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.

September must be his month.

Jim McCoy and Matt Hahn

What other doctor do you know that not only is recognized by his peers (2005 - Maryland Family Physician of the Year, 2006- finalist for American Family Physician of the Year), loved by his patients, and also gets inducted to TWO Hall of Fames in one month (and have both of them announced on the same page of the Morgan Messenger).

Dr. Matthew Hahn will be inducted into the Troubadour's West Virginia Country Music Hall of Fame this Sunday afternoon, during the Troubadour's famous Patsy Cline celebration. Come on out and enjoy the day and cheer for Dr Hahn! The afternoon is free, full of great LIVE music, and food. Bring a covered dish, the Troubadour supplies the meat. If you weren't aware, Dr. Hahn recorded a CD of Jim McCoy's music in 2007, "The Real McCoy." You may have seen him around town, performing this beautiful, old-style country music wearing Jim McCoy's original red sequinned suit.

Jeanne Mozier (the Voice of the Festival) and Matt Hahn

Then on Wednesday, September 21st, he will receive the honor of becoming an Apple Butter Festival Hall of Fame inductee for his work as MC of the Hog Calling Contest. If you haven't been to the Hog Calling contest, held the Sunday of the Apple Butter Festival, you've been missing out. People come from all around with their lively versions of hog-calls, co MC-ed by Dr Hahn and Jeanne Mozier.

Congratulations, Matt!

The power of art...

How do you feel when you look at a beautiful picture? Did you know that the pleasure you feel is actually very real? A study shows that looking at beautiful works of art effects the brain exactly the same way as falling in love does! And we all know how good that feels. In fact, looking at artwork can cause the blood flow in the brain to increase by as much as 10 percent.
We didn't know about this when we started collecting artwork for our office. We just knew that we have a lot of local talent, and so much inspiration from the beauty we have all around us. Why buy an anonymous, mass produced print from an equally anonymous mall store when we are so lucky?
One of our friends, Tom Darden, served as photographer in the Maryland State House under six governors. He very graciously framed and mounted in our office some of his beautiful photography that depicts our extraordinary natural surroundings here in Western Maryland. Be sure to check them out next time you're in the office if you haven't enjoyed them already. You can also view his art work on his website.

This weekend, we were at Art in the Park in Berkeley Springs where we live, and came upon the Artists of Merrywoods. Their photography captivated us. We loved the way the photographs are printed on canvas, and then, rather than being framed, were stretched over a beveled surface, giving it an "infinity" feel. The photographs are of all our favorite places: Cacapon State Park, the Cacapon River, and even Dolly Sods. The light in all of them is magnificent. We bought a piece, and then asked them if they'd like to hang some of their pieces in the office. So now our office doubles as a gallery! Come by and see it. All of them are for sale if you fall in love with them as we did.

Understanding your Explanation of Benefits (EOB)

Patients sometimes receive a bill from us and don't understand why they're getting one at all, or have questions about how their insurance paid a claim. (See also: When Claims Don't Get Paid). They may not realize they have a deductible to satisfy before their claims are paid in full, or that they have a co-pay. One question I usually ask them is whether they've reviewed the Explanation of Benefits (EOB) that they receive from their insurer. When a claim is considered by your insurance company, an EOB is sent to the patient to show how a claim is paid (or not paid), and we get a copy at the office along with a check (if there is one). Patients often disregard these, especially when they see "NOT A BILL" across the top of it! However, you should always pay close attention to these. Everybody makes mistakes, from the way the claim was billed at our office, to the way it was paid by the insurance. We are always happy to help patients review these, realizing they can be confusing.

The EOB usually consists of several columns:
Patient Name
Date of Service
Procedure: This could just be a code representing an office visit or procedure, sometimes accompanied by a brief description
Charges: This would be the actual charge for the procedure(s) from our office
Allowed Amount: This is the amount the insurance company has contracted to pay us for the specified procedure(s)
Co-pay/Deductible: Sometimes also called the Patient Responsibility, representing what the patient owes after the insurance has paid and discounted the bill
Contractual Adjustment: Not always included, but represents the amount the doctor's office has agreed to discount through the contract with the insurance
Amount Paid: Total amount paid to the doctor
Sometimes there are codes appended to any of these columns; explanations of what the codes are for are usually at the bottom of the EOB.

