The best remedy for a short temper is a long walk. ~Jacqueline Schiff
An early-morning walk is a blessing for the whole day. ~Henry David Thoreau
My grandmother started walking five miles a day when she was sixty. She's ninety-three today and we don't know where the hell she is. ~Ellen DeGeneres
Me thinks that the moment my legs begin to move, my thoughts begin to flow. ~Henry David Thoreau
I have two doctors, my left leg and my right. ~G.M. Trevelyan
Make your feet your friend. ~J.M. Barrie
Thanks to the Quote Garden!
Friday, September 16, 2011
Thursday, September 15, 2011
Walk Across Maryland!
In case you haven't heard, Hahn and Nelson Family Medicine's now famous Walk Across Maryland will be held this Saturday. So far the weather looks perfect, which is good news considering we could use a rest from all this rain. But we won't be resting until we've crossed the state of Maryland! Granted, we will be walking across the skinniest part of our beautiful state, but hey, it's all for fun. We'll have our new bright yellow Walk Across Maryland t-shirts available free for the first 200 walkers who show up. As in years past, we'll meet beginning at 8:30 at the Assembly of God parking lot (just keep driving up Pennsylvania Ave past Pittman's Grocery), and take a quick walk up to the Pennsylvania line. You can stop at our office about halfway and greet the staff from Hospice of Washington County, who will be accepting donations. From there, we'll walk all the way down Pennsylvania Avenue to the great Potomac River where we'll dip our toes. We'll have a shuttle available to drive folks back to their cars if you like. Once again Mike Cligerman will entertain us with his squeezebox, our loyal Hancock cheerleaders will cheer us on, and the Boomtown Hoop will join us too! I heard that some of those wild Zumba ladies might come along too, so watch out! All the office at 301-678-7007 or email bibi@hahnandnelson.com if you have any questions. See you there!
Monday, September 5, 2011
KISS! (Keep It Simple, Stupid)
We often wonder why health care in the United States is so much more expensive than in other countries. A large part of the answer is that administrative costs in the US system are far higher than in other countries.
A survey of physicians and their staff found that the administrative costs of and time spent interacting with multiple payers in the United States far exceeded time spent and costs in Canada with its single-payer system.
Specifically, U.S. physicians typically spent $82,975 a year administering claims to insurers. In Canada, where health providers only have to deal with one payer - the government - they spent $22,205.
One reason I can see for this discrepancy is that there is very little standardization among our payers. Sure, they all have to use the same codes for procedures (CPTs) and diagnoses (ICD), but from there, the similarity in how a claim is handled disappears. Each insurer has different rules about what diagnosis can be linked to what procedure, what fields on a claim form must be completed or left blank; even the Explanation of Benefits are all different so it's hard to zip through them when processing payments. Each provider is paid differently, according to whatever fee schedule they have negotiated with the insurer. I get bulletins from all our insurers periodically (we accept almost every insurance out there) with "edits" to how claims should be submitted. Do I have time to read all of them? Never. There is a whole industry out there for medical coders to learn the ins and outs of how to successfully code a claim because of all the mystery and confusion.
Another reason is that the rules and regulations governing health care billing and payment are extremely complex and cumbersome. For any office visit, hospital charge, or other simple service, there are multiple sets of codes, complicated documentation rules, and multiple decision points. Furthermore, many bills are divided into an upfront co-pay, an amount that the insurer pays, and then a third amount, to cover the difference between the allowable charge, and the amount that has been paid between the co-pay and the insurance payment. Sound complicated? It is, and this complexity is the cornerstone of a huge bureaucracy necessary to administer its ins and outs. It is also the foundation of a great deal of health care fraud, which can hide for years behind the tangle of complicated rules.
Even within a payer, things get tricky. I'm sure you're all tired of hearing me wail about Carefirst of Maryland, but it really is the bane of my existence. Almost all of our Blue Cross/Blue Shield claims must go through Carefirst of Maryland. The rules are not always the same for all of those BC/BS claims, so there are problems. However, I can't call a patient's "Home plan" to get answers: I must call Carefirst of Maryland, who then "wires" the home plan for a resolution -- that can take literally months.
The time I spend figuring out why a claim isn't paid very often cancels out the amount we end up getting. That $82,975 figure is very easy for me to believe; actually, I'm surprised it's not higher.
And those who shiver when they think about the government telling doctors how to do their jobs? Guess what. Private insurers tell providers how to do their jobs every day. Would you rather a profiteer be deciding on your health, or the government?
Are you a citizen who thinks that health care costs are too high in the United States? This is one of the reasons, my friend. If your doctor has to pay $82,000 a year to deal with insurance companies, who do you think the cost is getting passed on to?
It is obvious to us that a simplified billing system, with standardization across the board and streamlined billing and payment rules and regulations would be the key to better and less expensive health care.
A survey of physicians and their staff found that the administrative costs of and time spent interacting with multiple payers in the United States far exceeded time spent and costs in Canada with its single-payer system.
Specifically, U.S. physicians typically spent $82,975 a year administering claims to insurers. In Canada, where health providers only have to deal with one payer - the government - they spent $22,205.
One reason I can see for this discrepancy is that there is very little standardization among our payers. Sure, they all have to use the same codes for procedures (CPTs) and diagnoses (ICD), but from there, the similarity in how a claim is handled disappears. Each insurer has different rules about what diagnosis can be linked to what procedure, what fields on a claim form must be completed or left blank; even the Explanation of Benefits are all different so it's hard to zip through them when processing payments. Each provider is paid differently, according to whatever fee schedule they have negotiated with the insurer. I get bulletins from all our insurers periodically (we accept almost every insurance out there) with "edits" to how claims should be submitted. Do I have time to read all of them? Never. There is a whole industry out there for medical coders to learn the ins and outs of how to successfully code a claim because of all the mystery and confusion.
Another reason is that the rules and regulations governing health care billing and payment are extremely complex and cumbersome. For any office visit, hospital charge, or other simple service, there are multiple sets of codes, complicated documentation rules, and multiple decision points. Furthermore, many bills are divided into an upfront co-pay, an amount that the insurer pays, and then a third amount, to cover the difference between the allowable charge, and the amount that has been paid between the co-pay and the insurance payment. Sound complicated? It is, and this complexity is the cornerstone of a huge bureaucracy necessary to administer its ins and outs. It is also the foundation of a great deal of health care fraud, which can hide for years behind the tangle of complicated rules.
Even within a payer, things get tricky. I'm sure you're all tired of hearing me wail about Carefirst of Maryland, but it really is the bane of my existence. Almost all of our Blue Cross/Blue Shield claims must go through Carefirst of Maryland. The rules are not always the same for all of those BC/BS claims, so there are problems. However, I can't call a patient's "Home plan" to get answers: I must call Carefirst of Maryland, who then "wires" the home plan for a resolution -- that can take literally months.
The time I spend figuring out why a claim isn't paid very often cancels out the amount we end up getting. That $82,975 figure is very easy for me to believe; actually, I'm surprised it's not higher.
And those who shiver when they think about the government telling doctors how to do their jobs? Guess what. Private insurers tell providers how to do their jobs every day. Would you rather a profiteer be deciding on your health, or the government?
Are you a citizen who thinks that health care costs are too high in the United States? This is one of the reasons, my friend. If your doctor has to pay $82,000 a year to deal with insurance companies, who do you think the cost is getting passed on to?
It is obvious to us that a simplified billing system, with standardization across the board and streamlined billing and payment rules and regulations would be the key to better and less expensive health care.
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