Nathan Baar’s Post

A recent proposal to streamline prior authorization through CPT codes was unexpectedly withdrawn when a doctor discovered that prior authorization requirements were already in place for certain codes. I think this happens a lot more than many of us would think. While these codes are crucial for streamlining the prior authorization process, there still seems to be confusion over which ones are available and what they entail. Sharing this information as much as possible is critical for closing this knowledge gap! #Healthcare #PriorAuthorization #MedicalCoding

Very enlightening but not surprising article regarding physician dissatisfaction when working for a large hospital system or vertically integrated “pay-vider“ (which are essentially insurance companies that also own physician groups, facilities, and service delivery). Interestingly, this also highlights the fact that more physicians are looking at a Management Services Organization structure for their practice in order to remain independent but compete effectively with much bigger entities in a given market.

Dr. Greenfield, You raise a great point regarding the cost of our system of healthcare. It is a travesty how physicians are treated by corporate healthcare and insurance payors including Medicare which some would believe would provide the solution for universal healthcare. Insurance companies make profits by two mechanisms, limiting reimbursement to providers and denying procedures for patients to whom they refer as subscribers. In 2023 Athem posted Q4 profits over over $850,000,000 on $2.6 Billion in revenue. That’s a 33% margin. That’s ONE quarter! Medicare doesn’t cover 100% of costs for patients who are left with an 20% copay, and the reimburse providers only about 84% of the true cost of providing services. This forces Medicare providers to “cost shift” the remaining 16% to private carriers such as Anthem and patients. Mr. Levitz failed to mention that anesthesiologists while among the highest paid specialists also have some of the highest rates of litigation and pay some of the highest premiums for malpractice insurance on top of med school loan payments and income foregone while in training. When the author cites the amount paid per patient in other countries it’s important to realize the difference in those systems of care. In my opinion too many MBAs and clipboard carrying managers and too few doctors and nurses who actually practice medicine and nursing. I realize my opinion is biased, I would suggest that Mr Levitz’s opinion is biased as well. His views are narrow minded and clearly not influenced by any healthcare experience.

Controversies and uproar continuing about prior authorization even after most payor addressing with their individual reforms. Even when most practices want prior authorization gone, but we all know it has particular need in healthcare cost control, evidence starting from mid 90's, especially in HMO business. But we know in prior authorization space there are continual progress to make this process objective, timely, easy and transparent. We also need to know even though then prior authorization will have plenty controversies as all physicians isn't practicing the same way, not because of clinical difference, but because of philosophical, and lack of adopting and streamline clinical guideline.

Have you been to an hospital lately? It’s interesting how you even get there, and then end up staying there for far longer than you anticipated. Maybe you brought somebody else with you, a family member or a friend, or an employee perhaps! Regardless, you could be lucky enough to get diagnosed with strange conditions, illnesses, and disorders - the stuff you’ve probably read in obscure medical journals, while you’re at it. And the most interesting part of it all? You thought a great Medical, Accident, and Death Insurance plan with every possible Rider and benefit was enough to get in and get out quick, with no additional costs! Guess what? Things don’t seem to work out the way you think, or calculate, or anticipate. Because the system continues to evolve, and with it the gaps and loopholes grow into endless chasms deep enough to swallow your entire life’s savings, your immense wealth, and precious assets faster than you could probably digest your previous hospital meal (gruel?). Who says greed doesn’t affect those who portray themselves to be #altruistic saviors of the weak, helpless, and the desperate! All humans succumb to primal needs. After all, they have families to feed and care for, dreams and ambitions just like anybody else! And the business and service of #Healthcare is no exception to it.  Especially after we’ve lost thousands of good doctors and medical staff on the front-lines during COVID, the harsh truth of self-preservation and self-actualization must have struck, and deeply! #KPIs drive all businesses. And some KPIs for medical professionals (#Doctors) include: 1. Patient satisfaction: Measures how satisfied patients are with their healthcare experience, including the quality of care, facilities, and interactions with staff.  2. Patient wait time: Measures the average amount of time patients wait for appointments.  3. Bed occupancy rate: Measures the number of beds in a hospital that are occupied.  4. Staffing ratios: Measures the balance between the number of healthcare professionals available and patient demand.  4. Claims denial rate: Measures the rate at which claims are denied.  5. Treatment costs: Measures the efficiency and effectiveness of a hospital's treatments.  6. Average length of stay (#ALOS): Measures the average number of days patients spend in the hospital.  7. Operating margin: Measures whether a hospital is making a profit or incurring a loss.  Source: Generative AI As someone who’s been accompanying a #Cancer Fighter for several decades to various hospitals. I’ve had the privilege of observing this phenomena closely over a lengthy period. Maybe, somethings are simply unavoidable. Or maybe, they are totally avoidable. Whichever it is, it depends largely on us and how we treat ourselves. While holding these systems accountable. Salute! And get well soon! #malcified #cartoons #awareness #compassion #cure #insurancefraud #medicalfraud #scamsystem #UN #GARP #ACAMS #sustainability #transparency #AFC #Audit

