I think it was a scent

Well I hear we're about to screw those hospitals!

Outta what?[frypan] [frypan] [frypan]

I've seen that in both directions actually.

Seen billing where the insurance companies pay significantly less (because of negotiated rates) so a $500 procedure for an uninsured person only is a $200 hit against the insurance company.

I've also seen practitioners that have a flat rate (like $100) for uninsured, but do a full bill for the insured (likely shifting costs to the insurance companies from the uninsured)

When?

Was it the infamous Georgetown rubby beatdowns or the Chik-Fil-A demonstrations?

Billed charges mean nothing and are rarely tied to cost

Billed Charges...Cost? Are those Georgetown rubby players?

I'd bet that they have more "rates" than that...plus the insurance companies have their own "rates" that they pay that are completely different. It is like a Moroccan rug market (that was how it was described to me by a market insider once). As for the "betting on hope" comment earlier...there are several safety net provisions in the legislation including for those whom their employers stop providing insurance.

My personal opinion is that those employers put themselves at a competitive disadvantage with other employers but if they want to make a political statement to spite themselves then sobeit. The simple fact is that those employers that take care of their employees have higher profit margins, endure the market ups and downs, and generally have a higher net worth.


:-k

Florida restaurateur to impose surcharge for ObamaCare

Published November 15, 2012

Get ready to pay more for your Grand Slam.

A Florida restaurateur who operates roughly 40 Denny’s locations and five Hurricane Grill & Wings franchises in Florida, Virginia and Georgia intends to add a 5 percent surcharge to customers’ bills to offset costs from ObamaCare beginning in January 2014 when the Affordable Care Act is fully implemented.

“People are trying to find ways to avoid the penalties and to avoid having to pay for ObamaCare,” John Metz told FoxNews.com. “Everyone’s looking for a way to not have to provide insurance for their employees. It’s essentially a huge tax on all us business people.”

To further offset the costs, Metz, who oversees roughly 1,200 employees as president and CEO of RREMC Restaurants, LLC, said he also will slash most of the staff's time to fewer than 30 hours per week. That change will be announced to employees next month, he said.

“I want to explain it to everybody, to let them know what’s coming down the pike,” he said. “We like to keep our employees informed.”

The changes will force some front-of-the-house employees to look for second jobs, Metz said, but he simply cannot afford the penalties associated with ObamaCare.


“I have a choice: try to live within the rules, or go out of business.”
- John Metz, Florida restaurateur


“It’s a great concept,” he said. “We want to have everyone insured. The problem is, who is going to pay for it and how are we going to accomplish this?”

Under the current law, employers with more than 50 full-time (or equivalent) workers will be charged a penalty for the number of employees exceeding 30 full-time staffers who are not covered. With an average of 35 full-time employees per location, Metz said the $2,000 penalty would total roughly $70,000 per restaurant. Current coverage costs Metz up to $6,000 annually per full-time employee, he said. He currently provides coverage to about 250 employees.

“It’s going to be a big issue for all of us — for my employees and for me,” said Metz, who has been in the industry since 1975. “The ones that are working more than 28 hours, they’re going to act as if I’m cutting their hours and they’ll have to find another job.”

At Denny’s restaurants operated by Metz, the average check is $9, he said, meaning the ObamaCare surcharge if implemented would be 45 cents on that bill. At Hurricane Grill & Wings locations, where the average bill is $14.50, the surcharge would total 72 cents.

Metz said he believes the entire restaurant industry — even high-end locations — will ultimately embrace the idea.

“That is what I foresee and that is the easier, least painful way to deal with these added costs,” he said. “In a true playing field, everybody will impose this, from McDonald’s to Denny’s to even maybe the fine dining restaurants in order to have the funds to be able to pay for either insurance or the penalty for not providing insurance to their employees.”

Metz also is urging his employees to consider contacting their local elected officials in hopes of finding another solution to offset his looming increased costs.

