Thursday, February 26, 2015

Democrat In Republican Clothing #DIRC

You've heard about RINO's, Republican In Name Only.  Well, now I think it's time to take it a step further with DIRC, Democrat In Republican Clothing.  I would nominate Governor Chris Christie and Jeb Bush to start with.  There are many more.  Join me on Twitter and nominate your favorite #DIRC!
Senator Lindsey Graham-SC
Senator Orrin Hatch-UT
Senator Jeff Flake-AZ

Tuesday, February 03, 2015

You Can Lead a Horse to Water...but That Doesn't Make it a Leader

Egads, companies all across America are obsessed with "Leadership Training."  Every employee from the bathroom janitor to the CEO are spending hours and days in classes hearing canned PowerPoint presentations from perky presenters touting the latest 12-step program that will transform anyone and everyone into the next Steve Jobs.  Over my nearly 60 decades I have read dozens of books on leadership and sat through lectures, presentations and training on finding and developing the leader within me.  Well, guess what?  There ain't one in there.  So let me give you my curbside consultation on what I have learned and believe about all of this.
I postulate that within the corporate hierarchy there are basically four categories.  You can call them by different names, but essentially most companies are comprised of one or two (if they are lucky enough to still have one) Leaders, a small batch of Managers, Supervisors and then Workers. It is my belief that people are born with, or without the tendency to fall into one of those categories.  It is pretty much genetically dictated.  My uncle was born with musical talent.  He took violin lessons when he was very young and quickly mastered that instrument.  One day he sat down and started playing the piano.  He didn't need sheet music, he would just hear something on the radio and start playing it and would transpose it into another key on the fly.  I wanted to play the piano but was not born with the innate talent.  I took lessons for years, fighting and struggling.  I can pick out the notes off of the page, but I don't make music.  My uncle made music.  He was a musician.  I, with all my years of lessons still could not claim to be a musician. While you can tweak and develop and improve the skills within your particular category I don't believe that there is much movement of an individual from one category to another.  Wanting to become a Leader and attending all of these myriad leadership classes does not make you a Leader any more than standing in a garage makes you a car.  If you're not born to be a Leader, you're probably not going to be one.  Or a Manager or Supervisor either for that matter.  And just because your company anoints you as a Leader or Manager or Supervisor and sends you to class doesn't make it so either.  They may just be setting you up to fail.  Leadership training companies rake in billions every year telling rooms full of chickens to 'fly, you're an eagle!'  Well, chickens are not eagles and they're not going to become eagles.  There are very few eagles.  And we needs chickens, there's nothing wrong with being a chicken.  But the allure to be a Leader is very intoxicating.  In my opinion, there are very few leaders in government or business, but a lot of wannabes.
Leaders cast the vision for the product, service and company.  They were probably the founder(s) of that particular enterprise.  The original Leader many not even be around any more.  Sadly, after the founding Leader is gone, many companies never really have another Leader and wallow around until they go bust.  They try to hire another Leader or promote a Manager into leadership, but usually with disastrous results.  Leaders are big idea people, not detail.  They think outside of the box, come up with new, novel ideas and sometimes come off as a bit quirky, eccentric and impractical.  The words 'no' and 'impossible' are not in their vocabulary.  The fact that something has never been done before excites them while it scares Managers.  The are oriented to the future.  Once they have put an idea for a product or service in motion and handed it off to the Managers, they are pretty much done with that one and off dreaming up the next big deal.
Managers may go by many names:  CEO, President, Vice-President, COO, CFO, Manager, General Manager, Superintendent.  These people are responsible for taking the Leader's visions, manifested as a product, service or company and make it happen. They break the vision down into its component projects and steps and then manage the necessary resources, budgets, personnel, policies, legal and regulatory demands and timetables and deadlines. They hire the Supervisors who will oversee the workers who will ultimately do the work of the vision.  Managers are more oriented to the details of the vision, relieving the Leader of that burden.
Supervisors oversee the Workers who are doing the day-to-day grunt work of bringing the Leader's vision to fruition.  They hire and fire them, make sure they have the necessary tools and training, make sure the work is done safely and strive to meet the deadlines and budgets given them by their Manager for their particular project. 
Workers have very specific skills for very specific jobs.  These are comprised of the industrial trades, skilled and unskilled workers.  They perform the daily heavy lifting (many times literally) of accomplishing the vision.  They perform repetitive tasks on a very specific part of a step or aspect of a project making up the vision. Without them, nothing much would happen.
It is my premise that Workers rarely if ever make good Supervisors, Supervisors rarely if ever make good Managers, and Managers rarely if ever make good Leaders.  Thus the problem with promoting up the chain from within an organization.  People really do tend to rise to their level of incompetency, unfortunately that is usually the point where they are promoted from one of these categories up to the next one.  They were doing a great job in the position for which they are best suited, and this is probably why there were singled out for promotion.  That, and the fact that someone has been around for a long time and now it's their turn.  Eeeek!  Formula for epic fail.  Rather than leaving that successful person in their best-suited job and trying to help them be the best they can be there, the company out of the goodness of their heart promotes them up to the next category where they flounder and founder for years, while attending multiple seminars on how to be a success in that job, but secretly knowing they never will.  Surprise, I am not a big proponent of promoting from within.  If a company needs a Leader (or Manager or Supervisor or Worker) they should look everywhere for the best person with those particular skills, inside and outside the company and hire the best person for job.  It is more important that the candidate have the requisite skill set for the particular category of job rather than know the product, service or company inside out.  Someone from outside with the right skills can learn the company, product and service quickly.  But remember, it's the skills you are really after, not company knowledge.  Someone with all of the company knowledge and experience in the world will still fail if promoted beyond their God-given skill set. 
I believe that companies should stop sending everyone to leadership training classes and spend their money and resources identifying employees' innate skills, matching that to the right job and then investing in helping them improve those preexisting skills to the highest level within the job and category that best suits them.  If a position needs to be filled, fill it with someone from inside or outside the company that already has the right skills for that category, then train them in that position. 

