Insight, analysis & opinion from Joe Paduda
In all the excitement about the Democratic Presidential contenders’ health care plans and platforms, I’d neglected to check on their competitors across the virtual aisle.
Fortunately, Bob Laszewski has already done this. The net? GOP candidates are paying very little attention to health care.
I finally cracked the latest Health Affairs, and immediately found myself engrossed in Gerald Anderson’s piece on hospital pricing trends (paid subscription required for entire article).
While the article is focused on self-pay patients, the implications for workers comp payers are striking. And this isn’t some academic exercise, we’re talking serious money.
Continue reading Hospital overpayments in workers comp – part 2
We can’t afford universal health care. It’s too expensive.
Actually, that’s not true. We just choose to spend our dollars on other things. For example, medical care and indemnity payments to American troops hurt in the Iraqi war. The latest projections have the long-term expense of caring for Iraqi war veterans totaling 1/3 to 2/3 of a trillion dollars.
So far.
We sure do make interesting choices. Why just the other day Congress voted enough money to fund the war effort for another few months. That expenditure could have provided every uninsured American with health insurance for a year.
Sometimes all you can do is shake your head…
Obese people. 85% of those injured at a major manufacturer were overweight or obese.
If only it were that easy. I’m talking about the legislation proposed in Michigan to allow motorcyclists to ride without helmets. If they are dumb enough to do that, fine. Except we end up paying their health care bills, which is most definitely not fine.
When it is spending by the other party. Bob Laszewski points out the hypocrisy of Pres. Bush’s latest rant about the Democratic budget bill’s “excessive” discretionary spending.
Bob notes that Bush’s opposition to entitlement spending is a rather new thing, as he was not opposed to passing the Medicare Part D bill, one that saddled taxpayers with an $8 trillion debt.
the latest and greatest from the world of insurance and risk management resides this week at the Cavalcade of Risk. Read on, oh insurance geeks!
Here in no particular order are a few items of interest from the world of workers comp managed care.
The US health care system is a mess – it is a convoluted and ridiculous web of cross-subsidies and cost-shifting and billing practices that serves to tax some to pay for care delivered to others. And for some payers, it is grossly unfair.
One of those “some” would be workers comp insurers and employers. Some state reimbursement requirements are unfair at best, forcing WC payers to pay way too much for hospital care. That’s bad enough, but what’s worse is when WC payers ignore favorable regs, and reimburse more than they should.
Continue reading Why are comp carriers overpaying hospitals?
Pharmacy and Therapeutics committees have been around for ages in the provider community – they are the “link between medicine and pharmacy”. In the managed care world, P&T committees take on a somewhat different role, establishing formularies, reviewing medical device reimbursement (at some health plans), contributing to coverage determinations and benefit design.
Mostly, they provide the health plan or insurer with an expert opinion on most things pharmacy-related. Without a P&T Committee, these decisions often are left to a medical director, or worse, claims adjuster (in the P&C world), individuals who are not equiped to make educated decisions about pharmaceuticals.
