Month: May 2018

Memorial Day 2018

 rusreberg

Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. American hero. 

The battalion began the battle of Hatten with 33 officers and 748 en- listed men. Fifty-two hours later it had an effective strength of 11 officers and 253 enlisted men. All others were either killed, wounded or missing in action.

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How Do You Measure Savings?

Question: How do we know we are doing better (saving money) this year than last year?

Answer: What was this year is last year plus or minus this year’s change.

Question: Then if change is the only constant why do we need to measure it? You don’t know if something is better if you didn’t know how to measure what it was before.

AUTHOR UNKNOWN

Physician Strikes It Rich in Health Care Arena

A Texas doctor used his million-dollar private jet or drove in his Maserati, which were both emblazoned with his initials “ZQ” between his offices in the Rio Grande Valley and San Antonio…………he purchased private jets, luxury vehicles, clothing from high-end retailers such as Louis Vuitton and exclusive real estate located throughout the United States and Mexico………..all garnered through his successful clinic operation in deep South Texas………………

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Medicare + Fee Schedules

NATIONAL ASSOCIATION OF PREFERRED PROVIDERS (NAPP) Fee Schedule:

☑ Medicare plus 25% or 80% of billed charges, whichever is less.

☑ THREE RIVERS PROVIDER NETWORK (TRPN) – PPO Fee Schedule:

125% of the existing Medical fee schedule as total reimbursement for covered services less applicable co-payments, co-insurance or deductibles.

IMAGINE A ONE  OR TWO PAGE HOSPITAL CONTRACT INCORPORATING THESE FEE SCHEDULES…………………….

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Pointing Fingers

Republicans and Democrats blame each other for the great American health care failure. But isn’t it true that once government gets involved in anything costs go up? For example, food costs are higher because of the food stamp industry wherein recipients really don’t care what the cost of food is since its free. And how about college tuition? With rampant student loans students (and their parents) don’t feel the financial pain……………until much later. Isn’t the same true for the high cost of health care?

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Troubled School District Seeks Insurance Consultant………….Again

The Donna Independent School District in deep South Texas has had plenty of bad press during the past several years – board members sent to prison, hiring of convicted felons, lawsuits and counter lawsuits, sanctions by the Texas Education Agency, and now TEA oversight (Texas Border School Scandal Highlights Culture of Corruption – Breitbart).

Now we learn the DISD is again seeking yet another insurance consultant. This will make the sixth “insurance consultant” / brokers utilized by the district in less than three years………………..

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Plan Sponsors Gamble Even Though Odds Are Against Them

The 60 Minutes story (www.cbsnews.com/video/the-problem-with-prescription-drug-prices/) aired last night illustrates the continuing gamble most plans sponsors take in not addressing high cost specialty drugs. There is not a group in this country that offers ACA complaint health care benefits for their employees that is not at risk of bankruptcy, yet they continue to gamble they will beat the odds.

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Fake News Story Revised – The Power of The Press

Last week a story ran in the Victoria Advocate (Victoria, Texas) that told the sad story of mean insurance companies bankrupting a new start up business whose goal was to service the dire health care needs of locals. See Mean Insurance Companies Bankrupt Free Standing ER.

Now the same newspaper, different reporter, spins the story in a different direction…………….

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Bill Ebaugh 1930 – 2018

William Lee "Bill" Ebaugh Obituary

William Lee “Bill” Ebaugh

I have met a lot of people in the insurance business over the years, but Bill Ebaugh stands out. His knowledge and connections within the insurance industry was amazing. He was a master salesman, story teller, and visionary. His life’s experiences were something out of a movie. He attracted the best in everyone he met.
One day he called me –  “Hey Bill, why don’t you do a write up on what your’e doing with political subdivisions. It needs to be published!” So with much prompting I did as he suggested.
A month later I received a call from Bill – “Bill (we are both named Bill), what are you doing on December 17th?”
“Why nothing Bill, whats up?” I replied.
“The State of Wyoming wants to see you on the 17th. You will be getting a call from the governor’s office setting up the trip at the state’s expense” he announced.
Yeah right I thought. “Bill I will wait for the call” I said and hung up the phone. I turned to my secretary and said “Bill is one hell of a joker!”
I was in Wyoming on December 17.
– Bill Rusteberg

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Mean Insurance Companies Bankrupt Free Standing ER

In today’s Victoria Advocate newspaper (Victoria, Texas) there appears an article about a free standing ER closing down because the have “been having problems with insurance companies.” Actually the problem is not with the insurance companies. Its with hospitals gaming the system. Consumers equate free standing ERs as urgent care centers paying for services with other peoples money. An “office visit” there can cost several thousands of dollars for something as simple as a cold, insect bite or sprained ankle. The cost is so high and the profits so great it takes only 6 or 7 customers a day to reap a profit.

Yet you read the story below and come away thinking the mean, uncaring insurance companies seeking to pay as little as possible are to blame. BTW – insurance policies under the ACA cover emergencies.

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The Elephant In The Room

Health care is the focus of a national debate that never seems to end. So called “experts” on health care delivery offer all kinds of suggestions and advice to solving the health care financing crisis in this country yet they won’t admit the journey towards solving the crisis will soon end.

In my circle, for example, the discussion centers around performance based medicine, reference based pricing strategies, point of service claim adjudication/payment, wellness programs, direct contracting, value based outcomes and more. But all secretly recognize there is an Elephant in The Room.

The Elephant in The Room is the inevitable coming of a single payer health care system to this country. It’s only a few elections away and we all know it. Americans are fed up with the high cost of health care. Many employers  are simply running out of money to pay for it. The American middle class who has been bearing the brunt of the cost is a vanishing, diminishing class. Hospitals and third party intermediaries continue to raise pricing, compounded year after year well beyond true inflationary pressures. Drug manufacturers are reaping record profits on drugs that sell as much as 80% – 90% less overseas.

The experts mentioned above have the answers to solving our health care crisis and the proof to go with it but few seem to be listening………….

– Bill Rusteberg

The following article is about that Elephant:

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Therapeutic Interchange

The Academy of Managed Care Pharmacy (AMCP) supports the use of therapeutic interchange programs as a part of a comprehensive approach to quality, cost‐effective patient care. Therapeutic interchange is the practice of replacing, with the prescribing physician’s approval, a prescription medication originally prescribed for a patient with a chemically different medication. Medications used in therapeutic interchange programs are expected to produce similar levels of clinical effectiveness and sound medical outcomes, based on available scientific evidence.

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AVYM White Paper Spurs New Jersey Probe Into Health Insurance Contracts

“Based on court cases (cited in the paper), it seems apparent TPAs can and do hide ‘undisclosed’ administrative compensation fees within medical claims payments. These undisclosed fees, which can account for 30 to 60 percent of a plan sponsor’s health claims expenditures, are usually siphoned into the TPA variance account through ‘retention reallocations’ and ‘cross plan overpayment’ offsets, among other techniques………………..

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