Sunday, March 30, 2014

God and Government

Let's clear up this church and state thing once and for all.  It's really quite simple, not complicated in the least.  The people who founded this nation were fleeing religious persecution under a state-mandated religion.  They set up a nation based upon the concept of religious freedom.  A nation where religion of all kinds, or none at all could flourish unimpeded by the heavy hand of the government.  People would be free to worship when and where and what they pleased, or not at all.  They did not distinguish between private and public religious practice.  They were not concerned about people expressing and practicing their religion in the public square and in the halls of government.  Just look at how many of our early politicians held strong religious beliefs, talked openly about them in the chambers of government and how many mentioned their faith in speeches on the floor of the House and Senate.  Look at how many Presidents prayed openly and encouraged prayer for our nation. The sessions of Congress are opened in prayer and Presidents are sworn in on Bibles (or other religious books) and swear their oath, so help them God.  Our founders did not intend for religion to be hidden away to only be practiced in the home or Sundays in church.  No, what they intended was a vibrant religious fervor throughout the land, in homes and churches and schools and businesses and the halls of government, unchecked by intrusion from the rulers.  The thing they did proscribed was any establishment of a state religion or policies setting one religion above another, or giving one special treatment over another, or prohibiting some altogether.  This is not to be construed to an interpretation which keeps religion out of the public and government realms, but rather keeps government out of the religious realms.  The separation of church and state is to keep the state out of the church, but not the church out of the state.  We have come a full 180 degrees since George Washington said in his farewell address of 1796, "Of all the dispositions and habits which lead to political prosperity, religion and morality are indispensable supports."  Atheists and agnostics are now everywhere lobbying for the removal of anything religious from our schools, public squares and halls of government.  What gives them the right to do so anymore than those of us with religious affiliation the right to remove them and their beliefs from these same places.  One could argue that atheism and agnosticism are simply religions of faith in things other than a supreme being.  In the world of the First Amendment they have no more right to demand religious cleansing than the religious to demand their cleansing.  No, we must all co-exist and blossom together in all aspects of life.  The First Amendment guarantees the right of freedom OF religion, not freedom FROM religion.  I would recommend that those who seek to remove anything religious from the public square grow thicker skin.  What religious people do doesn't harm them, and what they do doesn't harm the religious.  Live and let live.  The industry of being offended has become too much a growth industry.  A lot of what they do and what happens in our country and the world offends me, but I choose to let it roll off of me like water from a duck's back.  I do what I can to make a difference in the world from my perspective, they would be advised to do the same.  By the way, the Constitution and Bill of Rights nowhere guarantees a right to not be offended.  It's part of life.  Amen.

