Code Green

Man gets $350,000 heart bypass by stealing friend's identity

Source:  Chicago Tribune

John Parsons apparently believed he would die without heart bypass surgery. To get it, the uninsured 57-year-old ex-convict took a step that has hospital officials shaking their heads--he managed to pass himself off as a mentally-disabled friend and, using the friend's Medicaid card, obtained the surgery. Now, officials at Chicago's Northwestern Memorial Hospital are stuck with a big bill and a lot of questions as to how Parsons pulled it off.

According to the authorities, Parsons got the surgery at Northwestern in 2007, generating about $350,000 in expenses. When bills started arriving at the home of the friend, Philip Johnson, Johnson's live-in caregiver discovered the alleged scam and notified officials. Parsons has since admitted stealing Johnson's identity. Northwestern, for its part, has agreed to cover the cost of the surgery so Johnson won't be responsible for it.

What has healthcare officials puzzled is the extent of the apparent deception. To get the heart bypass, doctors would have needed a lot of clinical information, including patient blood type, cardiac history, medical history and more, records that would be very difficult to fake, notes CMS spokesman Jeff Nelligan. Northwestern continues to investigate the incident.

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CA Medicaid Payments to Hospitals Stalled

With the state's $2 billion contingency fund now tapped out, hospitals in California are facing an extended wait for Medicaid payments as legislators wrangle over the state budget. Though some payments were issued this week, many hospitals are out of luck until state legislators resolve their issues. They're wrangling over methods to resolve the state's $17 billion budget shortfall, notably the governor's proposed cuts to social-service and healthcare programs.

Medicaid, which is known as Medi-Cal there, accounts for 20 percent of revenue for the state's hospitals overall. Some, however, are much more dependent on Medicaid income, with rural and safety net facilities often counting on Medi-Cal for 60 percent or more of revenue. The budget impasse has already led to a month-long delay in payment, and checks could be delayed another four weeks even after the budget issue is resolved due to provisions of state law. It makes you wonder whether the state legislature thinks that rural and safety-net hospitals, in particular, don't really need their income.

Study Shows Customer Experience is Path to Profit

ST. PAUL, Minn., Jul 14, 2008 (BUSINESS WIRE) -- Companies that have a definition for customer experience and use this definition in everyday decision-making are more likely to exceed profit and revenue goals than those that don't, according to a new study.

"Finding the Performance Payoff in Customer Experience" surveyed 644 business leaders at all levels of leadership, organizational areas and across industries, from health care to manufacturing. The research was designed and conducted by Aveus, a St. Paul-based global strategy and operational change consultancy.

Definitions of customer experience vary widely. The study breaks new ground by surveying business leaders about how their organizations define customer experience and which definitions yield the biggest performance payoff.

"Perception still hasn't caught up to reality," says Linda Ireland, Aveus partner. "When asked if their focus on customer experience is costing the company money, many business leaders still say 'yes.' But our findings show a clear difference between those who have an organization-wide definition of it and those who haven't. Customer experience is a path to improved profitability, not a trade off from it."

The survey showed that 26 percent of companies with a definition of customer experience report exceeding profit targets, while only 14 percent of those without definitions can report the same.
Furthermore, the survey showed that organizations with the strongest use of customer experience in daily decision-making report the strongest operating results. "Of these elite organizations, 67 percent report meeting or exceeding revenue targets; 65 percent meet or exceed profit targets," says Ireland. "Simply put, these organizations use customer experience as a strategy for achieving performance. And it's working."

Aveus released a first round of customer experience research in 2006. Both rounds consisted of online surveys for leaders at management level and above. Functional quotas were set so the sample was not over-represented by sales and marketing professionals. With more than 1,000 respondents combined, these two unique studies establish a baseline for the payoff from customer experience use in the United States.

"We believe that by examining the use of customer experience and its link to financial and customer performance, business leaders will be able to make the operating decisions that hold the strongest potential for performance payoff in their organization," Ireland says.

For-profit hospitals find ways to cut the bad debt they carry

Source:  amednews.com

Bad debt levels fell among for-profit hospitals in the first quarter of 2008, says a report by the international credit-rating agency Fitch Ratings.

