New Sermo Survey Indicates Physicians Moving towards Cash-Only Practices

Cambridge, Mass. November 5, 2009 — Sermo (https://www.sermo.com), the nation’s largest online physician community, today announced the results of a new survey, which indicates that physicians are moving towards cash-only practices as they cope with the business realities of an uncertain healthcare environment. The new survey comes on the heels of newly proposed healthcare reform legislation and an expected 21% cut in physician Medicare payments in 2010.

According to a Sermo survey conducted of 1,000 US physicians on Sermo between October 30 and November 4th:

• 61% have accelerated dropping 3rd party payors given the 21% proposed cut in physician payments.
• 91% of physicians state they could discount their services by up to 40% if they didn’t have to pursue reimbursement from third-party payors.

Physicians are more strained than ever before to stay in business and are searching for new models to help them succeed. In fact, according to a recent report from the Health Economics Institute, physicians’ offices spend between $23 and $32 billion dollars a year in administrative overhead trying to get paid by insurance companies.

Due to the increased burden of administrative overhead and cuts in payments for services, many physicians are weighing the benefits of cash-only practices — meaning they would stop accepting any form of insurance and leave patients to seek reimbursement from insurance companies themselves. When asked to select what their goals would be for improving patient care if they moved to this model:

• 80% selected “lower influences of 3rd parties on treatment plans”
• 75% selected “more time with patients”
• 75% selected “encourage patients to have a greater vested interest in their own care”
• 60% selected “provide services to patients that have no insurance or high-deductable HSA’s”
• 60% selected “I could offer patients more flexible payment terms and discounts”

“Our data continues to support the fact that physicians are becoming more and more concerned about the business realities now facing them,” said Dr. Daniel Palestrant, CEO and founder of Sermo.  “Because of this, we’re seeing a powerful trend in the Sermo community where physicians are turning toward new business models that can help improve their financial underpinnings and re-establish the centrality of the doctor-patient relationship.”

To support physicians as they revaluate their business strategies, Sermo today also launched the Sermo Practice Management Exchange™(PME).  PME is a new area within the Sermo community where physicians can share strategies and insights about how to run a successful practice while earning CME credits. To learn more, see press release dated 11/5/09 titled ‘Sermo Launches the Practice Management Exchange™ to Support the New Physician Practice in a Changing Healthcare World.’

About Sermo
Visit http://www.sermo.com.

photo credit: skpy

Doctors, patients routinely discussed payment in days before employer-sponsored insurance

By Richard Craver | Journal Reporter
Published: November 29, 2009

The cost of health care has long been the elephant in the room of doctor-patient discussions.

“Doctors generally avoid asking patients about health insurance and finances because physicians want what they believe is best for their patients,” said Mark Hall, a professor of law and public health at Wake Forest University School of Medicine.

“What’s best might not always be most affordable.”

That’s changing. Millions of Americans have no health insurance, and many of those that do are facing increasing costs, higher deductibles and larger co-pays.

The result: doctors and patients are being encouraged — if not forced — to talk money upfront like they would about buying a set of tires.

Not having the conversation could prove financially devastating. Researchers at Harvard University reported that medical problems caused 62 percent of all personal bankruptcies in 2007. Of those bankruptcies, 60 percent of the filers had private medical insurance.

Then again, having the discussions could open a Pandora’s Box for physicians.

Such as:

□ How much should a physician know about a patient’s job status, or consider the employer’s financial health, in determining ability to afford medical services?

□ Is there financial liability and ethical accountability for recommending the most costly surgical procedure, which could drain the patient’s overall finances if they lose their job and health insurance and can’t afford the bill?

□ Is there financial liability and ethical accountability for recommending a lower-cost option that significantly affects the patient’s quality of life — living with more pain than necessary — or projected lifespan?

□ How much defensive medicine — ordering tests that are borderline necessary to defuse any potential legal action — should be practiced?

Hall studied such issues for three years and co-wrote a report that recently appeared in The Journal of Family Practice.

