Thursday, July 17, 2014

Bald-Faced Prediction: Self-Funded Businesses Will Directly Contract for Care

Bald-faced lie.

An obvious untruth

I shall make a bald-faced prediction, an obvious truth, as contrasted to a bald-faced lie, an obvious untruth:

Direct self-funded health care , whereby employers provides health benefits to workers with its own funds will be the wave of the future.

Self-funded plans differs from fully-funded plans where the employer contracts with an insurance company to cover employees and dependents. These direct contracts will be with both independent direct pay primary care physicians and specialists and with ambulatory surgery centers, and in some cases, with hospitals specializing in special procedures requiring hospitalization and overnight or lengthy treatment.

The reasons for this switch in corporate strategies to direct-pay are self-evident.

1. It offers cash flow advantages. You know where your money goes and when to pay it .

2. You achieve significant cost savings, sometimes 30% to 50% savings.

3. You, rather than the insurance company, control the plan.

4. You can achieve flexibility by negotiating directly with the provider, rather than through the insurer.
5. You avoid paperwork and cost-generating, often bureaucratic delays, by dealing directly with the provider.

6. The total cost of the procedure or bundle of care is transparent in advance.

7. You avoid significant comprehensive mandated benefits, often imposed by states and governments at all levels, which are often unrelated to the procedure itself.

8. You satisfy employers, patients, and providers through lower costs, immediate access, and predictable outcomes.

9. You can contract for bundled primary care/concierge/retainer care and ambulatory surgery care.

You can control your costs for common procedures and services which can now be performed at ambulatory surgical centers and doctors’ offices at bundled prices agreed upon bundled prices in advance.

These procedures and services include operations and services increasingly performed because of an aging workforce, and which include.
1. Hip, knee, shoulder, and other joint replacements and procedures.

2. Cataract and other opthalmology procedures.

3. ENT procedures, cosmetic and otherwise

4. Endoscopic procedures such as laporoscopic gallbladder or other organ removals or procedures.

5. Bone marrow or other procedures requiring needle insertions or aspirations.

6. Cardiac procedures, some ambulatory, some requiring hospitalization.

7. Orthopedic microinvasive techniques for spinalstenosis and disc problems.

8. Imaging procedures – CT scans, MRIs, and PET scans.

9. Cosmetic procedures - face lifts, nose procedures liposcopic fat removal , breast and buttock augmentation, and skin cancer biopsies and excisions.

Medicare-approves 0f 2162 ambulatory surgery center procedures. With the shift towards outpatient-care and the drive for cost reductions, the number of indepedent ambulatory care centers and procedures will almost certain to increase. Many of the direct pay ambulatory care centers, by definition of the word “direct”, are not associated with Medicare, and more directed towards contracting with self-funded corporations. The number of procedures independent ambulatory surgery centers perform will not approach the number approved by Medicare, but the number pf procedure done are destined to mount.

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