Comments on: Looking under the rug – what insurers pay providers now public in Minnesota http://www.thinkinterval.com/2009/08/looking-under-the-rug-what-insurers-pay-providers-now-public-in-minnesota/ Welcome to the transformation Tue, 20 Dec 2011 22:42:09 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Chris Bevolo http://www.thinkinterval.com/2009/08/looking-under-the-rug-what-insurers-pay-providers-now-public-in-minnesota/#comment-84 Chris Bevolo Thu, 27 Aug 2009 17:28:42 +0000 http://www.thinkinterval.com/?p=1437#comment-84 Brandon - you hit the nail on the head (better than I did with my opaque "looking under the rug" reference) in that how reimbursement rates are set is a mystery to so many players in this game. My hope for something like this would be that, just as you say, consumers start looking at the almost random reimb. data and start saying "What in the world is going on here?" A huge part of this is how providers negotiate with payers - theoretically, the bigger, more powerful you are, the better the reimb. There is some logic to that, but it doesn't explain everything, and not sure it's the best way to set rates that affect so much. As you undoubtedly noted in my post, I'm not as convinced as you that patients having more skin in the game is the silver bullet (or even a regular bullet). I have a $6k deductible for my kids, but that would still have little impact on the care my son received last year when he broke his arm. How in the world am I going to question the imaging, labs and surgical procedures my ortho doc was recommending? Having my skin in the game helps, but I don't believe it's truly a game changer. I would imagine that many in the public would consider $6k worth of skin scary, yet it's not truly changing the game in my case. (Would be fun to battle that one out over a beer sometime.) Thanks a ton as always for posting. Will be interesting to watch how this hits and others react. Brandon – you hit the nail on the head (better than I did with my opaque “looking under the rug” reference) in that how reimbursement rates are set is a mystery to so many players in this game. My hope for something like this would be that, just as you say, consumers start looking at the almost random reimb. data and start saying “What in the world is going on here?” A huge part of this is how providers negotiate with payers – theoretically, the bigger, more powerful you are, the better the reimb. There is some logic to that, but it doesn’t explain everything, and not sure it’s the best way to set rates that affect so much.

As you undoubtedly noted in my post, I’m not as convinced as you that patients having more skin in the game is the silver bullet (or even a regular bullet). I have a $6k deductible for my kids, but that would still have little impact on the care my son received last year when he broke his arm. How in the world am I going to question the imaging, labs and surgical procedures my ortho doc was recommending? Having my skin in the game helps, but I don’t believe it’s truly a game changer. I would imagine that many in the public would consider $6k worth of skin scary, yet it’s not truly changing the game in my case. (Would be fun to battle that one out over a beer sometime.)

Thanks a ton as always for posting. Will be interesting to watch how this hits and others react.

]]> By: Brandon http://www.thinkinterval.com/2009/08/looking-under-the-rug-what-insurers-pay-providers-now-public-in-minnesota/#comment-83 Brandon Thu, 27 Aug 2009 17:12:57 +0000 http://www.thinkinterval.com/?p=1437#comment-83 Chris, I came across the Star’s Tribune article this morning too and visited mnhealthscores.org site. I had a similar experience and questions after using the site. The site wasn’t as intuitive as I was hoping. Not only did it not load properly, the data was difficult to interpret and difficult to put into perspective as you described. I think this is a step in the right direction. As I practice manager, I’d be delighted to share our fee schedule assuming we’d get paid at the time of service. And in fact, I often do with our self pay patients. The problem I see with this initiative is that mnhealthscores’ database uses insurance reimbursement rates. The fact is that insurance reimbursement rates are completely illogical. In our practice we have people that work for the same company, with the same health insurance plan, and we still get reimbursed differently on the same CPT codes. Why? Who knows. Anybody in the health care industry will tell you that insurance reimbursement rates are virtually undecipherable. The fact that one carrier reimburses $100 and another $75 for the same procedure does not mean anything really. And you’ll be hard pressed to find a reasonable explanation from an insurance carrier as to why the difference. Even Medicare reimburses differently (https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp). Put in a 99213 and look at the discrepancy in pricing from region to region. You can argue that it cost more or less to provide services in different areas of the country due to cost of living or overhead cost, but the complexity of the doctor’s decision making, expertise and advise (which is in fact what you are paying for) ought not to vary from region to region. In other words, managing a diabetic patient is not more or less complex depending on the region. Again, I think this is a step in the right direction. If anything, it prompts people to ask all these questions. And the questions – in my mind – ought to be directed at insurance companies, not medical providers. I order for an initiative like this to truly have value and have the implicit transparency mnhealthscores.org is trying to achieve, I think the insurance reimbursement rates have to be removed from the equation and a more pertinent question should be asked to providers. If you (the provider) doesn’t have to deal with the complexities of the insurance companies, how much would you charge me for procedure or service XYZ? Until the consumers/patients have their skin in the game, we will not see the reform needed to overhaul our health care system. @PediatricInc P.S. I enjoy the podcast you guys do at Interval. Keep up the good work. Chris,

I came across the Star’s Tribune article this morning too and visited mnhealthscores.org site. I had a similar experience and questions after using the site. The site wasn’t as intuitive as I was hoping. Not only did it not load properly, the data was difficult to interpret and difficult to put into perspective as you described.

I think this is a step in the right direction. As I practice manager, I’d be delighted to share our fee schedule assuming we’d get paid at the time of service. And in fact, I often do with our self pay patients.

The problem I see with this initiative is that mnhealthscores’ database uses insurance reimbursement rates. The fact is that insurance reimbursement rates are completely illogical. In our practice we have people that work for the same company, with the same health insurance plan, and we still get reimbursed differently on the same CPT codes. Why? Who knows.

Anybody in the health care industry will tell you that insurance reimbursement rates are virtually undecipherable. The fact that one carrier reimburses $100 and another $75 for the same procedure does not mean anything really. And you’ll be hard pressed to find a reasonable explanation from an insurance carrier as to why the difference.

Even Medicare reimburses differently (https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp). Put in a 99213 and look at the discrepancy in pricing from region to region. You can argue that it cost more or less to provide services in different areas of the country due to cost of living or overhead cost, but the complexity of the doctor’s decision making, expertise and advise (which is in fact what you are paying for) ought not to vary from region to region. In other words, managing a diabetic patient is not more or less complex depending on the region.

Again, I think this is a step in the right direction. If anything, it prompts people to ask all these questions. And the questions – in my mind – ought to be directed at insurance companies, not medical providers.

I order for an initiative like this to truly have value and have the implicit transparency mnhealthscores.org is trying to achieve, I think the insurance reimbursement rates have to be removed from the equation and a more pertinent question should be asked to providers.

If you (the provider) doesn’t have to deal with the complexities of the insurance companies, how much would you charge me for procedure or service XYZ?

Until the consumers/patients have their skin in the game, we will not see the reform needed to overhaul our health care system.

@PediatricInc

P.S. I enjoy the podcast you guys do at Interval. Keep up the good work.

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