“Each year, doctors are finding more and more that patients are coming in carrying substantial deductibles and having to pay more out of pocket,” Hall said. Physicians told of patients who left prescriptions unfilled or refused to get diagnostic treatments because they couldn’t afford them.

“Every level of stress needs to be identified and addressed, with job stress often going hand-in-hand with financial stress,” Hall said.

“More physicians are finding a balance of something good enough at a lower cost, such as a generic drug over a brand name. They are using professional judgment with practical wisdom as they provide a tray full of options to their patients.”

…

When asked when a doctor should address medical costs with a patient, she said “always and as often as possible.”

“Ultimately ­– it is the patient’s choice — but being informed well of the options, possibilities, treatment, recovery, etc., is important. Why wouldn’t all patients wish for this type of care?”

“We have to be persistent in wringing out what costs we can, to come up with other alternatives, which sometimes takes some creativity,” Long said.

“But that’s true of many of my patients in this economy. There’s no question patients are having to portion out their health-care dollars.”

Freda Springs, a spokeswoman for Novant Health Inc., said that its physicians view discussing health-care costs “as an obligation in caring for the whole person.”

“Patients will often confide in their physician when they will not confide in others,” Springs said.

“What we try to do is coach our physicians to ask pertinent questions, and if they believe the patient needs assistance, to get them to the customer-service navigator while they are in the office.”

Families USA, a consumer-advocacy group in Washington, recently released a consumer guide that offers strategies, tips and warnings to consumers to manage medical debt and avoid bankruptcy.

“Medical debt is a stealthy fiend, striking unexpectedly and feeding on both a family’s rising health-care expenses and what may be a growing inability to pay because of a loss of a wage earner’s income,” said Ron Pollack, the executive director of Families USA.

The group said that medical debt is a growing problem for both people who are uninsured and people who are underinsured — those with coverage with high deductibles, high co-payments, many uncovered benefits, and what it considers as insurers’ arbitrary limits on coverage.

Pollock said that medical debt contributes to mounting credit-card debt and can threaten a family’s housing security by putting rent or mortgage payments out of reach.

Dr. David Miller, an associate professor at Wake Forest who focuses on general internal medicine, treats mostly low-income patients at the Downtown Health Plaza.

Five years ago, he was the one initiating conversations on the cost of treatment.

“Nowadays, it’s more like 50-50,” Miller said. “It often starts when I begin to recommend a course of treatment. They are more upfront about saying ‘I really don’t have a lot of money right now.’

“It’s most uncomfortable when I talk with patients who want to put off further treatments for several months, or don’t get a prescription filled, because of concerns about cost.

“There are others who put off treatment out of a hope that they’ll land a job with health benefits by the time something might get serious,” he said.

A recent study of North Carolina employers by Mercer Human Resource Consulting found that they expect to pay a smaller increase in employee health-insurance costs next year.

The survey of 99 North Carolina employers — all with at least 10 employees — found an average projected increase of 4.7 percent over 2009 costs. The employers said they expect to achieve that goal by passing on more costs to their workers or by changing insurance plans or insurers.

Without making those changes, the average increase would be 7 percent.

Steve Graybill, a Mercer senior consultant, said that consumers could “benefit immensely” from having a discussion on the cost vs. the benefit of treatment options.

“That way, the doctor and consumer can agree upon an informed course of action,” Graybill said. “Most insured consumers do not even understand their maximum out-of-pocket cost should they have a major event.

“We will be unable to get medical cost under control unless we are all more educated on the cost of treatment.”

Hall said he encourages patients to bring up financial concerns in the examination room.

“You shouldn’t be afraid to talk to doctors about having to pay for things,” he said.

It’s not like having those conversations would be groundbreaking, Hall said. Several generations ago, before employer-sponsored health insurance was standard, doctors hashed out payment with patients daily.

Hall said that many doctors need training on how to effectively talk with patients about money.

“The experienced physicians interviewed for this study suggested asking patients not about ability to pay, but instead about the extent of the patient’s insurance coverage,” Hall said.

