and more.
As long-time IB readers know, health care transparency has been sort of my "pet cause" for a long time, and I've interviewed a number of industry folks regarding it. This promised to be interesting as well, and so I began to read through the material. My goal was to formulate the questions which IB readers would like answered, in preparation for the interview. In this regard, I’d like to acknowledge the invaluable assistance of long-time IB reader John Fembup, who graciously took weekend time to help me with those. Thanks, John!
MaryAnn Stump, RN, is the Senior Vice President and Chief Innovation Officer of Blue Cross and Blue Shield of Minnesota. In deciding how I wanted the interview to go, it occurred to me that IB readers would be more interested in how the whole process of rolling out a new service would go - “what were they thinking?” - as opposed to just product information.
So I asked MaryAnn to tell me how she became interested in this concept we call “transparency,” and how she came to the conclusion that bloggers could help get the message out. Her first response surprised me: she likes blogs. And she was well aware of ours in particular, because of our interest in, and frequent articles on, transparency. So it seemed to her kind of a natural avenue to explore. She asked “how else could we be heard, with authentic information and perspective” other than through the blogosphere? One of her primary goals with this program is to “demystify the data;” that is, make the raw information meaningful to the consumer.
This perspective intrigued me. I asked her to tell us a little about herself, and how she came to be the Chief Innovation Officer of a large insurer. Turns out, she started her career as a critical care cardiac nurse and, in fact, continues to work as a “health professional who happens to also be a health provider.” One of her major issues is that of competency: she tries to bring the same skillset that helped her with the “predictable unpredictability of cardiac care" to the field of insurance. She’s been with BX for 16 years, and took over as CIO a couple years ago.
In Part 2 (now posted),we look at how HealthcareFacts is looking to change the way we look at our own care, how it’s funded, and our own role as consumers.
Thursday, September 14, 2006
Risk vs. Fantasy
According to the latest UBA survey, the average cost of providing insurance through employee benefit plans is $311 per employee per month. This is based on a survery of 13,663 health plans sponsored by 9,603 employers covering 3.52M lives.
What is significant is the cost per employee per month . . . $311.
Compare that to the MN plan to insure everyone for $190 per person per month, and the infamous CA plan (BS 840) who claims to be able to insure everyone for $95 per person per month.
The $311 figure comes from people who are actually MANAGING risk.
The other figures come from . . . magicians.
The $311 figure includes plans that have deductibles & penalties for out of network utilization.
The other figures are based on plans with no deductibles and free access to any provider.
Carriers are risk takers with years of actuarial data to support their figures.
Politicians are people who watch the polls and make statements that have little or no data to support their promises.
Carriers are accountable to regulatory agencies.
Politicians are accountable to no one.
No doubt, having health insurance without restriction for less than $100 per month is something all of us would like. Making it a reality is like pulling a rabbit out of the hat.
What is significant is the cost per employee per month . . . $311.
Compare that to the MN plan to insure everyone for $190 per person per month, and the infamous CA plan (BS 840) who claims to be able to insure everyone for $95 per person per month.
The $311 figure comes from people who are actually MANAGING risk.
The other figures come from . . . magicians.
The $311 figure includes plans that have deductibles & penalties for out of network utilization.
The other figures are based on plans with no deductibles and free access to any provider.
Carriers are risk takers with years of actuarial data to support their figures.
Politicians are people who watch the polls and make statements that have little or no data to support their promises.
Carriers are accountable to regulatory agencies.
Politicians are accountable to no one.
No doubt, having health insurance without restriction for less than $100 per month is something all of us would like. Making it a reality is like pulling a rabbit out of the hat.
Wednesday, September 13, 2006
Cavalcade #8 is up...
Jay Norris, of Colorado Health Insurance Insider, hosts this week's edition of the Cavalcade of Risk. He's done a great job of organizing 14 posts, complete with interesting details. Thanks, Jay!!