Wednesday, October 23, 2013

Article V--Let's Go!!

Now that we have read Mark Levin’s latest book, The Liberty Amendments and realize that this really IS the only path forward; we must confront the questions of how we move this idea forward to fruition and what can and must each of us do in that endeavor.  
It seems to me that before we can start the process we need to know exactly where we are now and we must be able to track our progress and make necessary adjustments along the way.  To that end here is my outline:

  • We need a central, searchable electronic database to collect and track data on all state legislators.  This should include the state, the individual’s name, party affiliation, mailing address, telephone numbers, fax numbers and social media contact information and when they will next face re-election.  We need to track changes with elections and vacancies.  Should this database be owned by Tea Party Patriot’s, some other group or should some new entity be formed for this specific task?
  • Each legislator needs to then be contacted to find out if they have read Mark’s book or if they are familiar with it and/or the proposal.  If not, the book and other supporting information needs to be made available to them and then follow up with them after having a chance to read it.  For those already familiar with the idea we should document if they favor or oppose the concept or if they are leaning in favor or opposition, or if they are completely undecided.  Depending upon their position they made to be provided with further information or have someone contact them directly to discuss the idea and answer questions and provide more information.  This, I think should ideally be done by constituents in their respective districts if possible.   We should continually follow up to find out if their position on the idea has changed, and hopefully moved in a positive direction.
  • We should identify sympathetic state legislators who would be willing to carry the proposal forward in their respective state legislatures and become champions and persuaders amongst their colleagues and points of contact for our movement.

Sunday, September 15, 2013

Patient's Statement of Rights

Please review and attach to my chart.

            In this era of health care reform and rapidly changing paradigms many patients feel as though they are on the losing end of a quickly shortening stick.  Every time you go to a physician’s office or hospital you are bombarded with all sorts of forms to sign with all sorts of rules and regulations.  Who on earth can know what it all means?  It seems that everyone is telling patients what they can and cannot do; their physician’s office, hospitals, pharmacies, insurance companies and then government is telling everyone what can and cannot be done.  Is anyone actually looking after the patient?  Sadly, it seems no.  In light of these realities, here are some patient responses to all of this.  These are the things that I the patient, will and will not do or permit:

  • When I call to make an appointment with my doctor, I want to see my doctor.  Not some other doctor or physician’s assistant or nurse practitioner; unless I specifically request or agree to that.
  •  I will not be financially responsible for any charges or fees not covered by my insurance for any tests, procedures, consultations or lab unless those charges are specifically discussed with me prior to any of them actually being incurred.  After the charges are discussed, I will then decide whether to proceed or not and will inquire as to alternatives or if they can be done cheaper elsewhere.  Of course, this applies to routine situations, not dire emergencies.  It would be wise and helpful for you to post your routine fees and charges on your website and on a large sign in your waiting room.
  •  I will not answer any questions about or provide any social or behavioral information, except things I may relate to my physician in private and confidence directly.  I do not give permission for any such information to be transmitted in any form to anyone or any private or governmental agency (local, state or federal) other than my physician.
  •  I do not give my permission for any information of any sort to be transmitted to any private or governmental agency (local, state or federal) other than my insurance company.
  •  I do not give my permission for any information to be stored off-site of my physician’s physical office.
  •  I do not use my social security number as a personal medical identification number.  Please use an alternative number such as my employee ID number from my employer who provides my health insurance.  I will not provide my social security to anyone and do not give my permission for you to obtain it by any means or from any source and do not give my permission for you to retain and/or store it.

Thank you!

__________________________________________                                    ___________________
Signed                                                                                                              Date (in effect until further                                                                                                                                         notice)

__________________________________________                                    ___________________
Printed Name                                                                                                  Date of Birth

Tuesday, July 16, 2013

The Smart Medical Shopper

The Smart Medical Shopper
Kyle C. Akers, M.D.
Tuesday, July 16, 2013

     We have the best medical care in the world, bar none.  Unfortunately, we have the most confusing, convoluted method of charging, pricing and paying for it that one can imagine.  Our medical care financing system is unlike any other sector of the economy or industry in the country.  This mixed up system leads to frustration, anger and sadly ultimately to ObamaCare.  The misnamed Affordable Care Act is not about medical care and certainly has nothing to with affordability.  We have the best doctors, hospitals, medicines and technology available.  ObamaCare is all about payment and it is the worst possible solution to come down the pike so far.  What we need is less government regulation, top down control over pricing and payment for medical care and more simplified, streamlined common sense interaction between doctors, patients and insurance companies.

