Posts Tagged ‘Commonwealth Fund’

Standardized Medical Billing Could Save $7 Billion a Year

Wednesday, May 19th, 2010

Physicians could save $7 billion a year if insurers standardized medical billing procedures.  If healthcare insurance companies created a standardized billing system, it could cut physician office administrative costs by $7 billion a year, according to a study published in Health Affairs. Standardizing medical billing would assure transparency, as well as create a single claim submission deadline and payment posting rules.

That estimate is based on a 2006 analysis of the labor and overhead costs required to process health insurance benefits and claims at one large academic physician group practice.  According to the study, the physician group could hypothetically save $44 million if it processed all benefits and claims using Medicare payment rules.  Paperwork and follow-up with insurers totaled $33.1 million, while office labor and overhead ate up an additional $5.6 million that could be saved with standardized billing procedures.

According to the study’s authors, “The U.S. system of billing third parties for healthcare services is complex, expensive, and inefficient.  Physicians end up using nearly 12 percent of their net patient service revenue to cover the costs of excessive administrative complexity.  A single transparent set of payment rules for multiple payers, a single claim form, and standard rules of submission, among other innovations, would reduce the burden on the billing offices of physician organizations.  On a national scale, our hypothetical modeling of these changes would translate into $7 billion of savings annually for physician and clinical services.  Four hours of professional time per physician and five hours of practice support staff time could be saved each week.”

Healthcare Costs Add Up to 17.3 Percent of GDP in 2009

Tuesday, May 18th, 2010

Healthcare spending in 2009 reached a record high of 17.3 percent of the nation’s GDP, representing a growth rate of 5.7 percent in a year when the general GDP shrank.  The Kaiser Family Foundation, a non-profit and non-partisan group reports that healthcare costs for the average family have doubled over the past 10 years.Healthcare costs an average family $13,375 yearly, representing a 131 percent increase over 10 years.

The almost $2.5 trillion spent in 2009 was $134 billion more than 2008, when healthcare ate up 16.2 percent of the GDP, according to an annual report by the federal Centers for Medicare and Medicaid Services (CMS).  “The health system is hurting, and we are seeing that in these numbers,” said Karen David, president of the Commonwealth Fund, a healthcare policy authority.  Federal and state spending on Medicaid - the primary health insurance program for low-income Americans - climbed nearly 10 percent in 2009, according to the report.  Medicate spending increased eight percent last year.

According to the Kaiser Family Foundation, the average premium for a company-provided family health insurance plan soared from $5,791 in 1999 to $13,375, a 131 percent increase.  Employees’ portions of those costs have also risen, from $1,543 on average 10 years ago to $3,515 in 2009.

During 2010, companies said they planned to shift more costs to workers, with 42 percent saying they would increase employees’ premiums and 39 percent said employees would pay more for doctor visits.  Another 37 percent said workers would have to pay more for prescriptions.  “When healthcare costs continue to rise so much faster than overall inflation in a bad recession, workers and employers really feel the pain.  That’s why we are having a health reform debate,” said Drew Altman, Kaiser’s president and CEO.

Illinois Should Improve Healthcare Delivery Quality: Study

Wednesday, January 27th, 2010

Illinois places 44th in national survey on quality of healthcare delivery.  Illinois medical providers rank among the nation’s most ineffectual when it comes to providing cost-effective treatment  and avoiding unnecessary hospitalizations.

According to the nonprofit Commonwealth Fund’s report, Illinois ranks 49th among 50 states and the District of Columbia in terms of “avoidable hospital use and costs.” The study measures how often Medicare patients with chronic conditions such as heart disease are admitted to the hospital or how frequently nursing home patients shuttle in and out of hospitals.  New York came in 50th, with Louisiana occupying the last place.

Illinois also placed 44th in terms of how effectively hospitals deliver basic care that avoids complications.  Healthcare costs and volumes of tests and treatments were found to be unusually high, especially in metropolitan Chicago.

There was some good news for Illinois in the Commonwealth Fund’s study.  The state ranked 20th in access to care, quality in terms of income, race and ethnic background; 29th in quality-of-life measures such as infant mortality; and 32nd in death rates for colon and breast cancer.  The study places Illinois in 42nd place in terms of the quality of overall healthcare delivery.

Cathy Schoen, Senior Vice President of the Commonwealth Fund and a co-author of the study, noted that the findings underscore the need for wide-ranging healthcare reform.  “We need payment reforms with incentives to do well on outcomes and efficiency of care,” she said.

Healthcare Cooperatives Worth a Look

Wednesday, November 11th, 2009

The Obama administration floated the idea of healthcare cooperatives as one solution to fix the nation’s broken delivery system - a proposal that was rejected out of hand by the opponents of reform.  Co-ops thrive in environments where people with mutual economic interests share resources to maximize their market power.  Because co-ops don’t pay dividends to stockholders, they reinvest profits and have a strong track record of providing innovative, cost-effective healthcare.Healthcare Cooperatives Worth a Look

There are downsides to healthcare co-ops, though.  They are often too small to compete with the insurance companies and so lack the ability to negotiate effectively with large hospitals or physician groups.  Most can’t afford computer systems for electronic billing or the technologies to deliver physician services.

Yet there are stories of extremely successful healthcare co-ops.  The major players - in Seattle and Minneapolis/St. Paul - have more than 500,000 members and each runs their own hospitals, clinics, physician groups and insurance plans.  Bloomington, MN-based Health Partners compensates physicians based on productivity.  Between 1998 and 2002, the co-op saw physician productivity soar by 38 percent and costs fall by 20 percent.  In 2007 Health Partners paid $27 million in incentives to caregivers who met productivity and patient satisfaction objectives.

The 62,000-member Group Health Cooperative of South Central Wisconsin, based in Madison, is another success story.  The co-op has used electronic records for seven years, according to executive director Larry Zanoni, and a prominent industry group ranks it eighth nationwide among HMOs for the quality of healthcare it provides.