3 ms·
"The money is still going into the pockets of practitioners." And by inflating that amount... > Using newly available federal price transparency data, the res
by ceejayoz 6mo ago
"The money is still going into the pockets of practitioners."
And by inflating that amount...
> Using newly available federal price transparency data, the researchers found that UnitedHealthcare pays Optum physician practices about 17% more than non-Optum practices in the same region. In markets where UnitedHealthcare holds a large share of the insurance business, that difference was even larger, up to 61%.
their capped-by-law 20% cut of premiums goes up, too. "Oh, those mean old providers we own charge so much! We have to raise premiums again!"
- tptacek 6mo agoShow me the more recent NHE table where this effect shows up and I'll be ready to have the conversation, but right now this seems like a dodge. Whatever effect you're describing, if it's material, has to have started after the NHE data I just posted, from 2023. I don't remember thinking that the health system in 2022 was good. Fun thing about the NHE: you can project it as far back as you want. The data is there.
- ceejayoz 6mo ago> Whatever effect you're describing, if it's material, has to have started after the NHE data I just posted, from 2023. What? Insurers have been playing this game far further back than 2023. If an insurer doubles the time a doc has to fight over denials and has to hire extra billing staff to assist, where do you imagine that cost shows up?
- tptacek 6mo agoI feel like we've been in this argument before, and I like you just fine as a commenter, but do feel like you're tying yourself into knots to avoid a simple conclusion plainly supported by the data. I didn't post a trend story about what companies are doing or who they're acquiring; I posted the macro NHE table from last year. It simply refutes the argument you're trying to make.
- ceejayoz 6mo ago> I posted the macro NHE table from last year. Again: how will the “insurers force provider costs up” show up in said tables? It’s caused by the insurer. It shows as a provider’s cost. But it doesn’t mean said doc is making any more money at the end of the day. The insurer does, though! Their 20% cut got bigger, and the "computer says no" denials are cheap! TL;DR: Where in your link does "doc spends needless hours on phone fighting insurer" show up as a cost?
- tptacek 6mo agoIt literally breaks practice and net cost of insurance out!
- ceejayoz 6mo ago> It literally breaks practice and net cost of insurance out! But it's not a "Cost of Health Insurance" item. It's an expense at the practicioner level! They have to factor that non-billable time into what they charge for the procedure! Read their definitions: https://www.cms.gov/files/document/quick-definitions-national-health-expenditures-accounts-nhea-categories.pdf https://www.cms.gov/files/document/quick-definitions-nationa... "Administration" is the insurer's side of it.