4 ms·

Yeah, going single payer alone could reduce that 17% to 13%, maybe more, just through eliminating all the barriers insurers put up to providers being paid and a

by burnte 2y ago

Yeah, going single payer alone could reduce that 17% to 13%, maybe more, just through eliminating all the barriers insurers put up to providers being paid and administrative overhead.

gruez 2y ago
Source? A study from KFF puts "administration" responsible for only 12% of the increase the US pays over comparable countries, or less than 1 percentage points. [1] https://www.healthsystemtracker.org/brief/what-drives-health-spending-in-the-u-s-compared-to-other-countries/#Healthcare%20spending%20per%20capita,%20by%20spending%20category,%202021 https://www.healthsystemtracker.org/brief/what-drives-health...
- istjohn 2y ago
  > Administrative costs include spending on running governmental health programs and overhead from insurers, but exclude administrative expenditures from healthcare providers. From what I've read, healthcare providers spend an inordinant amount of time and effort dealing with insurance companies.
  - rickydroll 2y ago
    Don't forget the overhead created by PBMs and when insurance companies also own the PBM and the drugstore
  - burnte 2y ago
    Correct, it's cost both for insurers AND provider organizations. We have an entire team of humans who call insurance companies on the telephone to verify insurance benefits because most insurers make it EXTREMELY difficult to determine benefits in an automated manner because that makes it easier to bill them. They do everything they can to make it difficult for patients to get coverage and for providers to collect. We're actually working with an AI company to build a tool that uses AI and lots of data to predict with better accuracy benefit coverage. All because insurers want barriers to treatment to lower their costs.
- burnte 2y ago
  Source is my own lived work experience. In the healthcare companies I've worked in, the size of teams to investigate benefit coverage, to bill, and then to nag insurers to actually pay us works out to roughly 15% of the total staff. This is where _providers_ are about 25% of staff. Add to those salaries the costs of the tools we have to employ to manage it all, track it, and management of all of those folks, and it bloats the cost by 20%. We're actually working with an AI company to build a tool that uses AI and lots of data to predict with better accuracy benefit coverage. All because insurers want barriers to treatment to lower their costs. If we went single payer, we would virtually eliminate benefits investigation teams because Medicare is honestly super easy to determine benefits of a patient unless they're on the private Medicare Advantage plans. We could eliminate the need to work with clearing houses as we'd have one payor, not hundreds of payors each with dozens of plans and single-case agreements. RCM departments would shrink because with one payor, providers wouldn't have to constantly nag payors to actually send the money. The admin overhead is sickening.
  - apple4ever 2y ago
    The problem is the overhead of government is even worse.
    - psadauskas 2y ago
      [citation needed]
    - burnte 2y ago
      No, Medicare and CMS are run exceptionally well with some of the least fraud and waste in the entire government. CMS is NOT an agency you want to screw with because they come down like a ton of bricks when they find fraud. People go to prison. It's not like being a DoD contractor where they milk billions from the gov't.
    - mulmen 2y ago
      How much worse? How do you know? Reagan’s Nine Scariest Words quip sounds nice but it works just as well when you replace “government” with “corporate” or “church” or “next door”.

by burnte 2y ago

Yeah, going single payer alone could reduce that 17% to 13%, maybe more, just through eliminating all the barriers insurers put up to providers being paid and administrative overhead.

gruez 2y ago

Source? A study from KFF puts "administration" responsible for only 12% of the increase the US pays over comparable countries, or less than 1 percentage points. [1] https://www.healthsystemtracker.org/brief/what-drives-health-spending-in-the-u-s-compared-to-other-countries/#Healthcare%20spending%20per%20capita,%20by%20spending%20category,%202021 https://www.healthsystemtracker.org/brief/what-drives-health...

istjohn 2y ago
> Administrative costs include spending on running governmental health programs and overhead from insurers, but exclude administrative expenditures from healthcare providers. From what I've read, healthcare providers spend an inordinant amount of time and effort dealing with insurance companies.
- rickydroll 2y ago
  Don't forget the overhead created by PBMs and when insurance companies also own the PBM and the drugstore
- burnte 2y ago
  Correct, it's cost both for insurers AND provider organizations. We have an entire team of humans who call insurance companies on the telephone to verify insurance benefits because most insurers make it EXTREMELY difficult to determine benefits in an automated manner because that makes it easier to bill them. They do everything they can to make it difficult for patients to get coverage and for providers to collect. We're actually working with an AI company to build a tool that uses AI and lots of data to predict with better accuracy benefit coverage. All because insurers want barriers to treatment to lower their costs.
burnte 2y ago
Source is my own lived work experience. In the healthcare companies I've worked in, the size of teams to investigate benefit coverage, to bill, and then to nag insurers to actually pay us works out to roughly 15% of the total staff. This is where _providers_ are about 25% of staff. Add to those salaries the costs of the tools we have to employ to manage it all, track it, and management of all of those folks, and it bloats the cost by 20%. We're actually working with an AI company to build a tool that uses AI and lots of data to predict with better accuracy benefit coverage. All because insurers want barriers to treatment to lower their costs. If we went single payer, we would virtually eliminate benefits investigation teams because Medicare is honestly super easy to determine benefits of a patient unless they're on the private Medicare Advantage plans. We could eliminate the need to work with clearing houses as we'd have one payor, not hundreds of payors each with dozens of plans and single-case agreements. RCM departments would shrink because with one payor, providers wouldn't have to constantly nag payors to actually send the money. The admin overhead is sickening.
- apple4ever 2y ago
  The problem is the overhead of government is even worse.
  - psadauskas 2y ago
    [citation needed]
  - burnte 2y ago
    No, Medicare and CMS are run exceptionally well with some of the least fraud and waste in the entire government. CMS is NOT an agency you want to screw with because they come down like a ton of bricks when they find fraud. People go to prison. It's not like being a DoD contractor where they milk billions from the gov't.
  - mulmen 2y ago
    How much worse? How do you know? Reagan’s Nine Scariest Words quip sounds nice but it works just as well when you replace “government” with “corporate” or “church” or “next door”.