Caterpillar predicts $100M health care reform cost

J Roberts

It’s a fact that the new healthcare reform will create additional tax burdons for most US companies, including insurance companies. The net result could mean increased premiums or less benefits with greater out-of-pocket expense or both.  Read the expert from the Associated Press about Caterpillar.

(AP) — PEORIA, Ill. – Heavy-equipment maker Caterpillar says the new health care reform law will create a $100 million drag on its first-quarter earnings because of tax law changes. The Peoria company said Wednesday that the health care overhaul President Barack Obama signed this week will reduce the tax deduction it receives for its retiree health care program.

Caterpillar says even though the change won’t take effect until 2011, its liabilities for retiree health care are already reflected in its financial statements.

So Caterpillar expects to record an after-tax charge of $100 million in the first quarter.
And the company says the tax-law change is not reflected in its already cautious 2010 profit outlook of about $2.50 per share.

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New health care law likely to raise benefits costs

J Roberts

Healthcare reform. Yahoo!

Not so fast! Don’t get excited just yet. While it may be seen as progressive and a monumental task to provide coverage to nearly 32 million uninsured, the cost may outweigh the gain. Benefit companies, actuarial firms, employers and most importantly, health insurers have all stated that the passage of such legislation fails to address the fundamental issue that is plaguing the healthcare system: Cost. Under the new legislation Healthcare costs are only expected to rise making it more difficult to maintain affordable healthcare coverage.  In this time of uncertainty, it’s all the more wise you use an advocate to help you maintain your healthcare costs.  Medical Cost Advocate can assist.

By Lydell Bridgeford

March 22, 2010

While the health care legislation passed by House Democrats on Sunday expands coverage to 32 million Americans, the measure is bound to increase the costs of employer-sponsored health benefits.

With the 219-to-212 vote, the House enacted health care legislation that imposes a 40% excise tax on employers that provide high-end insurance coverage, which would take effect in 2018. Companies with health plans that have premiums of $10,200 or more for singles and $27,500 for families are subjected to the tax. The House measure also requires employers with 50 or more workers to provide affordable health insurance or pay a penalty of up to $3,000 per worker.

Government economists estimate that the new health care law comes with a price tag of $938 billion over 10 years. Employers and employee benefits analysts assert that the government will most likely raise business taxes and fees on health insurers, pharmaceutical companies and medical-device manufacturers to foot the bill.

Most corporate leaders and business owners believe that those industries will then levy the costs of the taxes and fees onto their companies, resulting in higher premiums or reduced benefits for workers.

“The legislation significantly expands coverage for millions of Americans, and takes steps toward aligning what we pay for health care and the quality of those services.  But several aspects of the legislation will inevitably increase, rather than mitigate, health care costs; and the overall financial integrity of the measure depends on future Congresses and Presidents making very tough political decisions,” says James A. Klein of the American Benefits Council. “We urge the Senate to make much-needed improvements to the new law – starting this week – as it considers the budget reconciliation measure,” Klein adds.

“The access expansions are a significant step forward, but this legislation will exacerbate the health care costs crisis facing many working families and small businesses,” says Karen Ignagni, president and CEO of the trade association America’s Health Insurance Plan.

Early this month, Helen Darling, president of National Business Group on Health, told a group of HR/benefits professionals and corporate leaders that health care reform will bring increased costs to employers. “The cost of administrating your health plan will go up. We are constantly talking to lawmakers about how expensive the administrative burden will be on some of their ideas about reforming health care,” Darling observed.

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Study Spotlights Provider Market Power to Negotiate Higher Payment Rates

J Roberts

Read how physicians and hospitals are joining together to increase their market share and purchasing power to better negotiate more favorable levels of reimbursement. This is a trend to watch, the net results may lead to an increase in health care premiums and out-of-pocket costs.