Still, these hospitals continue to have a higher percentage of unpaid medical bills than physicians and nonprofit hospitals.

For-profit hospitals saw bad debt levels as a percentage of revenues fall from 18.4% in the fourth quarter of 2007 to 17.7% in the following quarter, said Fitch Ratings' recently released "For-Profit Hospital Industry Quarterly Diagnosis" report.

Past surveys by the Medical Group Management Assn. estimated physician practices' bad debt level in the 5% to 10% range. For nonprofit hospitals, Fitch said the percentage in 2006, the latest data available, was 5.5%. Bad debt is generally defined as payments that are written off as uncollectable.

Fitch analyst Lauren Coste attributes the decline in bad debt among for-profit hospitals in part to decreases in the number of uninsured patients at those facilities.

In addition, hospitals have been more aggressive in collecting co-payments up front and have improved efforts externally and internally to collect debt, she said.

This has balanced a change in for-profit hospitals' accounting techniques, Coste said. They have become more conservative in their assumptions concerning how many of their patients would pay for their services, which results in more debt being written off as uncollectable. Before, their accounting figures reflected a more hopeful collection amount.

Health costs to rise nearly 10%

Source:  Yahoo News

NEW YORK - Employer health care costs are poised to rise almost 10 percent in 2008 — more than double the annual inflation rate — and nearly that much again in 2009, according to an industry report released Tuesday.

The study by PriceWaterhouseCoopers predicts that medical costs will increase 9.9 percent in 2008 and an additional 9.6 percent in 2009.

"Health care providers, insurers and employers will have to monitor medical costs carefully if we are to avoid a resurgence of the double-digit annual increases seen in the past," said Dr. David Chin, leader of the Health Research Institute at PriceWaterhouseCoopers.

The report identified two factors driving the increase:

• A hospital building boom, as hospitals replace facilities and add private rooms and centers for outpatient treatment.
• An increase in the expenses those with insurance are paying for those without. Cost-shifting from the uninsured, Medicare and Medicaid will account for nearly one in every five dollars spent by private insurers in 2009, according to the study, as the federal government underfunds public insurance programs and the number of people with private insurance continues to decrease.

One of the things employers are doing in response is increasing wellness, prevention and disease management programs, which they say not only keeps employees healthy but also raises productivity.

PriceWaterhouseCoopers surveyed more than 500 employers and health plans, with total coverage of more than 11 million people, for the report.

Even the Insured Feel Strain of Health Costs

By Reed Abelson and Milt Freudenheim, New York Times

Published: May 4, 2008

The economic slowdown has swelled the ranks of people without health insurance. But now it is also threatening millions of people who have insurance but find that the coverage is too limited or that they cannot afford their own share of medical costs.

Many of the 158 million people covered by employer health insurance are struggling to meet medical expenses that are much higher than they used to be — often because of some combination of higher premiums, less extensive coverage, and bigger out-of-pocket deductibles and co-payments.

With medical costs soaring, the coverage many people have may not adequately protect them from the financial shock of an emergency room visit or a major surgery. For some, even routine doctor visits might now take a back seat to basic expenses like food and gasoline.

To continue reading this article, go here.

How Much Do You Pay?

A hospital in northeast Ohio is willing to pay up to $1,000 to patients willing to reveal how much they and their insurance companies paid for care at rival hospitals.

The 192-bed Alliance (Ohio) Community Hospital is using advertisements and its Web site to offer the payments to those who'll turn over documents that detail how much three competing medical institutions charge and how much insurance companies and consumers end up paying.

The offer is part of the hospital's attempt to provide consumers with more information about the comparative cost of healthcare, said Chief Executive Officer Stan Jonas.

Each eligible statement—referred to as an "explanation of benefits"—is worth $100 with a maximum payment of $1,000, the hospital said Monday. — the Associated Press

Hospital Reimbursement Woes Continue

Health insurer WellPoint Inc., starting Oct. 1 will no longer pay for costs associated with 11 medical errors known as “preventable adverse events” and “never events.”

