Alithias

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I was having coffee with a client and overheard a woman next to me say, “I agree, but she is a bit much!”… and well, I guess my phone heard her as well ?? because this post popped up on my Pinterest feed - and I have to say, I just loved it ?? Be ‘a bit much’ today!! It’s also Red Cup Day at Starbucks! ?? Happy Thursday!

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“We, not I” ?? Happy Monday! - Alithias team

Dear Orthopedic Surgeon, One of my patient advocates referred a patient to your practice today. We chose your practice because we can see through our medical claim analytics that the expected cost for this procedure at your facility is 30% - 40% less than the area average. We can also see that the who perform the procedure in your practice are considered "Top Tier" (scoring in the top 25% of all orthopedic surgeons for patient outcomes for this procedure). My advocate faxed the patient's insurance information and order for the procedure to your office. The advocate called your office to let your staff know we were sending you a patient, confirmed your office received the fax and asked your staff to call the patient for scheduling. Your staff said they would call the patient. My advocate relayed this information to the patient who was excited she was going to a great doctor and that she would receive a significant cash incentive after the procedure. 9 days later, your staff still hadn't contacted the patient. My advocate called your office again and was assured the patient would be called. 3 days later, still no call. My advocate called your office again. 13 days after the initial outreach, your scheduler called the patient. Instead of welcoming this patient, your scheduler asked the patient, "Why are you driving all the way over here for this procedure? Aren't there doctors closer to you?" Following that interaction, the patient called my advocate and asked, "The doctor's office was surprised that I was going to their practice. Are you sure this is the right place?" You almost lost a patient (and >$25,000 in revenue) that day. Have you ever called your own practice to see how patients are handled by your intake staff? Have you surveyed any past patients about their experience in your practice? Sadly, today I removed a high value practice from our list of options for patients because of how the office staff treated patients we referred there. We appreciate the value your practice provides. But there are other high quality / high value options that also include a great patient experience. Some of them are listed at the bottom of this post. Yours is not. Orthopedic and Sports Institute OSMS Green Bay Chippewa Valley Orthopedics Twin Cities Orthopedics Summit Orthopedics SolsticeHealth Orthopaedic Associates of Wisconsin Orthopaedic Hospital of Wisconsin Renovo Health, Self Fund HealthJacob FastMelina (Marie Elena) KambitsiKyle L. MonroeChristina WipperfurthSmartScanMRIJane SanfordKeith SmithTimothy Murray, M.D.Jessa Cisewski, RNJessica ReederSteven Borene MDJosh JohnstonJeff Utoft David Foucachon N Scott Borden,Kenneth Strmiska Robert PfeifferJory ZunichAlex GeorgeAshlie DoverMichael HennessyAndrew BriggsKara PetersonGrace Torres Hodges, DPM, MBACharlie BerensGrace, RoryWrightMD, StankeNicole Hemkes MD MPHMarty Makary M.D., M.P.H.Jake Nolin, Patrick BlackallerWendell PotterTerry ShookMadelaine Feldman, M.D.

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?????????? ???????????????? ?????????????? ???????????????? ??????! ??? ??? ?? ??????? ???? ???????? ??? ???????????? ?? ?????????? ?? ??? ???????? ??? ????????? ?? ??? ??????????. ????? ??? ??? ???? ?????????? ????????? ?? ????????? ????????????? ??????? ??? ???????? ?? ??? ???????? - ??? ???? ?? ??? ?? ???? ?????. ????? ??? ??? ????? ??? ??????? ???? ?? Alithias ?? ????? ??????? ??????? ???. #???????????

The President stopped by my office last week. Parts of that statement is factually true as proven by the accompanying picture. The President did stop, and he was physically "by" my office. I didn't talk to him, but if I had the chance I would have asked him the following questions. 1). Despite the ACA passing in 2010, over 26M Americans still don't carry health insurance today and the number one reason is that it's too expensive. What plans do you have to reduce the cost of insurance coverage? 2) In many cities there is just one healthcare system that may operate like a monopoly, charging significantly higher rates for similar procedures in more competitive markets. Do you support Certificate of Need laws? In what ways will you discourage monopolistic actions by health systems in markets with no / few competitors? 3) The Cares Act required health systems to publish the reimbursement rate they receive across the insurance companies for which they have contracts. Reports say less than 50% are compliant, meaning the data must be accessible in machine readable files, cannot be behind a firewall, prices for 500 unique procedures must be included, the data for most insurance companies must be published, etc. My personal experience when working with the data is that <10% are compliant. Very few hospitals have been fined for non-compliance and few people, even people like me who have analyzed medical claims for >10 years, can make sense of what is published. What is your plan to increase compliance and require adherence to this law? 4) One of the key factors contributing to the shortage of physicians is the number of residency programs that is artificially limited due to the lengthy process to get new programs approved. What are you doing to increase the number of residency seats for new prospective physicians? 5) Do you believe that there is a conflict of interest when an insurance company owns both the hospital and the physicians providing the services, and the software to facilitate claim adjudication? Do you think that an insurance company that owns a hospital and a majority of the physicians in a monopoly market has an incentive to reduce the cost of care? What legislation would you propose to reduce or eliminate this possibility? 6) Staying on that topic, what legislation would you propose to reduce the risk of a single administrator or claims adjudication software provider effectively shutting down all payments to doctors and hospitals for many weeks, regardless of the reason for the disruption? What is the legislative recourse for these doctors and hospitals when their biggest payer happens to be the insurance company that also owns the adjudication software? I don't know what his answers would be, but it would be an interesting discussion.

From all of us at Alithias to all of our customers, brokers, partners and friends, Merry Christmas to all! We wish everyone a safe and happy holiday season!