“It’s never good news, but it is what it is,” Metz said of increasing customers’ checks. “We really should look for a better or different way to pay for [ObamaCare]. I think what we’re going to ultimately see here is a European-type system where we have a value added tax or a national sales tax.”

Metz continued: “I have a choice: try to live within the rules, or go out of business.”

In a statement to FoxNews.com, the National Restaurant Association said it’s “premature” to assess precisely how the health care law will affect individual businesses.

“We have warned for some time that the mechanics of the health care law are very difficult for the restaurant industry, which is a low-margin industry that works to keep costs down in order to provide value to customers,” said Scott DeFife, executive vice president of policy and government affairs for the National Restaurant Association. “All costs, from gas and commodities to labor and insurance, eventually impact the price on the menu. It is important that operators get very familiar with the provisions of the law and start planning for its implementation; however, it’s premature to make a specific assessment of exactly how the law will affect any individual business because there are so many details that are unknown.”


Film at 11.... 😟

Darden is doing the same thing...make everyone a part-time employee to get under the limbo of OwedumbaCare!

When I worked for a large health system (analyzing cost, charges and payment from various entities) our hospital charges were not tied at all to cost, in fact we had difficulty calculating what cost was (which mortified me when I started there but we fixed a few things as we went along). We had many hospitals as part of the system, and 400ish owned doctors.

Doc fees were pretty easy to decypher.... billed charges were roughly 2X what Medicare paid (maybe 1.8). The only folks that really paid that were private pay and maybe some small indemnity plans. Most insurance paid about 1.6 medicare (UCR) and sometimes we wrote off the difference sometimes we did not. Managed care plans typically paid us 1.25-1.4X medicare and we had to write off the difference. Of course Medicare paid us 1X Medicare (duh) and Medicaid paid us about .85 medicare (or less). Of course this all varied somewhat and was negotiable.

Hosp fees/charges/payment were a little more convoluted but played out similarly. The whole "they charged me $100 for an aspirin was laughable because thats not how hospitals get paid..... the itemized statement is largely smoke and mirrors.... it is a shell game and the moroccan market isn't far off.

That was then...this is now...SCOREBOARD BIZNITCHES!

I did negotiate some global budget arrangements with some insurance companies which were very interesting because you got to tie everything back to premium. Many of the insurance companies admin costs were north of 25%. We factored in around 15% and demanded they cut costs too.

25 cents on the dollar collected went to something other than providing health care. no mater what your patient mix this is terrible. You have to go through some mathmatic gyrations to get to Medicare's admin cost but it's nowhere near that high (not even double digit...maybe even counted on one hand (two for drafter))


I had worked negotiating contracts on the insurance company side prior to joining the health system. We never negotiated off billed charges..... meaningless.... you build from cost if available or if not available you build from market price.

🤔 sounds like the Red Cross....

:-k



I was thinking is sounded more like a right cross!🐴

That's kind of the point....

the problem with calculating Medicare's admin cost is you can not tie it to premium collected (there is no one to one relatioinship there). Some try to do that but it is artificial and helps make Medicare look better than it is. But you can calculate actual admin cost (you could argue this number is artificially low due to some absorbed govt wide costs but most models will account for these indirect expenditures) and tie it to actual medical expenditure. Then you have to do similar in private industry which is more problematic for data reasons. Kaiser does have some interesing data to play with and there is no perfect model.

There is no (credible) model anywhere that I have seen that remotely puts Medicare admin cost anywhere in the area of private industry. But that's sort of a no brainer considering the costs the private industry must support to stay in business, their lack of bargaining power (draconian in the case of the govt), economy of scale, and even considering what I said above...ie private pay nearly always paid more than Medicare in the first place (altohough in some geographic areas that has changed.... my area did not have massive managed care penetration).

That does not mean the govt is more efficient than private industry in this regard (at least completely) who do you think actually processes the claims etc. Not the gov.


meh....

facts are facts....

I was supporting that point.... vic you make it hard to love you.... which I find exciting

cousin eddie's gonna be pissed.... 😟