The Indianapolis-based insurer, which operates the national UniCare plan and Blues plans in 14 states, is following the lead of Medicare, which starting in October will not pay for costs associated with eight events.

The purpose of WellPoint’s new reimbursement policy is to ensure physicians and hospitals are using appropriate processes, technologies and strategies to prevent these types of errors.

Healthcare is a Consumer Market

By Kari Kemper, Provider Advantage

Health care is a consumer market, according to the 2008 Survey of Health Care Consumers, which provides a comprehensive assessment of consumer behaviors, attitudes and unmet needs related to health, health care and health insurance.

"Health care providers might be inclined to think of consumers as patients - passive, somewhat inactive, dependent on doctors to make decisions for them, and often non-adherent to treatment recommendations.  That perspective is short-sighted...."

"They want greater access to information....moving to an consumer orientation means viewing physicians as coaches rather than decision makers, enabling consumers to consider all available options, shifting more responsibility for adherence and outcomers to consumers and expecting consumers to be fully aware of and accountable for spending."

"They have an insatiable appetite for information and they are looking for a source that provides what they need in a useful and timely manner."

Is your registration department ready?

Interesting findings in the study:

• Consumers believe that hospitals are an important community resource...
• Only 7% of consumers say they are financially prepared for their future healthcare needs.  By contrast, 93% say they are insecure about their ability to pay for their future healthcare needs
• 52% of consumers with insurance say they understand their insurance coverage, but less that 1 in 10 consumers are confident they understand their coverage well
• Consumers are paying attention to prices for their prescriptions, office visits, hospital services, and insurance premiums.  They want tools to help them know in advance what those costs will be.

Health Savings Accounts - Private-market answer to rising costs has critics

Abridged version of original article by:

ANDY MILLER
The Atlanta Journal-Constitution
Published on: 03/06/08

In her old health care world, Karen Zapata used only HMO doctors, faced high insurance premiums and forked out the inevitable co-payments.

Now, with her health savings account, she pays lower premiums and enjoys more freedom in choosing her doctors. But she also has become a more savvy shopper for health care, learning when to ask for a lower-priced prescription.

It's a trade-off: Her new family insurance policy may offer cheaper premiums, but the first $2,500 comes out of her pocket. So Zapata sticks money into her tax-free health savings account (HSA) to pay medical expenses and offset the high deductible.

"I'm in control of my health care now," says Zapata, a DeKalb Medical system integration analyst. "I'm much better informed on how things work."

The popularity of health savings accounts has grown over the past few years, attracting employers and workers with a price tag that's significantly lower than other forms of insurance. Similar to a 401(k) account, HSAs are funded with pretax dollars. The money in an HSA grows tax-free. And it's tax-free when spent on health care. But, to be eligible for an HSA, an individual must have a high-deductible health plan.

Republican leaders increasingly have embraced HSAs as a private-market answer to both rising health costs and the uninsured. The idea is that policies with cheaper premiums and tax benefits will help small businesses provide insurance while helping to lure currently uninsured workers. Even financial rewards for healthy behavior — extra money added to a worker's HSA — are envisioned.

Skeptics say HSA growth potential is exaggerated, and that the accounts target healthy people, siphoning them out of insurance pools and leaving a sicker pool of patients — and higher premiums — behind.

Another problem: the lack of good, consumer-friendly information that allows people to make informed decisions on services, such as a comparison of hospitals and doctors' prices and effectiveness.

With the deductibles and tax-sheltered savings accounts, more of the patients' money will be on the line as out-of-pocket medical costs occur, HSA proponents say. So patients presumably will take time to shop for the best price and quality of services — and not seek unnecessary care. They will have a financial incentive to lead healthier lives. That way, health spending will be contained, along with employer costs.

Republicans say that something must be done to address the high number of uninsured or there will be more government involvement in the system — exactly what many Democratic reformers seek.

How much can HSAs grow?

"They won't have that big an impact on cost inflation," he says. "I don't see them becoming a dominant type of health insurance."

Consumer group Families USA says the majority of uninsured can't spare the extra money to stick into their savings account or even cover the deductibles.

To read the entire article, go here.