"Drive-By Doctoring" a Reason for Value-Based Purchasing

Here is my latest Risk & Insurance article that blog readers may find interesting. In it, I share some thoughts on dishonest practices in healthcare, and how value-based purchasing can eliminate them: "Drive-By Doctoring" a Reason for Value-Based Purchasing

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If You Can't Beat Them, Buy Them: Why Some Drug Costs Are Going Up

I have done some analysis on pharmacy costs for clients recently. During that time, I noticed an increase in the cost per prescription for some drugs. Our pharmacy partners have shown the same trend in their data. This upsurge made no sense to me.

Variability in Surgical Costs - Bill Goes Viral

This article features a patient that posted their $55K appendectomy surgery bill online, and it makes some very interesting points.

The University of California San Francisco researchers set out to find out how much an appendectomy cost in California. The price varied from $1,529 to $182,955. 

How the $9.8 Billion Charge in Healthcare Can Get Better

It's a stunning number -- $9.8 billion dollars annually.  This represents how much hospital infections are estimated to be costing us, based on a study released by JAMA.  This is just the financial cost.  It does not take into account the human factor -- the loss of life and limb associated with infections. 

NY Times Article on Implant Costs

​A recent New York Times article had some very interesting insight into healthcare tourism and the high costs associated with the US healthcare system, particularly implant costs.  

The article spotlights a man in America who receives a quote for a hip replacement. The implant costs $350 to manufacture in the US and $150 overseas.  He negotiated the wholesale rate of $13,000 for the implant ( it would have been much higher had the hospital billed their retail rate).  The hospital then wanted to charge another $65,000 for the room, with surgeon and anesthesia charges still extra. If all of these charges had occurred, the total surgery cost would have been more than $100,000.

Halifax Hospital - Largest Whistle-Blower Case Yet?

​A lawsuit is ongoing in Florida that could produce one of the largest whistle-blower penalties ever for the Halifax hospital chain.  An internal employee of Halifax says she witnessed more than a decade of billing fraud, unnecessary hospital admissions, inappropriate spinal surgeries and illegal kickbacks to doctors which could amount to more than $200 million in damages. 

Healthcare Costs on the Rise in Workers' Compensation

Medical inflation in workers' compensation is back. This article in Managed Care Matters documents the trends that we have seen in our own data.  Studies in IN, VA and NJ show significant increases.  Facility and hospital costs are driving a lot of this increase.  

ASC Behavior and Payment Disparity

Outpatient surgery in an Ambulatory Surgery Center (ASC) costs much less than in an outpatient hospital setting or ASC owned by a hospital.  The gap has been growing due to the need for ASCs to compete and be efficient, and regulations and rates as defined by the largest payer in the country, Medicare.

EMRs: The Law of Unintended Consequences

The government has been pushing for electronic medical record keeping for many years.  The thought was it would drive efficiencies, reduce costs and improve care.  Billions in incentives have been spent trying to get hospitals and providers to upgrade their systems to allow for electronic medical record keeping.

Obesity: Healthcare Costs on the Rise

Obesity is growing in the US.  This has huge implications for our society and the workers' compensation industry. Some studies show that medical costs for a workers' comp injury are eight times greater for an obese person than a person of healthy weight. 

Risk & Insurance Article on Rx Epidemic Features Rising's Technology

A great article on the Prescription Drug Epidemic was recently released in the September Issue of Risk & Insurance. It's written by Rising's Leslie Yeransian who attended the National Rx Drug Abuse Summit earlier this year and interviewed a number of experts who are trying to fix the epidemic.

California Implants

Implants are another hot topic for medical cost containment.  They're one of the biggest cost drivers in medical costs for workers' compensation and auto. A group in California was just indicted for fraud with medical billing.

Dr. Feelgood

More people are dying each year due to prescription drugs than cocaine and heroin combined. These non-illicit drugs are costing us more than $400 billion a year for healthcare, loss of job wages, traffic accidents, and criminal system costs. We no longer have a problem with prescription drugs, we have an epidemic, namely with pain killers and muscle relaxants which are considered palliative drugs -- they relieve or sooth symptoms of a disease or disorder without affecting a cure.

US Healthcare: Consumes 80% of World's Opioid Prescriptions

Prescription painkiller use is at an all time high in America. Eighty percent of the world's opioid prescriptions are taken in the US, yet we make-up just 4.6 percent of the world's population. That means we're consuming 83 painkillers for every one pill the average person takes around the world. So it's no surprise that a recent lead story on WorkCompWire centered on a widow whose husband overdosed on oxycodone (an opioid) and she was able to sue the employer for death benefits. Her husband was prescribed the meds due to a serious work-related accident.

More Consumerism in Healthcare

Here is another article about consumerism in healthcare. It discusses how people who cost the healthcare system more are going to be asked to pay more. I expect this way of thinking to become more common as the costs of healthcare rise and companies can no longer absorb the costs.