Health Care Provider Intrigued By Dr. Hummer’s Business Model

Below is a redacted email we received from one of our readers. We had posted an article on Gregg Hummer, M.D. and his approach to paying health care providers fairly, quickly and efficiently:

Bill, I was intrigued by simplicity health plan, and asked for feedback from one of my clients who was formerly a hospital administrator, and now runs a physician group of pathologists. I wanted to pass his input on to you… Cathy

George, If you have a second, take a look at the links below. I am curious how this would appeal to 1) a hospital and 2) a physician group. I would assume that knowing what you will get paid, and getting paid quickly appeals to both, but not sure about pricing based on cost plus Medicare rates. http://blog.riskmanagers.us/?p=10126

Cathy – This model is very intriguing. ┬áProviders spend tremendous amounts of money trying to collect payments from insurance companies, in large part because many insurance companies in the healthcare sector, including the large influential carriers in my experience, are highly creative and aggressive in crafting reasons to deny or delay claims reimbursement without regard to the accuracy, legitimacy, or timeliness of the claim submission. If that process and the associated costs can be eliminated, or at least mitigated, thereby allowing providers to expend fewer dollars on collections efforts, providers could obviously afford to accept a lower fee for each service. ┬áThe success of the model clearly hinges heavily on the claims authorization/payment process and a mutually-acceptable fee schedule, but this model has the potential to bring about real savings, unlike the “fixes” we are seeing come out of Washington and the alleged cost savings we will reportedly experience with the AFA.

 

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