December 2007

A Hospital's New Years Resolution List

As we prepare to enter a new year, many people are preparing a list of resolutions for changes or improvements that they would like to make during the new year. What about hospitals? What would be on a hospital's list of new year's resolutions?

If your hospital is like most, the list would probably be fairly long, and would cover topics such as patient safety, clinical excellence, lengths of stay, staffing, days in AR, implementing technology, and others.

If your hospital's list includes "Collecting all revenue due from insurance companies," then Health Check may be able to help you fulfill your resolution in 2008. Since 1995, Health Check has provided managed care auditing and recovery services to hospitals nationwide. We help ensure that hospitals are paid according to the contracts they have with insurance companies. In doing so, we have successfully added more than $144,000,000 to our clients' bottom lines.

To learn more about Health Check and our services, please visit our website or contact us at 800.633.2055.

From everyone at Health Check, we wish you and your family a wonderful holiday season and a very Happy New Year!

We appreciate the opportunity we had to serve our clients during 2007, and look forward to a mutually successful 2008.

Doctors Survey Says that Insurance Companies Impede Patient Care

A non-scientific online survey conducted by the Healthcare Administration Program at the University of Houston at Clear Lake recently asked almost 500 doctors to rate the six largest health insurance companies in Harris County, Texas on patient care, payment, and customer service. These plans included Aetna, BCBS of Texas, Cigna, Humana, United Healthcare, and Unicare.

Based on the responses, each of the insurance companies received failing grades. If fact, the results were so low that the plans could not even be ranked — they all finished last.

Among the results:

• 70% of the doctors indicated that insurance companies had denied claims for medically necessary procedures
• 66% said that they experienced difficultly obtaining preauthorization for diagnostic testing
• 83% of the doctors stated that the administrative burdens created by insurance companies forced them to hire 1-3 administrative positions per doctor to respond to billing and filing issues

Although this survey may not be scientifically or statistically relevant, it does highlight the ongoing disconnect between insurance companies and providers. During the 2008 Presidential campaign we are certain to hear a great deal of discussion regarding healthcare reform. This survey helps illustrate just how far we have to go to make the necessary improvements.

Insurance Caps Fail to Keep up with Other Increases

A November 29th article in the Wall Street Journal highlighted the plight of a patient who exceeded his health insurance company's lifetime maximum benefit and was left with huge medical bills.

Although this particular article went on to question American hospitals' charges, we at Health Check understand the nature of the US healthcare system, how hospitals determine their charges, and the infrequency at which anyone actually pays a hospital 100% of charges. We were more concerned with the fact that most health insurance plans include lifetime maximum benefits of about $1 million- a level that has not substantially increased in 30 years.

As the cost of delivering healthcare continues to increase (like everything other than perhaps computers), shouldn't maximum benefit levels also be increased? While in 1975 $1 million of lifetime coverage might have protected a vast majority of patients, anyone in the healthcare industry knows just how quickly a seriously ill patient can exhaust this benefit level.

Patients that are extremely ill or injured require the highest level, and usually most expensive, services that a hospital has to offer. Such care also brings out the very best in the hospital's medical, nursing, and support staff. Commonly, the hospital goes to heroic measures to care for and often save patients from further pain, suffering, or even death.

In many cases, this level of service is provided to uninsured patients. As a result, the hospital writes-off a vast majority, if not all, of their charges to charity- thus supporting their mission. But increasingly, even when the patient has insurance, the hospital is being forced to write-off significant portions of their fees due to disproportionately low caps on benefits.

Hospitals' costs and charges are increasing, and insurance premiums are certainly increasing. It is time for benefit levels to increase, as well.