Advice and Commentary on the World of Professional Consulting


Healthcare In A Minute - June 2016

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by George Chapman, GW Chapman Consulting

Medicare fraud. We are losing more than $60 billion annually to Medicare fraud. While the Affordable Care Act has greatly expanded resources to prevent and detect fraud among providers, it is still difficult to completely stop it. First, Medicare is huge. It is by far the largest healthcare insurer/payer in the country. It receives over  4.5 million claims daily and pays out over $1 billion to providers daily. Second, Medicare is more “open” (trusting) than commercial insurers. Once an applicant provider meets all the basic requirements, Medicare is obligated to begin processing the claims and paying. Medicare does not physically confirm the existence of all new providers be they a home health agency, medical group, pharmacy or durable medical equipment supplier.  In addition to the cost, fraud makes it more difficult for Medicare to make policy or health decisions because a lot of the claims upon which decisions are made are fake/tainted, distorting claims data. How much damage can just one doctor do? In 2012, Dallas physician Jacques Roy, bilked Medicare for $375 million through a phony home care company. It is still the largest home care fraud case in the history of Medicare.  Most get caught because they get greedy. Roy “enlisted” more than 11,000 beneficiaries to receive home care thru his phony company. This number was, by far, the most enrollees by a single physician in the country. Fraud auditors were immediately suspicious as this came up on their radar. Dr. Roy is serving a life term in prison, but most of the $375 million he stole is gone.

Fee for service being phased out. It has long been argued that fee for service or volume payments to physicians and hospitals has produced the wrong incentives and the highest costs in the world. In a FFS environment, there is no incentive to not provide unnecessary care or to focus on long term outcomes or to coordinate care with other providers. Expert believe the sooner FFS is gone, the better for all.  Recently, 52% of the members of the New England Journal of Medicine Catalyst’s Insights Council agreed that FFS reimbursements must go and it stands in the way of providing value based and outcome oriented care. The switch to value based reimbursement will not only change how physicians practice. Consumers will be increasingly expected to hold up their end of the bargain by eating healthy, exercising and following physician orders.  

Primary care physician salaries up.  Although most specialists still earn more, compensation for primary care physicians is improving. According to a reliable and respected national survey of medical practices, primary care compensation has increased 18% over the past five years. Specialist compensation rose 11% over the same period. This is good news because it should encourage more medical students to pick primary care and alleviate the predicted shortage of primary care providers.  The transition from fee for service to value based care shifts more responsibility, and therefore more money, towards primary care.

Family health insurance premium.  According to the Milliman Medical Index, health insurance for an average household of four, with an employer sponsored plan, costs $25,826. This is more than three time the cost of $8,414 in 2001. Employers still pay most of the premium (57%) but cost shifting to the employee is increasing. The average household is paying about $11,000 or about 43% of the total premium. The “good” news is  annual rates of cost increases have dropped from 10% years ago to 5% in recent years.  

Exchange rates up 8%.  According to the Robert Wood Johnson Foundation, the average premium on the exchanges rose 8.3 %, but there was tremendous disparity across the country. Rates went up almost 42% in Oklahoma, but fell 12% in Indiana.  So, the RJW researchers concluded the national average is a fairly meaningless statistic and more attention should be paid to comparing the characteristics of markets with high rates of increases to those with lower rates of increases. Despite the disparities among markets, many predicted the average rate of increase  would be in the double digits. Insurers like United are pulling out of the exchanges as the enrollment of sicker and more expensive consumers creates “unsustainable” losses. Some states (Alaska, Alabama, Wyoming so far) will have only one insurer on their exchanges next year. Insurer losses would be mitigated or offset by the enrollment of younger and healthier consumers. But the current penalty for not buying insurance is still far cheaper than buying premiums; so, younger and healthier people take their chances by foregoing insurance and paying the penalty.

Opioid overdoses.    44 people die every day from an opioid overdose. The epidemic is very costly to first responders, ambulances and hospital drug treatment facilities because many if not most of the patients lack insurance. The annual cost to treat these patients exceeds $2.3 billion, most of which is absorbed by the aforementioned providers.  Rehab cost between $16,000 and $20,000 per patient. If the patient contracts hepatitis C, typical for intravenous drug users, the cost jumps as much as $94,000 primarily for drugs.  Frustrated with little to no change in medical school curriculums, Harvard medical students have organized their own training sessions on treating opioid addiction. The FDA wants to require training for all physicians who prescribe opioids, but physician groups remain opposed.

Big Pharma “charity”.  You have heard on the ubiquitous drug ads that, “if you are having trouble paying for….. (the particular drug), financial assistance is available”. This seemingly charitable/humanitarian act is done  to deflect much deserved criticism for profit mongering and bankrupting the entire healthcare system and to boost sales. To offset the “charity” or discount, drug manufacturers merely increase the prices of their drugs.           

