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Friday, December 15, 2006

Going Solo? 5 reasons why you would benefit from a SINGLE PAYOR SYSTEM.

The United States has terrific health care for people with good insurance, yet millions of Americans who pay taxes and have jobs do not have adequate health coverage. Most of these people, in fact most Americans whether they know it or not, are 1 severe illness away from personal bankruptcy. Though most of us agree that a problem exists, people have not been able to come to a consensus regarding the solution to the problem. Single payor health insurance has been discussed by many as a possible solution to the health care problem that exists and it has many supporters as well as detractors. As a solo practitioner, you should be a supporter of a single payor system that covers everybody. Here are 5 reasons why.

  • Overhead reduction: Anyone in solo or group practice will tell that they spend huge sums of money not on the delivery of health care, but on its administration. In fact, 45% of GDP health care dollars go towards paying administrators, be they CEOs, call center workers, claims processors, billers, managers ect. Countries that have single payor systems spend far less on this beuracracy than we do in the US and practices in regions of the US that have less managed care penetration have lower administrative overheads than similar practices do in other, more MCO saturated environments. Practices that see a predominantly medicare population can operate at a fraction of the cost of a practice that takes 30+ plans, period.
  • Improved cash flow: We already have national health insurance, it's called medicare, and not only is it now one of the best payors, it is one of the fastest payors. Since payroll comes every 14 days, and bills come every 30 days, cash flow requirements dictate that payors pay at 30 days as well. In the wonderful world of managed care, most payments come not at 30, but at 45, and sometimes 90 days, despite electronic submission. Medicare payments come in the quickest and with the least hassle factor. With medicare alone can I estimate cash flow accurately and plan accordingly.
  • Practical Practice Simplification: Medicare, our national plan, does not care if I send a urine specimen to OurLab, or Quest, or Sunrise, or if I do it myself. As long as the claim is submitted correctly and it meets their requirements, medicare will pay. In addition, medicare does not care if I do a surgery at hospital 1 or hospital 2 as long as both participate. Finally medicare does not care if I send a patient for a CT scan at Medical Arts Radiology or Zwanger or Zilka or even if I do it myself. They'll pay regardless, as long as the claim is sent correctly and I meet their well documented requirements. Now contrast that to the managed care world where there are plans within plans within plans, each one with different, ambiguous requirements, preferred providors and labs, preferred meds, providor ID numbers, PRIS#'s, TIN's, etc. Some patients have plans that require pre-certs from many things, while other patients, often with identical ID cards, do not need such pre-certs. Finally, with medicare, you easily know what is and is not covered. Now contrast that to the commercials where coverability is often not known until after the fact, despite bonafide attempts to find out otherwise.
  • You'd make more money: Combine the effects of overhead reduction, practice simplification, amd improved cash flow with an absence of forced pro-bono work, and the math becomes easy to see. This is most true for physicians like orthopedists and general/trauma surgeons who do lots of ER work, especially in poorer areas. Because of a good law called EMTALA, these same surgeons must work very hard for these patients and neither the surgeon not hospital has any guarantee, nor prospect, or payment. Under a universal coverage plan, single payor or not, these doctors and hospitals would get paid.
  • It is the right thing to do: Enough said.