Entries Tagged 'Healthcare' ↓

Tonight I’m back home from a convention in Fort Lauderdale. I have to say that I didn’t quite remember some things from the last time I was there, about 3 years ago, and did remember some others.

It’s always nice getting together with colleagues who do some of the same things you do, or used to do, since I’m now independent and most of them still work in healthcare facilities. I find, though, that after so many years there are three groups of people I tend to categorize.

The first group are the fans, which is always nice. I use that term because there are some people who just seem to like me for whatever reason, and want to tell people all sorts of nice things about me. Some of them subscribe to one or both of my newsletters; some have seen my articles; some have used advice I’ve given on listserves; some I just befriended a long time ago and we’re still friends.

The second group are those that, for whatever reason, I’m estranged from. I see them year after year, always say hello when we’re confronted with each other, and then they either turn around and go back from where they came, or move past me without wanting to even try to think of something to say. That’s always an uncomfortable feeling because it makes me wonder whether they perceive I did something to them, or whether there’s just something they either don’t like about me, or don’t care to want to know about me.

Then there’s the third group, which are the unknowns. Some of these folks I’ve seen year to year, some have seen me, but because there are usually so many bodies (this year we hit 584) we’ve never had the opportunity to talk with each other. So, I always cherish when I do finally get an opportunity to talk to one of them to, hopefully, come across in a positive fashion. Today was one of those days, as I rode to the airport with this one lady and her husband, and she commented that she’s seen me at this conference for a few years and we’d just never had the chance to talk. It was a pleasant ride, and all of us enjoyed each other’s company, though we were heading in totally different directions (she lives in the cloudiest city in America, whereas I live in the number two cloudiest city). I had a few of those types of things happen this year, at least half of them introductions by the fans. I only wish I could remember names better; I’m going to have to work on that some more.

Educational sessions are always what these things are about, and this year had some good ones and some that weren’t so great, just like every other year. But I got to see my first astronaut in person; this has been a pretty good month for celebrity types, I’d have to say. He didn’t walk on the moon, but he’s walked in space 3 times; that’s fascinating for me, as someone who, at one time in his life, hoped to be an astronaut.

All in all, I had a fairly nice time, but man, was it really that hot and humid three years ago?

The same week I’ll be doing the presentation in Arlington, VA, on charge master issues, I’ll also be a part of a teleseminar being put on by HCPro on upfront collections. Along with a gentleman named John Kivimaki, we’ll be covering the pros and cons of setting up such a system in healthcare, as well as the training methods that might go into getting such a program to work well.

Why is this important? Most every business in existence gets its payment up front, then gives out its product. Healthcare is one of the few business where, often people are provided services, then pay later on. What happens is that the further time goes, the worse the treatment was in a patient’s mind. And, if the insurance company doesn’t pay on time, and it takes awhile to get your money from them, then you have to send a bill to the patient, it starts getting ugly because either the patient wants to gripe because they’re getting a bill they feel is late, or they don’t remember the services, or many other reasons. So, more and more healthcare entities are trying to set it up so that they’ll get at least part of the payment from the patient when they show up, the deductibles or co-pays. When one goes to most doctor’s offices, they have to pay before they get treatment, so why not hospitals?

So, there you go; it should prove to be interesting.

Ten years ago, I was diagnosed as being a Type II diabetic. I’ve had some ups and downs with trying to control my glucose over that time, starting out only on diet, and now working on it with exercise and medication. I’m still struggling, and at times I have to admit that I’ve felt like I’m not doing nearly enough to keep it down, as I have this issue with desserts that I just can’t get past.

However, this story from the New York Times is bringing something to my attention that I didn’t necessarily know, that being the relationship between diabetes and controlling cholesterol. I knew that it was important to control cholesterol because it’s crucial to trying to prevent heart disease. But learning, from this story, that what may be considered as normal for “regular” folks may be considered as high for diabetics is somewhat frightening to me, and it’s something that, unfortunately, I haven’t been educated as much on, though my doctor is actually pretty good.

So, I’m sharing this link and story, for as long as it stays alive, with everyone else, in hopes that, if you’re diabetic, or possibly predisposed to becoming diabetic, you’ll be duly informed, and have a chance to at least do something about it. And, based on this story, it’s not always your fault; I needed that.

I got this from another blog, The Health Care Blog, but it’s worth sharing here also. I’m a major fan of Hillary Clinton; just wanted to get that out of the way. I believe she was on the right track back in ‘93 when she did her investigation, then research into solving the health care problem for people in America.

Anyway, this was a response she gave to someone who was obviously a plant in the audience, who got shot down fairly easily. So much for her not knowing how to handle herself.

I’m going to be one of the main presenters for the World Research Group on October 22nd in Arlington, VA. The conversation will be on charge capture based on the charge master; yes, this is health care related. The pre-seminar brochure can be downloaded here.

