Quote:
Originally Posted by djplong
Katz: Here's an ugly secret that not too many people know. Insurance companies pay a FRACTION of what "Joe off the street" pays for every medical procedure. They negotiate with the hospitals and clinics to get the best rate possible which is an enormous discount from the "list price". Medicare, as far as I know, sets their price largely based on what those negotiated rates are.
For a continuing problem I had, each ER visit would "cost" $2500 or more (typically 2-4 attack per year). My insurance company paid nowhere near that. When the same thing hit me in Montreal while on vacation, I saw the FULL 'retail' bill was $550. (I paid $50 and my insurance paid the rest)
I learned about these 'negotiated rates' while working at Boston's Beth Israel Hospital. Just to give you an idea of what was going on - in the mid 1990s, as everyone is complaining about rising insurance rates, most insurance companies were lowering what they paid the hospital for inpatient admissions. We HAD been getting $1600/day and the next year many companies came in at $1200/day (looked suspiciously like collusion).
Yes - they paid by the day NO MATTER WHAT PROCEDURES YOU HAD DONE OE HOW MANY!!!
So the insurance companies were hiking their rates while paying us less. Guess where the extra money went. (Hint: The people who own the insurance company)
|
Where do I start...?
I have worked in the healthcare field for 36 years, been an x-ray, CT, and MRI technologist, director of an outpatient imaging center, and currently manage 40 employees in the departments of CT, MRI, Ultrasound, Nuclear Medicine and PET/CT. For the last 10 years I have overseen budgets in the millions and ensured patient satisfaction in numerous settings.
Having said that, I feel I have laid some ground work to be able to speak with a smidgen of authority and experience on certain matters...First of all I think that you have it backwards about who sets the price. Medicare sets the price that they are going to pay, no questions asked. We take a beating on the reimbursement that they give. If we only got what CMS (Medicare) deems proper, we would never be able to afford the purchase let along maintenance of the cutting edge technology that we use to SAVE lives.
It is set up that we should charge for what we use even tho CMS is not going to reimburse. Every several years, CMS will take these charges into account and MAYBE change their minds and pay us a little more. So Medicare sets the bar and we cannot negotiate that reimbursement. On the other hand, hospitals and insurance companies negotiate in and attempt to keep cost down by "bulk purchasing". The average CMS reimbursement for an MRI without IV contrast is about $250. The charge is about $2500 and the average payment made by insurance companies is $1600.
The average MRI scanner costs approx 2million dollars and maintnance fee is about $15,000-20,000/month. The average MRI tech (highly skilled, intelligent person-it's not just a video game we are playing) makes about $28/hr with approx $7/hr for benefits. A scan without contrast takes 45minutes so the facility can do about 20 exams/day...are you getting the drift? Insurance companies are the big bad horrible greedy companies that are still helping us out to be able to afford to help the American population prolong their happy lives.
Montreal? Dare we ever compare what goes on in the USA with what goes on in Canada in the healthcare arena?!?! I live in the Detroit/Toledo area, and as of 10 years ago there are more MRI scanners in my town than in the whole of Canada. We could and still can get a person in TODAY for the same exam that would have a waiting time of 6months to one year in Canada! I know, because we serve the overflow of Canadians that can afford to come here to have life savings measures done in a timely manner. You might have to just trust me on these facts...again, I refer to my experience, but you be the judge.
PAY BY THE DAY NO MATTER WHAT IS DONE...Yes this is another CMS mandated reimbursement protocol. It is called a DRG=Diagnosis related group. That means that is Mr. Jones comes into the hospital to have his Gall bladder removed and happens to mention that he has been having some neurological problems, like vertigo, ...guess what...His doctor decides that he needs an MRI to check for an acoustic neuroma. So, we bring him down and take the scan-Free of Charge! These free exams can take up about 15% of our workday, so go back and do the math to see the money we lose per day per month per year, etc,etc,etc.
It gets even better...with the advent of ObamaCare, the amount we are going to be paid as of July 1, 2011, will be determined by our HCAHPS Satisfaction scores! In order to get paid the full amount, 99% of the people surveyed need to answer ALWAYS to the questions that they are asked. (In the case of Mr. Jones, he could potentially complain that he had to wait til the evening to have his MRI. An MRI that could have waited until he recovered from his GB surgery and he could have returned @ his convenience). In the case of the university hospital that I work at, it has been nationally determined that if you come to our facility, you have TWICE the chance of surviving vs any other university hospital in the nation! That is the ULTIMATE SATISFACTION as far as I can tell...
Tell me what survey you have ever filled out in which you gave the place in question perfect scores across the board.
Our politicians made these rules. Maybe we should pay them according to their satisfaction ratings...hmmm, pretty sure it isn't anywhere near 99%. Think of the money we could save! We may have found a way to put a dent in the current deficit in DC!
Off my soap box for now...Oh, I failed to mention that if we provide a service to a person who has no insurance but doesn't qualify for Medicaid/Medicare, and we charged them something less than the CMS rate, it is considered Medicare fraud!...Ok, I'm done for now.
