Heathcare

Post: Fixing Problems

Are you having trouble fixing a problem?

I was talking to a colleague yesterday about the fact that people most often call me when they have a problem and they are having trouble fixing it. Why?

Common Issues:

1/ Flawed assumptions: Assumptions are made about what’s causing a problem without checking all the facts.

2/ Timeline: Deadlines to get the project done and the need to get it done overshadows whether it’s the best solution or not.

3/ Perception: People outside the department or discipline don’t understand or don’t care enough to prioritize your needs.

Best Advice: Taking a step back to reassess things is hard but it’s worth taking the time to get it right.

What I know to be true:

1/ People might not understand your needs but that doesn’t mean they don’t care. Help them understand.

2/ Often systems and processes just need to be fine tuned. Fine tuning requires less work than starting a new for your limited resources such as engineers.

3/ Deadlines are sometimes arbitrary. Know whether the deadline is someone’s ideal deadline or a real one and why.

Post: Self-Care

What do you do afterwork to decompress and recharge your batteries?

It was a ice-breaker question that members of a business group needed to answer as part of their introduction. Almost everyone in the group started with something along the lines of “well I know that I should be exercising” but what I really do is …. guess what they said.

As some of you know, I’ve been trying to get more people working out and living a healthier lifestyle [aka: Hello Workout]. My introduction was last so there was no bias in the responses for what I do or anything that I said.

After hearing everyone’s “confessions”, I almost felt bad introducing myself and sharing a bit about my lifestyle. If you’re wondering, I am a strong believer in regular maintenance whether it’s my car or my body. Both work better when they are cared for properly.

Inspiring, nudging and telling people to workout might not be the right approach. It makes people feel ashamed and it makes people initiating the conversation feel bad. It’s awkward all the way around.

Many in the business group talked about caring for others. There is no shame in caring for others. So maybe the better question is “How do you care for yourself?“.

Words are powerful. Simple changes can make a big impact.

Shame steers people into a life of silence, inactivity, lying and hiding.

~ Harriet Lerner

 

Post: Balance Billing

More regulations or should we fix the payment system?

Years ago, I attended a ABA conference and asked “why don’t we just fix the payment system” rather than add more regulation. I am reminded of that event this morning in reading the KHN proposed options for addressing balance billing.

The proposed solutions are a bunch of new federal and state laws addressing charges and billing practices. Regulation is an important part of protecting individual Americans against corporate wrong doing. However when regulation is used as a bandaid, regulations become part of the problem.

In the case of healthcare, additional cost. High cost is one of the big issues that the industry needs to address in order to make healthcare more affordable.

The problems that need to be addressed are:

1/ Fragmentation: Makes it difficult for patients to navigate and costly to administer.

2/ Network: Not all providers participate in commercial networks which means some patients are exposed to balance billing.

3/ Transparency: Insurers and healthcare providers don’t want their contracted rates shared to enable the consumer.

4/ Current Billing Regs: Healthcare services and products are marked up because everyone needs to be charged the same and there is variability in the contracted rates.

The problems require a more fundamental change.

Universal healthcare

Is it the end of employer-sponsored healthcare or the beginning of employer-driven healthcare?

When I posed this question to my Linked In network, many people viewed the post, some followed up for links to sources but no one commented even though healthcare is top of mind right now for many Americans.

Healthcare is an emotional topic. It’s something that everyone wants and needs but most Americans are struggling to pay for it. The healthcare jobs boom is still going strong which means the total cost of healthcare is continuing to increase. While there doesn’t seem to be a rolling average cost of healthcare per GDP publicly available to see the impact, the math is pretty simple  – more jobs means there is more healthcare being delivered which means more cost.

The total cost of healthcare will not decrease until we curb demand. 

Consumer Driven Healthcare initiatives failed.

Consumer driven healthcare initiatives such as high deductible health plans curbed demand in the short run but resulted in more costly healthcare outcomes. Americans simply couldn’t afford to pay their premiums and the patient portion of healthcare services under those plans. Consequently, they didn’t seek treatment until their health issue became a big problem. In simple terms, big problems cost more to treat. Other consumer initiatives such as pricing transparency never really saw the light of day.

