http://www.forbes.com/2010/08/30/health-care-insurance-hillary-clinton-opinions-columnists-merrill-matthews.html?boxes=Homepagechannels

Good article about transparency in the medical business. Also provides interesting website to comparison shop for medical procedures:  www.healthcarebluebook.com

The Jefferson Physician Group Dallas Morning News

Editor’s Note: One of our readers sent the following comments - 

Bill,  This is very interesting.  The owner of the Blue Book Health Care indicated in this article that he gave a presentation to the TMA in Fort Worth .  I was actually in the room when he gave this to the Socioeconomics Council, of which I am a board member.

 I think price transparency will evolve once more providers get comfortable with it.  The problem is that none of us knows what our true fee really is since we charge one thing, and get different reimbursements from multiple payors.  What this Jefferson group is really doing is simply offering an advertised cash discount price.  But then, how do they handle the various levels of care?  A provider can’t really quote a specific fee up front because they don’t really know how complex the problem is going to be, whether it needs an X-Ray or lab.  And we have a number of people who come in for one thing, and then as the doctor is walking out of the room, they say, “Oh, by the way, doctor, I have this one other thing……..”.   So it makes it hard to arrive at a specific fee ahead of time.

But I suppose over time, these things will work their way out and there will be some form of posted pricing.  It may have lots of asterisks.

PPO discounts save money. But are the discounts applied to reasonable fees, or unreasonable fees? What is a reasonable fee and what is an unreasonable fee? Are usual and customary fees the same as reasonable fees? How do reasonable and customary fees compare to PPO discounted fees?  What is the relationship between provider fees and cost?

Who develops PPO contract fees? Is it the provider in partnership with the PPO or is it the provider in partnership with the payer? If the payer who pays the bills is not a party to the PPO contract, why? After all, the payer pays.

Consultants are relied upon to advise clients. Consultants are experts and are unbiased, at least that is what they tell us. Many employers take the advice of their consultants, and often move their insurance to the company that provides the lowest cost.  Was the move the right move, based on the consultant’s advice?

Employer: How do we know we are doing much better this year than last year?

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

Editor’s Note: Change is the only constant, so 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.

Oral Order issued today postpones sentencing of “Half Guilty, Half Pregnant” Arnulfo Olivarez “until further notice.”

Editor’s Note: While awaiting sentencing for his crimes, Olivarez continues to be licensed by the Texas Department of Insurance.

 ”Half Guilty, Half Pregnant” Arnulfo Olivarez, Insurance Agent

A ‘final’ sentencing date has been set for all six people remaining in the PSJA Independent School District bribery scandal.

Rogelio “Roy” Rodriguez, Arturo Guajardo, Raul “Roy” Navarro, Evaneglina “Vangie” De Leon, George Alonzo Hernandez and Arnulfo Cuahtemoc Olivarez are all scheduled to appear in federal court together.

The case was originally filed back in May 2007 but one-by-one, each of the six pleaded guilty to their roles in the case between December 2007 and December 2009.

Their sentencing have been postponed numerous times with prosecutors dismissing charges against a seventh suspect Ricardo De Leon back in January 2008.

Rodriguez and the other five remaining suspects are now set to appear for sentencing before U.S. District Court Judge Ricardo Hinojosa in McAllen at 9:30 a.m. on Friday, August 27th.

Each of them faces different prison terms ranging from five to 20 years in prison.

Editor’s Note: Scamming taxpayers for millions of dollars deserves public retribution. Flogging in the Town Square seems appropriate, or a Tar & Feather Party at the McAllen Convention Center would be a good start. Maybe even losing one’s insurance license would be something to consider. Regarding the later, why are insurance carriers still recognizing and paying an admitted felon?………….. are his patented sales tactic of bribing public officials for lucrative insurance contracts contained in a subchapter in the carrier’s Ethics Manual?

MyHealthGuide Source: Hewitt, 8/2010, Hewitt Survey Report

Grandfathered health plans are only required to comply with certain provisions of the recently enacted health care reform law. In July 2010, Hewitt Associates conducted a brief survey of more than 450 U.S. companies representing 6.9 million employees to determine how these provisions will affect companies health plans and their grandfathered status. 

Survey findings

• 73% of surveyed companies have

•  
  • determined whether their group health plans will be grandfathered in 2011, and
  • the recently released guidance on preventive care did not impact their decision to maintain grandfathered status.

• 90% anticipate losing grandfathered status by 2014, with the majority expecting to do so in the next Iwo years.
• Employers indicated that they would most likely lose grandfathered status because of

•  
  • 72% – plan design changes
  • 39% – changes to company subsidy levels
  • 16% – consolidation of health plans
  • 16% – changes to insurance carriers
  • 15% – union negotiations

• Loss of Grandfathered Status Among Self-Insured Medical Plans

•  
  • 51% grandfather status loss in 2011
  • 21% loss in 2012
  • 8% loss in 2013
  • 8% loss in 2014
  • 12% do not expect to lose grandfather status

• Addressing additional cost associated with the new health care reform coverage and benefits requirements starting in 2011,

•  
  • 46% said they will pass the additional costs to employees.
  • 45% of companies have not determined how to handle these costs yet.
  • 9% said they will absorb additional costs.

Conclusions 

Most employers would rather have the flexibility to change their benefit programs than be restricted to the limited modifications allowed under the new law.

Editor’s Note: Beware of insurance agents and consultants using scare tactics - losing grandfather status by implementing needed benefit / carrier changes.

  https://v3.boardbook.org/Public/PublicItemDownload.aspx?ik=30529018

https://v3.boardbook.org/Public/PublicItemDownload.aspx?ik=30529019

Editor’s Note: This appears to be a classic case of decision making based on PPO discounts with little or no regard to fixed costs. As our three readers know, we have developed extensive information on PPO discounts and have written numerous articles on the subject. Few “expert” insurance consultants understand the matter completely, and often base their analysis using faulty premises. A challenge to the board’s decision may prove fruitful to the incumbent, however in the past that has not been the case. An incumbent must always “sell” themselves continuously to keep their clients informed and knowledgeable throughout the course of the contract. An ignorant and ill-informed customer often falls prey to vendor machinations.

http://www.pciplan.com/applicants/rates.html

The BISD long awaited health insurance audit is apparently in the hands of the members of the School Board. In a recent board meeting, the audit was discussed behind closed doors (Executive Session) with a note regarding possible litigation.

We are hopeful that the BISD will release the findings to the public expeditiously.

http://www.allbusiness.com/education-training/education-administration-school-boards/12983487-1.html