Protect your identity.  Hackers want to steal your personal information and your identity. Your mobile phone, laptop and router are all access points for thieves. The best way to reduce your risk of being hacked is to frequently change your passwords. The main reason why we don’t do this nearly enough is that we all have several (too many) passwords. Experts remind us that the hassle of changing our passwords pales in comparison to the disruption of life and financial loss if we are hacked.    

Healthcare In A Minute - May 2016

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by George Chapman, GW Chapman Consulting

Drug spending continues to soar. Total spending on drugs was $425 billion last year up a staggering 12% from 2014. According to the AARP’s Public Policy Institute report, the average retail cost of a year’s supply of typically used prescription drugs by seniors is over $11,000. The average annual cost for specialty drugs, like those treating cancer and hepatitis, was $53,384 three years ago.  Overall Medicare spending was up only 1% last year to put the 12% drug increase into perspective. Drugs now account for 25% of overall spending. (Thirty years ago, drugs accounted for less than 5% of all healthcare costs.) Currently, hospitals account for about 32% and physicians account for about 20% of overall spending. The balance of expenses goes towards skilled nursing facilities, substance abuse and addiction, mental health, durable medical equipment and implants, chiropractic, podiatry, nutrition, etc. Congress establishes Medicare payments to physicians and hospitals but cannot set drug prices.  

Reduce your exposure. Seven typical household items rank as most hazardous to your health if not used or maintained properly. They are : step ladders (falls), dryers (fires)  lawn mowers (injuries), bed rails (injuries dues to poor installation), humidifiers (mold), blenders (lacerations, scalding), toasters (fires).

Insurance mergers.   The pending mergers of insurance giants Aetna-Humana and Aetna-Cigna are undergoing increased scrutiny by the Department of Justice and are facing uphill battles. The DOJ is wary of all “super mergers” that may hurt consumers through less competition on service and price. Hospital mergers are in the same boat. This increased scrutiny by the DJ has been happening despite the Obama administration being relatively passive when it comes to blocking mergers.

ObamaCare premium subsidies.  The House Ways and Means committee is questioning the Administration’s method of funding premium subsidies for the indigent who are purchasing insurance through ACA exchanges. Anyone with income between 133% and 400% of federal poverty guidelines qualifies for the subsidy. (Those under 133% qualify for Medicaid.) Subsidies are expected to total $170 billion over the next ten years. Without tax payer support, insurers on the exchange could face the prospect of having to cover the subsidies themselves.

Calculating premiums.  Determining competitive/fairly priced premiums for new enrollees with uncertain health statuses has been a challenge for commercial carriers. United Health has already announced it is pulling out of most state exchanges next year. As more data becomes available each year, insurers will have more experience which allows them to better assess risk and determine premiums. The fear however is that if premiums are too high, it might drive away the relatively healthy. The only way to combat that potential exodus of the “healthy” is to make penalties for not participating much higher than they are now.

Medical errors.    According to researchers at Johns Hopkins University School of Medicine, medical errors in hospitals and other healthcare facilities are the third leading cause of death in the US, claiming over 250,000 lives annually. (700 a day)  Head researcher Dr. Martin Makary summarized: “It boils down to people dying from the care they receive rather than the disease or injury for which they are seeking care.” Only hospital acquired infections have shown improvement over the years.  Many experts believe healthcare has too much tolerance for variability in practice versus other industries. Lack of standardization makes it harder to identify and fix problems.

Oneonta physician creates center for transgender patients. Family physician Carolyn Wolf-Gould offers hormone therapy, counseling, and coordination with other physicians for patients seeking surgery.  Dr. Wolf-Gould said transgender patients come from as far away as six hours due to short supply of providers offering services.

Opioid addiction. The unfortunate death of pop superstar Prince Nelson has brought more attention to the opioid painkillers addiction epidemic in the US. Someone dies from an opioid overdose every 20 minutes. Many addiction experts question the rationale of turning to the pharmaceutical industry for more drugs to combat addiction to drugs. Treatment for the underlying psychological symptoms that can lead to substance abuse should be also be part of a provider’s arsenal. The FDA is considering making it mandatory (currently voluntary) for physicians who prescribe opioids to undergo safety training courses paid for by opioid manufacturers.

Short term policy.    It is a cheaper alternative to policies offered on the exchanges. It is meant to fill gaps in coverage, but for only a few months. However, short term policies do not meet minimum ACA requirements for coverage and benefits, so buyers will face significant tax penalties.    

   

Thought for the month.  “Discussion is an exchange of knowledge. An argument is an exchange of ignorance”. Attributed to American journalist and humorist Robert Quillen.