Employer-Driven Healthcare

Employer-Driven healthcare is a new theory and consistent with the Republican trickle down economic policies. The assumption is that if the Republicans can tweak policies enough to get the economy to full employment, every American or at least nearly all Americans will get a job with healthcare benefits. In theory, all employers will offer benefits that are rich enough to ensure timely access to healthcare services.

Some employers are taking initiative to implement on-site and near site clinics, lower deductibles and implement wellness initiatives even though there is a perception that wellness doesn’t work.

There are ways to make wellness programs work better but the key words for an employer-driven healthcare system to work is ALL and SOME. If only some employers offer rich benefits, many Americans will continue to be underinsured or uninsured.

Medicare for All

The idea of “Medicare for All” was endorsed this weekend by former President Barak Obama. The initiative is gaining traction due to the economics and financial condition of Americans.

1/ Healthcare is becoming a bigger portion of the take home pay of low and middle income Americans which means they have less money to spend on housing, food, clothing and other life essentials that affect their health and wellbeing.

2/ The middle class is eroding to the point that it needs to be supported with social wealth-fare spending. Reportedly, $1 in every $7 is now spent to subsidize the middle class.

3/ Republicans are working to privatize Medicare. More health plans are getting into the Medicare and Medicaid business. According to the press release for Oscar Health, it is a more “lucrative” segment. Oscar [co-founded by Jared Kushner’s brother, Joshua] historically sold individual and family plans on the exchanges. Many of the people purchasing policies on the exchanges were sicker and needed more healthcare than expected.

4/ New Medicare Advantage plans are now addressing social determinants and covering many basic living costs. Bankruptcy filings are increasing in the senior population.

5/ Koch brother sponsored study reports “Medicare for All” saves $2 Trillion.

What does this mean for healthcare?

If we just look at the economic condition of many Americans and how the financial strain is impacting their health, it’s clear that we need a new universal healthcare system.

If we consider the changes underway to Medicare and the momentum of the “Medicare for All” movement, it looks like Medicare will be the underpinning of the new universal system. It’s a good thing for you because all or nearly all healthcare providers participate in Medicare, it has well established coverage standards for medical care along with a fee schedule and excludes bad actors from participation.

If we factor in everyone’s deep seated emotions about healthcare, we need a system that offers choice.

What we end up with is a two tiered system offering basic coverage for all Americans and enhanced benefits for those who choose and can afford to purchase additional coverage.

Simplicity wins:

There are plenty of models in other first world countries that can serve as a framework. The key is choosing a framework that simplifies the healthcare system for all to navigate and understand. Not only will it make it easier for all Americans to access care when they need it rather than when they can afford it. It will also reduce the cost. The administrative burden of the current system alone is estimated at 30% of the total healthcare burden in America.

Automation + Motivation

Learn what you should be doing now as automation changes the way people work and get rewarded.

Last week I read about a recent Bain & Company report estimating the automation of 40 million jobs [25-30% of US jobs] within the next decade. White color jobs are not immune from outsourcing or automation.

That’s eye opening but technology has made the world feel a lot smaller since the dot-com boom. When I first started my online training business in 2000, a healthcare CEO asked me where my colleagues were located. Everyone was scattered around the US. It seemed to make him feel uncomfortable, but even then high speed internet access enabled my development team to communicate and collaborate in real time.

The tools are better now but technology is also getting smarter. In 2009, I closed my online training business for two reasons:

1/ Much of the revenue cycle work and financial reporting in healthcare could be automated.

2/ The companies that needed a training program were more focused on extrinsic rewards.

Algorithmic Work:
Revenue Cycle work for the most part is algorithmic work or in other words, work that requires routine processing. At least 90% of revenue related transactions can be automated now if companies have invested in their systems. Old patient accounting systems that relied heavily on data entry as a source of information are now the problem because much of the information contained in them is dated and incorrect. There are better ways to obtain, use and store the patient data needed for transacting business.

