Industry health:

Estimated costs of credentialing and billing surpass $85,000 per Doc

It’s not just time consuming, but also expensive! At the University of California, researchers figured that the annual cost of performing billing-related tasks comes to about $85,276 per physician. In another study by the Cornell Medical College and MGMA (Medical Group Management Association), researchers estimated that the total cost of the nation’s physician-health plan interaction is between $23 billion and $31 billion. This figure is equal to six times the amount spent by the federal government on The State Children’s Health Insurance Program!

The MGMA noted that the average physician works with about 12 different health plans—all require MDS to go through slightly different credentialing forms and procedures. Many of us thought that the credentialing issue was resolved in 2000 when the Illinois Uniform Data Credentialing Form was introduced by the Illinois Department of Public Health and later CAQH. But health plans, hospitals IPAs and PHOs figured out ways to increase the cost of credentialing with the additional attachments that are specific to an institution. (Robezniecks, Andis “Adding up the Costs” Modern Healthcare, May 18, 2009. page 10.)

Learn a lesson from bookstores

According to a recent survey by Forester Research, the industries that best satisfy customers are retailers, hotels, and insurance companies. Companies were surveyed on usefulness, ease of use and enjoy-ability. Barnes & Noble, credit card provider USAA, Borders, Amazon and Costco received the highest scores.

Most likely to get it wrong with customers are internet service providers, TV service providers and health insurance plans. Included way at the bottom were Medicaid and Blue Shield of California. Maybe they ought to read a page or two from bookstores’ playbooks. (Phyllis Korkki. “Can Bookstores Teach Others A Thing or Two?” NY Times. December 21, 2008.)

Underwhelming results of care coordination programs

The Medicare Coordinated Care Demonstration (MCCD), funded by CMMS, showed that care coordination for chronically ill Medicare beneficiaries had no effect on the number of hospitalizations of patients in 13 of the 15 projects in MCCD. Results from the two outlying hospitals suggest the potential for care coordination interventions to be cost-neutral and improve patients well being. (HFMA News, Wednesday February 11, 2009. Permalink. 2/11/2009 9:54:14 AM)

Molina Healthcare of Texas Insurance wins Texas CHIP contract

A little self-promotion never hurts. Loewenthal & Associates, Ltd. worked on the successful proposal by Molina Healthcare of Texas Insurance Co. to provide services to CHIP and CHIP Perinates in rural Texas – and I mean rural! Glad we were on the winning side! Superior HealthPlan and Molina Healthcare of Texas Insurance Co. have tentatively been awarded contracts to provide managed health care services to children enrolled in the Children’s Health Insurance Program (CHIP) in 170 rural counties in Texas. The contracts are contingent upon successful negotiation with HHSC. Currently, Superior is the exclusive CHIP managed care provider in the 170, soon to be 174 county service area.
(http://www.hhsc.state.tx.us/stakeholder/index.html)

Interested in seeing the world from the inside of a hospital room?

Pick a procedure and pick a country. How about including a joint replacement surgery as a souvenir of your trip abroad? Paid for by your insurance company? Medical tourism to date has been at the patient’s own expense, but this trend may be starting to change.

The number of medical treatments available abroad continues to increase, host and often the treatments are significantly less expensive than in the U.S.A. WellPont, Inc. is collaborating with a Wisconsin employer, Serigraph, Inc., to offer the employees the option of traveling to India for non-emergency procedures. Knee replacements, available in the U.S. for $60,000-$70,000 can be obtained in India for $8,000-$10,000. And the hospital might be one of 220 Hospitals accredited by the Joint Commission International (JCI). (“News Watch.” Healthcare Financial Management. January 2009 P.12.)

Not a great singer? Keep practicing “Stayin’ Alive.”

A University of Illinois College of Medicine (Peoria) researcher, David Matlock, found that subjects listening to “Stayin’Alive” improved their ability to perform chest compressions at the proper speed, and indeed their performance even five-weeks later was excellent. The song’s beats per minute is almost the exact rate at which chest compressions should be performed. The study consisted of 10 physicians and five medical students. They practiced chest compressions while listening to the Bee Gees’ hit song. The results were presented during the annual meeting of the American College of Emergency Physicians. (“Outliers.” Modern Healthcare. October 27, 2009. p. 36.)

Want to know what doctors think about various health plans?

Try reading the magazines they read. A recent issue of Physician Practice included payer rankings on the basis of hassle-factor: how quickly they pay, and how much they annoy docs with denials, delays, and red tape. PayerView, part of athenahealth, the nation’s largest physician-billing company, ranks payers on millions of claims processed and on performance measures that are important to physicians. The reports are done by geographic area. While reimbursement is key in a relationship with payers, so are these other listed factors. (“How do They Treat Docs?” Physician Practice June 2009, p. 17)