We’re in a tough place these days as it pertains to health care. Depending on which side you’re on, it’s either the fault of the hospitals, doctors, insurance companies, states, or the federal government. I’d throw the legal system into the mix as well as banks, suppliers and pharmaceutical companies. I could add to the list, but we don’t have enough time.

Here’s the thing. There are many things impacting health care in negative ways, and it’s almost an oxymoron to say that we have the best health care in the world coming from the United States. We can do some amazing things, but it all costs a lot of money. That’s why we don’t have flying cars (to answer the question from a commercial a few years ago).

Truthfully, the biggest problem facing health care today is costs, and everyone’s got them. It costs a lot to go to the hospital. It costs a lot for insurance coverage, and it costs a lot for insurance companies to pay hospitals and physicians. It costs a lot for hospitals to pay for supplies, pharmaceuticals, utilities etc. It costs a lot for physicians to pay for malpractice insurance. It costs pharmaceutical and medical equipment suppliers a lot of money to test all these things as required by law to then try to market them to hospitals and physicians. And unpaid medical bills costs everyone across the board.

I can’t solve all the problems in health care. Last March I shared on this blog my health plan for America; no one took notice. That doesn’t stop someone like me; one day someone might see something, put it in practice, and we’ll see where things go. Course, I won’t get any credit for it, but that’s okay. Because it’s okay, I’m going to throw 3 more things out there that most people probably wouldn’t think about if they’re not in health care, but it would really help all of us out.

1. Duplication of services. In the real world, you might have a Home Depot on one street and have someone decide to build a Lowe’s across the street from it (that’s actually happened here). Both stores offer pretty much the same thing, but there’s so many people who can buy from both places that even if their profits aren’t super high, both have a chance of surviving and doing pretty well.

That doesn’t work for hospitals. If one builds a sleep center and it’s working pretty well, another hospital in the area will probably start building one as well. If there are other hospitals nearby, they’re all going to start building the same thing. However, the folks who pay most of the claims are the insurance companies, and most locales have only a few insurance carriers that pay most of the claims.

What happens is the insurance companies start feeling like they’re being squeezed, and they decide they’re not putting up with it. So they start paying less, and hospitals start losing money because they can’t afford to keep these things open. Eventually quality goes down because the hospitals didn’t have the foresight to allow one hospital to become the main center for certain services.

2. Grade insurance companies based on how they process claims and denials, as well as how much money they spend paying providers as opposed to paying themselves. Some of this has started in a few states, where insurance companies have to justify the increases in premiums they want every year.

I’ll own up to the fact that pharmaceuticals are expensive, and care for some diseases (like diabetes; thanks insurance companies) is overwhelming. But that’s not the majority of their patients, and it also turns out that most of the money they pay for some of these things actually doesn’t go to anyone. Insurance companies set up deals with providers of payments often like this: they’ll take the physician’s fee, capt at at a certain amount based on what they call UCR (usual, customary and reasonable fees), then pay a certain percentage based on whatever calculation they come up with, then have providers write off certain amounts and either bill patients for a co-pay or deductibles of usually 20%.

What do insurance companies do with the money? Some build big, beautiful buildings. Some pay shareholders. Some take pretty big salaries. Whatever they’re doing with the money, many times less than 60% of what they have goes to providers. Under paying our hospitals and physicians doesn’t do any of us any good in the long run. Denying claims at a rate of even 25% doesn’t do us any good either.

At least Medicare pays claims, even if they then go back and take a lot of money back through RAC audits. If hospitals and physicians are messing up, then that’s on them; at least they had the money for awhile.

3. Revamp charity care & allow physicians to set up scales as well. There was a statistic that came out last year saying that 62% of the people who go into bankruptcy have at least one significant health care bill listed among their debts. That’s wrong on so many levels, though I kind of understand.

Medical providers deserve to get paid for services they provide, yet how many of us could come up with more than $10,000 at a moment’s notice? If your entire family’s income is $50,000 a year or more and you have 4 kids, you’re not going to qualify for any type of charity care. Any many hospitals have things set up where they want to collect on any outstanding balances within 6 months; trust me, I’ve read these types of recommendations on how to collect better from self pay patients for at least 15 years. I don’t know if physicians aren’t allowed to even offer charity care or not, but I’ve never met any that offer it.

Last year on my finance blog, I stated that the overall housing industry would have been better served if banks had found a way to try to work with homeowners instead of just foreclosing on their homes, especially at the rate they were, and still continue, to be taken. Even if they had worked out a one year deal with homeowners to accept half of the mortgage amount they’d have ended up financially ahead as opposed to taking the house and not being able to sell it because no one else was qualified to buy it.

The same type of thing needs to work for health care. We have high unemployment right now across the country, some areas harder hit than others. Hospitals and physicians need to find better ways to work with patients to get at least some kind of money in on a consistent basis, no matter what the amounts are. In my opinion, even $100 a month on a $10,000 bill is money I wouldn’t be getting any other way from some of these people. It could be set up where there’s a review every 3 to 6 months to see if circumstances have changed to determine if the patient can pay more at a certain point or if the situation is more dire and other measures have to be taken. Either way, it would be patient friendly, and if there is more than one hospital in the area, the publicity would be dramatically positive.

Of course there are more complicated things that can be done, but I think these are ideas that everyone can at least understand. Too bad I don’t believe many people will see them; we’ll find out at some point, won’t we?
 

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