The Healing Table

The Healing Table, Cotton, by John Dowell artist photographer

The Healing Table, 27” x 34,” Archival pigment print on cotton rag paper, 2017

65 thoughts on “The Healing Table

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  53. Hospitals are deeply concerned about the bad debt arising out of HDHPs. It is a real concern. Anytime you introduce self insurance, there is a risk of bad debt. However, the bad debt is limited to the maximum out of pocket cost mandated by the new law. After taking a deduction for bad debt and whatvshould be increasing reimbursement from formerly uninsured , now insured patients, my suspicion is the risk is limited for those losing sleep over HDHP proliferation.HDHPs offered alongside richer plans tend to drive better trends because the rich plans retain the high utilizers who are often driven emotionally to think of their lowcdeductible, low co-insurance plan as prepaid coverage e.g. Lower out of pocket, higher reimbursement etc. If an employer goes to a full replacement HDHPs as their only option, the cost of rising care ( medical inflation, demographics, technology, cost shifting from under reimbursement from government programs ) will eventually require more out of pocket from everyone. The pool of risk will have both high risk and low risk patients. Over time, normal consumption and rising unit costs will continue to corrode one’s purchasing power. Consumerism works for ambulatory services but does not work for catastrophic care which still drives a very large percentage of plan costs. I see unit cost and intensity of services increasing. In recent years, costs are lower due to decreased consumption and reduced admissions. We are nit sure if he orevalence of HDHPs is driving this or a sluggish recovery. In the future, we will see more $2m+ claims. End of life/palliative care will be an issue and an ethical hot potato. End stage renal failure is as much as $200k a year. Given our huge diabetes problem and the wildly poor rates of compliance among active diabetics with multiple co-morbidities ( conditions hat can kill them ), costs will keep rising. Private care will only prevail if hospitals form ACOs and can reengineer treatment to be rewarded on outcomes and not units delivered. The incentives must change. If not, hospitals and higher cost providers will cost shift to those who do not have the critical mass to get the best discounts. Once they run out of people to cost shift to, they either convert to risk sharing arrangements, sell, go out of business or form alliances. Met hospitals realize they need to cut operating cost by as much as 25 in the next few years or they will perish. The best plan of the future might offer 100 reimbursement up to some predetermined number ( Medicare + 25) for all ambulatory and elective procedures where consumers can make point of service decisions. We can provide provider concierge location services to navigate accesss issues which will arise. For all else, the best option is a Primary Care Based medical home/ACO model where all care is rendered in the narrow network. No out of network! Kaiser trends routinely runs 400-600bps better than traditional open access PPOs. The most controllable aspect of trend is variable unit cost and effective care management. Align the incentives and you can achieve the equilibrium we seek.

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