Golden Rule of Reimbursements
There are grumblings in Vermont about the disparity of payment to independent doctors versus hospital based doctors:
In 2015, commercial insurance companies reimbursed independent doctors about $100 for a typical primary care visit and paid academic medical centers $168 for that same service, according to data the Green Mountain Care Board’s staff presented at the meeting.
That’s a 68% pay raise, most of which goes to the hospitals, by the way. The brilliant cracker jacks on the Green Mountain Care Board are trying to figure a way to fix this. Their only answer is either to strong arm the hospitals via the budget process or make everyone join their “all-payer” model. As one member said:
“In a perfect world we would let the all-payer model solve this problem.”
Are you kidding me?
(Sign up here for your free newsletter. No Spam. No giving out of your info. Promise.)
The hospitals rule because they have the power. The medical golden rule is that those who have the gold make the reimbursement rules. And the hospitals have the gold. Independent doctors who continue to compete with this will always lose. In a perfect world, we need to leave the insurers behind and do direct primary care and NOT an all-payer model, which is more of the same.
It’s not clear from the article whether the different is the hospital facility fee, but it sounds like it. The facility fee is a huge boondoggle. I talked to a hospital administrator about it, and basically he said regardless of whether it was right or wrong it is the law and the hospital will take advantage of it.
How about a return to balance billing? The insurer says we’re going to pay X for this service, regardless of who provides it. The patient pays the difference. That would definitely put some market pressure on the academics to lower their charges.
C’mon guys, these hospital administrators need their golden parachutes…
And, lest anyone worry, this applies across the board, in all specialties. Therefore the problem, dollarwise, is exacerbated.
Spot on, Doug!