Heuristic Work:
Automating revenue cycle transactions also changes the skillsets needed to manage the systems and do the remaining 10%. The work becomes less about routine processing and more about creative and analytical problem solving also referred to as heuristic work. Given the nature of the work, heuristic work typically cannot be outsourced or automated.

Motivation:
Many healthcare companies still rely on incentive based reward structures to motivate people to work. Productivity goals made sense when much of the work involved routine processing. Unfortunately, it doesn’t work the same way for people intrinsically motivated by the work itself. In fact, “if then” rewards are often counter productive because it turns something that people enjoy doing into the drudgery of work. Worse yet, decreases in intrinsic motivation can lead to destructive behaviors.

Goals may cause systematic problems for organizations due to narrowed focus, unethical behavior, increased risk taking, decreased cooperation and decreased intrinsic motivation. ~Drive by Daniel Pink

 

Referring back to #2 of my reasons, companies led by people who are driven by immediate extrinsic rewards underperform over the long term simply because they underinvest in training, systems, research and development. Same is true for publicly traded companies who provide the most earnings guidance to Wall Street analysts.

Drive
Drive by Daniel Pink is a book about Motivation that does a good job of connecting the dots of several leaders in modern behavioral research.

Extrinsic rewards are addictive particularly for type A personalities but at a certain point, they don’t make people happier. In fact, people driven by extrinsic rewards are more likely to feel anxious and depressed than intrinsically motivated people.

Three Ingredients of Motivation:

1/ Autonomy: According to Tony Hsieh, founder and CEO of Zappos and author of Delivering Happiness, perceived control is an important component of one’s happiness. When performance goals are tied to compensation it become more about the money and less about the work. Plus when performance metrics are varied they are harder to finagle.

2/ Mastery: Tony Robins recently posted on LinkedIn “All my past failure and frustration were actually laying the foundation for the understandings that have created the new level of living I now enjoy.” That’s mastery. It’s a lifelong period of effort to improve performance in a specific domain. According to Carol Dweck author of Mindset, the effort that it takes to master something meaningful [aka: pain] is what gives meaning to life.

3/ Purpose: The most deeply motivated people – not to mention those who are most productive and satisfied – hitch their desires to a cause larger than themselves.” There are some good examples in Drive of companies leading with purpose. One of which is Toms shoes and another good example not in the book is Patagonia.

For me, our online training program was about giving our students a career path to better job opportunities and a brighter future. That’s why I remained so passionate about it for so long.

So what do you need to do now:

1/ Figure out what type of work motivates you.

2/ Invest in your skillset rather than relying on your employer for training.

3/ Deliberately practice so that you improve.

4/ Identify your Why or in other words, your purpose.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

 

Learn the three Ds

Use the three Ds from the process of “Get Stuff Done” to make good decisions and be more successful at work and in life.

The three Ds are Discussion, Debate and Decision from the process of “Get Stuff Done” described in Radical Candor. I happen to be reading the book this week and used the three Ds as a framework for explaining my process for flushing out the problems, generating ideas and developing the right course of action from a project.

My application of the framework isn’t an exact textbook example. However, it has served as a good way to frame the complexity of the project and balance the complexity with the drive to get the project done.

Discussion:

According to the book, discussion is supposed to take place in 1:1 meetings. Meetings between managers and direct reports are supposed to provide a safe and constructive environment for discussing new ideas, challenges and other issues.

The discussion phase for me happens with a small group of subject matter expertise. It’s a low key discussion to flush out the details of the problem and constraints so that we can generate new ideas for how best to address the need. We basically spend the time thinking about what’s possible. Afterwards I send out a recap of our discussion and capture any additional thoughts on the matter. The recap ensures that we all left the discussion with the same understanding.