The Patient Responsibility is the only amount you should have to pay. We are not allowed to bill you more than the insurance has contracted for our services.

If you ever have any questions about your bill, or your EOB please call us! We'll be happy to help.

Walking in Sunshine with Tori

The music world, especially our local music scene, will become a bit less bright soon. Recently our friend Tori Anderson decided to retire from singing after 17 years with  Possum Holler, a local treasure, due to her health.
Although she is saying goodbye to her musical career, she isn't one to surrender so easily. She will remain on air as a DJ and music director at radio station WAYZ. She has also made a commitment to do what she can to fight a disease she shares with all too many others.
Tori has organized The Walk with Tori To Find a Cure for Scleroderma. Every penny collected will be donated to the Scleroderma Research Center. The Walk will be on September 11 at Doub's Woods Park in Hagerstown, Maryland. Registration will begin at 1:00 and the Walk will start at 3:00. Many wonderful silent auction items are available for bid.
Hahn and Nelson Family Medicine is a sponsor of this event, and some of us will be walking. We would love to see you there, but if you can't come, your donations are welcome. To find out more about the walk, or to register, email walkwithtori@gmail.com or call (301)733-tori.
Click here to find out more about Scleroderma.

Boot Camp for Women Begins Again at Rankins Fitness Center

So it's the middle of summer, and you're just hanging by the pool. Do you like what you see? Do you like how you feel? Or have the barbecues and lazy days caught up with you? Well, it's not too late to do something about it! Rankins Fitness Center is once again offering its Boot Camp for Women, with lots of times to choose from, so  "I'm too busy" is not going to cut it as an excuse! Check it out. You can even get there at the crack of dawn and get your workout out of the way!
Every Tuesday & Thursday Starting NEXT TUESDAY
6:15am-7:00am
7:15am-8:00am
9:00am-9:45am
...
Monday/Wednesday (if we have at least 10 people!) START UP DATE TO BE ANNOUNCED
6:15pm-7:00pm
Sign up online www.rankinptfc.com and while you're at it, check out their other programs.... something for everyone - Judo, swimming lessons, tumbling! 

Bring it on, American Beverage Association

So it's being reported that the American Beverage Association is suing New York's Health Department for running ads that link drinking soda to obesity. Really? Really, ABA? Because, guess what. DRINKING SODA CAN LEAD TO OBESITY. When we get overweight patients in our office, we always encourage them to lose weight. They ask us, "How? I really don't eat that much." We ask them what they drink. When told that the typical can of soft drink contains at least 140 calories, they are flabbergasted. Some of our patients take a Big Gulp to work and drink it throughout the day. Guess how many calories? 800! Guess what happens when they stop drinking soda, and switch to diet, or even, better, water? THEY LOSE WEIGHT!!!!
I'll ask it again. Why can't these companies realize that they are contributing to the illness, and sometimes, death, of millions of people and either offer smaller sizes of their product, or simply offer healthier products? And/Or, why don't we tax these unhealthy products so we can use the taxes to support these people when they develop diabetes, or have heart attacks? Oh. Your blogger is so angry right now! All I can think is that they really don't care. All they want to do is pump your body full of junk so they can pump their bank accounts full of money.
But you know what? People have to start caring about themselves, too, enough to tell Coke and Pepsi that they don't want to die of foot infections caused by diabetes, or have to buy two seats on the airplane because one isn't big enough. They have to tell Pepsi and Coke that they don't want to take medications every day for an illness that is totally preventable, that they want to spend their money on their grandkids that they will live long enough to entertain.
In the meantime, American Beverage Association, I guess you'd better just come on over to Hancock and sue Hahn and Nelson Family Medicine. Because we, too, believe that your products lead to obesity. And we're not going to stop telling our patients the truth!