cmonfils | April 24, 2012
By CHRISTOPHER TOKIN, M.D., ABC News Medical Unit
April 23, 2012
In the middle of the night, Augustin Hong, a 34-year-old financial professional living in San Francisco, started to experience abdominal pain so severe it sent him to the emergency room. After some tests, doctors told him he had appendicitis and needed surgery — and that without surgery he could die.
http://abcnews.go.com/Health/medical-costs-vary-wildly-hospital-hospital-study/story?id=16196700
Category: Health Insurance, Medical Costs, Transparency |
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cmonfils | March 4, 2012
The Affordable Care Act includes new patient protections that give you greater control over the care you receive, as well as new resources to make the health care system more transparent and competitive. These developments will help ensure that you have the information to make smart decisions and assure you that you are receiving a better value for your health care dollars.
Category: Health Care Legislation, HHS, PPACA, Transparency |
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cmonfils | February 17, 2012
On Jan. 19, 2012, in the wake of the theft of an unencrypted laptop computer containing approximately 23,500 patients’ records, the Minnesota attorney general brought the first formal enforcement action against a business associate, Accretive Health, Inc., for an alleged violation under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), using her authority under the Health Information Technology for Economic and Clinical Health (“HITECH”) Act. Additionally, the attorney general appears deeply unsettled by the amount of information that Accretive Health collected about patients without the patients’ knowledge, alleging that this lack of transparency represents deceptive and fraudulent practices under Minnesota law.
Category: HIPAA, Transparency |
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cmonfils | February 9, 2012
What if I told you there was a cost-effective way to help businesses and employees lower their health care costs without sacrificing quality of care? Better yet, what if the solution could be easily implemented by businesses alone, without requiring government intervention or legislation? Finally, what if this solution could be launched today, with information that already exists, and deliver savings in a year?
Category: Health Insurance, Transparency |
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cmonfils | January 22, 2012
Today, the Department of Health and Human Services announced that, “Trustmark Life Insurance Company has proposed unreasonable health insurance premium increases in five states—Alabama, Arizona, Pennsylvania, Virginia, and Wyoming. The excessive rate hikes would affect nearly 10,000 residents across these five states.”
Category: Alabama, Arizona, Health Insurance, HHS, Pennsylvania, Transparency, Virginia, Wyoming |
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cmonfils | January 12, 2012
Healthcare Transparency Through HealtheReports Reveals Significant Savings Opportunities, Reducing Costs for Insurers, Preferred Provider Organizations, Self-Insured Employers and Their Members
(Lexington, KY)—Jan. 11, 2012—According to internal analytics for the year 2011, IF Technologies has determined that a consistent 400% or more price variance is typical amongst network providers for top routine surgical procedures across the US.
http://www.thinkift.com/News/2012_0109.aspx
Category: Health Insurance, Self-Funding, Transparency |
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cmonfils | January 10, 2012
With increasing health care costs, smaller employers are exploring innovative approaches to fund their employee benefit plans to save money. Risk retention groups (RRGs) or “captives” can generate savings for some larger employers that self insure their plans. Captives are now catching on with smaller employer groups between 25 and 500 employees. Smaller employers are becoming more educated and starting to understand how risk management works with their health plans. By pooling their employees and risk with other employers within a captive, it can be a creative way to save.
Category: Health Insurance, Transparency |
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cmonfils | January 3, 2012
Employer’s Guide to Self-Insuring Health Benefits December 2011 | Vol. 19, No.3
The lack of cost transparency stands in the way of health cost control because it makes plan members unable to see prices before services are actually rendered, and harms their ability to budget health spending. Problems include: (1) multiple providers; (2) multiple network-provider contracts; (3) providers that often don’t know how extensive a patient’s treatment needs are until they start treatment; (4) insurers say contractual obligations with providers prohibit the sharing of negotiated rates; and (5) providers afraid of sharing negotiated rates due to their proprietary nature. Leah Binder, CEO of the Leapfrog Group, suggested that most employers can bring more efficient purchasing to their health plan in two ways: (1) change plan documents to reward members for using high-performance providers (for example, by waiving deductibles); and (2) computerize drug ordering and management systems, which would have quality as well as cost and efficiency advantages. (more…)
Category: California, CMS, Florida, Massachusetts, Medicaid, Medicare, New Hampshire, Transparency, Wisconsin |
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cmonfils | November 7, 2011
www.myhealthguide.com
MyHealthGuide Source: Todd Leeuwenburgh, Thompson Blog on HR and Benefits, 11/3/2011, http://smarthr.blogs.thompson.com and Blog Source
Have you asked your doctor or dentist to see his fee schedule? When I did so once, a dentist flatly refused, and as he was showing me the door, he said in effect: “my prices are higher, but that’s what you need to get my quality advantage.” (more…)
Category: Claims Procedures, Transparency |
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cmonfils | November 4, 2011
Have you asked your doctor or dentist to see his fee schedule? When I did so once, a dentist flatly refused, and as he was showing me the door, he said in effect: “my prices are higher, but that’s what you need to get my quality advantage.”
