Ilovebenefits’s Blog

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From Fee for Service to Fee for Care

Support grows for move to bundled payments
Many health policy experts say it is time to dump fee-for-service physician reimbursement and move to a bundled payment model that could save money without reducing quality of care. Pilot programs have shown that the model can offer high-quality care, greater patient satisfaction and lower costs. The Washington Post (3/9)

Group appointments are a growing trend
Health care providers say patients like group appointments because they cut down on wait times, give them more face time with physicians and allow them to share experiences with other patients. The Future of Family Medicine Project named group visits one of 10 trends to be taken seriously. The Washington Post (3/9)


March 9, 2010 Posted by | healthcare, quality, Reimbursement | , , , , | Leave a comment

More Procedures = Higher Premiums and Higher Costs

Hospital Discharge Survey: Hip and Knee Joint Replacement Procedures

  • From 1996 to 2006, the hospital discharge rate for total hip replacement increased by one-third, and the discharge rate for knee replacement increased by 70%.
  • In 2006, total hip replacement rates were similar among men (18.1 discharges per 10,000 population) and women (20.5) . Discharges for partial hip procedures were about twice as common among women
    (23.9 per 10,000 for age 45 years and over) as men (13.0 per 10,000). Partial hip procedures, which are often used to treat fractures, were also more common among older persons.
  • In 2006, knee replacement discharges were more common among women 45 years of age and over (54.0 per 10,000) than men (34.9). As with hip replacement procedures, knee replacement discharges were more than three times as high for those 65 years of age and over (84.1), compared with those 45–64 years of age (25.7).

Source: CDC/NCHS, National Hospital Discharge Survey.
Publication: Health, United States, 2009.

March 8, 2010 Posted by | Cost, healthcare, hospitals, insurance, Medicare, Reimbursement | , , , , | Leave a comment

Is the Work Ethic of Physicians Changing

Editor’s note: As physicians retire and as younger physicians take their place they are seeking a work/life balance.

According to a recent report, the average hours worked by U.S. physicians dropped from 55 per week in 1996 to 51 in 2008, coinciding with a nationwide 25% decrease in physician fees between 1995 and 2006, after adjusting for inflation.

Source: “Trends in the Work Hours of Physicians in the United States,” Journal of the American Medical Association, Vol. 303 No. 8, February 24, 2010,

March 3, 2010 Posted by | physicians, Reimbursement | , , | Leave a comment

Physician Hours Declining

Editor’s note: It is likely a more complex root cause. It is more than simply payments. Values, cultural changes and other interests are likely to play a role.


Physician work week hours drop, study says
The average number of hours worked by U.S. physicians dropped from 55 per week in 1996 to 51 in 2008, a report said. The reduction was linked to lower physician payments, which decreased 25% from 1995 to 2006, data showed. Bloomberg (2/23)

February 24, 2010 Posted by | healthcare, physicians, Reimbursement | , , , | Leave a comment

Medical ‘Pay for Performance’ Programs Help Improve Care — But not Always, Study Finds
University of California – Los Angeles

November 24, 2009

Recent studies by The UCLA School of Public Health have found that California’s pay for performance program that was implemented in 2004, has greatly improved the overall experience of patient care.

However, the amount of improvement often depends on the incentive focus area. Too much focus on physician production may not lead to better health care while incentives used to focus on clinical quality and patient-clinician interaction seem to provide the best results.

For complete story, click here.

November 24, 2009 Posted by | healthcare, quality, Reimbursement | , , , , | Leave a comment

Provider Incomes Across OECD Countries

Editor’s note: This from John Goodman

International statistics show that the United States spends twice as much on health care per capita as the average OECD country. But are these numbers accurate?

Health care is a sector where normal market forces have been so suppressed that no one ever faces a real price for anything. So, adding over all the transactions produces a total number whose meaning is very unclear.

To make matters worse, other countries do more than we do to shift costs in ways that reduce the cash flow that government has to fund. For example, other countries are more aggressive than we are at suppressing provider incomes (not just doctors, but also nurses, hospital personnel, etc.) Here are the numbers on doctor incomes:


Source: Health Affairs; gated, but with abstract.

November 19, 2009 Posted by | Federal Government, healthcare, Reimbursement | , , | Leave a comment

Fee For Care vs. Fee For Service

Research examines potential for savings with bundled payments Moving U.S. health care from fee-for-service to a system of bundled payments for providers is one of the best ways to control health care costs, according to Rand Corp. researchers. U.S. government estimates peg the savings at $1 billion a year, but the Rand team said applying the concept to six common chronic diseases would boost savings even higher.

November 12, 2009 Posted by | Health care delivery, healthcare, Reimbursement | , , , | Leave a comment

Provider Reimbursement Policies

Editor’s note: While we have heard for years about providers issues with commercial carriers, does a less than 4.0 rating surprise you and communicate a new message about government plan reimbursements to providers?

Medicare Part B receives high ratings for disclosure of payment policies
The Medical Group Management Association (MGMA) conducted its second annual poll to determine group practice professionals’ attitudes about payer interactions. This year’s questionnaire focused on seven large payers; Aetna, Anthem, CIGNA, Coventry, Humana, Medicare Part B and United Healthcare. More than 1,700 practice professionals participated in the poll. Results reflect the members’ perceptions of the payer environment in areas of payer communications, provider credentialing, contracting, payment policies, system transparency and overall satisfaction.
How satisfied are you that the payer fully discloses it’s payment policies?
Ranking Payer Rating Average
1 Medicare Part B 3.86
2 Aetna 2.91
3 CIGNA 2.90
4 Humana 2.80
5 Coventry 2.79
6 Anthem 2.77
7 United Healthcare 2.61

Based upon a 5 point scale where 1= Completely dissatisfied, 2=Moderately dissatisfied, 3=Neutral, 4=Moderately satisfied, and 5=Completely satisfied.

Source: The Medical Group Management Association (MGMA), Practice Perspectives on Payer Performance, 2009.

October 22, 2009 Posted by | Federal Government, Reimbursement | , | Leave a comment

Health Care: You Get What You Pay For

Editor’s note: It has been long recognized that in health care (as elsewhere) you get what you pay for. In health care if you pay have a fee for service model you get services. If you have more physicians or MRIs per capita you get more physician services or MRIs performed per capita.

We need to move to more of a hybrid model that pays for care. In the following story, one locale is testing a new model based on fee for care.


Minnesota groups test new health care payment model
Minnesota’s second-largest insurer, Medica, and the local nonprofit Fairview Health Services are testing a reimbursement model that pays providers a fixed rate for patient care instead of the usual fee-for-service payment structure. Fairview’s challenge is to improve care and lower costs in the long run, which will mean higher payments, while Medica is investing in the project to help change the system of care delivery. National Public Radio (text and audio)

September 3, 2009 Posted by | Creative disruption, healthcare, Reimbursement | , | Leave a comment

Physician Practices Spend $31 Billion a Year on Health Insurance Plan Interaction

Editor’s note: What is absent from this story is how this compares to other businesses. For example, in the dental business what are the comparable numbers? My sense is that more dentists electronically adjudicate their claims with insurance companies reducing their time interfacing with dental plans. What about other industries outside of health care? How do auto dealers spend their time interfacing with auto makers? How about brokerage firms dealings with commodity, equity and other investment providers? 

The average physician spends nearly three weeks a year interacting with health insurance plans, at an estimated annual cost to practices of $31 billion, or $68,274 on average per physician per year, according to a study published as a Health Affairs Web Exclusive.

May 16, 2009 Posted by | Cost, Economics of Health care, Health care delivery, Reimbursement | , , , , , | Leave a comment