HFMA

An underlying driver of higher insurance premiums—the growing market power of hospitals and physicians to negotiate higher payment rates—has gone largely unexamined, according to a Center for Studying Health System Change (HSC) study published online today by Health Affairs.

Funded by the California HealthCare Foundation, the study examined the growing market power of many California hospitals and physicians, finding that providers are using various strategies, such as tighter alignment of hospitals and physician groups, to negotiate significantly higher payment rates from private insurers.

“Provider market power is the elephant in the room that no one wants to talk about in the national healthcare reform debate,” said HSC Senior Consulting Researcher Robert A. Berenson, M.D., of the Urban Institute, a coauthor of the study with HSC President Paul B. Ginsburg, Ph.D., and Nicole Kemper, M.P.H., a former HSC research analyst.

“Health insurers have been squarely in the crosshairs and blamed for the high cost of private insurance, while the role of growing hospital and physician market power has escaped scrutiny,” Berenson said.

The study also points out that California offers a cautionary tale for reform proposals that encourage hospitals and physicians to form tighter relationships through accountable care organizations.

“Reform proposals that encourage hospitals and physicians to integrate have the potential to improve quality and increase efficiency, but the savings may not be passed on to private payers if provider market power to command higher prices goes unchecked,” Ginsburg said.

The authors conclude that “unless market mechanisms can be found to discipline providers’ use of their growing market power, it seems inevitable that policy makers will need to turn to regulatory approaches, such as putting price caps on negotiated private-sector rates and adopting all-payer rate setting. Indeed, some purchasers who believe strongly in the long-term merits of increased integration of care delivery believe that price regulation may be a prerequisite for payment reforms that encourage integration.”

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Race Is On to Pin Blame For High Health-Care Costs

J Roberts

Who’s to blame for rising healthcare costs, insurers or providers, such as doctors or hospitals?  Depending who you ask, either side places the blame on the other.  Whether it’s insurers’ trying to meet the bottom line and remain profitable or physicians and hospitals attempting to increase revenue and improve their margins, one thing is for certain: Healthcare costs continue to rise.

Read on to determine where the blame lies.

By AVERY JOHNSON

A battle over who to blame for rising health-care costs is escalating, as groups seek to pin the problem on each other and say none of the health-care legislation under consideration does enough to solve it. U.S. spending on health care reached $2.5 trillion in 2009, according to federal estimates. It is expected to jump to $4.5 trillion in 10 years.

Insurers contend that they must pass on ever-higher bills from hospitals and doctors. Hospitals say they are struggling with more uninsured patients, demands by doctors for top salaries, and underpayments from Medicare and Medicaid.

And doctors say they are strong-armed by insurance monopolies and hampered by medical malpractice costs.

In the rush to point fingers, few solutions are emerging.

“It’s always someone else’s fault,” said Robert Laszewski, president of health-care consulting firm Health Policy & Strategy Associates. “There is not an incentive for these people to cooperate because the game they are all playing is getting a bigger piece of the pie.”

The issue has come into sharp relief as WellPoint Inc. has sought to defend its plan to raise some prices in California by up to 39%.

In a hearing Wednesday on Capitol Hill, WellPoint Chief Executive Angela Braly singled out dominant hospital systems for demanding 40% rate increases and drug companies for roughly 20% profit margins.

A WellPoint spokeswoman said that at least one hospital had asked for a 220% payment increase.

Many Democrats have cited lack of competition among insurers as a driver of higher prices. On Wednesday, the House of Representatives voted to repeal a longstanding insurance-industry exemption from federal antitrust laws. The bill now heads to the Senate, where its future is less certain.

Doctors complain of a lack of competition among insurers, as well.

A report by the American Medical Association this week argues that 500 insurance-company mergers in the past 12 years have led to markets dominated by one or two health plans.

This year, two insurers control 70% of the market in 24 states, up from 18 last year, the report said.

“There is no other company for doctors to go to” when an insurer comes to them with terms that they find unfavorable, said AMA President James Rohack. But insurers say is it doctors and hospitals that have gotten too powerful through consolidation.

