Day: October 4, 2010

In the spirit of transparency, we are posting our Cost Plus Reimbursement Schedule here:

Facilities: Cost Plus 12%                                    

Physicians  LOA: 115% RBRVS                                      

Physicians: 100% RBRVS                                      

Out-patient Rx: 100% Pass Through

Editor’s Note: Cost Plus payment is fair and reasonable. Most will agree, except hospitals. They are used to getting paid much more, much much more. For example, an actual claim for a pre-mature baby is eye opening: Billed charges were $450,000 (For those of you in Bluster Bunns, Montana, billed charges are whatever a hospital says they are, have no earthly or reasonable relationship to cost, and is the same strategy employed by automotive manufacturers). We ran this claim through a PPO contract we were privy to (a large national PPO) and the allowed charges reduced to about $250,000. Hey, not bad, right? But, when we ran the claim through our data base, using the hospital’s own cost report on file with the federal government, and adding a 12% profit margin (hey, we all deserve to make a reasonable profit), our employer’s self-funded medical plan cut a check to the hospital for about $98,000.

Concluesion – hospitals and car dealerships employ the same insane pricing strategies – the only difference is that hospitals dont employ salesmen (or are PPO’s acting as their salesmen?).

Christus Santa Rosa Health System plans to convert one of its outpatient surgery centers near Alamo Heights to a 35-bed surgical hospital that’s slated to open in early 2012.

The renovation and expansion of the building will cost $25 million.

While Christus will own the hospital, it will contract with a company owned by about 40 doctors to co-manage the facility — an arrangement that’s emerging as an alternative to hospitals employing or entering into joint ventures with physicians. Co-management deals are seen as a way to try to improve care while lowering costs.

“It is a huge change from the way hospitals participate in the management of hospitals,” said Dr. Michael Murphy, a member of the physicians committee developing the co-management agreement with Christus. “In a typical hospital arrangement, the doctors offer input and the administration does all the work.”

The hospital will cater to patients who require short says of two to four days.

“About 85 (percent) to 90 percent of inpatient surgeries will be done on this campus: that could be anything from hip replacements to appendectomies to gall-bladder surgery,” said Patrick B. Carrier, Christus’ president and CEO.

The hospital won’t handle more complicated procedures, such as open-heart surgery. It’s expected to employ about 100 people, with about 150 doctors on staff.

The hospital will replace the Christus Santa Rosa Physician Ambulatory Surgery Center that’s located in a 19,000-square-foot building at 403 Treeline Park. Outpatient surgeries will continue in the surgery center next door in a 31,000-square-foot building at 423 Treeline Park.

Redevelopment work on the smaller building, which Carrier said originally was built to inpatient hospital standards, will start in December. The work will include the addition of 7,000 square feet.

Christus acquired a majority stake in the two surgery centers, along with one in Stone Oak and one in the South Texas Medical Center about a year ago from Foundation Surgery Center of San Antonio. A local physicians group has a minority interest in the centers.

Affordable Care Act Gives Consumers New Tools, Makes Health Insurance Market More Transparent

www.HealthCare.gov now provides new information about private insurance benefits and pricing to improve competition and lower costs

 WASHINGTON, Oct 01, 2010 (BUSINESS WIRE) — The U.S. Department of Health and Human Services (HHS) today announced that new information and tools have been added to HHS’ consumer website www.healthcare.gov that will make the health insurance market more transparent, increase competition and help lower costs for individuals.

For the first time ever, price estimates for private insurance policies are available, allowing consumers to easily compare health insurance plans — putting consumers, not their insurance companies, in charge by providing one-stop shopping and taking the guesswork and confusion out of buying insurance.

To help consumers make more informed choices, the site includes new information including two notable metrics never before made public:

Insurance providers are required to provide the percentage of people who applied for insurance and were denied coverage. Insurance companies are required to provide the percentage of applicants who were charged higher premiums because of their health status.

“Millions of Americas have already logged-on to www.HealthCare.gov‘s Insurance Finder to see what health coverage options are available to them,” said Secretary Kathleen Sebelius. “This already unprecedented ability to search and compare coverage options is getting better with the new benefits and price information now available. These changes will help Americans find coverage that meets their needs and that gives them value for their dollars now.”

Created under the Affordable Care Act, www.HealthCare.gov was launched July 1, 2010, and is the first website of its kind to bring information and links to health insurance plans into one place to make it easy for consumers to learn about and compare their insurance choices. HHS’ Office of Consumer Information and Insurance Oversight (OCIIO) worked to define and collect detailed benefits and premium rating information from insurers across the country, and starting October 1, 2010, consumers will also be able to find information about health insurance options such as:

Monthly premium estimates; Cost-sharing information, including annual deductibles and out-of-pocket limits; Major categories of services covered; Consumer’s share of cost for these services; Percent of people in the plan who pay more than the base premium estimate due to their health status; and Percent of people denied coverage from a health plan;

More than 225 insurance companies have provided information about their individual and family plans for more than 4,400 policies, including policies in every state and the District of Columbia. Consumers can search for and compare information on plans available to them based on their age, gender, family size, tobacco use and location.

“We applaud the insurance companies that have provided us this information about their products. Together, we are improving competition in the insurance marketplace,” said Jay Angoff, director of the Office for Consumer Information and Insurance Oversight. “This type of transparent competition is critical to improving quality of coverage and lowering costs for consumers.”

For more information, visit our Facebook page at Facebook.com/HealthCare.gov, or the @HealthCareGov Twitter account.

To download a www.HealthCare.gov Insurance Finder widget — so that visitors to your website can easily start searching for health coverage options — visit www.HealthCare.gov/stay_connected.html.

Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.

SOURCE: U.S. Department of Health and Human Services (HHS)