“That way, they could avoid the embarrassment some patients feel admitting they can’t afford their doctors’ bills. This is just a fact that the doctor wants to know about.”

Hall said that by having the cost conversations, “if a patient subsequently chooses to take a cheaper route, there’s little chance of a lawsuit because the choice is ultimately for the patient, not the doctor, to make.”

photo credit: The Library of Congress

Healthcare Premiums Could Spike 20 Percent:

Many small employers face hikes of 20% or more for health benefits in 2010, local insurance brokers say. Large firms are in line for a more-moderate average increase of 5.8%, although that’s the steepest in four years, according to a recent survey of Chicago-area firms by Lincolnshire-based Hewitt Associates Inc.

Business hasn’t taken advantage of health savings account insurance plans, and now may be the time to revisit this approach to insuring employees.

It benefits the employer through reduced premiums, and the employee gets the the savings account (that carries over each year). Over a few years the account becomes sizable.

The real benefit to the insurance plan is that by paying for medical care, patients learn the real value of the care they are receiving. Also, doctors like being paid at the time of service, and often offer discounts for doing so.

The health savings plan also provides a tangible reason to focus on wellness. When it’s your money, you tend to look after it more than when it’s free.

The Patient-Doctor Alliance offers many health insurance options for out members. You can find out more by clicking here.

You can also read more about health savings accounts here.

photo credit: the_amanda

As the polls continue to be release on healthcare reform, it’s beginning to appear obvious that the polls are being manipulated to reflect partisan messages and goals.

Examples:

AP Poll: Public favors gov’t health plan

WASHINGTON — More Americans support creation of a new government-run health insurance plan to compete with the private insurance market, a new Associated Press poll finds, but the level of enthusiasm depends on how the question is asked.

Tell people that letting the government sell insurance would be cheaper for them, and a majority is in favor.

Tell them the government would be making decisions about what medical care they could get, and support sinks.

Poll: People not liking Obama health care plan

Then my favorite:

AP POLL: How to pay for health overhaul? Tax rich

The House bill would impose a 5.4 percent income tax surcharge on individuals making more than $500,000 a year and households making more than $1 million.

The poll tested views on an even more punitive taxation scheme that was under consideration earlier, when the tax would have hit people making more than $250,000 a year. Even at that level the poll showed majority support, with 57 percent in favor and 36 percent opposed.

“You know, I mean, why not? If they have that much money, it should be taxed,” said Mary Pat Rondthaler, 60, of Menlo Park, Calif. “It isn’t the same way that the guy making $21,000 is.”

Not everyone agreed.

“They earn their money. And they shouldn’t have to pay for somebody else. It doesn’t seem fair,” said Emerson Wilkins, 62, of Powder Springs, Ga.

An income tax increase on all Americans to pay for a health care remake — an approach Congress never considered — was overwhelmingly rejected in the poll. Seventy-five percent opposed that idea, and only nineteen percent were in favor.

Keep in mind that in Canada, and other universal healthcare countries, tax rates are significantly higher for all citizens.

So, let’s not fool ourselves. Healthcare reform is going to cost us all… a lot. So now is the time to decide if the government solution is right for America.

The Patient-Doctor Alliance believes that Americans can reform the system themselves.. through bringing the doctor and patients together to overcome special interests.

Tort reform, inefficiency, defensive medicine, high costs.

These will not go away with Obamacare. Only we can do it.

As millions have lost their jobs, health insurance becomes a major issue. Cobra The stimulus bill subsidizes 65% of COBRA premiums for workers laid off between Sept. 1, 2008, and the end of this year.  The subsidy only last for nine months.

COBRA allows workers who leave their jobs to continue their former employer’s health insurance coverage for up to 18 months. To keep COBRA coverage, they’ll have to pay 102% of the premiums. For the average family who is eligible for the subsidy, monthly premiums will jump to $1,078 a month from $377, according to the Kaiser Family Foundation.

