The mechanics of healthcare reimbursement have been getting more inches than you might expect in The New York Times recently. We've heard in the last few days about the length of time it takes insurers to pay providers (too long), the rate of electronic claims submission (getting higher) and how much Medicare pays hospitals compared to private insurers (not enough). Is it just coincidence? Or can I detect a little preemptive strike here as the players start to jockey for position in the coming world of transparency and pay-for-performance. Last year health economist Uwe Reinhardt published a much-talked-about Health Affairs article in which he showed that hospital pricing--and presumably hospital cost accounting--was opaque and presumably mostly guesswork. Today CMS began to release information about what it pays for several common procedures.
If providers are moving to a world in which what they charge for procedures is exposed and vetted by payer-related organizations like Leapfrog--let alone Consumer Reports--then they want to make sure that they are getting their stake in the political ground first. Meanwhile, employers and insurers are trying to pass the buck (literally) to consumers and the taxpayer, before those two sleeping giants awake. Of course, this all puts off the inevitable day when we really take a deep look at why we spend so much on healthcare when luminaries like Don Berwick tell us that up to 50 percent of healthcare spending is wasted. - Matthew