Debate:

Debates are bigger meetings to present the ideas so that others can raise their questions and concerns before a decision is reached. Keeping people in debate rather than decision mode is tricky when you have debaters and deciders in the room. Debate can be almost painful for those who already know what they want and/or want a quick decision. If you have ever felt like you got shut down too early during a debate meeting it’s a clear indication that you have debaters and deciders in the room.

The best thing you can do based on my own experience is to communicate your expectation for the meeting and what you want to get from it. If the ideas aren’t flowing, directly challenge the group on a specific problem or idea to spur further debate. The book has some techniques for making sure everyone is in the mind space for a debate meeting and for making it a fun process.

Decide:

People who have a strong grasp of the facts need to make the decisions. Those people are usually closest to the work. That’s why leading edge companies have a process for decision making and why many use the process for Getting Things Done. All of the meetings to discuss, clarify and debate the issues facilitate the decision making process.

The three Ds also help me respect the boundaries of my role as a consultant which is to help flush out the problem, generate ideas and facilitate the decision making process – and not make decisions no matter how tempting.

Application in life

You could apply the three Ds to other relationships as well. Think about the 1:1 meeting framework. When friends and family have problems, they often just want to someone to listen and to ask questions that help them clarify their issues and ideas. They don’t want to be told what to do and definitely don’t want to be judged.

Debate is necessary when decisions affect others. It gives everyone an opportunity to ask questions and raise their concerns so that they can be addressed before a decision is made. Debate often ends too early in the process and unfortunately, the relationships suffer. So keep the debate going until you can make a good decision.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Single Payer System

A Single Payer System will help “Make America Great Again”.

I am convinced healthcare in American needs to become a single payer system with an option to purchase private insurance. Why?

Many American are still slipping through the cracks of the current system because it’s so fragmented. With health insurers pulling out of the exchanges and the uncertainty of CHIP, even more Americans are likely going to slip through the cracks in 2018.

While reading Option B this weekend, I learned that 46% of Americans cannot afford to pay $400 in the event of an emergency. It’s no wonder hospitals are seeing an increase in bad debt. The average deductible in 2016 was just shy of $1500. With more Americans trying to lower their premiums, it’s reasonable to expect deductibles will continue to increase. Higher deductibles and out-of-pocket maximums means many Americans are underinsured and exposed to excessive financial risk.

Illness is a factor in more than 40% of bankruptcies and there is evidence that people with cancer are more than 2.5 times as likely to file for bankruptcy. Even relatively small unexpected expenses can have disastrous consequences: 46% of Americans are unable to pay for an emergency bill of $400. ~Option B by Sheryl Sandberg and Adam Grant

People need a certain level of support to shift into growth mindset which is essential to return America to greatness. Healthcare is an essential part of that support. As Sheryl acknowledged in Option B, paid family leave, quality healthcare and mental health coverage make the difference between people falling off and hanging on. In other words, they are essential to life.

Many leaders are acknowledging now that capitalism is not working for the vast majority of Americans. The fundamental goals of business and the welfare of Americans are misaligned.

I fully agree that the capitalist system as we know it with regards to compensation is severely out of balance when you compare the growth of executive level compensation with that of labor….The U.S. Middle Class is shrinking compared to the base of 1962 and is now about 47% of the population from about 62%… These are the kinds of trends that lead to social and political upheaval. ~ Fortune, CEO Daily

What’s clear is that we’ve tried to make universal healthcare coverage work and we’ve allowed things to get so far off track that we need to do something dramatically different. It’s time for Option B in healthcare.

We should consider a single payer system as the base of the American system. Access to healthcare should not depend on where people live or who they work for because it’s an essential service for the health and welfare of all Americans.

A single payer system is going to be expensive but to “make America great again” we need to reinvest in all people rather than just lining the pockets of the 1%. Warren Buffet one of the wealthiest people in American is onboard.

 

Subscribe to RUSH 360 for the latest developments in healthcare as well as our thoughts.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

 

No Easy Answers

There are no easy answers when it comes to healthcare.

Healthcare is something everyone wants because it’s an essential service for sustaining a healthy life. However, the cost of healthcare is what makes it a difficult service to provide to all Americans. Politicians are continuing to struggle with what to do.