Here are some timely tips from Sandra Block – Wellness.com

Losing your COBRA subsidy? You have health insurance options

*Don’t drop COBRA until you’ve found another source of insurance coverage, “even if you’re paying through the nose for a month or two,” says Phil Lebherz, executive director for the Foundation for Health Coverage Education, a non-profit supported by insurance companies. Applying for a private health insurance policy won’t affect your eligibility for COBRA, and once you’re approved, you can stop paying COBRA premiums. But if you drop COBRA and are turned down for private insurance, you could find yourself without coverage, Lebherz says.

*Consider different coverage for different members of your family. Find out whether your children qualify for the Children’s Health Insurance Program. CHIP is a federal-state partnership designed to provide insurance for families who are ineligible for Medicaid but can’t afford private insurance.

CHIP is particularly valuable if any of your children has a chronic medical condition, such as asthma. Most private insurers charge much higher premiums for family members with such conditions, or may not cover them at all.

For more information about your state’s CHIP coverage, go to www.insurekidsnow.gov.

If you or your spouse suffers from a chronic medical problem, you may be able to continue COBRA for that spouse and buy an individual policy for the healthy partner, says Marty Rosen, executive vice president of Health Advocate, a company that helps workers navigate their insurance coverage. You’ll lower your COBRA premiums while maintaining coverage for the spouse who may be unable to get private insurance. Check with your former employer first to find out if this change in coverage is allowed under the terms of your plan.

*Get a part-time job. Some large employers provide group coverage for part-time employees. To qualify, you’ll probably have to work a certain number of hours each week. Your portion of the premium may be higher than you paid when you had a full-time job, and you may have a higher deductible. Still, an employer-provided plan could be less expensive than an individual policy, Rosen says. And if the employer offers a group plan, you can’t be turned down because of a pre-existing condition.

Starbucks, for example, offers health insurance to employees who work at least 20 hours a week. Its least-expensive option costs about $40 a month.

*Buy an individual insurance policy — but scrutinize the details first. Premiums “are only part of the story,” Rosen says. Look at deductibles, co-insurance, lifetime coverage caps and conditions the plan may not cover. Also important: whether there’s an annual limit on your out-of-pocket costs. Look for a plan that provides 100% of coverage after you’ve spent a specific amount. Otherwise, you could end up spending thousands of dollars for your care.

You can review private health insurance policies at www.ehealthinsurance.com.

*Buy a short-term plan if you know you’re going back to work soon or are approaching Medicare eligibility. Many insurance providers offer temporary plans for up to a year. These plans are generally less costly than traditional individual plans. However, they should not be used as a substitute for long-term insurance. If you file a claim, there’s a good chance the insurer won’t renew your coverage when it expires.

The long and short is, Cobra is not the answer for a lot of people facing extended out-of-work situations, and also for those that are going from a job to a self-employed situation.

The Patient-Doctor Alliance is close to releasing an alternative for Americans… one to help navigate these troubling times. We’re working on a healthcare reform solution that helps both patients and doctors, while lowering the costs for everyone.

photo credit: inoneear

The Alliance For Health Reform brief looks at why the nation has a physician shortage, and what can be done to help ensure access to care after reform.

Some solutions explored are:

1) incentives for newly trained physicians to join the primary care workforce,
2) reforming provider payments to encourage primary care, and
3) reorganizing health care delivery so that more patients have an ongoing relationship with a primary care provider.

Written by Deanna Okrent, Alliance senior health policy associate. Supported by the Robert Wood Johnson Foundation.

Policymakers are debating how to cover the more than 46 million uninsured in the U.S. But if tens of millions of Americans gain coverage, does the current health care system have the capacity to meet the new demand?

It is estimated that more than 36 million people already live in physician shortage areas and are currently underserved. Projections indicate a worsening of the shortage even if coverage is not expanded. Other studies show that a decline in access to health care was already evident during 2003–2007. The decline in access was clearly related to physician shortages, including a lack of specialists.