I’m proud to have been asked to give this presentation. Of course, on Friday of the same week I’ll be part of a teleseminar being put on by HCPro on Upfront Collections in Healthcare Facilities. I hope to have more on that in a few weeks.

There’s an article on a blog called Kevin, M.D., talking about hospital charges and the uninsured. The writer got it right; hospital charge masters are NOT the cause of bills that self insured patients receive, and hospitals end up writing off much of what they’re charged for, both for insurance companies and for self insured patients through many charity care means.

A hospital charge master is a listing of all the services a hospital provides. The reason for a charge master is to make the process of charge capture and general ledger reconciliation easier. Charges have prices on them as well as a number of codes for both billing and reconciliation purposes. In other words, a charge master is a paper tool; nothing more, nothing less.

After a major judgment against a hospital system in Wisconsin in 2005, some hospitals across the country started coming up with ways to give self pay patients a chance to “compete” with some insurance companies when it came to what they were going to be billed. Some hospitals set up allowances that are writing off upwards of 50% in some cases for self pay patients, which may be consistent with reimbursement levels of some insurance payers for those hospitals, depending on which area of the country care is being given. And then, on top of that, patients always have the right to apply for charity care if they still can’t pay for those services.

Still, it is probably true that it’s harder for those without insurance, who don’t qualify for charity care because of their income level, to cover some costs related to their treatment. If someone from a family of 4, which earns around $35,000 a year, has to have surgery in a hospital that comes to $25,000 or more, even being on a payment plan, could cause a lot of pressure to be put upon them. Unfortunately, I don’t have any easy answers for those folks.

There, I’ve said it. The federal government, and, for me, the New York state government, is wrong on healthcare. Not totally, but they’re both further off than many people know.

Here’s the main issue. Both governments think that the way to fix healthcare is to reduce funds and close hospitals. Now, I will acknowledge that costs have skyrocketed. Our population over the age of 65 has increased much faster and greater than anyone ever thought possible, which is a good thing if you ask me.

However, there isn’t enough coming back in to the government so that they can continue paying higher and higher rates, because the cost of healthcare has gotten steeper. It costs a lot of money to test drugs so they can be sold as pharmaceuticals, and those companies have a very short life of profits for themselves before they lose their exclusive right. That, plus some of the things they come up with are for a relatively small group of people, so they can’t make their costs up in numbers like with something like aspirin, as an example.

Also, the cost of technology that makes things such as surgery not only go smoother, but in some cases eliminates it, isn’t cheap in researching either. Many exploratory surgeries have been eliminated with scopes and camera pills, but all of that still costs money. Knee surgeries that can be done in a couple of hours and have the patient back home before dinner, replacing long stays in a hospital, shows amazing progress, but it doesn’t always reduce initial costs.

But let’s look at the other side. In New York, many private physicians won’t see Medicaid patients because New York state will only pay around $15 for an office visit. As a point of reference, hospitals, for close to 20 years by now, still only get reimbursed $9 for a regular two view x-ray, but the costs for providing those have easily gone up. What else in America has stayed the same cost since 1987?

Also, there are studies, like the Berger Commission, that determine that struggling hospitals or hospitals in some remote areas don’t need to be there, and that will save money for the government. That’s illogical, though, because those patients have to go somewhere, so they’ll just go to another facility that’s probably struggling monetarily and have to pay them instead. Where’s all the savings?

Here’s my point. Hospitals are struggling; insurance companies are not. Not to pick on one in particular, but let’s look at Excellus Blue Cross. For 2005, it’s net income was around $197 million; in 2006, it was $151 million. Their reserves, cash they’re sitting on, is $1.1 billion. If they took just half of one year’s worth of net income and spread it around the hospitals that they actually contract with, all the hospitals in the area would be living life very well, and there wouldn’t need to be any conversation on whether one had to close or not. And that’s only the Blues; think about how nice life might be if some of the HMOs let go of their profits also.

That wouldn’t solve the Medicare and Medicaid issues, since both are more social than healthcare related, but it would be a good start. If governmental leaders can figure out a way to get insurance companies to make sure they’re being fair in their reimbursements, then we can have a legitimate discussion on curbing healthcare costs.

By now, most people in New York state know about the Berger Commission and it’s series of recommendations for hospital and nursing home closings, mergers, and the like.

Well, now word is getting out that almost none of the hospitals that the people who were entrusted to make these decisions about were actually visited. Instead, the commission took numbers and statistics and, for the most part, made their recommendations off that.

Suddenly, this takes on a different look and feel, one that’s already generating bad press and bad feelings across the state. Sure, it’s always valid to take statistics into account when making critical decisions. Not doing so would be totally irresponsible.