Changes to the ACA are still up in the air …“the president has no interest in bailing out insurance companies.”

Proposals to sure up the insurance options available on the exchanges require subsidies for low-income consumers. The GOP is willing to authorize the subsidies but there is a catch. Republicans want states to have more control over the implementation of the ACA – which essentially means health insurance available to Americans will vary state to state. Consequently, Democrats have expressed their concern for the consumer protections which were a fundamental part of the ACA.

Insurers are threatening to pull out of the exchanges if the funds for subsidies disappear. Lindsay Graham is suggesting block grants to states if all else fails which no one seems to like either because some Americans will get generous benefits and others not enough.

There is one thing they agree on:

Either way you slice it both Republicans and Democrats seems to be pointing to the complexity of the current healthcare system as a problem.

Republicans are making a case for a free market system that makes patients behave as healthcare consumers. The thought behind it is that consumers will only pay for what they need if they know the price. In theory, healthcare becomes a cash business which negates the need for the complexities of the current healthcare billing and collection industry. The problem is healthcare consumers may not have the cash for needed care.

Democrats on the other hand are making a case for a Single Payer system which will place the financial burden on the tax payer. A single payer system would provide a basic level of coverage to all Americans regardless of their ability to pay. The challenge is in defining the basic level of coverage because when someone else is paying most people think more always seems better – even if it isn’t. Bernie Sanders plan will be presented on Wednesday.

Healthcare billing and collection cost providers approximately $52 billion/year. Either strategy will put pressure on the Revenue Cycle industry providing billing and collection services because the healthcare payment processes will likely be simplified.

Bernie’s Plan

Labeled “Medicare for All” but is really “ACA Coverage for All” paid for by the tax payer. Hence a non-starter plan even though it is backed by 15 Democratic representatives.

The cost would likely exceed any cost savings even if the government “negotiates” all the prices with providers and drug companies. But let’s wait for the white paper that explains the savings and funding before we judge.

Fair Price for Healthcare

Getting a fair price for healthcare is tricky because it’s not an apples to apples comparison.

Benefit season is starting soon. I’ve compiled some of my recent posts to help you get your arms around the latest strategies being offered to establish a fair price for healthcare services and to help you manage your total cost of healthcare.

Charges [aka List Price]:

Healthcare charges still seem to be a bit of a mystery to everyone. So let me start by explaining how most providers develop their list price and why.

The charge for most services in healthcare is based on a multiple of the Medicare fee schedule — at least initially. There are so many billing codes that it would be really hard for providers to keep up with the cost of each one which is why most base their charges on Medicare.

The tricky part is the multiple because every payer has their own methodology for payment. To capture the full amount due, the provider has to establish a charge that is sufficient to capture any outlier payer. Unfortunately, the multiple [aka: the markup] can make the charges seem unreasonable.

The charge for new services usually captures part of the cost savings so that providers are incentivized to adopt new technology. It helps them cover the cost of doing so. The charge and the price [contracted rates] consumers pay usually go down over time assuming the provider updates their chargemaster.

Then there are what I will refer to as the “fraudsters” who will keep increasing their charges to capture more and more from insurers as benefit loopholes close, such as out-of-network coverage. Their charges defy all logic and unfortunately, create an aura of mistrust.

Tip: The best way to protect yourself from fraudsters is to ask for an detailed estimate prior to service. Have them explain it to you.

Ambulatory Surgery Centers (ASCs):

ASCs offer a lower cost alternative to hospital based services and are a good option for surgeries and other service for the low acuity population. For those with increased medical risks [obesity, heart disease etc.] hospitals are a safer option.

The Ambulatory Surgery Center (ASC) industry grew rapidly from 2000–2008 largely because it provided surgeons a way to make more money from something they already do. It also gave them more say in and in some cases, more control over their work environment in terms of support staff, supplies and business practices.

