Michelle Cooke, MD’s Post

"To shed light on where healthcare costs hit the hardest, our experts conducted an analysis comparing all 50 states and Washington, D.C. across nine key metrics. The findings of this study reveal which states are the most and least expensive for healthcare in 2024." https://lnkd.in/exfjj7Ui #healthcare #costs #expenses #billing #insurance #americans #patients #physicians #hospitals #qualityofcare

According to this report from the American Hospital Association, 40% of care delivery costs are now administrative, with ever-increasing rates of denial for payment for services rendered. Commercial insurance companies such as UnitedHealth Group, Anthem, Inc., Cigna Healthcare, CVS Health have adopted intentional strategies to not pay claims even for pre-authorized services. These administrative hassles are one important reason that U.S. healthcare underperforms the health systems of many other industrialized countries. #healthadministration #healthcarecosts #administrativecosts #healthcare https://lnkd.in/eEjetexR

📖 Important Read: This article sheds light on the complexities patients face due to contract disputes between insurers and healthcare providers. The article highlights how patients' ability to change insurance is limited, while insurers can abruptly alter contracts with healthcare providers. This disparity can leave patients vulnerable, especially amidst a surge in contract disputes spurred by hospital price transparency regulations. Patients often bear the brunt of these disputes, facing unexpected changes in coverage and potential financial burdens. While the article suggests obligating *providers* and insurers to maintain contracts for patients' full policy terms; maybe insurance companies should bear more accountability in ensuring stability and transparency for patients. Read more about here: https://lnkd.in/gkMfTQru #Healthcare #MedicalInsurance #PatientAdvocacy #HealthcareReform

If there's one thing providers and patient can agree on, it's their distain for dealing with insurance. According to a survey by the American Hospital Association (AHA), 78% of hospitals say interactions with commercial payers are getting worse, with 84% noting the rising costs of complying with insurer policies. Providers report spending more time on prior authorizations, yet the growing pile of denials includes pre-authorized services. The pattern of claims being denied and then granted on appeal drains financial resources, delays patient care and contributes to staff burnout. It's one of the big reasons that denial management of claims - and ideally, denial prevention - has become the new North Star for physicians and health systems.

🏥 How are private Medicare plans and vertical integration affecting healthcare? A recent article by Wendell Potter explores the complexities of these trends and their implications for patients and providers. The consolidation of services and the rise of private Medicare plans are reshaping our healthcare landscape, often prioritizing profits over patient care. Here's a quote that got me: "(UnitedHealth Group) now takes in nearly twice as much revenue from the 7.8 million people enrolled in (Medicare Advantage) as it does from the 29.6 million enrolled in its commercial insurance plans in the United States." It's essential to understand these developments and their potential impacts to ensure that patient care remains the top priority. 🔍 Read the full article below. 👉 What are your thoughts on private Medicare plans and vertical integration? Share your insights below! #Healthcare #HealthRosetta #Medicare #VerticalIntegration #PatientCare #Transparency

Shawn Martin, CEO of the American Academy of Family Physicians, discusses the bipartisan Bill H.R.7681 Primary and Virtual Care Affordability Act, legislation proposed by Congress to help ensure that insurance plans and employers can provide coverage for primary care services to individuals enrolled in HDHPs before they reach their deductible. "As the country grapples with escalating costs of coverage, it’s critical that patients, families, and communities can access primary care physicians—free of barriers and free of steep financial costs. Family physicians know this all too well and will be meeting with lawmakers next week to encourage Congress to enact patient-centered policies like the Primary and Virtual Care Affordability Act. This commonsense legislation can help us take important steps towards ensuring that patients and families have access to their primary care physician without worrying about how they’ll afford it—a vision we can all get behind." https://lnkd.in/g5H2jHnQ #AMA #AHA #HDHP #Telehealth #HealthcareFinance @HFMA @MGMA UnitedHealth Group #insurance #Centene

Continued Rising Expenses and Administrative Hurdles in Your Practice? "...health insurance company takeback schemes are costing physicians and hospitals more than $1.6 billion a month..." --AMA "Denials—when a claim is processed, but not paid—rose to 11% of all claims last year, up nearly 8%..." --AMA Healthcare providers are grappling with a challenging landscape: soaring expenses, declining revenue, and cumbersome administrative burdens. It's time to address the inefficiencies of prior authorization and advocate for a more streamlined process that prioritizes patient care and financial sustainability." #HealthcareReform #PriorAuthorization #PatientCare Struggling with soaring expenses and administrative burdens in your private practice? Revive Revenue Services is here to help! Let us streamline your revenue cycle management and tackle prior authorization challenges, so you can focus on delivering quality patient care. Contact us today to reclaim your financial health and reduce practice hassles. #ReviveYourRevenue #PhysicianSupport #HealthcareSolutions #RevenueCycleManagement #HealthcareBilling #denials #HealthcareClaims https://lnkd.in/g4PNYTdh

NEWS: The Guardian view on the privatisation of health: outsourcing will not save the NHS: "Private hospitals in England carried out more procedures on the NHS’s behalf last year than ever before..." Private medical insurance is booming, and we can see the direction of travel. The NHS will be left with less funding and more complex cases. This is a short-term waiting list desperation strategy that can only ever end badly. The NHS does require an overhaul - but privatisation is not the answer! We must not allow politicians or healthcare leaders under immense pressure to believe (mental shortcuts) that this is the solution. What do you think - is my view a mental shortcut? Am I thinking incorrectly? Let me know your thoughts on this topic. Thank you for your time. Francesca Dunn RGN, RSCPHN, QN, MBA, FRSPH, BRMP Lillian Morris EMMA EDWARDS Bethany Bishop Caroline Flynn Alister Martin Alan Howe RN MSc Leadership and Management Sue Bacon Tara Iles #NHS #HealthcareReform #PublicHealth #Privatisation #Outsourcing #HealthPolicy #SaveOurNHS #HealthcareForAll #PatientCare #HealthcarePrivatisation View the article here https://lnkd.in/eq7irtSp

Oak Street Health, now under CVS Health, has agreed to a $60 million settlement with the federal government. This resolution addresses claims under the False Claims Act related to Medicare Advantage kickbacks. Allegations pointed to Oak Street Health offering incentives to insurance agents for directing seniors to their clinics, highlighting significant compliance and ethical considerations in healthcare practices. Such cases underline the importance of stringent adherence to healthcare regulations and underscore the financial implications of legal oversights. #HealthcareCompliance #Medicare #CVS #HealthcareRegulation #CorporateEthics https://lnkd.in/eMa5CmWD

EDPMA and its leaders are trusted experts and share the real impact of the inefficient and costly rollout of the #NoSurprisesAct. Our survey data referenced in this article states that emergency medicine clinicians are seeing almost a 40% decrease in reimbursements since the NSA was enacted due to the health plans' artificially low initial offers. The article further states that if this decrease continues, physician groups may be forced to cut back on services, especially in rural areas. What's next? Higher insurance premiums? https://ow.ly/23nS50SsSYQ