Particularly striking was how long it takes to schedule an appointment in underserved areas. Health insurance issues presented other barriers, including instances where the health plan would not cover particular treatment options, and where the provider would not accept a patient’s insurance.

Though committees of jurisdiction in the U.S. House of Representatives and the U.S. Senate are addressing these and other insurance issues in the health reform proposals under consideration, the question remains: Will the shortage of physicians and allied health professionals, especially those in primary care, be exacerbated by health reform, or are there adequate provisions in the proposals to allay the shortage?

The declining interest in primary care as a professional goal contributes to the adult primary care shortage.

U.S. medical students are less interested in such careers now than they were in the late 1990s. Far fewer medical graduates entered residencies in family medicine and internal medicine in 2009 than in 1999.

Among the reasons graduating physicians choose specialties and subspecialties rather than careers in adult primary care are:

1) the large educational debt they accumulate and

2) the relatively low compensation primary care physicians receive, meaning it takes longer to pay back their debt.

The median income of family physicians was a little under $200,000 in 2009 vs. $548,186 for neurosurgeons and $641,728 for spinal orthopedic surgeons. With some regional variation, anesthesiologists, cardiac surgeons and dermatologists all earned in excess of $350,000.

It’s not just the money that steers medical graduates into the higher paying specialties. “When we get people in medical school, we often don’t mentor them,” said Nancy Dickey, president of the Texas A&M Health Science Center and a former president of the American Medical Association. “We don’t tell them that family medicine or general internal medicine is a good place to go.”

In addition to these barriers, rural areas face difficulties recruiting and retaining primary care providers due to professional isolation, limited for spouses. Recruiting physicians to practice in a rural area is somewhat easier and retention more likely if the physician grew up in a rural area. However, relatively few students from rural areas pursue medical careers, resulting in an unequal distribution of physicians and other health professionals between urban and rural areas.

Public programs and states implementing health reform provide additional examples of access barriers. Having a Medicare card, for example, does not guarantee access. As some people turn 65, they may find that their longtime provider who previously accepted their private insurance does not accept Medicare.

Though most beneficiaries do not encounter this problem, those who do have to seek primary care providers who will accept new Medicare patients. Ten percent of Medicare beneficiaries report seeking a new primary care provider. Of these, about 30 percent report having some difficulty finding a new primary care physician. This compares to 15 percent of beneficiaries seeking a new specialist and 15 percent of this group having difficulty finding one.

Some primary care physicians and specialists choose not to be Medicare providers because the program’s reimbursement rate is well below their customary rate. Medicare fees average 81 percent of private payers’ fees, a percentage that varies widely from place to place. In addition, physician practice costs have risen steadily over the past decade, while Medicare reimbursement rates to physicians are virtually unchanged. The Medicare Sustainable Growth Rate formula (SGR)could force repeated andsizeable cuts in Medicare payment to physicians in thefuture, putting access at evengreater risk. (For more information on SGR, see the testimony offered at a Sept. 11, 2008, hearing on Reforming Medicare’s Physician Payment System by the House Ways and Means Committee’s Subcommittee on Health .

Provider payment rates tend to create barriers for Medicaid beneficiaries as well. Medicaid reimbursement rates are set by states and vary widely. Overall, Medicaid fees are 72 percent of Medicare fees—66 percent for primary care services. Medicaid beneficiaries in many states have long found a limited supply of physicians willing to accept that form of payment, severely limiting their choice of providers.

Many physicians claim that Medicaid reimbursement schedules do not cover their costs. Some states have raised, or are looking toraise, reimbursement rates to improve this situation.
Massachusetts, for example, has raised its Medicaid payment rates for doctors and hospitals to help address the capacity issue.

Research shows that ethnic and cultural diversity among providers is important to improving access to health care, particularly in disadvantaged communities. Health professionals from racial and ethnic minority groups are more likely to practice in primary care settings that serve their corresponding minority groups, and tend to practice in underserved areas more frequently than their nonminority colleagues. Support for training programs that promote diversity in the health care workforce can improve access in these areas.

