I agree.
However, our reimbursements are much lower than five years ago.
How can we continue to provide
the best service when we are continually threatened with devaluing our services?
This is
not the type of 'business competition' (by IMHO arbitrarily reducing reimbursements merely to save costs) that created a system in which our healthcare providers are able to provide the
best care.
In short, how much is a healthy life (or a life that needs proper compassion and care) worth?
I know tat
all of us believe that we have an obligation to our fellow man - not just to extend the life of a patient but to the greatest extent possible a healthy life to those years.
Isn't that what
all of us desire for ourselves and our loved ones?
At the very least I ask that all medical providers be shown the respect and compassion by our insurers we extend to our patients.
Has anyone spoken to imaging centers (I use this example as I am in the imaging business) near the Canadian border?
We see patients in Maryland who have travelled to our area to receive
prompt treatment that in many cases is delayed for
months in the Canadian system.
In my opinion - In many cases, this is fair
to no one but those paying the medical bills as we have
no choice but accept what is offered.
For most individuals (fortunately) healthcare is an afterthought as most of us have the luxury of good health.
But for the
sick (which is 100% of our patient population) 100% of them deserve
the best we can give them.
And lowered reimbursements is contrary to our oath (and personal moral obligation) to help heal the sick.
So how do we ensure that we can continue to exist without at least the
opportunity to receive increased reimbursements to cover our ever-increasing costs?
How do we collectively work with our insurers so there is more input from
every provider?
Is this a reasonable question? How can we at least engage in respectful discussion as without
all citizens will lose.
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William Kisse
COO
Washington Open MRI, Inc.
Rockville, MD
bill@womri.com(301) 424-4888
https://www.linkedin.com/in/billkisse/------------------------------
Original Message:
Sent: 06-08-2020 10:46
From: David Smith
Subject: Insurers ask for 11.7% rate hike for 2021
William
I think New York is probably a different case from most of the rest of the country, and it wouldn't be surprising to learn that COVID has disproportionately impacted exchange plans. I know that in general, the national players expect that they will have to refund exchange premiums due to low utilization and medical expense requirements.
Our July 1 self-insured premium renewal came in with a 4% increase (after haggling a bit), and we anticipate that the refund of unused premiums for the plan year ended June 30 will more than offset that increase.
I agree about the need to negotiate with payors. Currently, I'm focused on mitigating the impact of the 2021 Medicare reduction. That means making sure that none of our commercial agreements are tied to current year Medicare and getting Medicare Advantage plans to factor in MIPS incentives. I think most insurers are awash in cash due to reduced utilization (as evidenced by their willingness to enhance coverage for COVID related services), so now is the time to make a deal.
I'm more concerned about a big spike in the numbers of people without insurance later in the year. As that plays out it might harden health plan negotiating positions.
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David Smith FACMPE
Executive Director
United Imaging Consultants
Mission
(785) 393-8387
Original Message:
Sent: 06-08-2020 10:19
From: William Kisse
Subject: Insurers ask for 11.7% rate hike for 2021
Isn't this wonderful news!!!
And I assume that our cost of doing business has decreased this past year?
It must have or at least stayed the same as NO ONE or NO GROUP has collectively lobbied on our behalf to make a reasonable and fair case for what would appear to any reasonable "business person" as price-fixing or at the least an awful one-sided 'TAKE IT OR LEAVE IT' negotiation.
How about an 11.7% increase IN OUR REIMBURSEMENTS? Better yet - how about 25% - which won't make up for the years of frustration we've all just 'accepted'.
Who is the collective voice among we providers to ensure that WE CAN REMAIN SOLVENT, ask for and receive increases as OUR expenses continue to climb?
WE are the ones on the front lines who are taking care of patient needs, we touch the patient, attend to their physical and emotional needs and ACTUALLY DO THE WORK!
And the insurers? They are simply doing paperwork and always crying about needed increases in THEIR reimbursements.
I implore all of you - it's time to be respected and all we do is sit, wring our hands and tighten our belts.
How do we create a 'method' during this insurance reimbursement madness?
And...many among us receive - in some cases - DOUBLE our reimbursement as a 'good business decision' on the insurers.
Shouldn't we be reimbursed on MERIT (taking care of our patient population in the most professional and effective way) instead of market share as dictated by our 'friendly and fair insurers'?
I choose to LIVE ON MY FEET instead of DYING ON MY KNEES!
Yes, this is something we ALL talk about and nothing happens. Why???
We have nothing to lose (except our livelihoods and businesses) and everything to gain (having the resources to provide only the best services to those seeking our care).
Insurers ask for 11.7% rate hike for 2021
New York insurers selling plans on the individual market asked the state to raise rates by a weighted average of 11.7% with some citing Covid-19 as necessitating higher premiums in 2021.
Oscar sought the largest premium increase on average in the individual market at 19.1%, the state Department of Financial Services said Friday.
Fidelis Care, the insurer with the largest share of the state's individual market, requested the second-largest increase, 18.8%. Fidelis has sold plans in all or nearly all of New York's 62 counties and typically is one of the cheapest options.
Fidelis attributed just shy of half its requested increase to expected higher costs related to Covid-19. The insurer said it "made a preliminary adjustment to reflect the increased risk and uncertainty associated with the pandemic and its secondary effects," according to its rate application.
Empire BlueCross BlueShield HealthPlus is seeking a 16.6% hike, UnitedHealthcare requested a 13.8% increase and Emblem plans to raise rates by 9.5% on average.
Some insurers operating upstate, HealthNow and Independent Health, sought permission to lower their prices by 1.9% and 3.7%, respectively.
The requests are averaged across different plan types and regions and don't necessarily represent exactly how much more an individual renewing coverage might pay for a given plan. DFS typically makes its decision on how it will adjust plans' rates by August.
In the small-group market, insurers requested to raise rates by a weighted average of 11.4%. That figure is heavily influenced by the request of UnitedHealthcare's Oxford, which has recently controlled about half the market and requested an 13.6% increase.
Eric Linzer, president and CEO of the state Health Plan Association, said the requests reflect the costs insurers incurred to respond to Covid-19. The plans complied with rules prohibiting them from collecting copays for testing, telehealth and essential workers' mental health services. They also provided cash advances to hospitals and delayed collecting premiums until at least June 1.
"New York's health plans have made extraordinary efforts to meet the needs of consumers, businesses, and our health care partners," Linzer said in a statement
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William Kisse
COO
Washington Open MRI, Inc.
Rockville, MD
bill@womri.com
(301) 424-4888
https://www.linkedin.com/in/billkisse/
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