      The current coding system for diagnoses and procedures which drives charges is a monopoly owned by the American Medical Association and is its largest source of revenue, given that only about 13% of physicians are members of this fading organization.  Medical charges are essentially driven across the industry by the Medicare tables of allowable payments.  This cobbled together system sets up a one-size-fits-all approach that tries to shoe-horn everyone into one payment system using the ubiquitous Medicare HCFA billing form, whether it works for individual doctors and patients or not.  Couple that with all of the different discount arrangements between insurance companies and doctors and you have a recipe for disaster and ever sky-rocketing costs.  No one knows what anything really costs.  In reality the same procedure can cost many different amounts for different insurance companies and patients.  Doctors have no idea what things cost and patients have no idea what charges they are incurring at the time of service, what insurance is going to pay or what discounts are being applied.  They only find out weeks or months later when they get an unexpected bill for their portion that insurance didn’t pay.  You would never buy a car that way.  You don’t buy anything else that way.  Would you let someone else pick things out for you, don’t tell you what they are costing you and after all is done send you a bill months later expecting you to pay for them?  Of course not.  Even attorneys meeting with a potential new client will explain what their hourly rate is, what the retainer will be up front and estimate what the whole cost will ultimately likely be.  All before the client pays a penny or commits to anything.  I once spoke with my doctor about my annual routine wellness laboratory work.  My insurance company pays 100% once a year for those tests.  He had no idea that if his office did not code the visit correctly, for a routine annual physical exam, then I would be liable for the full cost of the lab work.  Additionally, he was shocked that the cost of that lab work would be $600.00 out of my pocket (and actually it should be about $150.00 if you look at the actual real cost).

     Now, obviously in a medical emergency stopping to discuss fees and costs and options is not really feasible, but these situations account for a very small fraction of most people’s interactions in the medical system.  The vast majority of the time it would be possible for the physician to have a discussion with the patient about fees, costs and less costly options prior to committing to treatments and incurring expenses.  Unfortunately, right now doctors have no idea what those costs are.  They usually assume that insurance is going to pay everything, not realizing that their ordering decisions may incur hundreds or thousands of dollars in unexpected out-of-pocket expenses for their patient.  And the patient won’t even know that until weeks or months later. 

     Medical billing statements result from the coding employees at the doctor’s office reading through the doctor’s notes and trying to find the best fit diagnostic codes and procedure codes to reflect what was done.  This then drives the charges.  There is actually a lot of wiggle room in how these things get coded and what the ultimate charges wind up being.  Sometimes inadvertent mistakes are made, coders are only human.  Things get coded incorrectly or things get coded that never actually happened.  It’s not intentional fraud, just honest mistakes.  But these mistakes can cost you hundreds or thousands of dollars.  It’s funny, we will stop a clerk at the grocery store if the scanned price of an item does not reflect the $1.00 off sale price in order to correct it but we have no idea if the medical bills we get are accurate.  If you don’t get detailed, itemized statements and carefully review them, you just wind up paying these incorrect charges.  Many billing statements, particularly hospital bills only show the total owed, not the minute detail of the individual charges which comprise the total.  Always request and review detailed statements before making payments and ask questions if you’re not sure about specific charges.  Because of this slow, mixed up payment system doctors and hospitals routinely have patients sign forms (among the myriad forms one signs when checking in) agreeing to pay any charges not ultimately paid by the insurance company.  Wow!  How cool for them.  Why would anyone in their right mind sign such an agreement which could encumber you with hundreds or thousands of dollars in charges months down the road but you have no say or input at the time the charges are incurred?  You are generally not informed or asked to approve of the cost of things that are being ordered and done on your behalf at the time they are happening.  And let’s face it, most people are not medically savvy and are rather intimated by the people and process going on in a doctor’s office or hospital.  They might be sick or injured and not really thinking about cost at that moment.  Or it might be a routine visit, but people tend to trust the doctor and not question what is being done or inquire about the cost or less costly options.  It’s sort of like the restaurant menu that says “Market Price” next to the lobster.  Would you order the lobster without inquiring as to the “Market Price” today for the lobster?  No, of course not.  Doctors and hospitals should post their fees and prices on menus on their waiting room walls for all to see.

