City of Santa Fe – In A Boat Without A Paddle?

boat

By Molly Mulebriar

The City of Santa Fe has requested proposals for stop loss insurance for their self-funded employee health plan with a proposal deadline of February 23, 2015. However, New Mexico’s Insurance Superintendent issued a regulatory bulletin the week before the proposal deadline that effectively eliminates stop loss protection as a viable option for New Mexico employers that self-fund their employee health care coverage.

The task now before the city’s insurance consultant (AON Risk Solutions) and  third party administrator (United HealthCare – UHC) is to find stop loss insurance for the plan’s July 1 effective date. According to market experts this will be a near impossibility without divine intervention.  BUCA reps. are circling city hall anticipating the coming feast.

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Hospital Costs Explode Under ObamaCare – ACO’s A Cost Driver?

Transcending Obamacare Fig 17

Thanks to federal intervention in the health care system—Medicare, Medicaid, and the employer tax exclusion—hospitals have been able to charge whatever they want for their services, knowing that the average consumer has no idea how much he’s paying, because he’s paying mostly through taxes and other indirect means…………..

Accountable Care Organizations, whose explicit goal is to encourage hospitals to consolidate the provider industry, thereby gives them more leverage to charge higher prices…………

The U.S. hospital industry is crony capitalism at its finest

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Opinion: Three Ways ObamaCare Must Finish The Job

dendy Mike Dendy

No one will bring down America’s highest-in-the-world health-care prices until consumers and the employers who pay for most privately financed care know what the prices actually are, says Mike Dendy, CEO of Atlanta-based Advanced Medical Pricing Solutions. Americans not only pay the world’s highest prices for care, but what they pay varies wildly from doctor to doctor, hospital to hospital.

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Democrats Seek Relief From ACA Penalties

 

Prescription Drug Costs Plague Plan Sponsors

zombie What! A $10 co-pay!

“Why are patients paying more for health care?  It’s the drug prices…….increasing 13% last year alone…”

ObamaCare Solution: Bronze Plan $6000 deductible with no first dollar coverage. Rx covered after satisfaction of deductible, and is a reimbursement benefit to the insured (insured pays for Rx with cash, then files claim like in the old days…..)  A patient who must pay cash up front before reimbursement will be a better consumer with skin in the game instead of an entitlement zombie who could care less about what costs are other than that egregious $10 co-pay.

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Avoid Doing Business With The Government Doc – They Will Own You

biggov

“CMS: Meaningful Use penalties to reach $200M – Current CMS data indicate that eligible professionals are facing an estimated $200 million in Medicare reimbursement penalties in 2015 for failure to fulfill Medicare meaningful use obligations. The numbers were announced this week during a HIT Policy Committee meeting.” By Heather Caspi, February 13, 2015. (more).

http://www.healthcaredive.com/news/cms-meaningful-use-penalties-to-reach-200m/363963/

Regardless whether the eligible professionals deserve the claw-back penalties or not, the important lesson here is: Do everything you can to avoid doing business with the U.S. government, Doc. They will own you.

Dr. Pruitt – darrelldk2@gmail.com

If Mechanics Were Paid Like Doctors

mechanic

“My friend, Trent, is an auto mechanic. When he was growing up, he loved to work on old cars. He rebuilt his first one when he was fourteen — and drove it for 11 years. He loved finding problems and figuring out how to fix them. He never cared about getting rich; his goal was to make a decent living doing something he loves, and his dream had always been to open his own garage.”

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Lucent Health Solutions Completes Acquisition of Capitol Administrators

NaviMedCapitalLucentHealthSolutions

Second Acquisition in Three Months for New Employer Healthcare Benefits Platform

(Sacramento, California) January 16, 2015―Lucent Health Solutions, Inc., in conjunction with NaviMed Capital, a Washington, DC‐based healthcare growth capital firm, announced today its acquisition of Capitol Administrators Inc. (Capitol).

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Christus Santa Rosa Restructures Domestic Operations

Patrick Carrier

Patrict Carrier, CEO Christus Santa Rosa

“Christus Health, which operates hospitals in several Texas cities and in Louisiana, New Mexico, Chile and Mexico, is reducing the number of its domestic operating units from eight to three. Carrier said the changes will streamline and simplify Christus’ regional operations and expedite the decision-making process across all affected markets. He will divide his time between both markets.”

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Texas Wholesale Brokerage Community Outraged!

outraged Surplus Lines Agent

“To say the move both surprised and shocked the state’s wholesale insurance broker community would be an understatement.”

“Few were willing to speak publicly about it. However, off the record many members of the Texas MGA community expressed frustration and confusion — in some cases disgust — that the largest state affiliate of the Big “I” would go into direct competition with them in the wholesale insurance marketplace.”

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Ascende Dramatically Cuts Clients’ Pharmacy Costs, Reducing Trend In 2015

ascende

HOUSTON (January 23, 2015) Ascende just completed renegotiations with pharmacy benefit managers (PBMs) that dramatically improve guaranteed pricing agreements for the company’s pharmacy purchasing collective. This is expected to significantly reduce employers’ pharmacy costs in 2015 and result in a lower year-over-year trend

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Non US Citizens Exempt From ACA – Is Texas Uninsured Rate 0%?

interesting

According to yesterday’s article in the Brownsville Herald, 790,245 Texans are on health insurance welfare rolls (84% receive welfare, i.e, subsidies). Another 128,645 Texans are on health plans too but those poor bastards are not getting any type of welfare assistance (subsidies) at all. That’s unfair!

The article points out that there are approximately 6 million uninsured Texans. So that must mean that there were about 7 million uninsured Texans but now that 918,890 have become insured under ACA that leaves only 6 million left to sign up (80 signed up yesterday in Brownsville according to the article).

Are the 5,999,920 million left to sign up non US citizens? If so, then there are no uninsured Texans according to ACA rules.

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Health Care Industry’s Old Models Are Crumbling

truth

“Since the mid-1980s, hospitals and physicians have billed commercially insured patients extra to cover their losses on Medicare, Medicaid and uninsured patients…….”

But  “Losses” may only mean “less money” and not necessarily negative cash flow. If Medicare pays $10 for a service, and private payers pay $12 for the same service, one could claim the provider “lost” $2 on Medicare patients. Semantics is a powerful tool.

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