A study published Thursday in the journal Health Affairs appears to back up their point, saying that insurers are weakened in their negotiations by their inability to exclude prominent doctors and hospitals from networks.

Authors from the Center for Studying Health System Change, a nonpartisan research group, conducted 300 interviews with California doctors and hospital and insurance executives in late 2008.

The study said two big networks of providers now dominate the northern part of the state: Sutter Health owns two dozen California hospitals and medical centers, and Catholic Healthcare West runs 33 hospitals.

In addition, the study said, doctors who are increasingly banding together for negotiating power are commanding yearly double-digit payment increases.

Hospitals and doctors shot back that the study was largely anecdotal and said integration improved efficiency.

Catholic Healthcare West said it took on $1.5 billion in bad debt from government underpayments last year; its size, it added, makes it possible to achieve some savings.

Sutter Health said increases in its reimbursement rates from private insurers have been in the single digits.

“We are doing our best to keep costs down because these health-care premium increases are not sustainable,” said Bill Gleeson, vice president of communications a Sutter Health.

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Hospital costs: Pull back the curtain

J Roberts

Read how one state’s governor is not only reviewing insurance rates, but also hospital rates as he and the state look for ways to curtail excessive increases.

If nothing else, Governor Patrick’s proposal for state review of both hospital and insurance rates should start an overdue discussion of how to keep health cost increases from smothering economic growth in the state.

The course advocated by the state’s payment reform commission last year – a move away from fee-for-service payments – may be the long-term solution. But in the meantime, both employers and individuals are facing increases well in excess of the national rate of medical inflation. Forcing both insurers and hospitals to lay out their contract proposals before a rate-oversight body would at least end the shadow play that has kept the public in the dark about wide differences in hospital costs.

Also, Patrick’s proposed requirement that insurers at least offer small businesses a plan with a network lacking some higher-cost hospitals would ensure that companies have that more affordable option. In the past, consumers and their employers have been wary of plans that lack access to marquee hospitals, but years of spiraling health costs have probably changed some minds. Let the debate, or “conversation,’’ as Patrick calls it, begin.

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HealthPass NY Enhances Small Employer Health Insurance Plans with Medical Cost Advocate

J Roberts

Medical Cost Advocate is in the news again! Read about the partnership between HealthPass of New York and Medical Cost Advocate to provide medical advocacy and bill negotiation services to the employees that participate with HealthPass.

Addition of Medical Cost Advocate Helps Employees Negotiate and Minimize Out-of-Pocket Health Care Costs

Online PR News – 09-February-2010 – NEW YORK, February 9, 2009

HealthPass, the New York City-based non-profit health insurance exchange for small employers, today announced a partnership with Medical Cost Advocate Inc. to provide advocacy services to employees who participate in any of its health insurance plans.

Under the arrangement with Medical Cost Advocate (MCA), employees and families enrolled in any of HealthPass’ portfolio of coverage options will have access to the services of MCA’s advocates. Medical Cost Advocate’s professionals personally assist employees with reviewing their medical bills and reducing their out-of- pocket costs by negotiating discounts directly with health care providers.

“We are thrilled to be working with Medical Cost Advocate, especially at a time when employees are being asked to accept more of the responsibility for their health care costs,” said Vince Ashton, executive director of HealthPass. “Employees simply don’t have the time or expertise to understand the complexities of medical bills and explanation of benefits. This unique service gives employees in any of our plans direct access to experts who will review and negotiate all out of pocket expenses, often times reducing costs by as much as 50 percent.”

Medical Cost Advocate professionals will review and negotiate virtually any medical bill, regardless of insurance status or medical procedure. These include in and out-of network bills for full and excess charges, balance bills, deductibles, co-insurance and non-covered services. Employees are only charged for the service when the advocates are successful in saving them money. The Medical Cost Advocate program is the latest enhancement to HealthPass offerings for small employees also including COBRA/State Continuation Administration, the discount Rx cards and Health Advocate, which complements the Medical Cost Advocate offering perfectly.