Think About Being A Consultant

There are a lot of jobs that have been eliminated that just aren't coming back. Manufacturing in America is dwindling, and there's not going to be a renaissance for that either. We can't compete with the pay rates that countries such as India and China are willing to accept. That, and not having to deal with unions, will kill large manufacturing in America.

Everyone isn't suited to work menial, low paying jobs; many people are overqualified and won’t even get a second look from employers. Some of us are older and physically can't handle stocking shelves for long periods of time, or standing for a long time; our backs can’t take it. Some people might be able to do it, but not everyone.

What's left then? Loral Langemeier, who shows up on Dr. Phil and other shows often enough, wrote a book called the Millionaire Maker. She helps people set budgets that they can live on, but also gets real with people. She works with them to understand that they may have to sell their homes, their fancy cars, and live a simpler life. She also recommends that everyone take a good look within themselves to figure out what skills they have to work for themselves and bring extra money into the household.

Working for oneself isn't a new concept. America was built by people worked for themselves, who had more than one skill, and that’s how they made their living. Self employment has always been a big thing in this world. This is why consulting makes a lot of sense for people who have skills that can help others and a need to work as much as possible without the restraints of internal politics.

In Langemeier's book, she tells the story of people who hadn't thought about skills they had, that either came as a result of the jobs they did, or as the result of hobbies they had. One man was a teacher who realized he could do tutoring after school to make money. It turned into a full time career, as he hired other people and paid them a portion to do tutoring for him.

There was also the story of a lady who could build websites, something she learned at her job, and she turned that into first a part time job, then her new profession.

There are many things people need someone else to do for them. They go looking for someone to help them in their local newspapers. Or they look online for those people in the area where they live. New entrepreneurs realize they can put ads in these newspapers, offering services that someone might be able to use.

Many unemployed people need to take the time, while sitting on unemployment, to not only look for a new job, but try to see what they can do that may bring money into the household. Since most communities have a Chamber of Commerce somewhere near, contacting them and learning when they have networking events give you another chance to meet people who just might need your skills, both individuals and larger businesses.

It's up to you to think about your own self and your skills, and to figure out what you’re good at. Talk to someone to help you explore the thought if you need to; if you have to pay a few dollars for it, it may be worth it. Anything you do that's a positive step forward only brings positive things into your life. You owe it to yourself to think of ways to be independent, even if it doesn’t work out; you’ll gain valuable information that you may be able to use later on.

The Professional Consultant's Association of Central New York gets many new visitors who are people that are in a career transition and looking to see if consulting is for them. I'd estimate that 85% of them find themselves employed within 3 to 6 months later, having decided that they're more comfortable with a standard job than having to deal with the pressure of being self employed. We don't condemn anyone for those types of decisions; it's probably something those of us who have been independent consultant's for a long time have entertained here and there in our professional lives.

America is changing; change with it, and you may find a career that fits you like a glove, and that gives you more control over your life. Consulting is a pretty nice career change to think about. It's not easy, takes a lot of discipline in a lot of areas, and sometimes you'll have your ethics challenged in ways you've never imagined. Overall, you'll love the freedom, the sense of purpose in knowing that your success is on your hands, and you might even see the world on someone else's dime. :-)

Healthcare In A Minute - April 2016

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by George Chapman, GW Chapman Consulting

VA privatization?  Recent problems within the VA healthcare system have prompted a special VA commission to consider allowing vets to receive their care at private facilities while the VA begins to close their own hospitals beginning with the obsolete and little used.  Several veteran’s groups have expressed opposition to the proposal saying their opinions/feelings have neither been considered nor solicited.  The VA operates 150 medical centers and 1,400 outpatient clinics, employs 53,000 licensed professional and cares for 8.3 million vets.

Cyber-attacks.  The hacking of healthcare data is becoming more frequent and sophisticated. Most of the attacks come from Russia, China and eastern Europe. Hackers are looking for protected health information and medical technology intellectual property to sell on the black market. “Ransomware” is designed to destroy backup files and databases unless the victim pays a ransom to have their data unlocked. The FBI is encouraging victims NOT to pay the ransom as to do so would only encourage the hackers. The defenses against these attacks are costing the healthcare industry billions.

MD assisted suicide.  California is moving towards legalizing physician assisted suicide for the terminally ill. It’s already legal in Washington, Montana and Vermont. Of course, the eventuality of California entering the market has prompted the manufacturer of Seconal, developed over 80 years ago, to gouge the public. In 2009, a lethal dose of Seconal costs about $200. Valeant Pharmaceuticals has raised the price to $3,000.

