Solving Health Care Is Not Rocket Science

As consumers, we do have the power to say that hospitals and some doctors have been riding the gravy train on the backs of American employers for far too long, and it is time to derail it.

By Eric Chall, M.D. on Linkedin

I’ve been hearing a lot about accountability lately and it makes me think about healthcare.

Since we do know how to fix the healthcare system, it’s time that we hold those who are trying to maintain the status quo accountable. This starts by supporting the lab and imaging facilities, surgery centers, physicians and hospital systems that are friendly to reasonable cash pricing and ignore the rest.

“Reasonable cash pricing” is based on the actual cost of a procedure plus a fair margin to allow businesses to operate.

“Medicare rates” are the closest measure we have to the actual cost of a service; and a 30-50% margin is more than fair for physicians and outpatient services, 70-100% for hospitals. Lest they argue otherwise, almost half of their business in Florida is Medicare, so a 30-70% margin on top of that from those paying cash is a considerable “raise”, along with the convenience of being paid right away.

Any provider of a healthcare service that commands reimbursement beyond that is just being greedy.

As consumers, we do have the power to say that hospitals and some doctors have been riding the gravy train on the backs of American employers for far too long, and it is time to derail it.

The big 5 insurers (BUCAHs)—BC/BS, United, Cigna, Aetna, Humana—pay doctors in their overpriced networks 200-250% of Medicare and hospitals 400-800% of Medicare. They let them charge whatever they want so that, minus the fake “discount”, they make the grossly inflated margin above the cost of the service. If you have ever read an EOB, you know what I am saying.

The bottom line is that employers need to design their own plan with an independent TPA that gets them away from paying inflated BUCAH rates. Doctors are happy to take 130-150% of Medicare to be paid today; and if a hospital won’t take 200% of Medicare to service your employees, there is likely a competing hospital that offers as much quality for most services that is happy to gain market share by accepting such a fair margin from more employers.

So, let’s buy our healthcare like we buy TVs. Stop paying the inflated margins that the BUCAH’s command; use an independent TPA; self-insure and pay reasonable cash rates; use stop loss coverage to cap your risk. And take all the primary care claims out of the plan and pay for them directly with Direct Primary Care. This is being done all over the country TODAY.

There are advisors with expertise in designing YOUR plan this way. And in Florida, there is a community of DPC physicians to provide the CARE that goes with the coverage.

Contact me at tbdirectcare@gmail.com if you want to learn more. www.tbdirectcare.net

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