Difference Between HMOs and PPOs

The relative difference between HMO and PPO or other plans is less than 15%.

There is virtually no reduction in cost over time. In some cases, there is a percent savings, and some of that is artificial between plans owned by large companies offering different products.

Journalist; OB Story Wrong

So, I’m innocently reading the news and find myself researching a reporters comment.

Okay, so I’m conflicted. Either the reporter misquoted, misunderstood or is intentionally quoting incorrectly. Screen Shot 2015-09-17 at 8.32.09 AM

This is an unusually long post, but it has a number of good points. I didn’t wake up today planning on writing this post. But, it’s a good chance to write about things I’m passionate about that most people don’t spend their day thinking about.

  1. journalist integrity
  2. healthcare rules and how Universities shape our physicians
  3. how rules and word smithing is important
  4. how abortion is learned
  5. how insurance companies rely upon this training
  6. how us as Americans pay for this
  7. that rationing exists in our system today, this is an example
  8. the inconsistency in thinking that is soooooo costly

For those doctors and healthcare professionals who follow me, please engage with me on this note.

The reporter writes about, “The decades-old relationship between MU and Planned Parenthood,” says of medical school education;

Nursing and medical students were never required to work at any Planned Parenthood clinic, work at the clinic was not part of the core curriculum in either the nursing or medical schools and the placement was an optional…

Columbia Missourian, Elise Schmelzer, Sep 15, 2015; “State investigation focuses on decades-old relationship between MU, Planned Parenthood”

http://www.columbiamissourian.com/news/local/state-investigation-focuses-on-decades-old-relationship-between-mu-planned/article_de825b18-5bd9-11e5-b5d3-8b294f78e0ba.html

A small amount of digging

But, in doing a small amount of digging, I found the association responsible for setting out the rules for residence in training for OB work are required to train on abortions. My brain is a word smith brain which means I can’t reconcile what the journalist wrote with what I found in a quick look at her own link on the topic. I didn’t perform any further analysis but I’m sure the topic has much more detail.Screen Shot 2015-09-17 at 7.47.29 AM

When I read a journalists article that might be misleading I have to look for the detail. I want to know why does this not sound correct to me. I have an advantage over a young journalist with 29 years in healthcare finance. In this case, I wondered if the reporter intentionally left out an important fact, or skewed a statement. You decide. I think if they asked a few more questions they may have blown open a different discussion. And, an important one at that. They may have discovered the school is training residence on abortion, just not at planned parenthood. Makes you wonder if they use the tissue like planned parenthood, but they use it for University research. It is universities that use the tissue. The article and title make it sound like the university isn’t using planned parenthood clinic and are innocent of any relationship with the abortion business. Innocent enough I suppose on the surface, but what is the rule for OB’s? Where do the residence at this University get their required training?

A very small misquote, or misstatement changes the flavor of the article completely, upon close inspection, the phrase, “at a student’s request” conflicts with the written rule for the Universities accreditation.  Here is the authors quote, it’s there in bold.

The agreement with the medical school was required to meet Accreditation Council for Graduate Medical Education requirements that mandated schools provide training on abortion procedures at a student’s request, MU Chancellor R. Bowen Loftin said in a letter to Schaefer.

Columbia Missourian, Elise Schmelzer, Sep 15, 2015; “State investigation focuses on decades-old relationship between MU, Planned Parenthood”

http://www.columbiamissourian.com/news/local/state-investigation-focuses-on-decades-old-relationship-between-mu-planned/article_de825b18-5bd9-11e5-b5d3-8b294f78e0ba.html

It might seem silly but I live in a world of insurance where rules guide how our medical system works including how much it costs. Think about it this way, our educational institutions work because they have many rules to guide education. They are the one’s who write the rules, and these rules are used to train your favorite doctor. These rules make it possible for insurance companies to pay claims.

So, here’s my word smith problem. The quote below is a rule from a body that gives accreditation to medical education programs and this quote says it is mandatory for University programs, to be accredited, they must provide abortion training. It does not say, what the journalist wrote, “at a student’s request.” The rule as quoted says, they must train residence in abortion.

See, it says it right below in bold.

It’s on page 15 of the ACGME instructions, rules and guide (the journalist provided this link in their article). These rules are used by insurance companies to make sure doctors are properly accredited by properly accredited university training delivering the best care to the insurance company patience. These things, these rules, matter.

Screen Shot 2015-09-17 at 8.31.30 AM

“IV.A.6.d) Family Planning and Contraception IV.A.6.d).(1) Programs must provide training or access to training in the provision of abortions, and this must be part of the planned curriculum. (Core) IV.A.6.d).(2) Residents who have a religious or moral objection may opt-out, and must not be required to participate in training in or performing induced abortions. (Core) IV.A.6.d).(3) Residents must have experience in managing complications of abortions and training in all forms of contraception, including reversible methods and sterilization.”