NYS mergers driving up prices.  A study by the conservative think tank, the Manhattan Institute, concludes that the 100+ hospital mergers in NYS have served to only increase costs and decrease competition with no perceptible increase in quality. The Institute recommends greater price transparency among hospitals and to establish a commission mandated to monitor healthcare consolidation and costs. Mergers that result inI price increases would be subject to antitrust litigation. Accounting firm PWC agrees. According to their market analysis which included 5,600 hospitals, bigger hospitals have obvious economies of scale advantages over small hospitals; but it doesn’t carry over (so far) when these hospitals merge.  Hospital mergers have not resulted in noteworthy cost savings or improved quality.

Employer sponsored insurance.  Many thought the ACA would cause a decline in business sponsored health insurance.  According to the Congressional Budget Office, 57% of Americans, about 155 million, will still get insurance through their employer this year.  The CBO predicts this will drop slightly to 152 million in three years, but then remain stable through 2026.  The main reason for this stability is probably employees have come to expect coverage through their employer.

Controlling drug prices.  In an effort to control spiraling drug prices, Medicare is trialing a new payment model whereby physicians who prescribe drugs that are cheaper but equally effective as the higher priced options will be rewarded. The thought is to have both the physician and patient do the math. Physicians are still free to  prescribe the most expensive drug if they truly believe it is in their patient’s best interest.

Good Samaritans.  A survey of North Carolina physicians revealed that 93% took action in a medical emergency outside of their office.  The most common place for emergency services was on an airplane.

War on cancer.  This is one war we are actually winning. Cancer related deaths have decreased from 215 per 100,000 deaths in 1990 to 166 per 100,000 deaths in 2012. That is a 23% decrease in just 22 years. Cancer mortality has dropped across the board for all cancers. Since 1990:

breast -36%,

prostate -50%,

colorectal -39%,

non-Hodgkin’s lymphoma -28%,

ovarian -22%,

cervical -34%,

leukemia -15%,

lung -24%,

kidney -12%,

liver -70%,

oral -29%,

pancreatic -3%,

stomach -47%,

thyroid -25%,

brain -10%.

NYS #21. The annual United Health survey of states ranks #1 Vermont as the “healthiest” and #50 Louisiana as the “sickest”. The study considers factors like diet, smoking, alcohol intake and obesity in its  ranking.      

Measuring and reporting “quality” is expensive.  Your physician spends about $40,000 a year in staff time and money just to measure their progress against several quality measures imposed by Medicare and commercial payers. Many are calling into question the return on investment when it comes to value based payment.  What it costs a physician to comply and report almost negates any increased payment or rewards for meeting quality metrics. While measuring and rewarding quality is a laudable goal, the inefficiency in collecting and reporting the data clearly contributes to the negative attitude in the medical profession towards the whole concept.

April awareness month.  Alcohol abuse, autism, child abuse, distracted driving, minority health, world health and air quality.

 

Don’t Believe In Advertising?

By John Hunt, General Sales Manager, WOLF 105.1, Movin 100.3/96.5, 95.3/103.9 The Dinosaur And Fox Sports 1490AM

“A man who stops advertising to save money is like a man who stops a clock to save time” – Henry Ford

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Successful small businesses know advertising is an essential business plan component. For over ten years we’ve presented marketing workshops in conjunction with the Small Business Development Centers in Oswego and Onondaga Counties. These workshops are designed to help small businesses design the marketing chapter of their business plans.

We know that successful worldwide brands like Coke and Microsoft are household names. So why do they continue to advertise and market their products when they dominate their respective categories? Because – if they don’t, there is a better chance consumers will forget about the products and services over time. Marketing at this stage is designed to continue the brand experience in between the times when a consumer uses the product or service.

“That’s true, but small businesses don’t have the budget or resources that million dollar companies have.”

The principles that these successful companies use are the same principles all businesses are encouraged to use. Successful small businesses look at the patterns and strategies and adapt them for their own campaigns.

Start by looking at how the customers buy. What brings them to the small business? Follow the pattern.

Eventually, the small business will recognize the whole customer buying cycle. Now, focus the advertising at various points or milestones of the buying cycle so that the buying cycle will compress and encourage more frequent transactions.

“Our small business doesn’t have money to throw away on advertising. It needs to work.”

Our company believes all media works if it is used properly. If we know how customers buy from the business, our team can look at those patterns and help improve the buying cycle. There are patterns in every industry. If we compare our research with local small business’ trends, we will help see these patterns more clearly. Knowing these patterns brings about better results from advertising and marketing.

Want to know more?

Let’s review your business’ customer buying cycle at no obligation. Call us at 315-472-0222 or email me at jhunt@movin100.com to arrange a meeting with a member of our team. Or – if you have a group or trade organization that would like to host one of the small business marketing workshops at no cost and no obligation, we are scheduling appearances for summer and fall 2016 right now.