Payers such as Medicare, Medicaid and private insurers should not be driving healthcare reform with reimbursement cuts and those "never lists" we have all heard of. We all agree that healthcare costs are critically high and clearly the time has come where the industry must do what it can to mitigate the continued rise of costs associated with today's healthcare services. How do we do this?
Much effort and rhetoric has been aimed at establishing a universal health insurance for the nation. Several other countries have such social systems that have worked for them for many years but even now costs associated with healthcare internationally have become significant issues. It is likely that establishing such a social system domestically is not going to lessen our fiscal burden when it comes to healthcare.
I posted a quick comment on
Nick Jacobs' blog earlier today posing the question I will ask here. Why is healthcare letting payers drive cost control? If you and I go into a retail store and decide to purchase a service or product and we don't like the price listed, can we decide to pay the vendor say 60% of the posted price? Of course we can't. We must pay the retail price that the vendor has established. The hope here is that the price of the product is fair and equitable. That being said, then why is it that payers - Medicare, Medicaid and other private health insurance companies are able to dictate what they will reimburse healthcare organizations for after services are provided?
Establishing cost control on the back end which is what payers are doing now is the wrong approach. Insurance is a method of payment for services and products, it is not a cost containment vehicle. If the U.S. or any nation is looking to mitigate healthcare costs, those actions to control costs need to be build into the front end of providing healthcare services and products. If you want to save on your home heating bill you don't provide partial payment to the oil company, you improve your home's insulation, upgrade your windows, set your thermostat down a bit and put on a sweater, you get the point. So again why are we (the U.S.) looking towards insurance as a method of moderating healthcare costs?
Payers are forcing healthcare organizations to raise the bar on quality, which is a good thing. Clearly the U.S. could stand to have most of its hospitals improve the quality of care provided. We would all want that. However to do that it cost money. Improved patient nurse ratios, more providers, the establishment and integration of technology to improve the quality of care will cost hospitals millions of dollars. How can any business be expected to provide outstanding service and produce a quality product if it is constantly dealing with revenue problems?
Cost control for healthcare can only begin with the front end. If payers are allowed to continue to lower reimbursement rates, establish more and longer "never lists", healthcare organizations will have to close their doors or significantly cut services to communities. If that is allowed to happen, who do you think will pay then?
Much effort and rhetoric has been aimed at establishing a universal health insurance for the nation. Several other countries have such social systems that have worked for them for many years but even now costs associated with healthcare internationally have become significant issues. It is likely that establishing such a social system domestically is not going to lessen our fiscal burden when it comes to healthcare.
I posted a quick comment on Nick Jacobs' blog earlier today posing the question I will ask here. Why is healthcare letting payers drive cost control? If you and I go into a retail store and decide to purchase a service or product and we don't like the price listed, can we decide to pay the vendor say 60% of the posted price? Of course we can't. We must pay the retail price that the vendor has established. The hope here is that the price of the product is fair and equitable. That being said, then why is it that payers - Medicare, Medicaid and other private health insurance companies are able to dictate what they will reimburse healthcare organizations for after services are provided?
Establishing cost control on the back end which is what payers are doing now is the wrong approach. Insurance is a method of payment for services and products, it is not a cost containment vehicle. If the U.S. or any nation is looking to mitigate healthcare costs, those actions to control costs need to be build into the front end of providing healthcare services and products. If you want to save on your home heating bill you don't provide partial payment to the oil company, you improve your home's insulation, upgrade your windows, set your thermostat down a bit and put on a sweater, you get the point. So again why are we (the U.S.) looking towards insurance as a method of moderating healthcare costs?
Payers are forcing healthcare organizations to raise the bar on quality, which is a good thing. Clearly the U.S. could stand to have most of its hospitals improve the quality of care provided. We would all want that. However to do that it cost money. Improved patient nurse ratios, more providers, the establishment and integration of technology to improve the quality of care will cost hospitals millions of dollars. How can any business be expected to provide outstanding service and produce a quality product if it is constantly dealing with revenue problems?
Cost control for healthcare can only begin with the front end. If payers are allowed to continue to lower reimbursement rates, establish more and longer "never lists", healthcare organizations will have to close their doors or significantly cut services to communities. If that is allowed to happen, who do you think will pay then?