HealthPass is an innovative partnership that was created in 1999 by the New York Business Group on Health, the City of New York and the health insurance industry. Its original purpose was to offer small businesses quality, affordable health insurance options. This is accomplished through an insurance exchange that allows eligible employees to choose a plan that fits their medical needs and budgets from a wide range of choices of plans and carriers. Today, HealthPass serves more than 3,700 small businesses and non-profit organizations and 33,000 members in New York City, Long Island, Westchester, Rockland, Orange, Dutchess and Putnam counties.

“Medical Cost Advocate is delighted to be partnering with HealthPass and helping their members deal with the ever growing complexity and cost of health care bills,” said Derek Fitteron, Chief Executive Officer of Medical Cost Advocate. “Our service not only benefits employees, but also employers who can offer an expanded benefits package that will enhance their ability to attract and retain talented workers.”

About HealthPass New York
An innovative partnership between the New York Business Group on Health, the City of New York, and the health insurance industry, HealthPass provides small businesses and sole proprietors with an array of Fortune 500-quality healthcare options through an insurance exchange.

HealthPass enables eligible employees of small businesses and sole proprietors to choose a healthcare plan that fits their medical needs and budgets. There are more than 30 different coverage options from five leading carriers – EmblemHealth, GHI, Health Net, HIP (Health Plan of New York) and Oxford – as well as two dental plans, and a bundled product offered through Guardian. With more than 200,000 providers, HealthPass affords greater network access than any single plan. For more information, please visit www.healthpass.com.

About Medical Cost Advocate
Medical Cost Advocate (MCA) is a medical cost reduction firm that lowers consumers’ medical bills before or after treatment through professional negotiation. Serving consumers, employers, benefits consultants and financial institutions, MCA leverages a proprietary approach that regularly saves consumers 20% to 50% on their medical and dental bills. With out-of-pocket health care costs steadily increasing, MCA provides the professional advocacy every consumer needs to realize savings without risk. MCA’s services are easy to access through its website. For more information, please visit localhost/wp1

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Healthcare Spending Expected to Have Outpaced GDP Growth

J Roberts

Healthcare Financial News

Healthcare spending is on track to grow faster than the nations GDP for 2009. Unfortunately, we’ve seen this trend for the past few years and 2010 will promise nothing different. One thing is for certain, to combat the increased expenditure in medical services, employers and health insures alike are passing more costs onto employees and consumers.

Growth in U.S. national health expenditures (NHE) is expected to have increased faster than the growth in the gross domestic product (GDP) in 2009, according to a report issued today by the Centers for Medicare & Medicaid Services (CMS) and published online by Health Affairs. In 2009, NHE is projected to have reached $2.5 trillion and grown 5.7 percent, up from 4.4 percent in 2008 (the latest available historical year), while GDP, with the economy still in recession, is anticipated to have declined 1.1 percent. Health spending estimates for 2009 are projected because data for all of CY09 are not yet available.

The projected acceleration in growth for 2009 was due in part to faster spending growth for the Medicaid program (9.9 percent, up from 4.7 percent in 2008), reflecting increasing growth in enrollment associated with the recession. Also contributing to the acceleration was faster growth in the use of a variety of healthcare services as many people sought treatment for the H1N1 virus and an expected increase in the take-up rate for coverage provided through COBRA in response to the government’s subsidies for COBRA premiums. As a result of NHE growth outpacing GDP growth in 2009, the health share of GDP is expected to have increased from 16.2 percent of GDP in 2008 to 17.3 percent in 2009, which would represent the largest one-year increase in history.

