Year End House Cleaning Discovery Finds Rare Antique Hospital Agreement

molly1Molly Mulebriar, margarita in hand and a bottle of scotch in the other, dropped by our office early this morning to begin New Year’s Celebration festivities. (She is the former Miss Texas 1984 Tequila Chugging Champion and to this day manages to maintain a competitive edge in adult beverage competitions).

We told her it was a little early to begin celebrating, but she was welcome to help sort out our office in preparation for the coming New Year. Year-end house cleaning is a tradition at RiskManagers.us.

“What do you think I am, your maid!” she screams.

But Mulebriar was up to the task. With gusto she tore into an old dusty box under a pile of weathered DOS floppy discs. “Hey guys, look what I found! A veritable treasure worth saving, even framing! “I wonder if the Smithsonian would be interested in this!”

Sure enough, Mulebriar found a copy of Dr. Crafting’s (see previous blog posting) first negotiated direct hospital agreement back in 2003 for a client of RiskManagers.us. The client was a large furniture store chain in deep South Texas.

Preferred Hospital Rates For Edelsteins Better Furniture

10-July-03

INPATIENT SERVICES

Medical/Surgical – $ 950/day

Telemetry/Intermediate – $1,000/ day

OUTPATIENT SERVICES

Medical Observation – $395/<24 hours

Outpatient Surgery*  – 100% of ASC Medicare Rate

Outpatient GI/Uro procedures  – 100% of ASC Medicare Rate

Surgical Observation – $395/<24 hours

Mammography Screening – $75

Lab Services – 100% of ASC Medicare Rates

PT/OT/ST –  $75/hr

ER Visit – $170

All Other OP Services – 100% of ASC Medicare Rate

Stop Loss For Charges In Excess of $50,000 – 65% of Total Billed Charges

*For multiple or bilateral procedures, reimbursement will be 100% of the ASC Medicare rate with the secondary procedure to be paid at 50% of the ASC rate and subsequent procedures at 25% of the ASC rate. Devices and implants used in surgical procedures will be billed at provider’s cost plus 10%.

This Agreement between Edelsteins Better Furniture and a local hospital was, to our knowledge, a first of it’s kind at the time in the Lower Rio Grande Valley, Texas. Employers in those days relied on PPO third party intermediaries to set health care pricing. Not Ruben Edelstein. He practiced manage care in his own way.

 

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