     Now let’s not leave insurance companies out of the discussion.  Has anyone read a medical insurance policy cover-to-cover lately?  I didn’t think so.  It’s sort of like a mortgage contract.  No one actually reads those things before signing them.  And if you did you wouldn’t understand it.  It’s the same with medical insurance policies.  Try wading through the individual deductibles, family deductibles, co-pays, co-insurance, in-network/out-of network, discounts, tiered prescription formularies, maximum annual out of pocket (and what ACTUALLY is applied to that and what is not, you will be surprised) and all of the exclusions and exceptions.  If that’s not bad enough, try figuring out in July where you are for the year in all of that.  Yikes!  It’s virtually impossible to know before a procedure or test just exactly how much the insurance plan is going to pay and how much you will be getting a bill for in several weeks.  Don’t think that your co-pay is going to always cover your financial responsibility for an office visit or procedure.  It depends on exactly what is done.  An in-office steroid injection might be covered or not, partly or in whole.  Doctors typically don’t discuss that with patients before doing the injection.  Their office might contact your insurance company for prior approval or not.   You will probably not know.  Even if they do, they may not tell you anything before the injection.

     So what is the average, medically uninitiated patient to do?  Well, until the medical industry realizes that it must start acting like every other business and post and discuss its prices before charging people for things, the patient must act proactively and aggressively to avoid incurring enormous surprise charges weeks or months down the road.  Here are some tips to help keep you in control of your medical costs: 

  •  Make sure you understand your insurance policy.  Ask your carrier for a clear summation page of your benefits, co-pays, co-insurance, maximum annual out-of-pocket cost, individual/family deductibles, in-network/out-of network details, in-patient vs. out-patient tests and procedure costs, annual wellness/screening 100% covered expenses, pharmacy details/co-pays, exclusions and exceptions. 

  • Ask your insurance carrier to provide a way (online dashboard) for you to quickly and accurately check where you are in your expenses in all of the various categories throughout the year. 

  •  Ask your insurance carrier for a quick, easy way for you (and doctors/hospitals) to check on covered charges and what your potential liability portion would be before authorizing any tests, treatments, medications or procedures.

  • Request that doctors/hospitals contact your insurance company and pre-authorize anything beyond your co-pay and discuss that with you before it is done.  If necessary, you contact the insurance carrier.

  • Discuss the cost of any and all procedures, tests, treatments or medications that your doctor wants to order for you prior to agreeing to them.  Discuss the possibility of cheaper alternatives or just waiting a while if possible.

  • Always ask your doctor to choose generic medications or cheaper alternative medications when possible.

  • When checking in at a doctor’s office or hospital, give them a note that you have signed and dated informing them that you will only be financially liable for charges (particularly beyond your co-pay) that have been discussed with you in detail prior to you authorizing those things that incur the charges.  Don’t sign blanket statements that you will be liable for any charges that your insurance company does not pay.  Have them (and/or you) contact the insurance company for clarification/pre-authorization if necessary.

  • Always ask for a detailed, line-item billing statement; not just a total bill due.  Review the bill for accuracy.  Get someone who is medically savvy to help you if necessary.  If you don’t understand something, ask the provider for clarification.  If you think there is an error, speak up!

  •  When communicating with doctor’s offices, billing offices, hospitals and insurance companies about charges, bills and disputes; always get everything in writing.

  • When communicating with billing offices about charges, bills and disputes always copy your insurance company and your employer HR/Benefits office (if you have employer provided medical insurance) on all correspondence to and from the billing office.

  • If you think a charge is way out of line, do some research.  See if you can find what the actual cost is and what other places are charging for similar services or products.  Ask for a price match; Wal-Mart will price match, why shouldn’t doctors and hospitals?  These medical people are in business after all.  Let them know there is some competition for you business out there and you’re willing to go where you can save money.

