Blue Cross slapped on endoscopy incentives

Insurance companies need to understand what is involved in each aspect of care, each procedure before raising or lowering payments. ASCs have had a free ride all along and those lucky enough to win the CON lottery (quite aptly abbreviated, actually stands for "certificate of need") have made millions with the bountiful ASC facility fees whose (ASCs) payments are pegged to a certain percentage of the payment to a hospital OP department. This is a classic example of the result of hiring lousy managers at the helm of affairs by these insurance companies. They have taken the lazy way out by playing the percentages game. What the insurance company actuarial staff really needs to be doing is studying the utilization by individual doctors, studying the typical costs of procedures and typical outcomes by painstakingly reviewing charts for each of the procedures before negotiating with doctors about reducing or in some cases increasing their fees. If you do not know the costs, how can you fix prices? If you do not know the typical outcomes, how do you reward the best performers? The Hospital lobby is very corrupt, very powerful and will do everything possible to keep the cost of care inflated. ASCs and office based endoscopy procedures are essential to maintain the solvency of our healthcare system.

Insurance companies need to understand what is involved in each aspect of care, each procedure before raising or lowering payments. ASCs have had a free ride all along and those lucky enough to win the CON lottery (quite aptly abbreviated, actually stands for "certificate of need") have made millions with the bountiful ASC facility fees whose (ASCs) payments are pegged to a certain percentage of the payment to a hospital OP department. This is a classic example of the result of hiring lousy managers at the helm of affairs by these insurance companies. They have taken the lazy way out by playing the percentages game. What the insurance company actuarial staff really needs to be doing is studying the utilization by individual doctors, studying the typical costs of procedures and typical outcomes by painstakingly reviewing charts for each of the procedures before negotiating with doctors about reducing or in some cases increasing their fees. If you do not know the costs, how can you fix prices? If you do not know the typical outcomes, how do you reward the best performers? The Hospital lobby is very corrupt, very powerful and will do everything possible to keep the cost of care inflated. ASCs and office based endoscopy procedures are essential to maintain the solvency of our healthcare system.

Insurance companies need to understand what is involved in each aspect of care, each procedure before raising or lowering payments. ASCs have had a free ride all along and those lucky enough to win the CON lottery (quite aptly abbreviated, actually stands for "certificate of need") have made millions with the bountiful ASC facility fees whose (ASCs) payments are pegged to a certain percentage of the payment to a hospital OP department. This is a classic example of the result of hiring lousy managers at the helm of affairs by these insurance companies. They have taken the lazy way out by playing the percentages game. What the insurance company actuarial staff really needs to be doing is studying the utilization by individual doctors, studying the typical costs of procedures and typical outcomes by painstakingly reviewing charts for each of the procedures before negotiating with doctors about reducing or in some cases increasing their fees. If you do not know the costs, how can you fix prices? If you do not know the typical outcomes, how do you reward the best performers? The Hospital lobby is very corrupt, very powerful and will do everything possible to keep the cost of care inflated. ASCs and office based endoscopy procedures are essential to maintain the solvency of our healthcare system.