Please think about this: don’t you do what your boss tells you to do? Especially if you want to keep your job? Now think about this: instead of being an independent practitioner, more than 75% of all doctors are employees. That means their livelihood, even their family’s welfare, depend on keeping their BOSSES happy, even more than keeping their patients happy. And, businesses, private equity firms, and large hospitals profit off of the disparity between patient’s best interest (smallest meaningful treatment that helps treat their medical condition) and the employer’s best interest (most profitable procedures and treatments they can get the patient to undergo). After all, most hospitals, and large PE held groups, incentive there physician employees by the volume of care provided, instead of the quality of care provided. https://lnkd.in/ehJtmxRw Think about it. Institutionalization of the practice of medicine has turned “taking care of patients”into a “consumer-driven” business, where patients are encouraged to consume more, like a car dealer upselling a more expensive car, whether the person needs these features or not. And government programs like Medicare, and insurance companies, are helping in that assault on the doctor-patient relationship by cutting reimbursement for medical procedures. This is reducing the ability of private practice doctors to make a living doing what they do on their own. We are watching the slow death of the medical profession. By removing the “professionalism” and turning it into to a heartless, calculating machine.

How is the growth of private medical insurance aiding the independent hospital market? The ninth edition of LaingBuisson’s Private Acute Healthcare UK Market Report is now available for purchase. This edition highlights key shifts in the market, with PMI growth driving expansion in the independent hospital market and self-pay revenue growth stabilising post-pandemic. This report highlights the ongoing increase in NHS-funded care, the role of independent clinics and emerging trends shaping the future of private healthcare, featuring: • In-depth, comprehensive breakdowns of hospitals, clinics, and NHS PPUs • Updates on political and regulatory impacts • Investment and profitability insights • Capacity and patient activity trends • And more Purchase your copy of this exclusive report to stay ahead and navigate this rapidly changing market: https://lnkd.in/ehUc_PxK

How is the growth of private medical insurance aiding the independent hospital market? The ninth edition of LaingBuisson’s Private Acute Healthcare UK Market Report is now available for purchase. This edition highlights key shifts in the market, with PMI growth driving expansion in the independent hospital market and self-pay revenue growth stabilising post-pandemic. This report highlights the ongoing increase in NHS-funded care, the role of independent clinics and emerging trends shaping the future of private healthcare, featuring: • In-depth, comprehensive breakdowns of hospitals, clinics, and NHS PPUs • Updates on political and regulatory impacts • Investment and profitability insights • Capacity and patient activity trends • And more Purchase your copy of this exclusive report to stay ahead and navigate this rapidly changing market: https://lnkd.in/epDZfc-K

How is the growth of private medical insurance aiding the independent hospital market? The ninth edition of LaingBuisson’s Private Acute Healthcare UK Market Report is now available for purchase. This edition highlights key shifts in the market, with PMI growth driving expansion in the independent hospital market and self-pay revenue growth stabilising post-pandemic. This report highlights the ongoing increase in NHS-funded care, the role of independent clinics and emerging trends shaping the future of private healthcare, featuring: • In-depth, comprehensive breakdowns of hospitals, clinics, and NHS PPUs • Updates on political and regulatory impacts • Investment and profitability insights • Capacity and patient activity trends • And more Purchase your copy of this exclusive report to stay ahead and navigate this rapidly changing market: https://lnkd.in/eDFPD33X

How is the growth of private medical insurance aiding the independent hospital market? The ninth edition of LaingBuisson’s Private Acute Healthcare UK Market Report is now available for purchase. This edition highlights key shifts in the market, with PMI growth driving expansion in the independent hospital market and self-pay revenue growth stabilising post-pandemic. This report highlights the ongoing increase in NHS-funded care, the role of independent clinics and emerging trends shaping the future of private healthcare, featuring: • In-depth, comprehensive breakdowns of hospitals, clinics, and NHS PPUs • Updates on political and regulatory impacts • Investment and profitability insights • Capacity and patient activity trends • And more Purchase your copy of this exclusive report to stay ahead and navigate this rapidly changing market: https://lnkd.in/etJHKYSJ