  • Ask doctor’s offices and hospitals not to share any information of yours (even non-identifiable generic information) with anyone other than your insurance company.  Not with any private company or any government agency; local, state or federal.

  • Unless required by a federal program such as Medicare or Medicaid, do not use your social security number for identification and do not give your number to doctor’s offices or hospitals.  If you ask them to use an alternative form of identification they must comply.  Similarly, let your medical insurance company and employer HR/Benefits department know that you will not use your social security number for medical care identification purposes and you do not permit them to use it.

Sunday, May 19, 2013

Health Care Reform S.O.S.

I am a simple physician and family man, trying to make a living and doing the best I can.  I graduated from Texas A&M medical school in 1982, did a three year fellowship in general surgery in New Orleans until 1985 when I moved to Colorado Springs.  I married soon after that and have four children.  I worked in a variety of walk-in urgent care/minor emergency clinics for many years and did physical examinations for life insurance companies.  For the past eleven years I have worked as the Occupational Health & Medical Coordinator for Colorado Springs Utilities.  So I have seen medicine from many perspectives; as a private physician, a patient/consumer and now a municipal government employed physician.  Over the years I have endured the rise and fall of the H.M.O. managed care debacle, saw the boondoggle of Diagnosis Related Groups (DRG’s), observed the decline and fall of the solo practitioner as they have been gobbled up by the behemoth medical corporations and now have seen the greatest insult of all, ObamaScare.  I am not a Harvard educated economist and I don’t have an M.B.A. from Wharton.  I am certainly not a politician (we should all be thankful).  But I do believe that over the years I have seen some things, endured some things and learned some things about health care which I would like to pass along to you.  Of course, this advice is free and may be worth what you paid for it.

Let me begin with a little story.  About a month or so ago, one of my 17 year old twin daughters told me that she had been feeling poorly for a few weeks.  She was tired and had a sore throat.  I looked at her throat, it didn’t look too bad but she did have some swollen nodes in her neck.  I called to get her an appointment with our family doctor (no longer in his own little practice, now an employee of one of the monolithic companies in Colorado Springs).  Being the middle of the week of course they couldn’t see her until the next week.  Well, by Saturday morning she was still complaining so I took her to a satellite walk-in clinic run by one of our local hospitals and on our insurance company approved list.  They weren’t too busy and we got in fairly quickly.  I paid my $40.00 co-pay and we were taken back.  My daughter was seen by a nice nurse practitioner who did a quick history and examination and then ordered a rapid strep test which was negative.  Following that a quick finger-stick mono test confirmed my suspicions that she did indeed have mono.  A prescription for some prednisone tablets for throat swelling and we were on our way.  We had maybe 15 minutes of face-to-face time with the nurse, all that was really necessary.  No problem.  Well yesterday, May 18 I got a bill from the hospital.  The total charge for the visit was, wait for it…$770.00.  After my co-pay of $40.00 was deducted, a $338.00 ‘insurance adjustment’ (read discount, which would still make the total bill $432.00) and an insurance payment of $177.69, my balance remaining is only $214.31!  Now of those charges, $146.00 was for the professional fee (nurse practitioner).  This might be reasonable for a physician exam, but not for a nurse practitioner.  That should be maybe around $50.00.  There was a $242.00 clinic fee, no doubt to cover the overhead of the nice new building they are housed in.  Please note this is not an emergency room, it is a walk-in clinic much akin to your family doctor’s office.  And when you go to your family doctor you are charged only a professional fee, which includes all of the overhead.  You don’t get charged a separate clinic fee.  My doctor is housed in a nice, new, big building with radiology and laboratory services, but doesn’t charge a clinic fee beyond the doctor’s professional fee.  But wait, the final charge was for laboratory services in the amount of $382.00.  This for a rapid throat swab strep test and a finger-stick mono test.  I did some research and found that you can purchase rapid strep tests for $1.82 per test and the mono tests for $4.49 per test.  This is about what I remember from my private practice days.  Each test is quick, simple to perform and only takes about five minutes.  By my calculation this whole visit should have come to around $75.00.  Here then is a microcosm of the problems we are experiencing with the cost and payment for health care around the country.