I especially enjoyed David Williams' post over at the Health Business Blog, in which he examines how our parents managed risk "back in the day," especially since we're inundated with so much emphasis on safety.
I especially enjoyed David Williams' post over at the Health Business Blog, in which he examines how our parents managed risk "back in the day," especially since we're inundated with so much emphasis on safety.
The $2.5M Bite
In the summer of 2004, Jerry Ansley suffered a $2.5 million mosquito bite.
What started as a simple bite led to acute viral encephalitis and a bizarre onset of hemophilia that had doctors pumping Ansley full of a drug that cost up to $21,500 a dose.
The treatments saved his life. But he remains disabled and dependent on his wife, Kathie, for care. Now the Ansleys are being sued by the state-supported UNC Health Care system because they cannot pay their medical bills. They fear they will lose their home.
The Ansleys' story highlights both what is possible with modern medicine and the worsening problem of how to pay for it.
Note: I have written the reporter and am hoping to have more details to report . . . such as the name of the carrier . . .
After posting this article the reporter responded to my request and indicated the carrier was MidWest National of Tennessee. This carrier does not offer true major medical coverage, but limited benefit, hospital indemnity type plans with caps on reimbursement and little to no Rx benefit.
What started as a simple bite led to acute viral encephalitis and a bizarre onset of hemophilia that had doctors pumping Ansley full of a drug that cost up to $21,500 a dose.
The treatments saved his life. But he remains disabled and dependent on his wife, Kathie, for care. Now the Ansleys are being sued by the state-supported UNC Health Care system because they cannot pay their medical bills. They fear they will lose their home.
The Ansleys' story highlights both what is possible with modern medicine and the worsening problem of how to pay for it.
Note: I have written the reporter and am hoping to have more details to report . . . such as the name of the carrier . . .
After posting this article the reporter responded to my request and indicated the carrier was MidWest National of Tennessee. This carrier does not offer true major medical coverage, but limited benefit, hospital indemnity type plans with caps on reimbursement and little to no Rx benefit.
First You Are In, Then You Are Out . . .
Irene Greco knew she would have to pay from her own pocket to use the surgeon she wanted, rather than one in her insurer’s network, but she thought she knew how much the additional cost would be. She was wrong — by almost $5,000.
She had her operation at a hospital that was in Oxford Health Plans’ network. But Oxford, her insurer, says that because the surgeon was outside its network of doctors, the hospital bill as a whole would also be considered out of network, and therefore subject to less coverage.
I have to admit, this is a new one on me. Hidden providers are a frequent occurrence, but have not (yet) experienced a claim where a network facility was adjudicated as non-par simply because you used a non-par physician.
Ms. Greco said, “It’s an unreasonable policy that an in-network hospital suddenly becomes an out-of-network hospital just because you use a different doctor.”
Officials at the hospital and the Healthcare Association said they had never heard of such a practice until she complained to them. They say they have since learned of a few insurance policies with similar provisions, but that in those cases, the rules are more clearly stated.
This deserves more research.
She had her operation at a hospital that was in Oxford Health Plans’ network. But Oxford, her insurer, says that because the surgeon was outside its network of doctors, the hospital bill as a whole would also be considered out of network, and therefore subject to less coverage.
I have to admit, this is a new one on me. Hidden providers are a frequent occurrence, but have not (yet) experienced a claim where a network facility was adjudicated as non-par simply because you used a non-par physician.
Ms. Greco said, “It’s an unreasonable policy that an in-network hospital suddenly becomes an out-of-network hospital just because you use a different doctor.”
Officials at the hospital and the Healthcare Association said they had never heard of such a practice until she complained to them. They say they have since learned of a few insurance policies with similar provisions, but that in those cases, the rules are more clearly stated.
This deserves more research.
D. I. Study
Most of our focus is on health insurance and primarily individual coverage. Very little is said about disability mostly because it is an "oh by the way" topic. Very few agents lead with a disability insurance question and even fewer clients ask about the coverage.
