Archive for March, 2008

Possible Fix to the PPO Mess In Louisiana

Thursday, March 27th, 2008

As we all know, Louisiana has been an absolute mess in recent years when it comes to medical cost containment in the workers’ compensation arena.  Yet, finally, there is a bill in Louisiana that may solve the problem of not being able to take PPO discounts.

SB 545, http://www.legis.state.la.us/billdata/byinst.asp?sessionid=08RS&billid=SB545&doctype=ALL  attempts to allow for the application of PPO workers’ compensation discounts.  Specifically, the bills states “ Nothing herein shall be construed or interpreted to prevent the insurer from entering into agreements with preferred provider organizations which provide or fees and other payments which deviate from the schedule set forth in this section.”  Hopefully, this bill will pass and finally take care of this issue and allow for medical cost containment measures.

This bill also states that the employee or claimant shall be notified by the insurer that a PPO network is in place via a letter.  This notification letter notifying the employee of the PPO, will then be taken to their provider at the time of treatment.  Unfortunately, the employee can still choose any provider they want for treatment.

It’s certainly not a perfect bill, but it just might be the fix for workers’ compensation PPO issues in Louisiana.

Insurance is a Finance Tool

Tuesday, March 25th, 2008

This week was our annual open enrollment for group health insurance, which no one enjoys as there can be a lot of paper work.  Once again, we kept our insurance with Blue Cross as we only had a minor increase in premiums.  As the insurance agent gave his annual spiel on why we should all deposit more in our HSA accounts, he also explained how insurance is simply a finance tool for healthcare. In other words, healthcare expenses are what they are.  Insurance is simply one way to pay for healthcare expenses.  Other options, of course, include paying for all of our healthcare expenses out of pocket.  As I read various blogs, listen to media reports on TV, and read newspapers, it is clear that too many people see insurance as something other than a finance tool.  The anger towards insurance companies can be intense, as individuals have horror stories of how needed procedures or medicines are not covered at times when in need.  It’s all a matter of how the policy is written.  Yet, often these people see themselves as being “denied” care by the insurance company.  It is unfortunate that this view is so prevalent.  We all have universal access to healthcare now.  That is, we can go to a physician and get treatment for a fee.  The real issue is the method of paying for the healthcare.For me, private insurance (not the government) continues to be the best way to finance healthcare.  If the government ever took it over (single payer system) we would all be very sorry to see what “free” healthcare really costs.

Coldest Winter Since 2001

Friday, March 14th, 2008

I guess Global Warming is still a topic that can’t be questioned?  Well, here is the latest information that seems to contradict Global Warming fanatics.  According to NOAA,

http://www.ncdc.noaa.gov/oa/climate/research/2008/feb/feb08.html

The average temperature across both the contiguous U.S. and the globe during December 2007-February 2008 (climatological boreal winter) was the coolest since 2001.  It was also the 54th coolest winter since national records began in 1895.

In a related topic, the founder of The Weather Channel wants to sue Al Gore for Fraud.  Now that is a fun twist.  John Coleman started The Weather Channel in 1982, and does not like the direction of the channel’s attempt in his mind to tell people how to live based on the climate.  According to Coleman he said the following about Global Warming: “I think if we continue the cooling trend a couple of more years, the general public will at last begin to realize that they’ve been scammed on this global-warming thing.”  http://www.foxnews.com/story/0,2933,337710,00.html

What do both of these articles have to do with Healthcare?  See a previous post on this topic, but here is the point again.  The Global Warming crowd is the same group of Liberals that want to run healthcare because they know better than the rest of us.  Once again, the science points toward a climate that is constantly in motion and changing, not the scam as John Coleman describes it of Global Warming. 

TX and TN, Proposed Legislation

Friday, March 7th, 2008

It is legislative season again.  I am always nervous between January and May of each year, as you never know what the various state legislatures might put in place for Workers’ Compensation.  This year is no exception, as legislators and commissioners are out to “tweak” the system again in various states.

In my home state of Tennessee, SB 3886, has both a House and Senate bill for consideration.  This bill is making its way through the process, and is rumored to have support of the Lt. Governor.  To summarize the bill very quickly, it basically says that a workers’ compensation PPO in Tennessee must be able to produce a workers’ compensation contract between the provider and PPO on demand.  Also, the contract must be between the PPO and the provider, and that contract cannot be assigned to another entity including another PPO.  Thus, a PPO in Tennessee could not lease any other PPO; instead, they would have to be direct contracted in the state.  For example, if Coventry or Focus are not directly contracted in any given county or MSA, they could not lease another network to fill in that gap.

The word on the street is that this bill has legs.  As always, only time will tell.  But, I do know that providers in Tennessee are really tired of bill disputes when it involves lease networks.

In the state of Texas, new rules for “medical billing and processing” is underway which seems to indicate that providers are going to have to be informed of exactly who is accessing them under the voluntary and informal system.  This of course is outside of the HCN model that Texas has adopted.  Some PPOs already inform their providers of anyone accessing them via website or other electronic means.  Proposed 133.4 would require electronic notification to the providers of who is accessing them for discounts on a quarterly basis.  There is also an “800” number requirement for providers to call into.

