Managing Director at Kaufman Strategic Advisors and Matterhorn Strategic Advisors
WSJ. July 8, 2024, Insurers Pocketed $50 Billion From Medicare for Diseases No Doctor Treated So it goes n8 Don't be an MA enabler! #physicians #hospitals #valuebasedcare #Medicareadvantage #healthsystems https://lnkd.in/gGWnsPj7
The healthcare industry wastes $496 billion ANNUALLY on billing and insurance-related (BIR) costs. (https://www.americanprogress.org/article/excess-administrative-costs-burden-u-s-health-care-system/). There are 1,100,101 physicians in the United States (https://www.statista.com/statistics/186269/total-active-physicians-in-the-us/#:~:text=As%20of%20January%202024%2C%20the,physicians%2C%20followed%20by%20New%20York.) If we dropped the billing and coding non-sense, you would have $450K extra per physician to provide care. Split that and give half to the doctors (to pay off medical school for example and then increase salary to office staff) and the other half to the hospitals to provide the medical care ($248 billion to pay nurses and etc.), there would be plenty of $$ around to make a big dent the healthcare issues. Just saying US wastes so much money in the bureaucracy of healthcare.
There are a number of factual errors in this article, from misconflating risk adjustment with spending, to saying the base rate means paid zero. But the part that is most intriguing is what role Adelade ACO played and what part quality metrics for the diabetic eye exam played.
Ron Howrigon
1w
So they take money from Medicare for diseases no one treated while they are denying claims for services that were actually performed? Nice racket. I can see why UHC's stock price has doubled over the last 5 years.
Gaming of risk adjustment by larger health care entities is a challenge. Eliminating it creates other issues, e.g., adverse bias/risk deselection by insurers via provider behavior, while the status quo operates against naive health plans that do not aggressively maximize ICD capture.
I knew every time they called to arrange a home visit that it was bull crap.
Shameful!!!!! Or as the kids say these days, "cringe!!!!!"
Jeff Hayes
12h
Interesting!
Senior Executive Leader • Marketing and Communications. Decisive, strategic leader who leverages data and analytics to deliver world-class, multi-channel initiatives that produce quantifiable results.
1dYou always have great insights. Maybe a bit of good news once in awhile would be nice.