Let us remember in these discussions that what we are all talking about is cost and payment for health care services.  We have the best health care in the world here in the United States.  This debate is not about health care.  It’s about payment.  The problem with our system now is that the federal government has meddled in the payment system over the past decades and really screwed things up. 

For some reason health care is one of the few, if not the only service we purchase with no idea of what the actual final cost will be at the point of sale.  Doctors don’t know, patients don’t know, the providing institution/company really doesn’t know and the insurance company doesn’t know until the final charge is hammered out weeks or months after the fact.  This is driven in part by the coding and recoding of diagnoses and procedures so to as to maximize the charges by the providers.  This thanks to the ICD-9/CPT coding monopoly owned by the American Medical Association (their primary source of revenue since only about 13% of practicing U.S. doctors belongs to the association) and promulgated by the Medicare system.  We need to divorce ourselves from this byzantine rubric and let doctors and institutions charge whatever they want in a free market where quality and service-level reviews and surveys are available for all to see.  Let insurance companies and patients choose where they want to spend their health care dollars to get what they perceive to be the best bang for the buck.
There are myriad different prices for this insurance company or that insurance company, for cash, for Medicare, for Medicaid; contract prices and discounts.  The providing institution doesn’t really know the price up front.  Frankly, I can’t believe that insurance companies agree to pay some of these outrageous charges.  The complexity of insurance company deductibles, co-pays, co-insurance and knowing where you and your family are in that calculation at any given point in time is impossible, particularly at the time you are receiving service.  Doctors don’t really know the cost of things they are ordering (and thus incurring costs) on behalf of patients.  There is no menu up front, in advance like say, in restaurants.  I recall a conversation in my doctor’s office about a year ago.  I was having my annual physical exam and the doctor ordered the usual annual lab work.  I asked him to make sure that he coded it as annual wellness lab work which is covered 100% by my insurance; otherwise I would wind up having to pay about $500.00 out of my pocket.  He was shocked and frankly in a state of disbelief.  He really thought I was joking.  When I explained that I and my co-workers had all experienced the high cost of these lab tests he honestly related that he had no idea that it was all so expensive.  So to try and put it in perspective, imagine going into Dillard’s (doctor’s office) to buy some jeans.  There are no price tags on the jeans and the store clerk (doctor) has no idea how much they cost.  But don’t worry they tell you, just pay a little bit now (co-pay) and we will bill you in a few weeks if it winds up costing any more.  Well, how much more you ask.  Well, we really don’t know right now.  So a month later you get a bill from Dillard’s for $250.00 for the balance on the jeans.  And oh by the way, it’s too late to return them.  Would you go for that?  Of course not.  If the prices were right on the jeans for all to see you would either buy them or look for a cheaper pair or go elsewhere to look for jeans.  Here is a real life story.  About six months ago on a Sunday afternoon I drove into Jiffy Lube to get an oil change.  You drive right up the garage door and they open your door and tell you to go inside while they drive your car into the bay.  There are no prices posted anywhere outside, they don’t hand you a menu of prices or tell you what the prices are (I know, I should have asked.  But shouldn’t the business tell you?).  Anyway, I got inside and the clerk started ringing up my order while they started working on my car.  The oil and filter change with a tire rotation came to $65.00.  I looked out the window at the Tire World next door and on their sign it read, “Oil/filter change and tire rotation $18.99.”  I instructed the Jiffy Lube clerk to stop work on my car and informed him that I did not want any service.  They sheepishly gave me the keys to my car (I have no idea what they had already done to it) and I drove next door for service.  Why shouldn’t medical care work that way?  One final real life example.  In my capacity at Colorado Springs Utilities I order a lot of MRI scans.  If we do them at the major hospital/medical corporation facilities they run $2000.00 to $2500.00, it takes several days to get one done and then a couple of days to get the results back.  We recently contracted with a small private company that does the same scans for about $700.00 to $900.00 per scan, they often get our employees in the same day we call and the reports are done much quicker.  There is also more personal communication between the radiologists and me, they are much easier to get in touch with and get questions answered.  The quality is just as good as the hospitals’ and the service is much better, not to mention the price!  Isn’t this the way it should be for everyone?  What a wacky system where people are consuming very expensive services, many times on a moment’s notice in difficult and emotionally charged situations and no one knows the cost of what is being purchased at the time.  It is being ordered by a doctor who doesn’t know, on behalf of a patient who doesn’t know, provided by an institution that doesn’t know and paid for by an insurance company that doesn’t know.  There is no direct accountability.  People are spending other people’s money on behalf of someone else.  And its six months before anyone has any idea of what just happened, then shazam!  Look what we just spent!  Oh well, whatever the insurance company won’t pay we’ll just bill to the poor unsuspecting patient.
With health plans paying less and less of the cost lately coupled with the federal government lowering the pre-tax flexible spending account family annual allowed contribution from $8000.00 to $2500.00, individuals are discovering that they are suddenly on the hook for high costs that they never were in the past.  Much of this happens after they have actually incurred the costs and can’t really do anything about it.  One result of this will be that people simply stop going to the doctor and getting tests done, sort of self-selected rationing.  And maybe that’s what the progressives in government want.  But the result will be a less healthy population, less preventative care and ultimately much higher costs down the road for late intervention.