For Texas, these proposed rule changes are 35 pages of legal speak, that will require a lot of interpretation.  Yet, it seems the intent is that providers need to know who is accessing them.  My understanding is that these proposed rules/regs will probably go into effect.  Stay tuned.

Both Texas and Tennessee seem to have the same intent, which is to eliminate silent PPOs in workers’ compensation and to provide the medical provider with assurance that there discount to a PPO is being given for the stated purpose.  By the time May gets here, who knows what will have passed in these two states or any other, but hold on its always a wild ride this time of year.

Hillary Will Take Care Of Us??

Sunday, March 2nd, 2008

As I was getting ready for the day, I flipped on Fox News and heard Hillary’s live speech in Ohio.  As Ohio has some economic problems, she is focused on the economy and playing to the fears of people in that great state.  In her speech, she gave an example of a man that has to drive 70 miles every day to work, and thus suggested he can’t afford his gasoline cost.  Hillary seemed to show great empathy for this him.  Thus her solution was very simple.  Elect Hillary and she won’t let this happen to him.

First, Hillary has no control over the price of gasoline or oil just as George Bush has no control.  Second, the guy in her example can simply move.  Yes, that would cost him money to move, disrupt his family, and cause him an overall major change in life.  Yet, it is not Hillary’s job to make his life easier.  We became a great country because of individualism.  It was not because the government cared if it cost us too much to live 70 miles from our job.  What is my idea for this man?  MOVE if you can’t afford the drive or find a new job.  I have moved for jobs many times in my life, so can everyone else if that is what is needed to take care of your family.

We just have to quit looking for the government to take care of us.  In Ronald Reagan’s words, the government is the problem.  For the life of me I don’t understand why this country is moving toward socialism, it is a poison proven by history.

Healthcare Agenda

Saturday, March 1st, 2008

As the 2008 campaign rages on, I continue to refine my thoughts on how healthcare can change.  This is important, because it is clear that between reality of healthcare, the media, and the secular progressive mindset of the country at the moment, a new healthcare agenda is going to be set for the country starting in 2009.   Below are my current thoughts on how real change can occur.

First, take the purchase of healthcare out of the hands of employers.  I believe that individuals always make the best decisions.  As an employer, I am making the healthcare insurance decision for my employees.  Yet, I can’t but help to think that it would be best if each person could make their best deal by purchasing their own insurance in a competitive environment.  Also, it would be great to see insurance companies price their policies based on healthy lifestyles.  For example, if you want to smoke, great and good for you.  Yet, your insurance carrier may charge you more, which would be their right.

Also, it certainly is a cost burden for employers to shoulder such a large cost of healthcare insurance.  With an Obama Presidency (or Hillary) I feel sure my corporate and personal taxes are going to go up.  Having relief as an employer in the area of healthcare would certainly help me grow the company, thus creating more jobs and ultimately revenue (isn’t that the idea anyway?). 

Second, I believe we need to require all American’s, by law, to purchase Healthcare insurance.  I know, this is simply something my most conservative friends disagree with, and significantly.  Yet, Americans seem to always choose their cell phone over healthcare, and for those of us that have to pay for the uninsured, it just does not seem fair to me.  I would prefer that the government have no involvement, but a new era of Big Government is now upon us with the current congress and a more probable Obama presidency.  Thus, having the government support private insurance, is much more preferable to a government ran single payer system.

Third, and this is the federal government’s big role and only real role, provide a voucher system to American’s on a sliding scale that would allow the purchase of healthcare insurance for the most disadvantaged or disabled.  This is in direct support of the second point above.   In response, insurance companies will via the free market develop cheaper policies focused on simple coverage.  In my mind, vouchers are the only way in the end to keep the government out of the private sector.

Fourth, develop a risk pool for highly at risk individuals that need coverage.  Insurance companies would then bid on the business from the pool.  For Insurance companies to maintain their business license in any given state, they must pay a small amount of all premiums into the pool.  I will have more on this later in other posts.  The basic idea however, is that all insurance companies contribute to the risk pool for the at most risk individuals.  The Tenncare fiasco in Tennessee during the 1990s should make everyone stand up and pay attention to setting this up correctly.  Who is at risk or not being accepted by insurance companies would have the potential to be a gross mess if not administered properly.  Of course, given the opportunity, government will make a mess.

Fifth, we need major tort reform.  It is time we get lawyers out of healthcare.  As mentioned above, I watched the Tenncare mess in Tennessee turn into a healthcare system ran by the lawyers.  They were always trying to require more coverage.  I don’t think we are all entitled to gold plated healthcare, but basic healthcare insurance is something we should all purchase.  Also, law suits in many cases are just out of hand, and medical providers need relief, which in turn will help reduce healthcare costs.

There is more that can be done than just the above, but I believe it would be a good start.  What are your thoughts?