However, healthcare is a totally different animal than retail, and has to be handled much differently. For instance, every hospital in this state, and in most states across the country, must have an emergency room and provide emergency services, even though almost every single emergency room in the country loses money, some lots of money. How many businesses are forced to continue carrying product that isn’t selling, or purchasing services that aren’t in their best interests?

Healthcare is also more community directed, as opposed to regular industry. Sure, closing a factory might have a major impact on the economy of a community, but closing a healthcare facility basically means that some people are going to have to go through hoops to figure out where to go for their healthcare needs, often much further. For instance, without mentioning names, one hospital I worked for, which is now closed, meant people who used that hospital had to now decide, based on which side of the facility they lived on, whether to go 45 minutes to either Rochester or Oswego, 40 minutes to Syracuse, or 35 minutes to Newark or Geneva for healthcare, whereas they only had a 10 minute ride before, and, living in the snowbelt region, who knows what the ramifications were for those who might have been injured somewhere in the middle, and whether they might have survived with a facility much closer (if anyone has been paying attention, the snowbelt area has been hammered particularly heavy the last few weeks).

As I stated in a previous past, it’s never easy to make decisions as to whether a medical facility should be closed. Usually these types of decisions involve a lot of emotions and struggle, and no one takes it lightly. Making such an important decision sight unseen seems cowardly, and seems to bring less credibility and fairness to the overall process. Healthcare has never been all about money, no matter what people believe.

Well, it finally came. The Commission on Health Care Facilities in the 21st Century finally finished their report on health care facilities in New York state, and it wasn’t pretty. Literally, the report is almost 250 pages long. Figuratively, it’s created a major firestorm in the state, including my own area of the state fairly directly.

In their own news release, they talk about how the reductions: 4,200 hospital beds, closure of 9 hospitals, 50 restructurings, and reducing nursing home beds by 3,000. This is expected to save the state around $1.5 billion dollars annually and save Medicaid around $806 million annually.

My first thought when I heard the news about the report was “Wow”! My second thought was “this isn’t going to be pretty”. My third thought was “this isn’t going to pass”. The first two thoughts have already come to pass; the third one is still to be determined. The scariest thing about this last one is that, if the state congress doesn’t decide to reject the report, and instead does absolutely nothing, this goes into effect as if it had been passed; that stinks. It could let every politician in the state off the hook and allow them to later say they were totally against it, but couldn’t get the political leadership of the state to consider it.

And that’s unfortunate because it really does need to be addressed. A few of the closings on the report do make sense, especially the ones in the New York City area. Some of those hospitals have been in financial trouble for a long time, and there is a glut of hospitals in that area, though it’s hard to say that when there are 8 million people in the area. But health care has changed, and there’s more need for outpatient services than there are for inpatient beds. Many hospitals didn’t keep up with that reality in the 90’s, and they’re paying for it now.

But some of the rest,… well, one of the small hospitals locally is on the list to be closed, but what the commission didn’t take into account is that they’re well placed for when the bad winter weather comes. In the winter, it really could be the determination between life and death. Another decision involves two hospitals, one actually run by the state, and they’re talking about merging these two mega-hospitals, reducing the number of beds, and moving the state facility into public hands (oh yeah; New York state doesn’t allow private hospitals, which is why selling them to a hospital system is out of the question). One of the best reasons for having state run teaching hospitals is that they can afford to try out new technologies and train doctors on their uses; take that away, make it a bottom line proposition only, and most hospitals aren’t going to pursue them.

Yeah, I know it’s a tough decision for a commission like this to put together recommendations with its main purpose being financial. The federal government went through this same thing a couple of years ago when it looked at closing VA Hospitals around the country and put some of them on the chopping block. Communities went crazy, and with good reason. The savings that either state or federal government may enjoy is a major hit on the economies of every community that has one of those hospitals, as the hospitals are usually the biggest employer in the area.

We’ll know by the end of the year which direction this has gone in, but the protests have already begun.

Diagnosis codes, for billing and coding purposes, are known as ICD-9 codes. That stands for International Classification of Diseases, 9th revision. We’ve been using these codes for decades now, adding and modifying as needed.

There’s a new version that’s ready to bust out, the 10th revision. Many other countries have already adopted this classification system, where the numbers are a little different, but the coding is more accurate because, after all, we’ve learned a lot more over the years.

However, here in the United States, we’re not ready for it yet. Why not? Because the government can’t figure out how it wants the electronic billing format to look and work. Just so you know, the implementation of this format was supposed to occur in 2003, a byproduct of the Health Insurance Portability and Accounting Act of 1997. Now, it’s been estimated that we won’t be ready to implement this standard until 2010 at the earliest.

The United States is supposed to be a leader on things like this in the world. It’s embarrassing that we’re falling so far behind. What the government should do is hire consulting experts and just let them go at it. I know some people who would have had this thing done already. Most people have no idea what any of this stuff means, even in healthcare circles. I only know that we’re falling behind the rest of the world, and that can never be a good thing.