A recent Harris survey reveals some interesting facts.
-- Nearly two-thirds (64 percent) of working adults place either their homes, savings/investments or car/boat/vehicle as most valuable assets, as opposed to income from work.
Reality check: The average salary of a white collar professional is $48,000, meaning a 30-year-old would earn nearly $1.7 million by retirement age. By contrast, the average price of a U.S. home is $264,000.
-- More working adults (42 percent) would rely on savings to make ends meet than on any other resource through an extended disabling illness or injury.
Reality check: The average American family maintains just $3,800 in savings. In fact, the U.S. Department of Commerce reported that Americans actually spent more than they earned in 2005 - something that hasn't happened since the Great Depression.
-- The overwhelming majority of workers (97 percent) believe some level of disability income replacement is necessary. Ironically, just over a third (37 percent) has the coverage.
Reality check: Disability insurance is a very affordable employee benefit. For every dollar an employer spends on benefits and compensation, an average of 6.7 percent supports health insurance, 0.2 percent supports life insurance, 0.2 percent supports short-term disability and 0.1 percent supports long-term disability.
-- Nearly half of U.S. adult workers (47 percent) thought income replacement coverage for one year or less was adequate.
Reality check: Industry experience shows that the odds are as high as 1 in 3 of missing at least three months' pay due to injury or illness. Once an individual has been disabled for 90 days, the average length of disability is two years.
-- Of those surveyed who carry disability insurance, nearly two in five (37 percent) did not understand that this benefit would replace a portion of income and help pay for monthly expenses.
Reality check: Disability insurance can provide a level of income replacement of 50 percent to 100 percent.
Bob Taylor, executive director of a new disability industry organization, the Council for Disability Awareness, sees the lack of awareness about the growing potential of becoming disabled as a real issue for many workers and their families. "The likelihood of becoming disabled is on the rise for working Americans while the financial consequences are growing more severe," Taylor said. "Most working folks either don't realize or grossly underestimate how vulnerable they may be."
A recent Harris survey reveals some interesting facts.
-- Nearly two-thirds (64 percent) of working adults place either their homes, savings/investments or car/boat/vehicle as most valuable assets, as opposed to income from work.
Reality check: The average salary of a white collar professional is $48,000, meaning a 30-year-old would earn nearly $1.7 million by retirement age. By contrast, the average price of a U.S. home is $264,000.
-- More working adults (42 percent) would rely on savings to make ends meet than on any other resource through an extended disabling illness or injury.
Reality check: The average American family maintains just $3,800 in savings. In fact, the U.S. Department of Commerce reported that Americans actually spent more than they earned in 2005 - something that hasn't happened since the Great Depression.
-- The overwhelming majority of workers (97 percent) believe some level of disability income replacement is necessary. Ironically, just over a third (37 percent) has the coverage.
Reality check: Disability insurance is a very affordable employee benefit. For every dollar an employer spends on benefits and compensation, an average of 6.7 percent supports health insurance, 0.2 percent supports life insurance, 0.2 percent supports short-term disability and 0.1 percent supports long-term disability.
-- Nearly half of U.S. adult workers (47 percent) thought income replacement coverage for one year or less was adequate.
Reality check: Industry experience shows that the odds are as high as 1 in 3 of missing at least three months' pay due to injury or illness. Once an individual has been disabled for 90 days, the average length of disability is two years.
-- Of those surveyed who carry disability insurance, nearly two in five (37 percent) did not understand that this benefit would replace a portion of income and help pay for monthly expenses.
Reality check: Disability insurance can provide a level of income replacement of 50 percent to 100 percent.
Bob Taylor, executive director of a new disability industry organization, the Council for Disability Awareness, sees the lack of awareness about the growing potential of becoming disabled as a real issue for many workers and their families. "The likelihood of becoming disabled is on the rise for working Americans while the financial consequences are growing more severe," Taylor said. "Most working folks either don't realize or grossly underestimate how vulnerable they may be."
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