Spending growth in three of the major healthcare sectors is expected to have accelerated in 2009. Hospital spending growth is expected to have increased 5.9 percent in 2009, up from 4.5 percent in 2008, and reached $760.6 billion. Physician and clinical services spending growth is expected to have increased 6.3 percent in 2009, up from 5.0 percent in 2008, and reached $527.6 billion.

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Help With Medical Bills

J Roberts

Read what others who have serious medical illnesses and conditions are doing to help relieve some of the financial burdens associated with high cost treatment and medical care. Like the services mentioned in the below article, Medical Cost Advocate can assist you with reducing your high dollar medical claims.

By M.P. MCQUEEN

A diagnosis of cancer or other serious disease can be devastating to one’s financial as well as physical health — even for people with insurance. But there are a handful of programs that can help ease the monetary burden.

The programs, run mainly by nonprofit and charitable groups, offer financial aid to patients with specific life-threatening or chronic diseases to help cover the cost of co-payments, deductibles and other medical expenses. Patients usually must meet specific income and treatment guidelines.

Patients typically are referred to the programs by the financial counseling or patient-advocate offices of big hospitals and treatment centers. But you also can seek them out online.

Cutting Cancer-Care Costs

The CancerCare Co-Payment Assistance Foundation (at 1-866-552-6729 or CancerCareCopay.org) helps eligible patients cover the cost of insurance co-payments for treatment of specific cancers. The program, founded in April 2008, now lists seven diagnoses eligible for assistance: breast cancer, colorectal cancer, head and neck cancer, non-small cell lung cancer, pancreatic and renal cancer and glioblastoma.

Some diseases have a $10,000 annual limit on aid, others have a $5,000 limit, says John Rutigliano, chief operating officer of nonprofit CancerCare. Most people who qualify receive between $2,500 and $5,000.

He says these days more employees are bearing a larger share of the cost of care, with higher co-pays and deductibles.

Since the CancerCare program began, about 7,000 people have applied for co-pay assistance, and about 80% of them have received aid. Half of those who received aid were on Medicare and the other half were privately insured.

The foundation rejects less than 7% of applications, mostly because applicants’ income exceeds guidelines. The cutoff for assistance is 400% of the federal poverty level — slightly above $43,000 for an individual and $58,000 for a family of two.

Nancy Francisco of Crystal Falls, Mich., received financial help from CancerCare when she was diagnosed with glioblastoma, a type of malignant brain tumor, early in 2009.

Mrs. Francisco, a 45-year-old registered nurse and electronic medical records technician, became disabled as a result of the illness and treatment. Her husband is her full-time caregiver. She continued her health-insurance coverage under her former employer’s Cobra plan, but out-of-pocket expenses for treatment exceeded $10,000. CancerCare helped her with a $10,000 grant, says the mother of three, which helped cover co-pays for chemotherapy and IV transfusions.

“I couldn’t believe there was help,” says Mrs. Francisco, who learned of the program from her hospital social worker and pharmacist, who also helped her fill out the application.

Other Options

Other groups offering financial assistance for the treatment of cancer and other diseases: HealthWell Foundation HealthWellFoundation.org, which helps with co-pays and premiums for patients with group and individual insurance, Medicare and Medicaid. The Leukemia & Lymphoma Society’s Co-Pay Assistance Program (leukemia-lymphoma.org) helps with private-insurance premiums.

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Negotiate Your Medical Costs: Interview with Derek Fitteron, CEO of Medical Cost Advocate

J Roberts

Medical Cost Advocate is in the news! Reporter Miranda Marquit from All Business News recently spoke with CEO Derek Fitteron about negotiating medical costs. Read on to learn about Medical Cost Advocate and what they are doing to help consumers who have large medical expenses. It’s great to know that there is a company working as an advocate on behalf of consumers to reduce healthcare costs.