Another problem is the costs created by liability and malpractice litigation and the resulting payments and settlements.  We need meaningful tort reform and perhaps a system like Louisiana where all malpractice and medical liability cases go before a diverse board who rule on the validity and likelihood of success of the case before going to trial or mediation or settlement (at least they did back in the 1980’s, not sure about today).  Sort of like a grand jury.  You can still go to trial with an adverse ruling by the board, but the likelihood of prevailing is very small.  Most don’t.  This weeds out frivolous suits and grandiose settlements.  A cap on payouts based upon reality and common sense would also help, as well as making the loser pay the other party’s legal fees.

With all of the vacant commercial real estate available why do medical companies and clinics need to build fancy new facilities, and then have to pass all of those costs on to patients and insurance companies?  Why not use existing buildings which can be re-finished for far less than new construction?

Get the government less involved, not more involved.  They have already screwed things up and driven up costs enough with Medicare/Medicaid and now ObamaScare.  When the government gets involved they just screw things up, make things too complex, less efficient and effective and increase costs 10-100 times.  Get the government out of the way and let the private sector solve these problems.  The reason we have these challenges in the health care payment/insurance industry in the first place is because of government meddling, regulating and dictating.  To paraphrase Ronald Reagan, in our current situation government is not the solution to the problem, government IS the problem.

Get rid of the electronic medical records requirement!  Virtually every physician I have talked with despises electronic medical records.  They are a disaster.  They are impossible to use, they don’t fit the model of what doctors do and trying to find useful information in them is like looking for a needle in a haystack.  Not to mention the privacy implications and problems.  And I just received a notice from my malpractice insurance carrier informing me of a seminar they are going to be providing discussing the difficulty of defending malpractice lawsuits due to electronic medical records.  Just say no!

And by the way, never, never, never let the I.R.S. get anywhere near health care, health insurance, medical records or anything health or health payment related!  Period.  After the recent scandalous revelations need I say more??

Repeal ObamaScare in its entirety immediately and replace it only with the free market!
Doctors are now talking about and actually are retiring, retiring early, switching professions and jobs to something out of the health field.  They are advising their children not to go into medicine.  All as a result of ObamaScare and the mess the federal government has made of the health care industry.  They are leaving in droves and the projected shortfalls are staggering.  And you can’t make that up with physician assistants and nurse practitioners.  Not that I would want to.

We must begin to look at the opportunity for different ways of delivering health care, such as Indian Reservations, off-shore, cruise ships, concierge medicine, private co-ops, etc.
I know you have heard from many highly placed Ph.D. health care economists with all of their complicated, complex solutions to the problem; many including much more government involvement.  Just take a moment and think that the solution might actually be less, not more.  It might be simpler, not more complicated.  It might be less government, more private sector; less government control and more personal freedom and responsibility.

Well, thank you for the opportunity to bend your ear a little bit from someone in the trenches on the front lines out here in fly-over country.  I hope maybe one little thing I have said might make some sense and spur some further thought and discussion.  Hopefully we can fix this thing before we have to wake up Ralph, because of course he ain’t never seen a wreck like this before in his life (story for another time!).  And I fear the health care industry is headed for a wreck of epic proportions if we don’t do something in a big way and quick.

God help and bless us all and God bless America!