Insurer details its unequal payments

[HughMoran]

Source: Boston Globe

Harvard Pilgrim lists hospital, doctor fees; State to open hearing on health care costs
By Liz Kowalczyk
Globe Staff / March 16, 2010

Newly released documents from a major insurer detail how certain hospitals and doctors are paid dramatically more than others for the same types of services, sometimes as much as three times higher.

The vast inequalities emerged in documents filed by Harvard Pilgrim Health Care Inc., the second largest health insurer in Massachusetts, before the start today of state hearings investigating why health care costs are rising so rapidly. Written testimony from Harvard Pilgrim discloses which of the hospitals and physician groups in its network are the best paid and which are paid the worst.

...

Harvard Pilgrim’s testimony mirrors the results of a yearlong investigation by Attorney General Martha Coakley’s office, which found that the highest pay goes to the providers with the most clout and not as a reward to those hospitals and medical practices that provide the highest-quality care. The attorney general’s report looked at payment rates from all large insurers. Unlike Harvard Pilgrim’s testimony, Coakley’s preliminary report did not identify providers by name.

A 2008 Globe Spotlight Team series focused on the Boston market found that a small number of hospitals such as Mass. General and the Brigham typically are paid 15 percent to 60 percent more for essentially the same work as other hospitals, even though the quality is not superior. It said the fees paid the Partners hospitals were helping to drive up health costs in Eastern Massachusetts, something critics have called the “Partners effect’’ but that Partners disputes.

...


Read more: http://www.boston.com/news/health/articles/2010/03/16/insurer_details_its_unequal_payments/

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It's not just the insurance companies jacking up our healthcare costs; as this article shows, hospitals and doctors are being paid excessive amounts of money based on clout and NOT based on better outcomes for patients.

[defendandprotect]

1. In fact the outcomes for patients are deteriorating . . . as the $$ rises . . .

[supernova]

2. The free market at work

What's unusual about this?

In any given company, it's not the most talented people who do the most work the best who get the biggest salaries or the biggest raises. It's the people with the most "clout" and the biggest egos.

Of course, it's a fucked up priority system.

[Supersedeas]

11. the power of collution and insider trading is the essence of the free market system

free to collude and hobknob with insiders

[NJmaverick]

3. This has always been the case and anyone with a background in health care knew and understood this

unfortunately many driving the debate lack the knowledge and background to do so.

[No Elephants]

5. It's not a matter of what has always been. It's a matter of what should be the case going forward.

[NJmaverick]

6. No it shouldn't be the case

[supernova]

7. I hope your'e saying

that we should be paying the hospitals and practices the most who have the best patient care outcomes, not those who are collecting $$ based solely on their reputations.

[NJmaverick]

8. All hospitals and doctors should be getting the same rate

rather than the bigger and wealthier hospitals getting better rates than inner city hospitals and big doctor practices getting more money than the country doctor or the single doc practice.

[Oregone]

10. Private industry gets to determine the rates

Whatever the excesses, they must be worth letting capitalistic insurance determine the best way to distribute care to the population.

If it wasn't worth it, wouldn't the Democrats have thought of reform that addressed the private market failings?

[NJmaverick]

12. See this is why it's important to understand the system

the reason the rate structures vary is because hospitals, hospital systems and physician practices NEGOTIATE their rates with the insurance companies. The insurance companies try to get the lowest rates while the other side is pushing for maximum rates. The larger healthcare systems and multi-physician practices get the higher rates because they are in the position to negotiate better rates for themselves. It works against inner city hospitals (at there are usually more than one in a city and the insurance companies play them against each other) and small physician practices.

[Oregone]

13. They really should only vary be region

If the US wasn't doing single-payer, they should have at least set up a regional rate negotiator or something on that manner, that sets max & mins on what rates, per procedure, could be negotiated between insurers and providers. This would task insurers with essentially just running the paperwork, if private insurers just *must* be involved. Now, they are still running most of the show and this type of inequality in payments will persist.

[HughMoran]

4. delete

delete

[Oregone]

9. But one you force everyone into the shitty system, this stuff will magically go away

[pattmarty]

14. Boy, I can't wait for the prices to drop dramatically also.

:sarcasm:

[HughMoran]

19. Nope. The work has just begun

But now the government has a stake in reducing costs and politics are involved - which is not always a bad thing.

[grasswire]

15. RICO -- seize the computers and evidence now

There is obviously a huge racket going on, with no oversight or regulation. So "influence" now determines the amount of insurance payments?

What the hell is going on????

This is as bad as the banking industry and Wall St.

Send in the feds. This is a criminal enterprise.

[DesertFlower]

16. i went to the emergency room last year.

the doctor spent 5 minutes with me. his charge was $599 plus the hospital charge. i called my insurance company (united health care). they said that $599 was the standard payment for an emergency room visit throughout the country.

BTW. i had to pay it because i hadn't satisfied my deductible.

[Jefferson23]

17. Thank you for posting this Hugh.

This is beyond disgusting...criminals they are.

[HughMoran]

26. Needs to be part of the equation going forward

We can't reduce costs with mafioso hospitals and doctors.

[flyingfysh]

18. Harvard Pilgrim is my HMO

They carried my stepson (severely bipolar, epileptic, etc) for several years until he got onto Social Security. Other companies would have found some excuse to dump him.

For an insurance company, they are definitely among the good guys.

[drdtroit]

20. And this is the sociopathic, criminally insane industry we are all going to be

forced to support through mandates.

[HughMoran]

22. What alternative hospitals and doctors do you propose we use as an alternative?

This article is about hospitals and doctors - the government will now be trying to reduce costs because it now has a political stake in the industry. Only good can come from starting the process of reform.

[DesertDiamond]

21. This is what I've been trying to say. We can't cure the insurance problem while the health industry

is still sick. The problem reported on above is not the only problem. The BIGGEST problem is that the health industry does not have the wellness of its patients as a goal. Its goal is to keep the patients coming back for more treatment, which they describe as "management," or, what I feel is more accurate, "maintenance." As in the case of say, garden maintenance, you keep the garden alive. In the maintenance of an illness, you keep the illness alive. For the obvious reason.

I think the vast majority of Americans have lost all concept of wellness, thinking that their only option is taking larger and larger numbers of medications and having more and more surgeries, and living in poor health for the rest of their lives.

It's true that when this is called "health care reform" is is MOST DEFINITELY a MISNOMER. Health care reform is what we NEED.

[Uncle Joe]

24. I believe money has a corrupting influence regardless, however I believe the for profit

"health" insurance industry is still the key.

A centralized single payer system; Medicare for everyone or a strong public option could eliminate or at least greatly reduce the abuses cited in the O.P.

One thing about hospitals and doctors, at least they provide a necessary, non-redundant service, the same can't be said in regards to for profit "health" insurance corporations; there is no logical reason for their existence.

[Jefferson23]

27. +1

[Uncle Joe]

23. Perhaps this is the motivation behind the hospital lobbyist purported to have struck a deal

with President Obama to eliminate the public option?

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x7930459#7931906

Thanks for the thread, HughMoran.

[BlueIris]

25. Yikers. nt