10 December 2009
Hey, Republicans! Try This One!
Hey all you nay-saying, fumbling opponents to a single-payer health insurance system, you might have come up with your own plan, but I guess when you say you are not "pro-choice", that does mean in everything, eh. Okay, instead of being dead serious, I'll just be serious on this topic and suggest there is at least one other way to reform our national health system. Read on. . . .that means you Democratic senators who cannot commit to an position if it is right in front of your face, blocking your re-election views.
From my perspective of almost 30 years of auditing and management consulting in the patient care institutional settings, I believe that hospitals and clinics should consider a different approach to recording and accounting for patient care revenues, contractual adjustments, accounts receivables and bad debt write-offs.
The first step to change the current, ubiquitous approach for patient receivables would be to stop the Admissions practice of having the patients agree to be financially responsible for all charges related to their care. Especially because 1) most patients do not have the financial resources to pay cash or the debt access [thanks, banks!] to pay the tab, 2) the uncertainties of the upcoming changes in health care insurance from both federal and state governments, and 3) the possible continuing, arcane, cost accounting policies that differ among non-profit, governmental and for-profit insurers, to require the patient to assume an unknown financial burden seems moot, at best, bad business at worst.
The admitting institution should have full financial responsibility because it has to bring in enough revenue to cover at least its direct and indirect costs to remain in business.
Normal purchasing by individuals is a decision made by price, perceived quality of product or service, and, with services, a comprehensive knowledge of what is being bought at point of sale. Price lists would help to choose among providers. I have yet to see human health care priced to allow for the patient to decide between providers, or, once admitted, whether to incur the costs entailed in further pathology interventions available, or to expect to have tiered, treatment decisions that incorporate incremental costs that may be chargeable to the patient as part of the often available consent discussions presented to patients prior to various treatment protocols. [As a side note, I doubt whether patients have the information and knowledge to make an informed, conscious decision whether to agree or not to agree to the content of existing, informed consent forms.]
Normal purchasing by individuals is a decision made by price, perceived quality of product or service, and, with services, a comprehensive knowledge of what is being bought at point of sale. Price lists would help to choose among providers. I have yet to see human health care priced to allow for the patient to decide between providers, or, once admitted, whether to incur the costs entailed in further pathology interventions available, or to expect to have tiered, treatment decisions that incorporate incremental costs that may be chargeable to the patient as part of the often available consent discussions presented to patients prior to various treatment protocols. [As a side note, I doubt whether patients have the information and knowledge to make an informed, conscious decision whether to agree or not to agree to the content of existing, informed consent forms.]
The other health care system in the US is veterinary practice. I know when I take my dog to his veterinary clinic how much an office visit, a procedure and, if needed, boarding, will cost--barring unforeseen issues. I also have opportunities to decide whether to put my pet through a procedure because of possible quality of life effects as well as because of price. We could argue about the difference in the emotional environment of such a decision, but how many patients are willing to bankrupt their families to live a few months more? *
I believe that hospitals and clinics should bill their costs of treatment and care plus all other charges from physicians, pharmacy, ancillary and others) directly to whatever insurance entity is applicable to a given patient and to whichever research grant or beneficiary fund is appropriate, if appropriate. Further, any billing sent to the patient should be net of any contractual allowances and other write-downs the institution makes. Such a procedure could result in the patient receiving one bill for the entire care and treatment services (including any ED, physician professional fees, ancillary charges and pharmacy) for illustration sake, of $5,000 instead of $190,000. The patient would receive one bill, from the hospital only. The hospital would be responsible for remitting professional fees that now are billed separately to the patient.
The hospital would receive revenue for all costs incurred during the particular patient's care and treatment while in the hospital, net of professional fees for physicians. The patient would be able to compare posted prices to billed prices in a clearer, more understandable manner. The billing institution would have the option of initiating the patient billing concurrent with billing insurers and others, thereby speeding the time between billing and receiving payments--or with establishing a specific accounts receivable amount and payment program with the patient. The billing institution would have to bear the amount of net revenue and could have a more timely balance sheet for operating management.
Such a divergent change from long established pricing and billing procedures could reap additional benefits if hospitals published price lists. A clearer, more transparent competitive market would enable patient and referring physician to make more informed decisions about appropriate providers offering various, more intensive options for treatment and care.
My point is radical, yet if we in the US are serious about offering the best care for the market-bearing prices, it would be easier to have a single biller and still remain a privately financed, national health care system. There will always be a need for a publicly fund for health care, but no one wants to offer a single biller structure for institutional care as aviable alternative to the moral benefits of a single payer structure for our nation's health care system.
Such a divergent change from long established pricing and billing procedures could reap additional benefits if hospitals published price lists. A clearer, more transparent competitive market would enable patient and referring physician to make more informed decisions about appropriate providers offering various, more intensive options for treatment and care.
My point is radical, yet if we in the US are serious about offering the best care for the market-bearing prices, it would be easier to have a single biller and still remain a privately financed, national health care system. There will always be a need for a publicly fund for health care, but no one wants to offer a single biller structure for institutional care as aviable alternative to the moral benefits of a single payer structure for our nation's health care system.
* Since our relationship with our pets is custodial or of stewardship, the ethical imperative for me is to minimize my pet's exposure to pain and suffering, if there were no realistic potential for recovery. My dog has not spoken to me in years, but I can tell when he is in pain and that he would want never to have to go out in the rain again, if possible. I do equate human choice about humans with the choice humans make for animals who are dependent on us humans for the quality of their lives. It's in the Bible. ( "God entrusted animals to the stewardship of those whom God created in God's own image." n. 2417, ref. Gn 1:26)
Labels: Democrats, health care financing, hospitals, patients, professional fees, Reid, Republicans. Pelosi
