Day: June 29, 2009

Physician Price Fixing In Laredo, Texas ?

This makes for fascinating reading – laredo-provider-community-conspiracy. Behind the scenes PPO physician contracting may be good material for a “whodunit” best selling novel.

Could a hospital administrator, whose hospital competes with another hospital five minutes away, have any financial intersts in the amounts paid to doctors who have admitting privilages at both hospitals?  With leverage applied to PPO networks, could a hospital administrator get better reimbursement rates for key community physicians who agree to “play ball” with steerage of patients to his facility?

There are a lot of unanswered questions it seems.

BUCA Hospital Contract Reviewed

We received a copy of one of the BUCA’s hospital contracts from a reliable source. We compared it to several rental PPO hospital contracts we have acquired recently. Contrary to popular perception, these contracts are not lengthy but short, 9-12 pages long, excluding the addendums. A side by side comparision of these contracts, hospital specific, is the only method to be employed in comparing who has the best and lowest cost for their insureds.  Otherwise the “smoke & mirrors” approach most commonly (actually exclusively) used will prolong the medical  and insurance community conspiracy of silence.

Some employers rely on professional, licensed and credentialed fee based insurance consultants to guide them through the PPO maze of hype and deception. These “experts” employ strategies in PPO comparisons such as an exercise of “re-pricing” a sampling of claims. In a future posting we will show the reader why this method does not produce a viable comparision and in fact leads to a numbers game that can be twisted in the direction the consultant wants the client to embark upon. As you know, you can make numbers tell any story you want to tell.