Some analysts call for a three pronged approach to remedy the primary care dilemma: revitalizing the training pipeline, reforming provider payments and reorganizing health care delivery.

Revitalizing the pipeline

Relief from medical education debt could provide an incentive for newly trained physicians to join the primary care workforce. The American Recovery and Reinvestment Act of 2009 (ARRA) provided such relief through expanded funding for the National Health Service Corps. It is too early to measure the effect of this effort.

The House health reform bill (H.R. 3962)* would build on ARRA and expand support for primary care through the National Health Service Corps, bringing scholarships and loan repayment funding levels to $300 million annually.

The House bill also contains measures to prepare the workforce to adapt to changes in health care delivery; and recognizes the need for diversity in the health care workforce. The bill also supports expanded nursing education, and the training of advance practice nurses who will deliver care in shortage areas.

The bill approved by the Senate Committee on Health Education Labor and Pensions (HELP) addresses workforce issues in two major provisions. One would establish a National Health Care Workforce Commission to make recommendations and disseminate information on workforce priorities, goals, and policies including education and training, workforce supply and demand, and retention practices. The other provision would enhance graduate medical education (GME) to increase the supply, education, and training of doctors, nurses, and other health care workers, especially in pediatrics, geriatrics and primary care.

This part of the bill authorizes $125 million in grants to develop and operate training programs and academic units in primary care, including financial assistance of trainees and faculty, and faculty development in primary care and physician assistant programs. It gives priority to programs that educate students in teambased approaches to care, including the patientcentered medical home. Provisions to support an increase in funding for GME with a preference for primary care also appear in the Senate Finance Committee bill.

*  The provisions in various health reform proposals cited as of this writing are likely to receive extensive debate in Congress and may be revised throughout the legislative process.

Reforming provider payments

More health care professionals might enter primary care if they were paid more or differently. This could mean paying physicians more for primary care services such as chronic care management that don’t necessarily require visits to the doctor’s office. It could also mean paying for allied health care professionals, such as nurse practitioners and physician assistants, to provide some of the services previously delivered by physicians.

Paying differently might mean bundling payments for physician and hospital care, and paying for episodes of care rather than fee for service for individual visits or procedures. Many questions arise when considering payment reform. They include: Where will the money come from? Will specialists have to sacrifice some of their incomes for the system to be able to distribute more to primary care physicians? In bundled payments, who gets the payment? How will episodes of care be defined? Will there be monetary rewards for higher quality outcomes?

Reorganizing health care delivery

The private sector has fostered a number of innovative integrated delivery system models that have been able to cut costs, improve quality and offer patients a “medical home.” Examples include the Mayo Clinic, Intermountain Healthcare and the Geisinger Health System. Though hard to duplicate widely because of their unique organizational histories, these models have been getting a fair bit of attention.

The patientcentered medical home (PCMH) is believed by some to be an important practicereform model. A PCMH offers coordinated care in treating the complex needs of chronic care patients. It provides a health care setting where patients have an ongoing relationship with a primary care provider, and have access to nonemergent primary, secondary and tertiary care that is linguistically and culturally appropriate.

Though private sector models have been ongoing for several years, the Medicare Medical Home demonstration project authorized in the Tax Relief and Health Care Act of 2006 granted its first awards in January 2009. A provision in the House bill would establish a Medicaid Medical Home pilot program as well.

Both the Senate HELP Committee and Finance Committee bills, and the House bill call for Medicaid expansion to include adults who aren’t otherwise eligible. However, unless the Medicaid reimbursement rate is increased in most states, beneficiaries may find themselves without a “medical home.”

The HELP bill would also increase the number of community health centers and schoolbased health centers, steps that may help to alleviate a barrier to access for some populations.
Massachusetts offers both cautions and encouragementto supporters of nationalhealth reform.