Unfortunately, many were more focused on making a fast buck from the out-of-network strategy [aka: fraudsters] rather than providing an efficient service to lower the cost of healthcare. That’s changing.

Economical Credentialing and Narrow Networks:

Some health plans have been developing narrow networks that are economically credentialing some providers [aka: the fraudsters] out of their networks for past behaviors. It’s one way to lower cost but many not be a win for those that value choice.

Unfortunately, penalizing providers usually forces more consolidation which drives up price. Many ASCs are being sold to hospitals and healthcare systems that have more leverage with the payers to negotiate higher prices for their services. Pricing transparency tools that use historical claims data may not reflect the new higher prices.

Bundled Payments:

Bundled payments are catching on as a new reimbursement model in healthcare but not all bundles are the same.

Bundles are a flat fee paid to a healthcare provider for a full episode of care. By limiting the payment, it forces the provider to reduce the cost of care for the defined service and guarantee a certain outcome.

If you’re considering using bundles as a way to control your healthcare costs, there are several questions that you should be asking, such as:

1. Who are the providers included in the network? Not all providers are included in every network or selected the the same way.

2. What is the scope of service included? The services and amount of service included in the flat rate will vary bundle-to-bundle.

3. How is a quality outcome defined? Is the patient returned to pre-injury condition or returned to a basic ambulatory state or returned to work?

4. How much control do employees/patients get? Can they select all their providers or just some, the location, the time, the supplies and implants used or is that the tradeoff for a lower cost?

5. What is the expected cost savings over standard contracted rates? What level of savings makes it worth it to you?

Understand what you’re getting and trading off for a lower cost of healthcare. Bundles can pose problems is they are not Administered well because there are always some who will game the system. You have to think through these deals carefully.

Change is Hard Won

Changing the healthcare system takes time. Everyone needs to do their part to lower the cost of healthcare.

1. Healthcare Consumers: Many Americans don’t change their unhealthy habits until they have a major life event like a heart attack, cancer scare or some other health related crisis. The cost of all those unhealthy habits plus the life events drive up healthcare costs for everyone and no one wants to foot the bill.

2. Healthcare Providers: Healthcare providers don’t change until there is a financial benefit for doing so. Many providers didn’t adopt technology that costs maybe 1–2% of their revenue until the government incentivized them to do it. Why? Because they were focused on their top line rather than their bottom line.

3. Health Plans: Health Insurers don’t change their coverage and payment practices until they understand how something impacts their medical loss ratio. Untimely payment decisions make it hard for providers to change how they serve and delight patients. As you know, not many people are willing to work for free.

There are no silver bullets to fix healthcare. Americans need to take a good look in the mirror and own their part, providers need to focus more on the bottom line and insurers need to do more timely financial modeling to fix the incentives for providers.

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About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Join us on Hello Workout for help covering the weekly minimum requirements for good health, telehealth appointments with Sports Medicine experts and other tips to help you achieve more success in work and life.

Moral Obligation?

Is it a moral obligation to provide healthcare to all Americans – or not?

That is the question that as Americans we need to answer. It’s clear now that many voters did not understand that it was the question they needed to answer for themselves before voting to “repeal and replace ObamaCare” when voting for Trump. In fact, Trump himself may not have even understood that given his comment about the Republican healthcare bill being “mean”.

If you haven’t been following the development of the latest Republican healthcare bill, here is a simple explanation of the differences between ObamaCare and TrumpCare. You’ll get a good idea how it affects you as well as why at least some consider the policy to be mean.

The policy problem became crystal clear to me this week when I listened to an interview given by the former CEO of Aetna. He spoke briefly about how ObamaCare is based on incompatible policies. On the one hand, the Democrats wanting to provide everyone with “good insurance” similar to the policies provided to our elected officials. On the other hand, the Republicans wanting everyone to behave as healthcare consumers which is a cornerstone of their free market economic philosophy.

