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  #91  
Old 05-13-2019, 01:38 PM
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Some of the rates seem high in the Rand study to what I've modeled recently. I can only compare the IP piece as I do not have Medicare rates to compare OP too.
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  #92  
Old 05-13-2019, 01:41 PM
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Some of the rates seem high in the Rand study to what I've modeled recently. I can only compare the IP piece as I do not have Medicare rates to compare OP too.
Regardless of it being 150% or 300% of Medicare, physicians aren't going to just give up those margins in the name of Medicare for all.
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  #93  
Old 05-13-2019, 02:42 PM
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Some of the rates seem high in the Rand study to what I've modeled recently. I can only compare the IP piece as I do not have Medicare rates to compare OP too.
Sounds reasonable, given that they're comparing price levels based on service & procedure:
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In this report, prices reflect the negotiated allowed amount paid per service, including amounts from both the health plan and the patient, with adjustments for the intensity of services provided. These negotiated prices are then compared with Medicare reimbursement rates for the same procedures and facilities to determine relative prices.
Medicare fee schedules are a LOT lower than commercial payers. But the severity mix and the incidence rates are dramatically different, so the aggregate effective cost PMPM is lower for commercial.
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  #94  
Old 05-13-2019, 09:20 PM
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Good link..It made me think of groups like the AHA, and of course they have disputes haha

https://www.aha.org/news/headline/20...e-health-plans
That's an even better link! I think it is safe to say that they are not in favor of Medicare For All.
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  #95  
Old 05-14-2019, 09:36 AM
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I could make another argument for the quote here:

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Further, Medicare payment rates, which reimburse below the cost of care, should not be held as a standard benchmark for hospital prices. In 2017, hospitals received payment of only 87 cents for every dollar spent caring for Medicare patients. Simply shifting to prices based on artificially low Medicare payment rates would strip vital resources from already strapped communities, seriously impeding access to care. Hospitals would not have the resources needed to keep our doors open, innovate to adapt to a rapidly changing field and maintain the services communities need and expect
Uuuhmm, then you are doing something wrong imo. Or you are performing to many useless procedures.

I should see what the providers are trying to BILL as a % of Medicare and write a rebuttal.
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  #96  
Old 05-14-2019, 10:39 AM
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I could make another argument for the quote here:



Uuuhmm, then you are doing something wrong imo. Or you are performing to many useless procedures.

I should see what the providers are trying to BILL as a % of Medicare and write a rebuttal.
100% agree. When I looked at this (a while ago), 100% of MCR was equal to roughly 18% - 20% of billed charges. I realize this varies a LOT by hospital, area, etc. but taking a step back, that means billed charges are just comical (as most who work in the industry would know).
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  #97  
Old 05-15-2019, 11:33 AM
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Regardless of it being 150% or 300% of Medicare, physicians aren't going to just give up those margins in the name of Medicare for all.
The State of Montana is using 243% of Medicare rates for their state employee health plan. North Carolina is implementing 177% of Medicare rates for their state employees.

The recent "public option" in Washington was passed with a 160% of Medicare rate clause.

It seems like the notion of paying X% of Medicare is picking up steam.
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  #98  
Old 05-15-2019, 03:15 PM
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I would argue that the state of Montana probably has more population per provider is a chunk of reason why they are paid a bit more. But I agree, because of the "Medicare for All" hype there will be more attention to paying as a % of Medicare.
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Old 05-17-2019, 08:49 AM
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The State of Montana is using 243% of Medicare rates for their state employee health plan. North Carolina is implementing 177% of Medicare rates for their state employees.

The recent "public option" in Washington was passed with a 160% of Medicare rate clause.

It seems like the notion of paying X% of Medicare is picking up steam.

Have you read yet anywhere or heard from any news sources that there may be a standard percent that is included in future legislation or political discussions that we can start to understand on a cost analysis project that would lead our future business plans?
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