Category: Transparency |
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cmonfils | November 4, 2011
Health reform has passed and it was supposed to change the world. But it has yet to take effective action on the biggest problem — the upward spiral of health costs! Raise your hand if you think there is a connection between insurers’ and providers’ lack of transparency on premiums and fees, and that upward spiral.
http://smarthr.blogs.thompson.com/2011/10/21/are-forces-of-secrecy-still-standing-in-the-way-of-consumer-driven-health/
Category: Health Care Legislation, Transparency |
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cmonfils | September 27, 2011
www.cfo.com
In the era of consumer-directed health plans, emerging technologies promise to save companies a bundle by making it easy for employees to avoid high-priced services.
David McCann, CFO.com | US September 12, 2011
During the 20 years or so since managed health care burst on the scene in a big way, a certain scenario became ingrained in the minds of employers and their employee consumers alike.
That is, an employer negotiated and contracted with an insurance carrier or third-party administrator (TPA) for a provider network. Plan members found doctors in that network and paid them a fixed co-payment, with the employer picking up the rest of the tab. Rather than getting information on individual claims, the employer received aggregate plan data (largely in order to maintain the privacy of plan members). (more…)
Category: Transparency |
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cmonfils | June 13, 2011
www.cms.gov
| For Immediate Release: |
Friday, June 03, 2011 |
| Contact: |
CMS Office of Public Affairs
202-690-6145 |
AFFORDABLE CARE ACT PROVIDES NEW OPPORTUNITY FOR THE USE OF MEDICARE AND PRIVATE SECTOR CLAIMS DATA IN EVALUATING THE PERFORMANCE OF PHYSICIANS, OTHER PROVIDERS, AND SUPPLIERS
The Centers for Medicare & Medicaid Services (CMS) today proposed rules that will enable consumers and employers to select higher-quality, lower-cost physicians, hospitals and other health care providers in their area. The new rules will allow organizations that meet certain qualifications access to patient-protected Medicare data to produce public reports on physicians, hospitals and other health care providers. These reports will combine private sector claims data with Medicare claims data to identify which hospitals and doctors provide the highest quality, cost-effective care. This initiative is part of a broader effort by the Obama Administration, made possible by the Affordable Care Act, to improve care and lower costs. (more…)
Category: Transparency |
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cmonfils | April 25, 2011
All of you have undoubtedly dealt with a situation where there are only a few hospitals in a region, and they abuse that fact liberally. This dispute, which was recently settled in Texas, is titled United States of America and State of Texas v. United Regional Health Care System, 2011 WL 846762 (N.D.Tex.). You will recognize the story, as it has certainly happened to you, too! (more…)
Category: Provider Billing, Transparency |
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cmonfils | April 22, 2011
2011 WL 846762 (N.D.Tex.) (Trial Pleading)
United States District Court, N.D. Texas.
Wichita Falls Division
UNITED STATES OF AMERICA and State of Texas, Plaintiffs,
v.
UNITED REGIONAL HEALTH CARE SYSTEM, Defendant.
No. 7:11CV00030.
February 25, 2011.
Complaint
For Plaintiff United States of America, Christine A. Varney, Assistant Attorney General for Antitrust.
Joseph F. Wayland, Deputy Assistant Attorney General.
Patricia A. Brink, Director of Civil Enforcement.
Joshua H. Soven, Chief, Litigation I Section.
Peter J. Mucchetti, Assistant Chief, Litigation T Section.
Scott I. Fitzgerald (WA Bar #39716), Andrea V. Arias, Amy R. Fitzpatrick, Adam Gitlin, Steven B. Kramer, Richard Liebeskind, Richard D. Mosier, Mark Tobey, Kevin Yeh, Attorneys for the United States, United States Department of Justice, Antitrust Division, Litigation I Section, 450 Fifth Street, N.W., Suite 4100, Washington, DC 20530, Telephone: (202) 353-3863, Facsimile: (202) 307-5802.
For Plaintiff State of Texas, Greg Abbott, Attorney General of Texas.
Daniel T. Hodge, First Assistant Attorney General.
Bill Cobb, Deputy Attorney General for Civil Litigation.
John T. Prud’homme, Jr., Chief, Antitrust Division, Office of the Attorney General, 300 W. 15th St. 7th floor, Austin, TX 78701, Telephone: (512) 936-1697, Facsimile: (512) 320-0975.
The United States of America, acting under the direction of the Attorney General of the United States, and the State of Texas, by and through the Texas Attorney General, bring this civil antitrust action to enjoin defendant United Regional Health Care System (“United Regional”) from entering into, maintaining, or enforcing contracts with commercial health insurers that effectively prevent those insurers from contracting with United Regional’s competitors, in violation of Section 2 of the Sherman Act, 15 U.S.C. § 2, and to remedy the effects of its unlawful conduct. Plaintiffs allege as follows: (more…)
Category: Provider Billing, Transparency |
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