The Republican policies already in ObamaCare are the marketplaces created to sell health insurance, the high deductibles to ensure individuals have more “skin in the game” [that means more money from their own pockets], the marketplaces to sell healthcare services and enable “shopping” etc. Many of these consumer initiatives have failed to engage Americans as healthcare consumers or reduce total healthcare spending. That’s essentially why we are having the healthcare debate all over again.

What’s different about TrumpCare now?

The changes in coverage requirements for employers, the penalties for not having insurance and coverage reductions for pre-existing conditions. Forcing people to pay for something that doesn’t meet their needs is a tax.

From my perspective it is time to start calling it a tax and treat it as such especially if you believe healthcare is a moral obligation. There are more costs that can be rung out of the healthcare industry if we simplify it.

Single Payer

What I have also discovered recently is that many Americans don’t understand what a Single Payer system is or how it could help them. We don’t need to look to Canada or elsewhere for a good example. Our best example is Medicare. A lot of thought and work goes into that program and in many respects it is used by the private sector as a coverage and payment framework. The core of Medicare has 2 parts: Medicare Part A (Hospital Coverage) and Medicare Part B (Medical Coverage). Part A is covered with tax dollars and Part B is paid with premiums.

A national framework similar to Medicare that is paid with a blend of tax dollars for medically necessary services [i.e. no Viagra coverage] and premiums for services that increase quality of life [i.e. Viagra coverage] would work for Americans and the healthcare industry. People are being needlessly scared by the thought of rationing and long lines for healthcare if America moves to a single payer system.

Why now?

A single payer system is the one change that can make the biggest impact for Americans now. It would give all Americans peace of mind that they will be cared for when they are injured or sick.

Basic Income

Silicon Valley leaders are recognizing the need to provide people with a “basic income” as more jobs are automated. Basic income means that industry leaders are expecting more Americans to drop in socioeconomic class. The working class [low and middle income Americans] will be impacted the most by the Republican healthcare bill. So over time it could mean that even more Americans may not have healthcare coverage or access to healthcare services.

Hospitals are required to stabilize everyone who enter their doors regardless of their ability to pay and often in good conscious provide more service than that now. If there is not enough people who can pay, the cost goes up for those who can pay or those who can’t pay go without. That’s the reality of a free market system.

Pricing Regulation

California AB 72 has been signed into law. It limits the amount patients can be billed when treated by a non-contracted provider in a contracted facility.

For example: Let’s say you have surgery at your local hospital. Your surgeon and the hospital is in your health plan’s network. The fees are reasonable for the services being provided because they are discounted to the contracted rates. However, after services are provided you discover the anesthesiologist was not in-network. Now, unless the anesthesiologist has made an agreement with you prior to service, your liability will be limited to an estimate of a contracted rate. The bill limits the total amount due from you and your health plan to the greater of the average contracted rate or 125% of the Medicare fee schedule.

For healthcare providers, it impairs their ability to negotiate contract rates that reflect the “fair market value” of their services. It’s effectively like a company adopting a pay scale that has no exceptions for knowledge, skill, experience and performance. Everyone gets the same pay. That’s a step toward developing a single payer system.

Medical Risk

I attended a Designing for Behavior Change event recently. The one statistic presented that really shocked me was that 90% of the people at risk for chronic health conditions like heart disease and diabetes related to obesity don’t know it. One third [33.3%] of the American population is obese which means their BMI > 30. How is that possible after having an increased focus on wellness? It makes you wonder what exactly gets communicated to patients about their health status.

I have spoken with clinicians [doctors and nurses] as well as health plan administrators and most have little faith that they can change the obesity trend. Most feel that their words of warning are falling on deaf ears. It’s sad because when you combine that trend with America’s aging population Medical Risk has the potential to skyrocket.

That’s probably why budget conscious Republicans [also referred to as the far right] want to pull back on Medicaid funding and why we all as Americans need to make the decision about whether healthcare is a moral obligation or not. All of us — even those currently covered by employer based insurance — will be directly impacted by your decision.

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About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Join us on Hello Workout for help covering the weekly minimum requirements for good health, telehealth appointments with Sports Medicine experts and other tips to help you achieve more success in work and life.