Miranda Marquit

I recently saw an increase in my health insurance premium, and I will see it again quite soon, thanks to age-based premium increases. As a result, I am seriously thinking of a Health Savings Account and a high deductible plan. The ridiculousness of rising medical costs is really starting to be annoying — and increasingly moving toward unaffordable. Many people already experience the fact that health care in this country is unaffordable for them. So it was interesting to learn a little bit about a company that works to negotiate medical costs.

I recently spoke with Derek Fitteron, the CEO of Medical Cost Advocate, and he gave me some insight into what his company does to help consumers reduce their health care costs.

“Expectations were that health insurance premiums would go up six to eight percent,” Fitteron told me. “Instead, they are going up 10 to 12 percent. That means that employers are passing more costs on to employees, and consumers find that they have to pay more out of pocket. What we do is work to negotiate out of pocket expenses so that consumers pay less.”

The way it works, he explained, is that consumers can submit their out of pocket expenses, spent to meet a deductible or due to out of network treatment, and Medical Cost Advocate will attempt to negotiate a lower payment. Fitteron said that the company only charges if the fee is successfully renegotiated. “We take a percentage of what we accomplish. If the bill isn’t reduced, we get nothing.”

“We also help the uninsured,” Fitteron continued. “About 15 percent of the people we serve are not insured, and we can help them get a better rate, since they don’t have the advantage of a group rate through insurance.”

Fitteron also told me about a program that can help manage a family’s health care costs. “For 200 dollars a month, it is possible for us to track bills, review insurance and negotiate your costs. And this is for the whole family.”

Services offered by Medical Cost Advocate can be paid for using money from Flexible Spending Accounts or Health Savings Accounts. I haven’t used these services, but they seem intriguing. If I decided to go with a Health Savings Account, and have to pay out of pocket for more of my health care, it might be worth it to see if cost negotiation can save me a little more. I’m not sure that I would need the monthly service, but it might be worth it to check into the negotiation service offered.


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Reform pits coverage against cost

J Roberts

Healthcare Finance News

Providing coverage to the nations nearly 43 million uninsured, while well intentioned, will only be detrimental to an already fragile system if the ever increasing rise of the cost associated with the delivery of care is not curtailed. Did Congress forget to address this issue when both the House and the Senate approved their versions of the bill? As Diana Manos, describes in her editorial,’It will be an interesting year..’

Diana Manos, Senior Editor

It doesn’t take a crystal ball to predict a major portion of what’s in store for the healthcare industry in this New Year. The top issue will remain: What do we do about rising healthcare costs, now at 16 percent of Gross Domestic Product?

The Senate paved the way for more debate on how to bend the cost curve by passing its version of a healthcare reform package on Christmas Eve. As Congressional leaders begin melding it with the House version, passed Nov. 7, sparks will fly over how to make compromises needed to pass the bill that don’t water down the social objectives too much.

In debates last year, the health insurance industry was singled out as the enemy of social good, responsible for the exclusion of coverage for millions of Americans. Capitol Hill shuddered at the personal stories of denial of coverage over pre-existing conditions.

President Barack Obama has called the Senate and House reform packages “the toughest measures ever taken to hold the insurance industry accountable.”

Yet as much as they’ve been called villains, insurance companies are merely businesses, going about what businesses do best. They are not non-profits. Blaming them for the demise of healthcare in America would be like blaming sharks for being the most effective hunters on earth. It’s in their nature.

If Congress is able to come to a resolution on healthcare reform, it will likely include measures to oversee the insurance industry. Yet that’s not a silver bullet for ensuring that health plans won’t find loopholes for their own fiscal survival.

There has been outrage over so-called universal coverage, and mandates that would force Americans to buy healthcare coverage. However, how can insurance companies be asked to cover more sick people without increasing the pool of healthy beneficiaries to support it?

This comes down to the question of whether the American government can single out portions of our market and designate limits for profit. Liberals would argue it has to be done sometimes for the social good.

But where do we draw the line for where social good ends and free enterprise begins? This is a debate that has launched wars and spilled blood.

It will be an interesting year, to say the least.

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