That state’s farreaching health reforms went into effect in the fall of 2006, ushering in an era of nearuniversal health coverage. Between fall 2007 and fall 2008, working age adults (age 18 to 64) were more likely than before to report that:

• they had a usual place to go when sick
• they had one or more doctor visits in the past 12 months,
• they had seen a specialist in the past 12 months,
• they had a preventive care visit or a dental care visit, and
• they had taken any prescription drug.

“Gains in insurance coverage have translated into gains in access and use in the state,” said Sharon Long of the Urban Institute, who has extensively studied the reform effort there.
But the increased number of insured in Massachusetts created some bottlenecks. Between fall 2007 and fall 2008, the share of adults reporting that they did not get care they thought they needed in the past 12 months increased slightly for:

• doctor care
• specialist care
• medical tests, treatment or followup care,
• prescription drugs, and
• dental care.

This demand is expected to stablize over time as people have coverage for a full year and longer, according to Ms. Long. The increased demand, moreover, created an environment ripe for innovative solutions to take hold. Retail clinics came in to help fill the access gap and within a few months, more than ten thousand patients were treated for acute problems on a walkin basis.

However, retail clinics are not seen universally as a solution to filling primary care shortages, and the rate of expansion of retail clinics in Massachusetts has not been mirrored nationwide. In fact, most large clinic chains have not met growth expectations; there were more clinic closings than openings in spring 2009. A change of strategy may be on the horizon, with analysts foreseeing more retail clinic partnerships with hospitals to help clinics weather initial losses in tough economic times.

Other innovations in Massachusetts include supporting access through alternative payment methods on the part of the insurer. Blue Cross Blue Shield of Massachusetts is experimenting with an Alternative Quality Contract— a five year, global payment contract in which the physicians and hospital are paid as a single system accountable for meeting quality and cost standards. Primary care payments are to be significantly increased.

No matter the approach toexpanding coverage, policyoptions to improve accesswill need to be considered as well. Among these, workforce issues merit major consideration. Proposals to establish a national planning commission to address workforce policy appear in the House bill and the Senate Finance Committee bills.

Such a commission might consider workforce policy issues like training and education, recruitment and retention, payment reform, and the use of an expanded workforce— including physicians, nurse practitioners, physician assistants and other clinicians and allied health professionals—to meet current and future health care needs.

As evidenced in Massachusetts, health reform is a dynamic process. Coverage expansion is not an end, but a beginning. The reform process will have to continue to address other aspects of access to care, including expanding the workforce and serving the underserved while changing payment incentives, maximizing efficiency, and improving quality.

photo credit: interplast

From the Harvard Business Site:

Health savings accounts (HSAs) are tax-protected savings accounts connected with a high-deductible, low-premium plan. Most HSAs provide for a fully covered annual physical and then a high deductible for any other medical needs. The HSA account carries over year to year and can be used tax-free to pay for any medical, dental and most alternative medicine treatments. Upon retirement HSA funds can be withdrawn without penalty for retirement (however funds used for expenses other than medical are taxed as income).

Sounds simple.. so why isn’t everyone on one.

Probably because employers haven’t jumped in.. yet.

The plan makes a lot of sense, and it has great benefits:

1) You allocate a part of your premium to a savings account. This is forced savings and comes from money that was being spent already. This money follows you when you leave jobs and grows each year.

2) You change your insurance to a high deductible plan, saving close to 70%. This means you’ll be covered for anything over the deductible, of say $5,000.

3) Overall the cost of insurance drops… up to 40% for a family. This is after you take the savings account contributions into account.

The real benefit to the overall system is that because you are paying cash for doctor visits, and regular medical care under $5,000,you let the doctor know you have an HSA – which leads to getting a discounted rate.

Doctors are willing to give a discount because they get the money at time of performing the service. One of the largest challenges doctors face is cashflow, as the health insurance companies can take months to process payments.

When patients begin to get the sense of the real cost of health care, they become more responsible in contriolling it.

Everyone wins.

And with an HSA, you actually build financial security over the long haul…

I’d be interested in hearing from anyone that is on a Health Savings Account plan. Let me know how it’s working out.

photo credit: Liutao