ACGME Program Requirements for Graduate Medical Education in Obstetrics and Gynecology, ACGME approved major revision: September 28, 2014; effective: July 1, 2015, Page 15.

https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/220_obstetrics_and_gynecology_07012015.pdf

This quote is current, the document doesn’t dictate any specific place for the training, it doesn’t even mention planned parenthood.

Rationing is a phrase I use and when I do most people do one of two things; their eyes glaze over in confusion, or they object out of ignorance because they incorrectly believe rationing will never happen in America. In fact, this article, this misquote or misstatement by the person quoted leads to rationing.

Let me try a different tact.

You’ve been to school and you know from the office of the registrar to commencement day policies, paperwork and rules are required before you get your diploma. It shouldn’t surprise anyone then, that there’s rules for medical school.

Ever wonder where the rules come from?  Who writes them, why they write them a certain way? Ever wonder why these rules are important? Did you ever consider these rules influence the healthcare you pay for? Do you understand how this simple language has an evil twist for medical students? Ironically, what the author wrote would be the logical way most people would write the rule, “students have the choice if they want the training.” But, the fact is, the training is required and students at that University are getting it. I haven’t researched this, maybe, the University is outside the norm and their doing it as quoted. Then, the national standards for OB’s is not being followed and this is not a good thing….

It leaves me in this article examining the person in the article who the journalist quoted as not telling the truth, or answering the journalists question about planned parenthood with a strictly narrow answer. And, the unknowing journalist innocently took them at their word. Or, the journalist intentionally wrote an untruth.

The point? The point is OB residence are mandated to take abortion training, it’s not optional. They can opt out for religous beliefs. This is opposite what the journalist wrote. She wrote, students can opt in for that training. This would be how most Americans would assume it’s taught, as an option for medical students. It is a small, razor thin edge isn’t it.

Okay, shift for a minute with me to the actual topic of abortion

Consider that our country makes physicians learn how to perform induced abortions and kill babies. They are in fact babies because this same system pays million upon millions to keep alive babies at the exact age. The contrast to me, originally a claim payor is almost too much to bare. Why, how, as a country did our healthcare system get to a point where this contrast is so great.

It’s because the masses follow what they read from journalists, because they’re not word smiths, because they don’t have time, blah, blah, blah.

This is where the problem starts, it’s where the evil begins. It’s where medical students, in the hallowed halls of educational institutions are provided the means to promote abortion, to agree with them as a course of study and health for a women. You have promoted this behavior by paying for the medical school education, by paying insurers premium, by having policies that promote the idea this is healthcare, that new physicians are mandated to learn about and accept abortion as care. The societal endorsement for doing abortions is trained, it is a medical school endorsed practice.

For the baby, for the voice of the babies, for increased medical premiums, for rules that don’t provide health but death we need to change our methods in the US.

Editing needed

If you’ve slugged through my poor grammar today I hope the overall point was worth it. I’ll return to edit grammar and such but for now, this should suffice.

What Have We Tried?

Pick which of these “carrier driven consultant driven directions has been successful at bending the trend as they have been telling you they will do.

Every new carrier and agent, consultant/broker brings with it the same solutions (watch the video).

For instance, in the 90’s and up to today, you’ve been sold CDHP, HMO, PPO, POS and other plans. In the kaiser 2012 survey of plans (KFF Employee health benefits survey, chart ref. pg 2), the price difference from lowest to highest is barely over 15%. If one solution was superior wouldn’t you expect it to be bending the trend by now and saving money?

As a specialist in pricing of plans, I can say, there’s never going to be some special plan that is going to make a difference unless we fundamentally agree the system needs changing. No more plan dejour, career dejour, government dejour or consultant dejour. Roll up your sleeves and get messy!

Continue to follow us and our posts as we outline our research to prepare you for better understanding of our coming white paper.

“Solutions” of Healthcare

Over the past 40 years, there have been many times that many have tried to come up with a cost-saving solution for healthcare.

In the 1970’s, it was Medicaid and Medicare. In the 1980’s, HMOs and PPOs. 1990’s, HIPAA and Flexible Spending Accounts. In the 2000’s, HSA’s and HRA’s and in the 2010’s Obamacare and Defined Contribution.

From that list above, have any been a successful cost-saving solution? The answer to that is no. None of those options have worked. 40 years worth of solutions from the brightest and best have not worked and these are the people proposing today’s solutions that won’t work either.

We have done research that we will be sharing with you over the next 50 posts. We’re laying the groundwork for our white paper that proposes real solutions that are not being talked about.